Recollecting an ethics of care: Heideggerian questions in medicine

Austin Lam is a medical student in the Class of 2021 at the University of Toronto

 

I remember the final oral examination for my Phenomenology course at McGill University. I was nearing completion of my undergraduate degree, yet I remained uncertain as to whether I had been accepted to medical school or not. My professor, who knew of my aspirations, presented me with a poignant question after the exam: “What does it mean to care in healthcare?”  We had studied Being and Time (BT) during the course, in which Heidegger developed a nuanced, intricate, and memorable illustration of Care.

This powerful question has stayed with me through the fledgling stages of my medical training.

Some writers—such as John Paley—object to the application of Heidegger in developing an ethics of care, arguing that to do so is to equivocate the ontic with the ontological and to read “ought” from “is.”  In contrast, Philip Buckley articulates a vision of ethics based on Heidegger’s philosophy that I believe can help medicine pose questions from a different perspective and engage in a different form of dialogue: one of aletheia.

What is Care for Heidegger? Put succinctly, “Dasein’s Being reveals itself as care,” (BT, 227) where Dasein is the type of entity whose being is an issue for itself—namely, human beings. “Care thus unifies Dasein's three central features: existentiality or ‘being-ahead-of-itself’, facticity or ‘being-already-in-a-world’, and falling or ‘being-alongside’ entities within the world” (Inwood, 37).

So, how can there be an ethics of care through Heidegger? While Paley claims that the ontological details (such as Being-towards-death) are not pertinent to ethical considerations, Being-towards-death is perhaps where ethical considerations can find their genesis.

For Heidegger, Being-towards-death is the possibility of impossibility that allows for all other possibilities; i.e., death as limitation allows for what we can do. “If Dasein stands before itself as this possibility [of impossibility], it has been fully assigned to its ownmost potentiality-for-Being” (BT, 294). Limits to possibilities are what make projects significant for us—as such, Being-towards-death is an orientation to freedom.

Growing from Being-towards-death, Heidegger develops notions of “conscience,” “guilt,” and “resoluteness.” Conscience is a call for Dasein to recognize its own necessary death and the accompanying anxiety in this encounter; guilt is the ontological indebtedness that human existence exacts from us. Thus, we become resolute when we heed the call of conscience and recognize our guilt. As Buckley notes, “This resoluteness, which is the authentic acceptance by Dasein of itself, is described by Heidegger as a ‘letting-oneself-be-summoned’” (Buckley, 201; BT, 345). Essentially, we are summoned to encounter ourselves.

This is how we can move towards an “ethical subject” in Heidegger’s philosophy. Buckley points out that an ethical life springing forth from Heidegger is analogous to an artistic life:

“The resoluteness intended in Being and Time is not the deliberate action of a subject, but the opening up of Dasein, out of its captivity in that which is, to the openness of Being. [...] Neither in the previously mentioned creation [of a work] nor in the willing mentioned now do we think of the performance or act of a subject striving towards himself as his self-goal” (The Origin of the Work of Art, 55).

The artist is resolute, involved in what Buckley calls “an essential active-passive interplay: the authentic act of creation on the part of an artist” (Buckley, 214). Just as “the ‘decision’ to respond to the artistic muse is not a rational, willed decision. [...] The ‘decision’ that plays a role in [...] ethical life is not based on calculative thinking or upon ‘prudence’” (Buckley, 215).

Thus, ethics is about a call: “the call comes from me, and yet from beyond me and over me” (BT, 320). As Heidegger noted, perhaps critiquing consequentialist and deontological ethical theory: “We view action only as causing an effect. The actuality of the effect is valued according to its utility” (Letter on Humanism, 329). Taking into account pre-Socratic philosophy, Heidegger expressed that “ethos is not a set of rules for right behavior, for maximizing utility, or for achieving a ‘good life.’ Rather, ethos must be thought of as a ‘home’ or ‘dwelling place’” (Buckley, 216). We are called to this dwelling place.

All of the above speaks to an ethics of care in medicine. In attempting to usher in a new era of patient-physician collaboration, medicine as a field ought to take heed of Heidegger’s ideas by questioning the exclusivity and domination of calculative thinking while also acknowledging its role. The nature of calculative thought is “opposed to” contemplative thought, which is “marked by a fundamental ‘passivity,’ [consisting] of a certain ‘letting-go’ of all ‘attitudes,’ of any ‘picturing’ of the world” (Buckley, 221). Thus, an ethics of care is about being open—not in the sense of tabula rasa—rather, in the sense of being open to the call of ethos as a home while already “Being-in-the-world.”

An ethics of care in medicine is hence possible as an art. The question posed now is whether the field of medicine can embrace its role as an artist who “seeks ‘to say’ something, though not for the sake of herself, but for the sake of what is to be said” (Buckley, 214). Can we “let-go” and disclose the revelation of an ethical life?

And what does any of this mean “in practice”? Perhaps we can consider a different attitude towards responsibility. “‘Contemplative’ thought [...] seeks neither to measure nor to control things, but to uncover their meaning, and above all, to question the meaning of things” (Buckley, 219). Accordingly, contemplative thought helps uncover a different notion of responsibility. While the traditional notion stresses foreseeability, “connected to the desire and attempt to see all,” Heideggerian responsibility is “to respond to what comes from afar and to assume the care for that which we can never master”—a response that encompasses gratitude and remorse and stems from a call to ethos as a home (Buckley, 227).

We owe to each other much more than calculative preponderance; let us recollect an ethics of care that places the Being in Human Being.

 

Works Cited

Buckley, R. Philip. “Heidegger and the ‘End’ of Ethics.” Phenomenological Approaches to Moral Philosophy, edited by John J. Drummond and Lester Embree, Kluwer Academic, 2002, pp. 197-228.

Heidegger, Martin. Being and Time. Translated by John Macquarrie and Edward Robinson, Harper & Row, 1962.

Heidegger, Martin. “Der Ursprung des Kunstwerkes” translated as “The Origin of the Work of Art.” Holzwege, edited by Friedrich-Wilhelm von Herrmann, Vittorio Klostermann, 1977.

Heidegger, Martin. “Letter on Humanism” translated by Frank A. Capuzzi. Pathmarks, edited by William McNeill, Cambridge University Press, 1998.

Inwood, Michael. A Heidegger Dictionary. Blackwell, 1999.