A few months ago I had the opportunity of listening to a speech delivered by an American physician who was an expert in palliative care. Caring for the terminally ill involves daily confrontation with the pain and the suffering of people who no longer hope for recovery, and require other forms of hope and solidarity.
It is not easy to transmit serenity to a person that is coming to terms with his or her condition of mortal being.
Nor is simple to practise the medical profession in these conditions – one has to seriously reassess the final ends of medicine as established and publicized by certain optimistic scientism.
When there remains nothing more to try against disease, the centrality of man emerges in all its importance, as does the need for appropriate interpersonal relations. The relations between doctors and patients have been, and are, the subject of a great number of books.
So much interest can derive from one of two causes: from a new, more mature, consciousness, or from the decline of human relations, which have been made void of personality in the name of improved efficiency and task distribution.
The extent to which these considerations affect daily practise remains to be seen.The American physician exposed with great clarity and depth the moral principles at the heart of his profession, and the various solutions he had adopted to assist his patients in their final stages. What impressed me, however, were certain rules on which he would not compromise, whose function it was to remind all health workers that they were dealing with a person and not just a patient.
He had ordered that upon entering a patient’s room, even if the latter was under sedation or considered unable to respond, every health worker should first knock on the door.
The reason for that, expressed in disarming simplicity, was that when you enter “another’s house”, you announce yourself. The house metaphor, although paradoxical, was profound – a sick person’s room becomes his place of daily existence and even of his privacy.
Once inside, moreover, operators were to introduce themselves and state the reasons of their presence. No manoeuvres on the patient, even if explaining what was being done and why. Simple suggestions of good manners, inspired by the principle that persons should be treated as such.
These rules called health workers to awareness: you are not just doing your job, you are relating with someone, and you must do so respectfully.
It is not just a body you are examining, nor is that just a patient under cure, but a human person.
These rules of etiquette simply indicated the proper manner of interacting with others. They also led to the creation of an interpersonal process of recognition, which would sometimes be lacking of reciprocality when one of the subjects could not communicate.
However, because of this behaviour and these rites, “the other” became part to a relation based on respect, which was of good use to the health workers themselves: when the other can express himself only as suffering corporeality, the need for respect must be continually recalled through the “proper acts”.
In this example, the recognition of the other as a person occurs on the minimum common ground for preventing any discriminatory response – the other is recognized for the very fact that he is “one of us”, one of the human family.
He is not asked to “prove” his belonging to the human race, because a person is not identified by his exercising will and intelligence, but by his concrete bodily presence.
Patients do want something specific from physicians and from medicine: they wants to be cured, or at least treated.
But no doctor-patient relation can be emptied of its human component, because it is always, somehow, a relation of trust. Medical competence is a necessary but insufficient condition for the establishment of a healing relation, which has always moral implications.
Those rules of etiquette, which do not appear to be observed by all and sundry in our hospitals, provided yet another function for a doctor: they reminded him that he was equally important as a person and as a valued professional, because if he should one day choose to abandon his surgeon’s gown, he could never relinquish his moral personality – to which he was continually adding in the course of his daily medical practice.
Not only were health workers required to treat others as persons, they were expected to act as persons as well.
By dealing with others as persons, one learns to behave as one.
Those few elementary rules, applied in a hospital ward, are a small but vivid example of how the daily practise of medicine can be humanized, even in those dark circumstances where the border between life and death is difficult to grasp.
Translated by interpres sas
Adriano Pessina
Cattedra di Bioetica
Università Cattolica di Milano
When there remains nothing more to try against disease, the centrality of man emerges in all its importance, as does the need for appropriate interpersonal relations.
...Adriano Pessinaf. cr
