R-E-S-P-E-C-T: Even More Difficult to Teach than to Define

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“Respect” is a word like “empathy”, “love”, and “compassion”, that everyone agrees connotes a positive attribute; however, there are innumerable ideas about what respect means. Perhaps the reason it is so difficult to define is because it can mean different things to different people, depending on whether it is being used as a verb or as a noun, on the person’s cultural background, and the context in which it is being discussed. For instance, when a parent tells a teenager “to show some respect” the meaning is somewhat different than when philosophers talk about “respect for persons”. Aretha1 put it very simply: “R-E-S-P-E-C-T, find out what it means to ME!” Still, it is useful to examine why and how a physician can show respect to patients. After all, the American Board of Internal Medicine’s Medical Professionalism in the New Millennium: A Physician Charter mentions “respect for patient autonomy” as a core principle and the Project Professionalism states that “Respect for others (patients and their families, other physicians, and professional colleagues such as nurses, medical students, residents, and subspecialty fellows) is the essence of humanism, and humanism is both central to professionalism and fundamental to enhancing collegiality among physicians.”2,3 In this issue of JGIM, Beach et al attempt to define the object of physicians’ respect and what respect requires4. They believe autonomy is too limited as the object of our respect because it seems to make respect conditional on whether we admire a patient’s values, and because it limits our obligation to those patients who lack autonomy. They propose that it is a physician’s moral duty to respect all patients equally as persons, as a professional extension of one’s universal duty to respect all people because of their “unconditional intrinsic value as human beings.” They go on to describe this respect as bidimensional; that is, the concept of respect is both an attitude and a set of behaviors that one ought to have as a physician. Both dimensions, they argue, are morally required of physicians. This article is likely to be widely read and discussed. Whereas philosophers may argue about whether their concept of autonomy is biased, we agree that respect should not be contingent on a patient’s lifestyle or health decisions. For medical educators who are charged with training respectful physicians for the future, the article raises questions about the barriers to respect, how to teach respect, whether a focus on behavior is sufficient, and what behaviors constitute respect. We will focus our attention on these issues.