ENGAGEMENT AND SUFFERING IN RESPONSIBLE CAREGIVING - ON OVERCOMING MALEFICIENCE IN HEALTH-CARE

The thesis of this article is that engagement and suffering are essent ial aspects of responsible caregiving. The sense of medical responsibi lity engendered by engaged caregiving is referred to herein as 'clinic al phronesis,' i.e. practical wisdom in health care, or, simply, pract ical health care wisdom. The idea of clinical phronesis calls to mind a relational or communicative sense of medical responsibility which ca n best be understood as a kind of 'virtue ethics,' yet one that is inf ormed by the exigencies of moral discourse and dialogue, as well as by the technical rigors of formal reasoning. The ideal of clinical phron esis is not (necessarily) contrary to the more common understandings o f medical responsibility as either beneficence or patient autonomy - e xcept, of course, when these notions are taken in their ''disengaged'' form (reflecting the malaise of ''modern medicine''). Clinical phrone sis, which gives rise to a deeper, broader, and richer, yet also to a more complex, sense than these other notions connote, holds the promis e both of expanding, correcting, and perhaps completing what it curren tly means to be a fully responsible health care provider. In engaged c aregiving, providers appropriately suffer with the patient, that is, t hey suffer the exigencies of the patient's affliction (though not his or her actual loss) by consenting to its inescapability. In disengaged caregiving - that ruse Katz has described as the 'silent world of doc tor and patient' - provides may deny or refuse any 'given' connection with the patient, especially the inevitability of the patient's afflic tion and suffering (and, by parody of reasoning, the inevitability of their own. When, however, responsibility is construed qualitatively as an evaluative feature of medical rationality, rather than quantitativ ely as a form of 'calculative reasoning' only, responsibility can be v iewed mole broadly as not only a matter of science and will, but of la nguage and communication as well - in particular, as the task of respo nsibly narrating and interpreting the patient's story of illness. In s ummary, the question is not whether phronesis can 'save the life of me dical ethics' - only responsible humans can do that! Instead, the ques tion should be whether phronesis, as an ethical requirement of health care delivery, can 'prevent the death of medical ethics.'