Meredith Schwartz

Schwartz fills an important gap in existing health care ethics literature by describing an egalitarian conception of moral respect which applies to autonomous and non-autonomous patients alike. It reframes questions about respect, from its target to the role that respect plays in our moral lives. Taking into account various forms of objectification, it suggests that the unique role of moral respect is to recognize a person as more than a mere object; to recognize them as an equally intrinsically valuable being who possesses dignity. Schwartz describes various forms of objectification and considers three cases in which patients are disrespected even while the doctor is upholding their autonomous decision-making.

Schwartz describes phenomenological accounts of embodied agency and the objectification and alienation that are part of many experiences of illness. In health our bodies are the centre of our world but rarely the centre of our attention: there is a seamless unity between the object-body and the body as subject. Experiences of illness focus our attention on the object-body which is thematized as a problem and a limit to our agency. In disabilities present since birth this involves not a changed embodiment, but a lack of fit with the habitus of the social world. Phenomenological accounts of illness and disability explain the importance of moral respect in health care contexts from an autonomous patient’s perspective. Respect does a better job of dealing with objectification than empathy because empathy inappropriately adds to the emotional labour of health care professionals whereas respect does not.

Schwartz uses the account of moral respect developed in the previous chapters to apply it in concrete cases of medical care for non-autonomous patients. She considers the importance of respecting the dignity of children to their development of self-respect and draws on Dillon’s concept of care-respect as a second-person concept. She considers care for patients with Alzheimer’s disease and suggests that when patients cannot advocate for themselves there is a particular danger of objectification and so moral respect becomes all the more important. In such cases understanding second-person care-respect as asymmetrical can directly include non-autonomous persons among those who are owed respect because of their dignity.

Schwartz draws on the distinction between the interactive and objective stances to explain why moral respect is a central concept in health care ethics. Medicine, medical research, and medical epistemology are inherently objectifying. Medicine focuses on treating the body as a physiological object and develops knowledge about generalized disease kinds. Objectification is sometimes morally permissible, and other times morally troubling—a context of respect can help to distinguish between these situations. Moral respect is important in health contexts because of the inherently objectifying nature of health care.

Schwartz offers a summary of the egalitarian concept of second-person asymmetrical moral respect. Moral respect is grounded in dignity and affirms the equal moral value of each member of the moral community. The concept of moral respect is egalitarian because it is not grounded in contingent facts or capacities. Moral respect affirms a person’s value as more than a mere object. Schwartz summarizes various forms of objectification described in the book. The account of moral respect has advantages because it is thoroughly egalitarian and can explain why the concept of moral respect is central in objectifying medical encounters. The discussion of moral respect is limited because the relations involved take time and material resources; they cannot be reduced to a checklist or set of tasks.

This book fills an important gap in existing health care ethics literature by describing an egalitarian conception of moral respect which applies to autonomous and non-autonomous patients alike. It reframes questions about respect, from its target to the role that respect plays in our moral lives. Taking into account various forms of objectification, it suggests that the unique role of moral respect is to recognize a person as more than a mere object; to recognize them as an equally intrinsically valuable being who possesses dignity. Further, the book argues that respect is central to health care because medicine and experiences of illness are both inherently objectifying. Objectification is sometimes morally permissible, and other times morally troubling—a context of respect can help to distinguish between these situations. Because we can reduce others to mere objects in ways other than violating or denying their autonomy, the approach presented here can also accommodate non-autonomous patients directly without considering them as marginal cases.

Discussions of both personal responsibility and the importance of trust in health-care settings are increasingly prominent in the bioethics literature. In this paper I link the two discussions and argue that health policies that include personal responsibility ought to address climates of social trust. Trust is a social good that is not always fairly distributed. Disadvantaged social groups often face default distrust. I suggest that agent-centered models in which responsibilities are negotiated do a better job of repairing social distrust than authoritative models in which responsibilities are assigned . Attending to climates of trust, distrust, or antitrust is essential for addressing health inequalities.

Discussions of both personal responsibility and the importance of trust in health-care settings are increasingly prominent in the bioethics literature. In this paper I link the two discussions and argue that health policies that include personal responsibility ought to address climates of social trust. Trust is a social good that is not always fairly distributed. Disadvantaged social groups often face default distrust. I suggest that agent-centered models in which responsibilities are negotiated do a better job of repairing social distrust than authoritative models in which responsibilities are assigned. Attending to climates of trust, distrust, or antitrust is essential for addressing health inequalities.