Toward a medical ethics that cares. A theoretical and normative study of ill-being and care in medicine
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AbstractThis thesis stems from a wish to better understand human illness and patient care and the connection between them in medicine. A main assumption in the thesis is that the understanding of both patient and physician in medicine and medical ethics is too narrow to accomplish the goal of helping and taking care of the sick. In the thesis I carry out a theoretical study with the aim of investigating some of the preconditions for reaching this goal of caring for the sick in medicine, focusing on ill-being and care.
The thesis consists of two parts, with the first part of the study focusing on the human being in need—the homo patiens—and the state of being ill, and the second part of the study focusing on the medical helper—the homo compatiens—highlighting a perspective that is seldom focused on in medicine and medical ethics: namely, the physician as carer.
First, I focus my attention on the illness dimension of human ailment, aiming to advance an understanding of illness as “a way of being human.” As a conceptual point of departure, I suggest the notion of “pathic existence” as developed by the German physician and philosopher Viktor von Weizsäcker (1886–1957). Through an analysis of his conceptualization of the pathic and of pathic categories, I demonstrate how this auxiliary typology may be of help in revealing different modes of ill-being.
Second, to provide a richer account of what it means to conceive of the physician as helper and caregiver, I analyze care and the relevance of care ethics in medicine, arguing that care should be given a more central role in medical ethics than it has received to date. Care ethics challenges medicine’s “eye,” and being able to see patients with what Kari Martinsen calls a “perceiving eye” can help us take better care of the patient as well as improving our clinical “nose” and our diagnoses. I refer to the latter aspect as the epistemic potential of care. Further, I point to how an assumption of the self as being “autonomous and alone” combined with the underlying attitude of medicine to human ailment as something to get rid—of “weg damit”—may contribute to poor conditions for care in medicine, leading to situations where patients are harmed by the absence of care.
In order to facilitate care in medicine and medical ethics, we need to realize the relational reality of the moral self and acknowledge the pathic mode of human existence. When a human ailment is considered not just as something to get rid of but also as basic and constitutive for our existence, for our way of being human, both the illness dimension of an ailment as well as caring approaches to it may be given more room to develop in medicine.
List of papers. Papers 2 and 3 are removed from the thesis due to publisher restrictions.
Paper 1: Martinsen, E. H. (2011). Care for nurses only? Medicine and the perceiving eye. Health Care Analysis, 19, 15–27. doi:10.1007/s10728-010-0161-9 This article is published with open access at Springerlink.com
Paper 2: Martinsen, E. H. (2011). Harm in the absence of care: Towards a medical ethics that cares. Nursing Ethics, 18(2), pp. 174–183. doi:10.1177/0969733010392304
Paper 3: Martinsen, E. H., and Solbakk, J. H. (2012). Illness as a condition of our existence in the world: On illness and pathic existence,” Medical Humanities, 38, 44–49. doi:10.1136/medhum-2011-010108