Engaging ‘Respect for Persons’ in Music Therapy
The goal of this article is to bring clarity to the notion of ‘respect for persons’ and to outline possible applications for the clinical music therapist. An argument is made that we can build understanding about respect for persons by raising a series of pertinent questions, beginning with, 1) How does a clinical Code of Ethics deal with respect for persons? 2) What do I mean when I call someone a ‘Person’? 3) What are key issues concerning personhood? 4) What do we mean when we ‘respect a person’? 5) What are some implications of ‘respect for persons’ in clinical music therapy? and importantly, 6) How do I understand respect from the client’s point of view?
Date received: 29 April 2021
Date accepted: 11 March 2022
Publication date: 1 July 2022
As humans developing relationships, we hope to be treated with respect, and in fairness would wish that for the other. As therapists, we may choose to look deeply into the topic of respect for persons. This topic has been briefly alluded to in works dealing with ethics in music therapy (Bates, 2015; Dileo, 2000). From my experience as a clinical music therapist and educator, ‘respect for persons’ has emerged as a seminal topic, one that in my view could use a more fulsome explanation, coupled with a convincing rationale as to its importance for music therapy. This focus on generative principles aligns with a movement towards aspirational ethics as adopted by the American Music Therapy Association and other related health care professions – an approach that is less about “dos and don’ts,” and more about positive principles that serve as a guide to action (Shultis & Schreibman, 2020). The goal of this article is to bring clarity to the principle of ‘respect for persons’ and to outline possible applications for the clinical music therapist. An argument is made that we can build understanding about respect for persons by raising a series of pertinent questions, beginning with, 1) How does a clinical Code of Ethics deal with respect for persons? 2) What do I mean when I call someone a ‘Person’? 3) What are key issues concerning personhood? 4) What do we mean when we ‘respect a person’? 5) What are some implications of ‘respect for persons’ in clinical music therapy? and importantly, 6) How do I understand respect from the client’s point of view?
1. The First Principle
As the essential first principle in the Canadian Association for Music Therapists (CAMT, 1999) Code of Ethics, “Respect for the Dignity and Rights of Persons” serves to ground professional practice. There are intimations in the Code as to what this means, but I believe that a more expansive consideration of ‘respect for persons’ will serve the music therapist in their work –– providing clarity as to how one may approach each individual in their presenting conditions, as well as guiding the development of collaborative strategies for bringing positive change to the situation. To begin, let’s examine how the CAMT Code of Ethics (1999) articulates this principle:
Music therapists accept as essential the principle of Respect for the Dignity and Rights of Persons; that is, they uphold the fundamental rights of each person, and accept that an individual should be treated primarily as a person, not as an object or a means to an end. Music therapists acknowledge that all persons have a right to their innate worth as human beings, and that this worth is not enhanced or reduced by their culture, nationality, ethnicity, colour, race, religion, gender, marital status, sexual orientation, physical or mental abilities, age, socio-economic status, and/or any other preference or personal characteristic, condition, or status. In adhering to this principle, music therapists are specifically concerned with the values of General Respect, Privacy, and Informed Consent. (p. 2)
The authors of the Code explain personhood by what it is: they speak of the positive notions of dignity, fundamental rights, and innate worth as human beings, grounding them in a belief that “an individual should be treated primarily as a person” (p. 2). These comments are helpful, but require further explanation. The authors also describe respect for persons by what it is not: that a person is not an object or a means to an end, and that this value is not enhanced or reduced by culture and the broad range of contexts for the individual as listed above. Yet, to describe a phenomenon by what it is not can leave one spinning in a circular logic; it still doesn’t tell me what it is. Moving forward, I will be deliberately sublating the concepts of dignity, rights, and innate worth into this fundamental category of ‘respect for persons.’ In which case, the Code leaves me with two pertinent questions concerning respect and persons:
