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An Issue of Ethics: Fall 2006

Respect and the concept of ‘Respect for Persons’ is a central part of the ethical value system of all professional health care providers.


September 29, 2009
By Cidalia Paiva

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Respect and the concept of ‘Respect for Persons’ is a central part of the ethical value system of all professional health care providers.

Unfortunately, all too often, we best understand something when we experience its lack, absence or loss. We understand the value of honesty, for example, when we experience dishonesty, the value of loyalty when we experience betrayal, and respect when we experience disrespect.

Examples of disrespect abound us in everyday life. An elderly woman is violated in her home, a black woman is discriminated against at work, a child is abused because an adult believes that children are not worthy of respect or at least not respect equal to adults.

From our earliest days we learn that respect is of great importance in daily life. As children we learn to respect our parents, teachers, rules, laws and traditions and we come to value respect for such things as we grow older and more mature.

As members of a Western culture we internalize the importance of respect and the belief that at some level we are all worthy of respect. Why? The answer provided by Immanuel Kant, the great 18th century German philosopher, is because persons are rational, sentient creatures with free will. Rocks and trees cannot think, they do not have free will and they cannot discern right from wrong. In all creation only human beings are capable of high level rational thought and only human beings are sentient moral agents able to exercise their free will.

Yet, while we think we may understand the concept of respect, sometimes we have a hard time understanding its application. One of the more contentious areas in which we sometimes have difficulty understanding its application in is health care. Respect and the concept of “Respect for Persons” is a central part of the ethical value system of all professional health care providers.

How does respect apply to massage therapists as health care professionals? What does the concept of “Respect for Persons” require of us? Respect begins with a very basic validation of the patient or client as a person, their humanity and individuality. We validate the patient or clients humanity by recognizing that he or she is a human being capable of rational thought and able to exercise their free will. We respect their individuality because we recognize and appreciate that as human beings we are in some ways as different as we are similar.

We have different ways of seeing, experiencing and being in the world and leave our own unique footprints on the lives we touch. However, we clearly share one undeniable commonality. As human beings, and even more importantly as patients, we are vulnerable persons. That is, we are persons who by virtue of our lack of knowledge, skill, pain, immobility, mental health, social status may find ourselves in a position where we must entrust our vulnerability to another person whom we trust and hope will sincerely care for us and our well-being.

The trust and hope infused in the therapeutic relationship is broken when the patient or client is disrespected. There are many ways that disrespect can show up in the therapeutic relationship. A woman from a culture different from our own presents as a patient. Her value beliefs around disrobing clash with our own and we find this situation very frustrating. The patient refuses to disrobe even partially thereby making treatment difficult and increasing the therapists frustration level. The therapist considers telling the patient a “little white lie,” essentially telling her that the treatment is not working and cannot work unless she agrees to disrobe. Why shouldn’t she tell this very helpful “little white lie” to her patient?

Because by telling that “little white lie” to the patient we are in effect saying to the patient you are not worthy of the truth. I do not value and esteem you enough to be honest with you. My discomfort and frustration is more important than my commitment to serve your best interests. I cannot sincerely be said to respect you if my respect comes attached with a condition, namely that our value systems be compatible. If we sincerely respect our patient’s humanity we will accept their differences and work through the challenges that these differences present.

We do this because we know at the deepest level of our being that genuine respect requires acceptance not merely tolerance. And we know that if we simply tolerate our patients and clients they will know the difference. The generic and conceptual commitment to respect persons is really pretty easy to give and to live with.

But true, sincere acceptance and regard for our patients and clients sometimes difficult and challenging. But it is this kind of respect that our patients really need from us as health professionals and it is this kind respect we need to give as health professionals not just to our patients or clients but also to ourselves.

Immanuel Kant was not just talking about us respecting and valuing the humanity of others, he also held that as human beings each of us owes a special duty to his or herself to respect him or herself.

How does respect for self show up in the therapeutic relationship? In the most basic and primitive sense by taking care of ourselves, by valuing ourselves and practicing healthy self-care. This means we do not run ourselves ragged seeing more patients than we can, placing the needs of everyone else in our lives far above our own to our detriment, denying ourselves the rest and relaxation we all need to help us keep our professional promise.

This also means that we create healthy boundaries with our patients and clients and a safe environment and space in which we can give and receive gratitude for what it is, sincere gratitude for our knowledge, skill and caring intent instead of validation of our being.

If we respect ourselves we will meet our own personal, physical, emotional, psychological and social needs and we will meet these outside the therapeutic relationship in venues and in personal and professional relationships we create to support us in taking care of ourselves and validating our own humanity and the fact that we care enough about us to take care of us.

cidalia-head-shot.jpgRespect in the therapeutic relationship is not easy and it is not simple. Life can and will get in the way. We will be challenged by the differences our patients and clients present us with; our own emotional needs will from time to time get in the way. We will forget that our humanity and our individuality are not only our greatest gifts but also our greatest challenges and our greatest growing places. We need to keep in mind that genuine respect is a way of life, not a goal with an end, something to work at each and every day with our sincerity, goodwill and commitment to value our clients and ourselves to the best of our ability.


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