Thursday, October 11, 2007

Response to Warren T. Reich on ars moriendi

Philosopher of Phronesis
(Image from Wikipedia)

I suppose that I can now name one of the scholars whose papers I'm responding to.

Yesterday at Sogang University's Death, Dying, and Spirituality Conference, I responded to two papers, but I'll report on just one of my two responses, the one I made to Warren T. Reich's paper on "The Art of Caring for the Dying: A Crisis in Western Culture."

Professor Reich, by the way, is a Professor Emeritus of Bioethics at Georgetown University (Washington, DC), where he holds a position as Distinguished Research Professor of Religion and Ethics.

I won't summarize his entire article here because I'm pressed for time this morning, but I'll draw some passages from my response to a distinction that he made between negative and positive empathy, and I'll also include some observations relevant to caring for the dying:
You make the interesting point that empathy for the feelings of another requires not simply positive but also negative attention to the other as an individual. I confess that I had never thought of this negative aspect of empathy, by which you mean our need to diminish the attention given to anything distracting us from feeling 'with' the other.


I'm not a professional caregiver, but when I lived in Tübingen, Germany, I knew a young man named Daniel from Uganda who was dying of AIDS. I didn't know him well, but because we had a friend in common and because Daniel was very alone, I decided to visit him every afternoon in his hospital room on my way back from the theology library where I was pursuing my doctoral research. In doing so, I had to learn a capacity within myself to be with another person who is dying, and that requires patience, something that I'm not abundantly endowed with. I had to give up my impatience, my desire to do things quickly, for I did not know how long his dying might take. Perhaps by negative empathy, you mean something like that? I also had to relinquish some other things, such as disgust, for I occasionally had to help hold Daniel as the nurse wiped him clean after he had used the toilet. That also involved my overcoming my own trepidation about the virus that he carried. However, my knowledge of the disease helped me in that, for I knew that HIV is very hard to contract.


Recently, I have read reviews of a book by a young physician who has learned some of the lessons [about empathy, consolation, and care for the dying] that you describe. Her name is Pauline W. Chen, and her book is titled Final Exam: A Surgeon's Reflections on Mortality. She also maintains a blog, and in an entry titled "Our two jobs," she writes:
I met a woman whose father had practiced surgery from the 1950's until his death from pancreatic cancer in the 1980's. He had a very busy practice and on top of his clinical duties was chairman of surgery at two of the local hospitals.

One day, this woman went to visit her father at the hospital. She found him in a patient's room, sitting at the bedside and reading the Bible aloud to his patient. When he later left the patient's room, his daughter asked him, "Why were you reading to that patient?"

"She asked me to read from the Bible to her," her father replied. "And because I could no longer do anything for her medically, I did what I could." (Chen, Amazon Blog)
Chen tells us that she was trained in surgery at a time when therapeutic failures were an exception but that older surgeons learned at a time when such failure was the rule. Older doctors understood the importance of taking time, and Chen advises younger doctors to learn the importance of doing so as well:
[S]ometimes the most therapeutic thing you can do has nothing to do with another drug or operation. Sometimes all we can -- and should -- do is simply be with our patients, make them comfortable. Sometimes the very best thing we can do as someone's doctor is to sit at their bedside, take their favorite book, and read aloud. (Chen, Amazon Blog)
I think that Chen and you are asking us to develop wisdom, a sense for the right thing to do.

From your citation of Walt Whitman as nurse and as poet, I gather that you would agree that he was one who had this sort of wisdom. Concerning the wisdom of knowing what to do, I am reminded of an anecdote about Abraham Lincoln:
Towards the end of the war, Lincoln went to see Seward, his Secretary of State, a man with whom he often disagreed and whom he did not particularly like. Seward had managed to break both his arm and his jaw in a carriage accident. Lincoln found him not only bedridden but quite unable to move his head. Without a moment’s hesitation, the President stretched out full length on the bed and, resting on his elbow, brought his face near Seward's, and they held an urgent, whispered consultation on the next steps the administration should take. Then Lincoln talked quietly to the agonized man until he drifted off to sleep. Lincoln could easily have used the excuse of Seward's incapacity to avoid consulting him at all. But that was not his way. He invariably did the right thing, however easily it might be avoided. Of how many other great men can that be said? (Paul Johnson, A History of the American People, (New York: Harper Perennial, 1999) page 487; citing David Herbert Donald, Lincoln, (New York: Touchstone, 1996) 580-1)
William H. Seward was not dying, of course, but he was suffering, and Lincoln showed wisdom in extending a special kind of compassion -- negative empathy in relinquishing his dislike for the man, and positive empathy in recognizing that Seward needed company, someone to be there in his suffering until he drifted off to sleep.

Could we call this sort of practical wisdom by Aristotle's term for it: phronesis? Or is it a different sort of ethical wisdom? If so, could you suggest a different term?
Such was a portion of my response to Professor Reich's interesting paper on the issue of how to care for the dying, which I cannot quote directly since it is not yet published. Reich seems to have liked what I said, for he replied by remarking at the outset that my response "was the finest that he had ever heard at any conference that he had attended in his life," or something to that effect. I was so surprised that my astonishment may have interfered with my capacity to retain his exact words, which were, actually, the nicest thing that anybody's ever said to me.

Anyway, he did confirm that he was thinking about Aristotle's category of phronesis, or "practical wisdom," and he later asked me if he could have the sources for the quotes from Chen and Johnson.

Now, I must ready myself for another day at the conference.

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At 9:13 AM, Anonymous Anonymous said...

Being the son of a medical practioner and having the benefit of years - having lost too many friends that I miss too dearly, this concept of negative empathy is not beyond my - well ken - shall I be permitted to say.

Grandfather died in hospital. But his body lay in his own home with his wife, my Mamaw and daugthers attending.

I enjoyed the process of losing my good friend JLS. Not at the time mind, but having had some time to consider, I have come to realize that Death can be a friend. I am uncertain that I understand the totality of my current feelings but I can attest that when a final outcome is certain - whether one views empathy as positive or negative - the simple act of reading to the dying, or whatever: in maintaining presence is the keying factor.

One who is occasionally slightly known, as in the case of unfortunate warfare or perhaps a car accident and the outcome is certain. Whether positive or negative, it is empathy I am certain. If the case is that one is well known - the knowledge of negative is better understood both in its immediacy and its aftermath. I cannot lend any wisdom here, each occurrence is to the one attending the events, unique.

Herschel Ducker

At 4:37 AM, Blogger Horace Jeffery Hodges said...

Thanks, H.D., for your comment. You have indeed the knowledge and experience to speak.

Jeffery Hodges

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