"Forward Dreaming, Future Leaning, and That Little Girl Hope: Continental Perspectives on the Patient's Experience of Medicine and Dying"
Ashley Moyse, PhD, Columbia University; Jordan Bauer, RN, MS, CHPN, Saint Louis University; and Benjamin Parviz, Saint Louis University
Illness, disease, disability, and pain cause rupture, disintegration, and self-alienation. They put into doubt answers to questions of which one was previously sure: who am I? what do I do? what am I for? what am I about? When one gets out of bed in the morning, answers to these questions are the understated foundation to how one goes about the day. In the state of illness, getting out of bed is a challenge not merely due to illness but also because in a state of alienation it is difficult to know what one would do once one does get out of bed. Drawing on Gabriel Marcel’s description of despair, unable to get out of bed, one experiences time as a ship stuck in ice. Hope, as Ernst Bloch put it, is forward dreaming, projecting oneself into a radically new and unknown future. Illness is a challenge to hope and an opportunity for hope to restore a disintegrated and alienated patient to wholeness and coherence. This panel will examine experiences of hope and despair as they interact with medicine and dying, drawing on perspectives from continental philosophy.
Relying on Marcel, the first paper from Benjamin Parviz (Saint Louis University) will argue that the materialist-physicalist metaphysic and the ethic of autonomy are both temptations to despair that have the two-fold effect of pushing individuals toward despair and denying individuals access to sources of hope. Contemporary Western societies are established on such metaphysics and morality, as is medicine within such contexts. The practice of medicine in contemporary Western contexts acts as a temptation to despair and demonstrates this two-fold effect. This will be demonstrated through an analysis of the goals of care discussion (GOCD). From its place of power over an ill and alienated patient who looks to medical practitioners for help, medicine requires patients to assume its preferred concept of self-understanding—the autonomous individual—and its preferred materialist and physicalist metaphysic as a necessary pre-condition to cooperation in a GOCD. Patients who agree to such terms and demonstrate the ability to identify goals of care and make decisions about particular interventions within the confines of these terms are welcomed as participants in a GOCD. If a patient either refuses to accept medicine’s moral and metaphysical terms, or if the practitioner is not convinced of the patient’s ability to operate within those terms, then a GOCD cannot proceed. By requiring patients to assume medicine’s stance, medicine alienates the patient from himself and from the existence within which he knows himself. Unable to participate in a GOCD for refusing medicine’s terms or for struggling within the confines of these terms, patients are cut off from the source of help that they look to for hope. The aim of this paper is to help patients and practitioners to see materialism, physicalism, and autonomy as temptations to despair, to help them to identify such temptations in medical settings and elsewhere, and to resist such temptations.
The second paper from Jordan Bauer (Saint Louis University) brings Charles Péguy’s unique perspective on hope into conversation with end-of-life experiences, examining expressions of hope and despair found in this context within the deeper context of God’s own hope for humanity. The end of life incites a negotiation of hopes. What do you hope for? If that does not occur, what else would you hope for? As healthcare practitioners, we engage in a politique of hope, a grappling with hope on the surface. We help our patients adjust their plans in the face of uncertainty, still feeling the need to encourage hopefulness. However, the virtue of hope is typically associated with the future, an aspiration for something not-yet. When an expectant not-yet encounters a relentless will-not-be in temporal life, hope demands a reckoning. Is there anything left worth hoping for in this life? Or is the only thing to hope for now a life of bliss in heaven? Péguy offers a perspective on hope that is neither tied to the temporal success of the future nor to strictly eschatological promises of fulfillment. The expression of hope in time is a marvelous product of deeper realities. God has crafted an eternal-temporal movement of confidence in humanity, paradigmatically through the Incarnation. This paper will contend that by returning to the mystique of hope embedded within Christian belief, we can make better sense of the external expressions, comprising the politique, of hope that we engage with during our care for the dying.
The third paper from Ashley Moyse (Columbia University) will offer a formal response to both papers, offering critical and constructive reflections on the arguments.
Relying on Marcel, the first paper from Benjamin Parviz (Saint Louis University) will argue that the materialist-physicalist metaphysic and the ethic of autonomy are both temptations to despair that have the two-fold effect of pushing individuals toward despair and denying individuals access to sources of hope. Contemporary Western societies are established on such metaphysics and morality, as is medicine within such contexts. The practice of medicine in contemporary Western contexts acts as a temptation to despair and demonstrates this two-fold effect. This will be demonstrated through an analysis of the goals of care discussion (GOCD). From its place of power over an ill and alienated patient who looks to medical practitioners for help, medicine requires patients to assume its preferred concept of self-understanding—the autonomous individual—and its preferred materialist and physicalist metaphysic as a necessary pre-condition to cooperation in a GOCD. Patients who agree to such terms and demonstrate the ability to identify goals of care and make decisions about particular interventions within the confines of these terms are welcomed as participants in a GOCD. If a patient either refuses to accept medicine’s moral and metaphysical terms, or if the practitioner is not convinced of the patient’s ability to operate within those terms, then a GOCD cannot proceed. By requiring patients to assume medicine’s stance, medicine alienates the patient from himself and from the existence within which he knows himself. Unable to participate in a GOCD for refusing medicine’s terms or for struggling within the confines of these terms, patients are cut off from the source of help that they look to for hope. The aim of this paper is to help patients and practitioners to see materialism, physicalism, and autonomy as temptations to despair, to help them to identify such temptations in medical settings and elsewhere, and to resist such temptations.
The second paper from Jordan Bauer (Saint Louis University) brings Charles Péguy’s unique perspective on hope into conversation with end-of-life experiences, examining expressions of hope and despair found in this context within the deeper context of God’s own hope for humanity. The end of life incites a negotiation of hopes. What do you hope for? If that does not occur, what else would you hope for? As healthcare practitioners, we engage in a politique of hope, a grappling with hope on the surface. We help our patients adjust their plans in the face of uncertainty, still feeling the need to encourage hopefulness. However, the virtue of hope is typically associated with the future, an aspiration for something not-yet. When an expectant not-yet encounters a relentless will-not-be in temporal life, hope demands a reckoning. Is there anything left worth hoping for in this life? Or is the only thing to hope for now a life of bliss in heaven? Péguy offers a perspective on hope that is neither tied to the temporal success of the future nor to strictly eschatological promises of fulfillment. The expression of hope in time is a marvelous product of deeper realities. God has crafted an eternal-temporal movement of confidence in humanity, paradigmatically through the Incarnation. This paper will contend that by returning to the mystique of hope embedded within Christian belief, we can make better sense of the external expressions, comprising the politique, of hope that we engage with during our care for the dying.
The third paper from Ashley Moyse (Columbia University) will offer a formal response to both papers, offering critical and constructive reflections on the arguments.