Caregivers and patients

Certain forms of care carried out by nurses in hospital structures are aimed at patients who are no longer able to move or even express their feelings. This incapacity results from their state of health (comatose state, in the alarm clock or partially vegetative, deceased individual), but also from the invasive nature of the treatment: tubing, probes, lining, artificial breathing, infusions, drugs that exhaust or disturb thought, etc. Resuscitation, intensive care and organ sample services are in no way populated by patients able to be “ subjects »Capable of performing completely ordinary actions such as communicating, moving, contemplating, etc. They seem to be only bodies-objects, inert or almost inert, on which nurses carry out medical treatments ordered by doctors. The care appears, in this extreme situation, in the form of a relationship between a subject (the caregiver) and a subject which is no longer able to be (the patient in critical condition). Is the nurse himself an autonomous subject, that is to say, capable of taking initiatives, if his role is limited to performing a partition prescribed by the doctor ? Is it not just a transmission belt ? Doesn’t nursing care not become, ultimately, an object-object relationship ?

Revisit the philosophical concepts of care and subjectivity through critical care

The task of Critical care philosophy is primarily to show that, contrary to appearances, this relationship remains a subject-subject relationship. To achieve this, the author conducts a series of interviews she records and comments with four nurses: “ L. “Work in trauma,” G. “In intensive care,” P. “In pediatric resuscitation and” K. In the organ sampling service. These interviews reveal not only the initiatives that these nurses take to make the treatment possible, but above all reveal the way in which these professionals manage to restore the status of subject to patients who find themselves in critical state – or who are simply dead.

This is why Flora Bastiani comes to formulate this “ assumption “According to which” The whole constitutes the fundamental modality which precedes separate existence (P. 64). In other words, to be able to be a subject, it is necessary that initially another subject makes me a subject. It is important that another subject takes the initiative to treat me as if I were a subject (which we first lived “ together ), Before I even can once again become capable of leading a “ separate existence »Of his.

When L. informally asks the patient what he likes “ drinking (P. 100), or when she collects her doubts about the need to benefit from such a heavy medical treatment, she does not just be simply pleasant. She gives him the opportunity to familiarize himself with her hospital room (to live what the author calls a “ world ”) And to become an ordinary actor of his organization again (of his» body “, As she writes in this sense). It thus fights against the anxiety which results from being helpless (which is a care of a psychiatric nature) and facilitates in parallel the establishment of invasive technical treatments (difficult to install and maintain, especially if the patient resists physically).

In the same way, “ K. tries to make room for the presence of the dead “, Even if his task is ultimately to carefully take some of his organs. It strives as much to enforce the decisions of the dead (the authorizations of sample which it signed or manifested at a time when it was still a subject) as to preserve its dignity (symbolized here by the care granted to its corpse). “” It is no longer only a question of making his voice heard, of enforcing his choices, but of standing with the death, in the same way (that K.) would do it with a living patient (P. 233).

Flora Bastiani thus seizes a state of human subjectivity (“ The phenomenon of the whole ») At a time when it is not yet able, or is no longer able to be independent, where it only exists thanks to the subjectivity of the caregiver and exclusively within the care relationship. To treat a patient, it is not enough to mechanically administer a treatment ; On the contrary, you have to give the patient the status of subject. The novelty, here, is that restoring the patient this status does not consist in taking into account his opinion or his feelings, since he is no longer able to formulate it or even sometimes have one, but to cure end -to -end as If he was a subject.

Rethink the theoretical anchoring of care philosophies and subjectivity

To simultaneously extract this singular conception of the critical care and the subjectivity of the patient in critical state, of a set of concrete practices (richly reported in the four chapters which mark out the work), the author is forced to carry out a double methodological work. It must, at first, over the first pages of a long introduction (p. 7-11), briefly inventor the different philosophical approaches to care, as they are currently defended by the theorists of “ care (Gilligan, Tronto, etc.). It is a way for her to underline the originality of the design of the care that the practices of these four nurses convey: the consideration they bring to the subjectivity of others is not added to an act of care of a purely technical nature, as often consider the theorists of care ; On the contrary, it constitutes a full and whole component of the technical act of care, without which it loses not only in humanity, but also, in the first place, in efficiency, as the author regularly emphasizes. It is thus a question of protecting against these discursive perspectives which prevail across the Atlantic (reflect on the meaning of words such as “ care “, Or on the relational and moral qualities of caregivers or” female », Without first proceeding to observations pushed in care centers), and which generally remain too far from what matters to professionals in their daily tasks (p. 9-11). These prospects are not content to draw up a “ dated portrait “, Rive without his knowledge with” religious origins of the hospital institution, with the notions of dedication, self -denial and compassionate vocation »(P. 10) ?

Flora Bastiani must then list, in the rest of its introduction (p. 11-65), a multiplicity of philosophical conceptions of subjectivity (Husserl, Merleau-Ponty, Lévinas, etc.), developed in very different contexts of its own, in order to show that the domain that it chose (critical care) reveals an aspect of human subjectivity (the whole) remained in the shadow. This sheds light on the conceptual philosophical innovations that it intends to bring to the themes of care and subjectivity, but also makes it possible to rigorously supervise the case studies that follow.

Rethink the philosophical method: microphilosophy

There “ microphilosophy From the author, as she calls it, actually consists in inviting caregivers to describe how they apprehend and carry out their professional activity daily, in order to extract ideas likely to solve general philosophical problems (what is care ? What is a subject ?). Such an enterprise inevitably leads any philosopher to guide discussions (even if it rightly endeavors to do so) and to retain, in addition, that the aspects on which the question insists at the moment, for various reasons, rightly or wrongly. This is why it is preferable to have meditated and explained beforehand his observation grids, so to speak (the philosophical questions that we wish to enlighten after having carefully examined the way in which previous literature provides), rather than believing himself illusoryly invested with a neutral look which, willy -nilly, would only project unconscious prejudices (often theoretically poor). The long theoretical introduction proposed by the author is therefore as conceptual as a methodological necessary as necessary.

It is also at this stage that the Flora Bastiani method is perhaps more specifically phenomenological: the author starts from the experience of caregivers, that is to say the way in which they consciously perceive the functioning of their professional activity. She therefore does not seek to extract from their acts of care from political, social, economic or psychological mechanics escaping these caregivers. This is probably why she exposes interviews rather than personal observations in situ. In this sense, this is not a hermeneutic of care, but indeed a phenomenology of care, a philosophical tradition from which the author is clearly.

Critical care philosophy is ultimately an innovative work whose scope greatly exceeds the explicit intentions of its author. As we have just summarized, it offers not only a singular phenomenological light on the essence of any act of care, as its author aims, but it also renews, more generally, the philosophical method as well as in part our understanding of human subjectivity.