Respect & Dignity

June 16, 2014

By Cynda Hylton Rushton, PhD, RN, FAAN


Routinely nurses are challenged to uphold the first provision of their Code of Ethics—to care for each person, regardless of their unique characteristics, with respect and dignity. As our world has become more complex and diverse, it is clear that a “one size fits all” approach is neither desirable nor possible.


What does it mean to honor a person’s inherent human dignity? What actions demonstrate the intention to understand and individualize care that is consistent with what matters most to the person? How do we create the conditions for demonstrating respect as a dynamic and reciprocal process?


Respect is a foundational ethical value with subtle nuances that can easily be overlooked in the fast-paced health care environment.


Recently I was speaking with a group of clinicians who were struggling to understand the requests of a patient who was dying of metastatic pancreatic cancer. He had experienced many episodes of severe hemorrhage that required large amounts of blood products. He was often in pain.


Everyone knew he was dying but he wanted to know that “everything”, including more blood, had been given until the very end.


He was a deeply religious man and drew strength from his faith—as did his family. The team caring for him was concerned that continuing to give blood in such large amounts was depleting the blood supply and prolonging the inevitable dying process. They wondered if it was ethically permissible to use these scarce resources in this circumstance.


Embedded in the ethical discourse are questions such as: What does respect mean in this situation? How do we honor the life of this patient so that his sense of dignity is preserved? How do we inquire into the meaning of the treatment (blood in this case) to the patient and his family? How do we understand the conflict experienced by the clinicians? How do we demonstrate respect for their notions of integrity?


Looking forward, nurses must consider what competencies, skills and ways of being are necessary to demonstrate respect for the human dignity of all persons, for example, developing the self regulation skills to truly listen to our patients, when time pressures distract us from the moment we share with them. Or, recognizing the ethical tensions that accompany authentic and honest disclosure of risk and benefits of treatment options-especially when the benefits are uncertain.


We will be challenged to create a system where the relational aspects of respectful care are valued and expected rather than relying on heroic acts to demonstrate them.


Reflect on your own experience. Where have you noticed respectful care being demonstrated in your practice setting? What supports you in being able to live the value of respect in your work?



(Don’t miss our next #NursingEthics Twitter Chat: June 17th, 8-9pm EDT/ What keeps nurses up at night – respect, trust and dignity edition.)


Rushton_JHU1140_a_squareCynda Hylton Rushton, PhD, RN, FAAN, is the Anne and George L. Bunting Professor of Clinical Ethics. She holds a joint appointment in the Johns Hopkins University schools of Nursing and Medicine – Department of Pediatrics – and is a founding member and core faculty at the Johns Hopkins Berman Institute of Bioethics

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Cynda Rushton
Nursing Ethics

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