2. What do I mean when I call someone a Person?
First, the big picture. I appreciate Ervin Laszlo’s (1996) summary of our standing in the universe, that “We are natural systems first, living things second, human beings third, members of a society and culture fourth, and particular individuals fifth” (p. 21). For Ludwig von Bertalanffy (2009), a system is either isolated from its environment (closed system), or continuously exchanging matter/energy with its environment (open system). As an open system, a natural system is one that does not owe its existence to conscious human planning and execution. As a natural system, a human being shares the four common features of all open natural systems: 1) Natural systems are wholes with irreducible properties –– a whole possesses characteristics which are not possessed by its parts singly. 2) Natural Systems maintain themselves in a changing environment –– they move towards the balance of steady-state, as in biological homeostasis. 3) Natural Systems create themselves in response to the challenge of the environment –– when subjected to constant external forces, systems can reorganize their own constraints and acquire new dimensions in a process of adaptive self-organization, as witnessed in ‘neural plasticity.’ 4) Natural Systems are coordinating interfaces in nature’s hierarchy –– in the course of evolution, organisms that last do so because they are hierarchically organized as part of a ‘multi-holon’ structure, where wholes (holons) are also part of other wholes. As open natural systems, humans are living beings who share the atmosphere, the geosphere, and the biosphere with the non-living and all other living beings on the planet (Laszlo, 1996, pp. 24–58).
A person is a kind of ‘human being.’ The term ‘human’ has more than one meaning. As ‘one of the people,’ an individual is a biological ‘member of the species Homo sapiens.’ As a ‘person,’ the individual possesses certain qualities of being a ‘real human being,’ whose role is that of self-conscious agent in the world around them –– members of a society and culture. The word ‘person’ has its origins in persona, the Latin word for the mask of classical drama –– the resonant voice of the character coming through the mask worn by the actor, covering the face, yet revealing the character. The word was possibly borrowed from Etruscan phersu mask (Barnhart & Steinmetz, 1999).
What are the essential conditions for being a ‘person’? In reviewing the work of several scholars–– Nicholas Rescher’s (1990) reflections on conditions for personhood; Peter Singer’s (2011) practical look at the value of human life; Bernard Lonergan’s (2016) study of the existential subject; M. W. Hughes’ (1973) discourse on our concern with others; and R. S. Downie and Elizabeth Tefler’s (1969) analysis of respect for persons –– we get a sense of the extent and specificity needed to answer this question. My definition of persons is both an amalgamation of the salient aspects of persons as developed by these authors, and my own life experience, which surely has informed the practical and theoretical insights I may have. As a crucial component of our very nature as the sort of beings we are, ‘personhood’ requires several conditions which I organize within this working definition: as a person, I am an individual human being with a quality of consciousness –– a self-determining agent, potentially capable of social engagement.
Let’s break this down:
2.1. as a person, I am an individual human being: We have identified humans as living beings who function as natural systems. The person is the individualized human being who is to be valued, as the Code suggests “not as an object or a means to an end” (CAMT, 1999, p. 2). I will expand on this notion of value as we continue to explore consciousness, subjectivity, and self-esteem.
2.2. as a person, I have a quality of consciousness: Consciousness is a multi-layered phenomenon. For Bernard Lonergan (2016, p. 69) we are subjects/persons who move through at least six different levels of consciousness. I begin with Levels 1 through 4.
When in dreamless sleep or in a coma, I am potentially conscious. My neuro-physiological being continues to function, cycling through schemes of recurrence according to the chrono-biological patterns of physiology that all humans share –– the infradian, circadian, and ultradian rhythms, particularly the Basic Rest Activity Cycle of 90–110 minutes of activity, then 15–20 minutes of rest (Rossi & Nimmons, 1991). Level 1 is characterized by deep sleep Delta (1–4 Hz) brain waves.
When dreaming, I have a minimal degree of consciousness and subjectivity. Dreams are an integral aspect of a person’s inner life. When remembered and included in one’s ongoing narrative, dreams have the potential to help the individual through a process of self-transcendence, a kind of psychic conversion. Level 2 is characterized by the deep meditative Theta (4–7 Hz) brain waves.
When I awake, I experience the world at the empirical level, responding to my environment in an immediate way by seeing, hearing, touching, smelling, tasting, perceiving, imagining, feeling, moving. “We become the subjects of lucid perceptions, imaginative projects, emotional and conative impulses, and bodily action” (Lonergan, 2016, p.69). Moving forward, I am now potentially engaged with both Alpha (7–13 Hz) and Beta (13–40Hz) brain waves.
At the intellectual level of consciousness, I move from the immediate world to a reality that is mediated by meaning as gathered through inquiry. I ask the pertinent questions, I experience insight, I come to understand, and to express what I have understood. I am able to acquire and process information and to develop, maintain, and modify beliefs about the world and my place within it. I am alive to my experience and develop insight from within each situation.
As a complement to cognitive inquiry, I also have the capacity for affectivity. I react to developments in the affective range of pleasure/pain, positive/negative, preference, temperament, mood, emotion. I see the world’s developments as good or bad, fortunate or unfortunate. From this world of feelings, I am able to discern that which is important to me, my values.
