Background Respect is essential to providing high quality healthcare, particularly for groups that are historically marginalized and stigmatized. While ethical principles taught to health professionals focus on patient autonomy as the object of respect for persons, limited studies explore patients’ views of respect. The purpose of this study was to explore the perspectives of a multiculturally diverse group of low-income women living with HIV (WLH) regarding their experience of respect from their medical physicians. Methods We analyzed 57 semi-structured interviews conducted (...) at HIV case management sites in South Florida as part of a larger qualitative study that explored practices facilitating retention and adherence in care. Women were eligible to participate if they identified as African American (n = 28), Hispanic/Latina (n = 22), or Haitian (n = 7). They were asked to describe instances when they were treated with respect by their medical physicians. Interviews were conducted by a fluent research interviewer in either English, Spanish, or Haitian Creole, depending on participant’s language preference. Transcripts were translated, back-translated and reviewed in entirety for any statements or comments about “respect.” After independent coding by 3 investigators, we used a consensual thematic analysis approach to determine themes. Results Results from this study grouped into two overarching classifications: respect manifested in physicians’ orientation towards the patient (i.e., interpersonal behaviors in interactions) and respect in medical professionalism (i.e., clinic procedures and practices). Four main themes emerged regarding respect in provider’s orientation towards the patient: being treated as a person, treated as an equal, treated without blame or prejudice, and treated with concern/emotional support. Two main themes emerged regarding respect as evidenced in medical professionalism: physician availability and considerations of privacy. Conclusions Findings suggest a more robust conception of what ‘respect for persons’ entails in medical ethics for a diverse group of low-income women living with HIV. Findings have implications for broadening areas of focus of future bioethics education, training, and research to include components of interpersonal relationship development, communication, and clinic procedures. We suggest these areas of training may increase respectful medical care experiences and potentially serve to influence persistent and known social and structural determinants of health through provider interactions and health care delivery. (shrink)

“Natural” and “law” form a particular symbol pertaining to one mode of discovering the order of goodness, this mode invented by the classical Greek philosophers. They relied on a number of basic experiences and symbolic concepts: a) the nous (mind, reason); something divine in man participating in the mind of divinity; b) the distinction between “being” as the immanent order of “things” and “being” as the divine transcendence; c) the realization that man, possessing language and moral discernment, has an order (...) not merely as a “thing” but also as a participating partner of the transcendence. In modern times these concepts and underlying experiences have been lost. “Mind” and “rationality” to us mean the opposite of what they meant to the Greek philosophers. We have no longer a concept of “man” resembling theirs; the concept of “soul” has disappeared; all values are completely relativized. We cannot, therefore, bring back “natural law” simply by reading the classical texts. The awareness of the order of goodness must be regained, but we have to pay a price for that. It probably requires the kind of deeply shaking experiences that came to members of Soviet labor camps as described by Solzhenitsyn and his friends. It also would include jettisoning our Enlightenment concept of history. Short of such sacrifices we would do well to use the concept “natural law” reluctantly, if at all. (shrink)

Is "natural law" actually the "Laws of Nature" as Thomas Jefferson explains in the Declaration of Independence, meaning the rights of Life, Liberty & the pursuit of Happiness, or the ecclesiastical view which holds that laws of the government must conform to "natural laws" in order to be binding? This text examines this conflict, yet leads the reader to draw his own conclusions.

Few philosophers would deny that unconscious motives enter into causal explanations of human behavior. But many would be reluctant to say that deeply unconscious motives have anything to do with the intentionality with which we act. I argue to the contrary that deeply unconscious motives can indeed contribute to agent-intentionality on the following condition: If she were self-aware and honest with respect to her unconscious motive, the agent would believe that it constituted her reason for the action of which it (...) was a cause. I conclude that when an agent’s conscious reasons are vague, confused, or self-deceiving, her unconscious reason-grounding motive may fill what would otherwise be a gap in her intentionality. (shrink)