Respect for persons: the foundational moral disposition in medicine (a renewed physician ethos: respect for patients as persons)

Abstract

Medicine needs re-articulation of its moral commitments and obligations and re-dedication to the recognition of patients as persons. The practice of medicine is crucially dependent upon patient trust to accomplish its goals of caring for and healing patients.

This dissertation argues for re-establishing respect for persons as the foundational moral principle of medicine and grounding the doctor-patient relationship in a covenant of trust. Respect entails the Kantian duty to recognize humanity, both in the universality of persons and in the particular individual patient, as having unconditional value. Respect grounds not only obligations but also virtues particularly applicable to medical practice such as fidelity, trustworthiness, honesty, humility, and caring. Respect begins in the physician obligation to establish an atmosphere of trust with the patient that ensures shared decision-making.

Patient-centeredness is an important focus of high quality patient care, yet little effort has been devoted to grounding it in an explicitly moral concept such as respect for persons or to locating it within a covenantal relationship of trust. Respecting all patients as persons both empowers patients with functional autonomy and protects non-autonomous patients, as the Belmont Report made clear. Unfortunately, in the re-description of ‘respect for persons’ as ‘respect for autonomy’ by Beauchamp and Childress in Principles of Biomedical Ethics (1979), only autonomous patients could qualify as persons and thus deserve respect. As a consequence, respect for persons could no longer provide a universal ground for medicine. Since that time, respect has increasingly functioned as a rhetorical device in bioethics discourse and no longer grounds all other ethical principles.

Respect is developed in this dissertation as caring, which demands recognition of the person as a whole, not merely as the bearer of an illness or of a diseased body part. In respect and care we find the ethical resources for justifying the integrative approach of covenant. Covenant personalizes physician focus upon each patient and develops caring respect as a moral feeling. The rational principle of respect simultaneously affirms the physician’s universal commitment to promote the well-being and dignity of all patients.