Respect is frequently invoked as an integral aspect of ethics and professionalism in medicine—an essential feature of how good physicians ought to conduct themselves. Many things are said to warrant our respect, including, but not limited to, people, ideas, and institutions. Some advocate respect for human life and dignity
Many regard respect for autonomy
as the preeminent principle of contemporary bioethics.2–4
Health care professionals are frequently reminded to have respect for cultural differences
Disclosure of sensitive medical information to third parties is proscribed on account of respect for patient privacyand confidentiality
References to respect, it seems, are ubiquitous in the medical literature.
It is not always clear what (if anything) it means to respect those things we are supposed to respect. Is the respect one has (or at least ought to have) for one’s patients the same as the respect one has for one’s colleagues? For individual privacy? For autonomy? For the profession of medicine? Most professional organizations use the term ‘respect’ in their descriptions of professionalism,1,8–10
but nowhere is it defined. There are benefits and drawbacks to such an approach. Nearly everyone can agree about the importance of respect when it is not defined, perhaps because everyone naturally reads into it his or her favored connotation. Unfortunately, this version of respect is devoid of content: it tells us nothing about what we should believe or how we ought to act. It forces us to ask whether respect has any particular meaning, or whether it is merely used rhetorically in defense of what one happens to believe or support.
In this paper, we develop a conception of respect that we believe imposes a genuine moral duty on physicians. This duty cannot be reduced to other concepts, like politeness, honesty, deference to patients’ wishes, and so forth. While many things may merit our respect, in this paper, we focus on the idea of respect for persons, or more specifically, respect for patients as persons. We develop an account of respect as recognition of the unconditional value of patients as persons. Such respect includes respect for the autonomy of patients, but we challenge the prevailing idea that respect for autonomy is a complete or self-sufficient expression of respect for persons. We suggest that the duty to give this sort of respect is independent of its consequences, and therefore, different from duties of beneficence and nonmaleficence. Furthermore, we suggest that the type of respect that physicians owe to patients is independent of patients’ personal characteristics, and therefore, ought to be accorded equally to all. Finally, the respect that we promote has both a cognitive dimension (believing that patients have value) and a behavioral dimension (acting in accordance with this belief). While we recognize that there are many other reasonable ways to think about and use the term ‘respect,’ our account is meant to clarify the type of respect that we believe physicians ought to have for all patients.
At the outset, it is important to distinguish between respect for persons in the broad sense and respect for persons in the context of clinical medicine. The former, we regard as a universal obligation that people have toward other people in general. The latter sense of respect is a further specification of this duty. It is because physicians have a special kind of relationship with their patients that the nature of this obligation to respect them has special features. The same might be said of respect, for example, between children and parents or between teachers and students.