2.3. as a person, I am a self-determining agent: I now have judgements to make, choices to determine, decisions to act upon. I engage in consciousness levels 5 and 6:
At the rational level of consciousness, we “check our formulations and expressions, ask whether we have got things right, marshal the evidence pro and con, judge this to be so and that not to be so” (Lonergan, 2016, p. 69).
Finally, at the responsible level, that of rational self-consciousness, I am that self-determining agent who has found good reasons to act –– reasons that are grounded in aims and values to which I am committed. As a person, I am intentional. I am capable of goal-oriented action, a free agent who is able not only to pursue goals, but to initiate them, to set them for myself. As a person, I am an autonomous agent whose goals proceed from within my own thought processes and accordingly I am responsible for my actions.
As an intelligent free agent, I have self-understanding, operating in a dimension of belief, evaluation, and action. A person has self-consciousness. Coupled with this self-understanding comes the awareness of self-esteem. I value myself as an intelligent free agent who is able to act upon my own decisions. As a person, I have a conscious moral dimension. I appreciate the freedom of my responsibilities, and the responsibilities of my freedom.
Note: These six levels of consciousness are distinct but also related in a process of sublation, each higher level retains the lower, preserves it, yet transcends and carries it forward to a fuller realization within a richer context.
2.4. as a person, I am potentially capable of social engagement: This means that I have the capacity for mutual recognizance, that I am “disposd to acknowledge other individual agent humans as persons and be prepared to value them as such. I operate and I co-operate. With persons there must be not only feeling, but fellow-feeling; persons must function in a context of community” (Rescher, 1990, p. 7). Persons live out social roles. They communicate, usually but not exclusively, through verbal language.
3. What are some key issues concerning personhood?
Further questions concerning the ‘person’ have to do with value, as when the Code asserts that, “all persons have a right to their innate worth as human beings” (CAMT, 1999, p. 2). This can be framed in the light of dichotomies, including:
3.1. Ends and means. The person is an end in themselves, not merely a means to an end for another.
3.2. Subject and object. The person is to be related to as a subject, not merely some kind of object. In Martin Buber’s (1996) terminology there are two basic kinds of relationship, the subject to subject, I–Thou relationship, and the subject to object, I–It relationship.
3.3. Identity or the identified. The person is able to define themselves, to have a personal identity, to define their priorities and preferences, and not merely to be defined by the other.
3.4. The knower or the known. The person is able to know for themselves, to interpret the world around them, not merely to be a known quantity or type within the social sphere.
3.5. Body and soul. Human beings as a species are usually distinguished from other species because of mind, reason, and spirit (soul). A therapist’s view on the body/mind or body/soul problem has influence on their chosen scale of values, and this is bound to affect therapeutic choices at a deep level. F. F. Centore (1979) outlines the six possible positions concerning the material body and immaterial soul –– that a person as human being is
Only a Body: this is the most extreme view at the materialistic end of the spectrum. It analyses humans as matter in motion; any reference to mind, soul, and spirit is ruled out as mere superstition.
Body with Soul: in this view it is accepted that humans do possess a soul as connected to a somewhat observable inner life. It does not consider that this immaterial soul has a separate existence, as distinct from the material components of the body.
Both Body and Soul: the soul is really distinct and separate from the body. In this psychosomatic view, the soul exists in its own right as the organizing principle of the body, it gives unity to the organism. In this view, the soul is not immortal; body and soul die together.
Body and Immortal Soul: while alive, body and soul constitute one organism, the soul being the cause of the organized body. The soul does not depend upon the body to exist, and at death survives the body. This is psychosomaticism with immortality.
Body and Soul are separate: the body is seen as separate, and even unnecessary with respect to the soul. In fact, the soul can pre-exist, and in this view it makes sense to talk of the transmigration of the person’s soul from one body to another in some future life.
Only a Soul: in this extreme view at the spiritualistic end of the spectrum, the body is utterly denied as possessing any real existence independently of the mind/soul.
3.6. The Person as Individual Human Soul Versus The Ideology. Do I recognize the person as an individual human soul? If so, how do I understand the value of the person? Some religious/spiritual traditions place humanity as the highest created value, and argue that authentic human relations between persons are the basis for social morality (Hatcher, 1998, pp. 1–35).
