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Are Respectful Behaviors Sufficient?

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Finally, we wish to emphasize that our conception of respect involves valuing patients, or at the very least, acknowledging their value. This attitude of valuing will typically express itself in certain behaviors—extending common courtesies, expressing concern for others and their well-being, taking their feelings and experiences seriously.

Indeed, many accounts of respect in medicine and in the professional education of physicians rightly emphasize behaviors.

These behaviors therefore must be responsive to each individual patient. Thus, in our account of respect, we wish to emphasize the attitude, which may be more universal than any given set of behaviors. Actions and behaviors are certainly important, but are not a sufficient substitute for having a genuine attitude of respect.

If respect for a person entails recognizing the value of a person, as we have suggested, it will come in two forms: believing the person has value and acting in light of that belief. The two should not be confused. It may be possible to act in a way that is interpreted as respectful without having the corresponding attitude of respect. One may simply behave that way because someone else is watching or because one wants to avoid the consequences of not being courteous. Conversely, it may be possible to have an attitude of respect and still behave in a way that is inappropriate e.

Behaving respectfully and courteously to patients is clearly important, and we do not mean to suggest that such behaviors ought to be ignored or discounted. Our point is that physicians do not fulfill their moral responsibility unless they also engage in the internal work of appreciating the value of the people they treat.

An unreflective emphasis on behaviors with a corresponding de-emphasis on the essential attitudes may have undesirable effects. We do not doubt that, at first, it feels unnatural to respect everyone. There are some patients of whom it will be difficult to appreciate the value. Most would argue that, even when such respect does not come instinctively, we still ought to act respectfully, and we agree. But simply because a feeling does not come instinctively or naturally does not mean that it can never come.

This logical disconnect cannot survive for long. Either alternative is undesirable. Actions and attitudes are so closely intertwined that having one without the other simply cannot suffice.

We need both, or we end up leading a sort of moral double life—never quite succeeding at connecting who we are on the inside with what we do on the outside. For example, it is often said that respecting people essentially requires that we not interfere with them, leaving them free to do as they please. It is commonly thought that people deserve respect based on their status or their accomplishments, and by the same token, that they can sometimes lose our respect, or, it is suggested that respect is solely a matter of following norms and rules of social engagement—something we can do by rote.

Because these common ways of thinking about respect do not capture what, in our view, ought to be the moral obligation of physicians to respect patients, we have developed a conception of respect that calls for recognition of the unconditional value of patients as persons. We expect that our view of respect is controversial, and we hope that debate on the topic will occur.

It is only through reflection and discussion about the meaning of respect, and about what sort of moral obligation it imposes on physicians, that we can make any sort of sincere commitment to respect patients.

Acknowledgements Dr. Potential Financial Conflicts of Interest None of the authors has any financial conflict of interest to report. References 1. American Medical Association. Principles of Biomedical Ethics. New York: Oxford University Press; Medical professionalism in the new millennium: a physician charter.

Ann Intern Med. Gillon R.

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