Everyone Knows Respect, Right?
The meaning of respect is polysemic in nature and often eludes specificity. While the intuitive meaning of respect may be widely understood, its specificity within bioethics requires careful recognition. We must explore the nature of respect and its application in the field, particularly examining the influential account proposed by the founding fathers of biomedical ethics — Tom Beauchamp and James Childress. By analyzing the strengths and weaknesses of this perspective, we aim to assess its value in contemporary bioethical discussions and explore alternative perspectives, like that of Timmons and Lysaught. Ultimately, this exploration seeks to refine respect’s meaning and its role in guiding my own ethical decision-making.
When Beauchamp and Childress addressed respect, they reframed the foundational principle from respect for persons to the principle of respect for autonomy, commonly truncated to autonomy. In doing so, they prioritize individual autonomy, recognizing the right of competent individuals to make decisions about their medical treatment and research participation. They emphasize the need to provide individuals with sufficient information to make autonomous choices, known as informed consent.
Beauchamp and Childress also acknowledge that certain individuals may have restricted agency, and in such cases, they advocate for protections from harm-causing conditions (Beauchamp and Childress, 108). Furthermore, they acknowledge that respect for autonomy may sometimes conflict with other important principles, such as beneficence and non-maleficence. Therefore, a balance among these principles must be met on a case-by-case basis, considering the specific circumstances and the best interests of the individual (Lysaught, 676-677). This approach set their work apart from other texts in the field of bioethics, contributing significantly to their influence — the pair elevated the discourse to a higher, more philosophically rigorous level.
Beauchamp and Childress's conception of respect, while influential, presents significant limitations. By narrowing the scope of respect to autonomous individuals, their framework is often conflated with autonomy. This reductionist approach diminishes the moral weight of respect, particularly for those who cannot exercise autonomy, such as infants, the elderly, or those with cognitive impairments (Lysaught, 678). Instead of being protected by the principle of respect, these individuals are rendered to the domains of beneficence and non-maleficence, which are often interpreted in utilitarian terms. I would argue this shift undermines the inherent moral worth of individuals. Moreover, the focus on non-interference as the primary expression of respect can lead to a neglect of positive obligations. While respecting autonomy is essential, it should not overshadow the obligation to provide care to those in need, while also sustaining the needs of one’s values (Lysaught, 678). A truly respectful approach requires a balance between individual liberty and social responsibility.
Timmons paints a beautiful picture of this social responsibility. Imagine two cultures: one culture, much like our western ideals, values the life and wellbeing of the elderly, while the other culture believes in an afterlife where an elderly’s physical conditions matter. They believe that a person's soul enters the afterlife with the body they had at death. Now, let's say this second culture believes that it's respectful to ensure a good afterlife for their elders. If an elderly person is frail and weak, they might not be able to fully enjoy the afterlife (Timmons, 43). So, to show respect, they choose to end the elderly person's life before their body deteriorates too much. On the surface, it seems like a fundamental moral disagreement. However, both cultures share the underlying value of respect for the elderly. The difference lies in the prioritization of this value within their cultural context and beliefs (Timmons, 43). This example illustrates that moral disagreements aren't always about conflicting fundamental values — merely differences in interpretations.
Even with its weak points, Beauchamp and Childress’ respect for autonomy remains a crucial principle in bioethics. In my career, it is my duty to disseminate Long COVID research findings; I work with journalists who act like a tour guide, leading visitors. They must be knowledgeable, honest, and impartial, and while they can point out interesting sights and offer insights, they ought to respect the visitor’s choice of path. The intent is to provide a clear, unbiased view of the world, allowing the visitor to form their own opinions. In many instances, however, sensationalism or varying interpretations can reroute the public discourse.
To know respect, one must understand its multivalent and rich nature — it extends beyond individual autonomy, encompassing the social responsibility intertwined within the interpretation. To truly honor respect, we ought to engage in this thoughtful and inclusive moral discourse — acknowledging how this concept manifests across cultures and contexts. By recognizing the polysemic nature of respect and the challenges of using precise terminology, we can foster a more compassionate approach to bioethical principles.
References
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed., Oxford University Press, 2013.
Lysaught, M.T. "Respect: Or, How Respect for Persons Became Respect for Autonomy." Journal of Medicine and Philosophy, vol. 29, no. 6, 2004.
Timmons, Mark. Moral Theory: An Introduction. 2nd ed., Rowman & Littlefield, 2013.