If the person as individual human soul is not the highest value, then the potential exists that some ideology will emerge as that highest value. In theory and practice, an ideology exists to pursue the propagation of certain doctrines, and these are held to be more important than any individual, and is therefore potentially poised to sacrifice the individual person to the doctrines if necessary. Sacrificing individual persons becomes the means to accomplish the envisioned doctrinal ends of the ideology. Ideologies are found in both religious and humanistic moralities. Hatcher (1998) explains that one humanistic morality is collectivism, where all value is extrinsic to the individual, and is usually defined with reference to some particular collectivity. Yet another humanistic morality is individualism, which holds that the individual has value because they have “demonstrated some special abilities or competency above the socially perceived norms” (p. 21). Hatcher affirms that unlike the collectivist, power-seeking ideology, or the individualist competitive ideology, the mark of authentic relationships between persons is “altruistic love, which leads to reciprocity, mutuality, and symmetry, not to asymmetry and dominance” (p. 23).
Note: The body/soul question is challenging, multi-dimensional, and not easily answered. Concerning the individual and ideologies, I consider the individual person to be more important than any religious/political/economic ideology. Although I may not always be aware of how this influences my work, I acknowledge that having this view most likely edges me, at times in subtle ways, towards making specific choices during the treatment process.
Thus far, I have described how as a person, I am an individual human being with a quality of consciousness –– a self-determining agent, potentially capable of social engagement –– and have outlined some key issues concerning personhood. With this necessary groundwork in place, we can tackle the notion of ‘respect.’
4. What does it mean to ‘Respect a Person’?
There are both legal and moral answers to this question. Being a person is a social mode of existence within an environing culture –– balancing rights and responsibilities, considering necessities and desires. Concern, empathy, sympathy –– how are these to be understood in our notions of respect? From the Latin respicere, respect is literally the “act of looking back at one.” In this process of regard, respecting a person entails three important approaches: active sympathy, seeing the potential person, and openness to another’s rules for living.
Active sympathy for self-determining agents.
To begin, if respecting a person involves positive regard for them it will involve what can be characterized by the concept of sympathy. Sympathy can mean various things, and to qualify what we mean when engaging respect, we can distinguish three types of sympathy (Downie & Telfer, 1969):
Animal sympathy is a kind of physiological or emotional contagion from one creature to another. This can create a kind of indeterminate psychological atmosphere, where there is little or no sense of others as independent individual centres of experience.
Passive Sympathy or ‘empathy’ involves consciousness of the other as an experiencing subject. It’s a matter of having an emotional identification of ourself with the other, communicated as intersubjective language. For example, a smile is highly perceptible, natural, spontaneous, irreducible, capable of various meanings –– including empathy.
Active Sympathy is being engaged in a practical concern for the other (Hughes, 1973) as distinguished from simply feeling with them. It is helping others in pursuing their chosen goals, a proactive and creative emotional response to the other, the sympathy of respect.
See the actual and the potential person.
We attend to the person we see before us –– to what they have become, to what they have accomplished and accrued, to the place they have made for themselves in the world. But respect goes deeper than this. For Bernard Williams (2006), “It enjoins us not to let our fundamental attitudes to men be dictated by the criteria of technical success or social position [ … ] that each man is owed the effort of understanding [ … ] each man is to be (as it were) abstracted from certain conspicuous structures of inequality in which we find him” (p. 237). Respect attends to the person in their potential –– to the person they may become. We recognize the person’s ongoing journey of growth and development, the past, present and future of their life.
Readiness to consider the other person’s rules (Downie & Telfer, 1969, pp. 27–28).
In this third sense of respect, we understand that the person is able to act because they can see good reasons for their actions. We consider their views in an open and unbiased manner, knowing that we all have our own ‘rules for living.’ We even go so far as to consider how far their reasoning may apply to us –– that we will surely have something to learn from this person.
5. What are some implications for music therapy?
I return to the specific applications of ‘respect for persons’ as outlined in the Code of Ethics (CAMT, 1999), “In adhering to this principle [Respect for the Dignity and Rights of Persons], music therapists are specifically concerned with the values of General Respect, Privacy, and Informed Consent” (p. 2).
