Introduction
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:
Principle 1: Respect for the Dignity and Rights of Persons
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:
What do I mean when I call someone a ‘Person’?
What does it mean to ‘Respect a Person’?
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.
Level 1
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.
Level 2
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.
Level 3
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.
Level 4
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:
Level 5
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).
Level 6
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).
General Respect
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.
Privacy
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.
Informed consent
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.”