Respect for personhood: Concrete implications of a philosophical misunderstanding

Intentionally or not, our clinical practice is informed by our philosophical premises. A subtle misunderstanding can have frequent, though insidious, implications in day-to-day clinical encounters. The author draws from a clinical encounter with an aphasic patient to argue that the bioethical principle of Respect for Personhood has come to be understood in an unnecessarily narrow sense—as self-determination—due to the failure to distinguish between its application in research ethics versus clinical practice. This erroneous equivalence is present even in the very landmark texts that marked the beginning of contemporary bioethics, largely due to a misunderstanding of autonomy in Kantian ethics. The resulting emphasis on self-determination has, in turn, threatened to cast the clinical partnership between patient and physician in a falsely adversarial light. The author maintains that Respect for Persons is a principle that is intended to go beyond the imperative to ensure self-determination, and that a change...