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What seems like a fairly obvious question, "Do patients treated with dignity report higher satisfaction, adherence, and receipt of preventive care?" is the subject of a study involving over 5,500 patients living in the US. Researchers from Johns Hoplins University reported in the Annals of Family Medicine that "although involving patients in their own health care is known to be associated with improved outcomes," they conducted this study to determine whether respecting persons more broadly, such as treating them with dignity, has additional positive effects.
The authors point out that the current literature in bioethics provides strong evidence that links patient involvement in care (and physicians' behaviors that facilitate patient involvement in care) to positive outcomes and that this aupprots the underlying principle of respect for autonomy. "There has been considerably less attention paid, among ethicists and health services researchers alike, to the broader ethical principle of respect for persons, from which the principle of respect for autonomy is conceptually derived. Respect for persons has been broadly defined as the recognition that all persons have dignity or inherent worth. Thus, involving patients in decisions (respect for autonomy) is only part of the broader issue of respect for persons.
 The aims of this study were (1) to examine the independent contributions of being treated with dignity and being involved in decisions to 3 patient outcomes (satisfaction, adherence, and optimal use of preventive health care), and (2) to examine whether there are differences across racial/ethnic groups in the degree to which being treated with dignity and being involved in decisions are related to positive outcomes.
Subjects responded to multiple choice questions that rated their perceptions of health care from their last physician encounter. Some question items were directed at the idea of respect for autonomy and others at respect and dignity, "Did the doctor involve you in decisions about your care (as much as you wanted, almost as much, less than you wanted, a lot less than you wanted)?" and "Did the doctor treat you with (a great deal of) respect and dignity (a fair amount, not too much, none at all)?"
Results
Results showed that 76% of respondents reported being treated with a great deal of respect and dignity, and 77% reported being involved in decisions to the extent that they wished. There were no differences in the percentage of respondents reporting either type of respect by sex or education, yet there were differences in reports of involvement in decisions and treatment with dignity across age, race/ethnicity, and income. Being treated with dignity was significantly associated with adherence to treatment plans for racial and ethnic minorities, whereas being involved in decisions was significantly associated with adherence for whites.
Conclusions
First of all, it is difficult to interpret these data without wondering what being treated with dignity actually means. Involving patients in decisions may seem fairly straightforward in comparison with the more ambiguous notion of treating patients with dignity. The authors suggest that treating someone with dignity primarily involves recognizing inherent value in that person. Data from this study, however, do not offer an account of the specific behaviors that are associated with such a valuing. The survey items used in the survey did not specify what being treated with dignity entailed, and so we do not have a clear notion of what respondents were thinking when they answered the question. It is suggested that patients are somehow able to determine when clinicians present a valuing attitude, and this perception seems to correlate with important outcomes. These perceptions may correlate with whether the patient was treated kindly or rudely. Further research is needed to understand what clinician behaviors are interpreted by patients as an indication of treatment with dignity.
Finally, being involved in decisions and being treated with dignity are independently important from patients' perspectives. Respect is not limited to respect for autonomy; it also entails regarding the patient as having inherent value. Health professionals ought to involve patients in decisions; however, doing so does not replace treating each patient with respect and dignity.
Annals of Family Medicine 3:331-338 (2005)
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