The notion of general respect as identified in the Code (p. 6) correlates very well to the development of human rights since the 1940’s. It wasn’t till the 1945 San Francisco Conference, held to draft the Charter of the United Nations, that a proposal to embody a “Declaration on the Essential Rights of Man” was put forward. Since then, there has been a slow but steady development in the articulation, agreement, and promotion of basic human rights worldwide. Highlights of these developments are (Savi, 2011, pp. 177–178) The International Bill of Human Rights, which includes 1) Universal Declaration of Human Rights (1948), 2) International Covenant on Economic, Social and Cultural Rights (1976), and 3) International Covenant on Civil and Political Rights (1976) (Emmel, 2012, pp. 248–294); and various International Covenants on Discrimination Against: Race (1965), Women (1979), Torture (1984), Children (1989), Migrants (1990), Persons with Disabilities (2006), and Disappearance (2006). It is rather surprising to note the very recent development of these covenants on discrimination against all of these vulnerable populations. As a music therapist, I continue to educate myself concerning these enlightened international declarations and covenants. They inform my awareness in my respectful support for each person as a self-determining agent.
The Code requires that the therapist inform the person as to how their information will be obtained and stored, and makes clear the client’s right to this information. How do we integrate this core value of ‘respect for persons’ in a world of powerful digital technologies that are constantly finding new ways to infringe on personal privacy –– so capable of objectizing the person? We take appropriate precautions concerning confidentiality (CAMT, 1999, p. 10) in all our communications. In practice, we store paper documents in locking file cabinets and we use encryption protocols to store digital files on the hard drives and other electronic media we employ.
The music therapist explains the purpose, nature of the activity, mutual responsibilities, likely benefits and risks, and some sense of timeline for the therapy. The Code encourages the therapist to make sure that client consent is not given under conditions of coercion or undue pressure (CAMT, 1999, p. 7). As well, the therapist is sensitive to the importance of the self-determined agent having choice in the sessions. Allowing for continuous client input –– engaging in client-preferred music, encouraging the creativity of improvisation, song-writing, and other choice-inducing techniques are examples of well acknowledged music therapy approaches that encourage and respect client independence in music therapy.
What of the individual who is unable to articulate a choice or to act upon it in the moment? Here the therapist will offer the same level of respect –– through the individual who serves as advocate for the person in therapy.
What of my personhood as a therapist? I frame my answer as a pertinent question that never goes away: Is there a diminishment in my own personhood if I do not actively advocate for the self-determination of the other? As a music therapist, I advocate for the person by doing the best job that I can. I work to follow the guidelines, reviewing and reaching up to the Code’s principles concerning responsible practice, integrity in relationships, and service to one’s community and profession. As a music therapist, I stand in relation as I listen to the person.
6. A person speaks about respect …
Note: I now take on the dramaturgical voice (Ihde, 2007, pp. 167–176), in order to express this principle from the individual person’s point of view –– myself as client:
“How will you as a person, engage respect for me as a person, a client in music therapy? Will you show active sympathy, a generous good will for me to succeed as a self-determining agent? Will you see the potential in my immediate presenting conditions? Will you listen to what I have to say, to what I really feel and believe – consider it seriously? You know that as a person, I am an individual human being, an individual whole (holon) composed of many parts, and as a whole I am in turn a part of a larger whole, in an unfolding hierarchical natural system, as we all are. As an integral whole, I am one-of-a-kind, a self like no other self. I have a quality of consciousness that functions on many levels. These levels change, enjoin as schemes of recurrence throughout the day. Day by day I explore, engage, and enhance my capacity at all levels of consciousness. You are dealing with a self-determining agent, someone who can evaluate, judge for themselves, has the will to choose, can decide, act on that decision, and is willing to be responsible for that action. As well, I am not only capable of social engagement, but keen to be actively involved in all my relations. I was born a human being and continue to ‘become the person’ I can be. I am writing each chapter of the only life I have. I can see you are a person too, as is everyone who may join us. You’ve explained the ground rules, and I agree as to how we’ll proceed with finding ourselves in music.”
This article begins by pointing out that the CAMT Code of Ethics articulates ‘respect for persons’ as a first principle and that, in my view, the code is ambiguous and incomplete concerning this fundamental value, and requires elucidation. I have presented a possible interpretation of it, by defining and explaining in turn: persons, issues of personhood, respect for persons, and applications and implications for the clinical practice of music therapy. I have worked from my own personal experience, study, and consideration; there may be other interpretations, depending on one’s philosophical perspective and empirical evidence. Think of this paper as offering a construct, a model, an approach that offers a set of related notions that may prove useful to have around when the time comes for the practicing music therapist to consider engaging with the fundamental principle of ‘respect for persons’.
Shultis, C. L., & Schreibman, J. (2020). AMTA and Aspirational Ethics. Music Therapy Perspectives, 38(1), 2020, 7-8. https://doi.org/10.1093/mtp/miaa004