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Moral Respect, Objectification, and Health Care Meredith Celene Schwartz Moral Respect, Objectification, and Health Care Meredith Celene Schwartz Moral Respect, Objectification, and Health Care Meredith Celene Schwartz Department of Philosophy Ryerson University Toronto, ON, Canada ISBN 978-3-030-02966-1 ISBN 978-3-030-02967-8 (eBook) https://doi.org/10.1007/978-3-030-02967-8 © The Editor(s) (if applicable) and The Author(s) 2019 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. 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Cover illustration: © Melisa Hasan This Palgrave Pivot imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Acknowledgements My academic thinking has been deeply shaped by the work of Susan Sherwin who was my supervisor and continues to offer guidance and support. I am grateful to Dr. Sherwin for reading an early draft of this book. Adam Auch, Alex Wellington, Anna Macdonald, Jo Kornegay, Jordan Wadden, Khadija Coxon, Laurenne Ava Kredentser, Madelaine Ley, Mara Marin, Mitchell Wideman, Robert Murray, Rosemary Wharton, Tim Mt. Pleasant, and Victor Bruzzone all read early drafts of some of the chapters and I benefitted greatly from their feedback. I have also presented versions of these chapters at the International Feminist Approaches to Bioethics conference and the Canadian Society for Bioethics conference and received useful feedback from the audiences. Jordan Wadden was my research assistant for part of the writing process for this book, and he offered invaluable advice on restructuring some of the arguments. I would like to thank my parents, Mary Ann and Paul Schwartz in whose back yard most of this book was written. I benefitted greatly from our conversations and their comments on multiple drafts as I was writing. My stay at their home was a perfect demonstration of the second-person care-respect that I described in the chapters of this book. v vi Acknowledgements I am also grateful to my partner, Joel Swedburg, who supports me through my worst angst-ridden moments of writing and my most joy- ous moments of living. I would most especially like to thank Kelly Oliver whom I met in October 2017. I had been casting about in need of guidance and meet- ing Dr. Oliver helped me to set my course. I was deeply moved by how much interest Dr. Oliver took in proving me with mentorship even though we had only just met. Without Dr. Oliver’s guidance on strate- gies for academic publishing, this book would never have materialized. Dr. Oliver is a truly generous philosopher, not only with her own stu- dents and junior faculty but for even those junior faculty members she has just met. All of the errors, omissions, and oversights remain my responsibility alone. Contents 1 Introduction 1 2 Dignity, Respect, and Objectification 23 3 Respect and Non-autonomous Patients 55 4 Respect and the Lived Experience of Illness 87 5 Conclusion 111 Index 127 vii Abbreviations ACT Assertive Community Treatment hCG Human Chorionic Gonadotropin HSG Hysterosalpingogram NT Nuchal Translucency ix 1 Introduction Abstract 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 intrinsi- cally 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. Keywords Moral respect · Objectification · Dignity · Second-person standpoint · Respect for autonomy · Informed consent © The Author(s) 2019 1 M. C. Schwartz, Moral Respect, Objectification, and Health Care, https://doi.org/10.1007/978-3-030-02967-8_1 2 M. C. Schwartz 1.1 Introduction My aim is to provide an egalitarian account of moral respect as it applies in health care contexts. The concept of respect is central to medical ethics. Some discussion of ‘respect’ has been part of medical ethics since the early days of the discipline (e.g. The Belmont Report 1979). The dominant discussion of ‘respect’ in the context of health care ethics focuses on ‘respect for autonomy’ and this conception is well-entrenched in legal frameworks in a number of countries. The conception of ‘respect for autonomy’ leaves a gap in medical ethics because it does not apply to those patients who are not autonomous. In the seventh edition of The Principles of Biomedical Ethics, Beauchamp and Childress explicitly write that the principle of respect for autonomy does not include those who are not autonomous and cannot be rendered autonomous, such as children or patients diagnosed with late- stage Alzheimer’s disease. They state that those who are not autonomous are still covered by the concept of moral respect (Beauchamp and Childress 2013, p. 108). The concept of moral respect remains unan- alysed in their edition, however. I fill this gap by reframing questions about moral respect around the role that the concept plays in our moral lives. I suggest that the fundamental role of moral respect is to recognize a person as more than a mere object, as an entity with intrinsic value of dignity rather than merely use-value of price. To further explore the role of respect as recognizing someone as more than a mere object, I consider what it means to treat someone as an object. I suggest that disregarding someone’s autonomy or violating their autonomy is one important way of treating someone as a mere object. So respect for autonomy will remain central on my account. There are, however, a number of additional ways that we can reduce someone to a mere object and I pay particular attention to these additional forms of objectification. I describe three aspects of the concept of respect: the grounds of respect, the target of respect and the behaviour that enacts respect. The ground or basis of respect tells us why respect is owed or warranted. The target of respect identifies what sorts of things must be respected.