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Health Care Analysis
Published in: Health Care Analysis 1/2011

Open Access 01-03-2011 | Original Article

Care for Nurses Only? Medicine and the Perceiving Eye

Author: Elin Håkonsen Martinsen

Published in: Health Care Analysis | Issue 1/2011

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Abstract

In this paper I introduce a theoretical framework on care developed by the Norwegian nurse and philosopher Kari Martinsen, and I argue that this approach has relevance not only within nursing, but also within clinical medicine. I try to substantiate this claim by analysing some of the key concepts in this approach, and I illustrate the potential clinical relevance of this approach by applying it in relation to two care scenarios. Finally, I discuss some of the concerns that have been raised in relation to the aim of highlighting care in medicine.
Footnotes
1
However, this does not mean that there is agreement on how care is to be understood in relation to nursing. On the contrary, the concept of care in nursing may be understood in different ways and relates to different theoretical traditions.
 
2
Even though Kari Martinsen’s point of departure is the philosophy of nursing, her analysis focuses more on the relationship between the patient and health care professional in general than on the particular relationship between patient and nurse. Therefore I find her analyses also relevant in relation to medicine.
 
3
Holm concludes that other healthcare ethics should learn from the resistance of nursing ethics to analytic reductionism, however, he does not ascribe this resistance to influences from an ethics of care [21]. Instead, he points to other theoretical positions such as some feminist ethicists (however, not the feminist ethicists dealing with care) and modern particularists emphasizing the situational importance of ethical decision making, as well as influences from various schools of continental philosophy.
 
4
I use the terms ‘eye’ and ‘gaze’ interchangeably throughout in the text.
 
5
Through phenomenological investigations, Løgstrup came up with some basic phenomena which govern human interaction, and in his later writings he calls these modes of reaction “spontaneous manifestations of life” or “spontaneous utterances of life.” Løgstrup argues that phenomena such as trust, hope, compassion and the openness of speech are pre-cultural characteristics of our existence, and ontologically express the basic entanglement of individual human beings [29, 30].
 
6
According to Tronto, the three other elements of care are: to take care of, care-giving and care-receiving [57].
 
7
Here Martinsen is influenced by Løgstrup and his position of “phenomenology of creation.” To be perceptive and open reflects thus the attitude of the phenomenology of creation, of being reticent and of receiving the other as a gift [39, 40].
 
8
The story of the Good Samaritan is regarded as an exemplary story in the Nordic tradition within care ethics and nursing ethics, and its intrinsic value of charity is also considered as part of the basic values in the Norwegian health care system [54, 48].
 
9
Even so, there are different attempts to include the patient’s perspective to a greater extent into medical practice. Patient-centred medicine represents one example of such an approach, in which the importance of pursuing both the patient’s and the physician’s agenda is emphasized [4, 44]. The works on clinical empathy in medicine by Halpern [15, 16] represents another example, as well as the works of the Nordic general practitioners Malterud and Hollnagel [33, 34].
 
10
Martinsen’s perspective has been debated widely. She has been criticized for pursuing an altruistic notion of care [18, 50], and for emphasizing “samaritanism” as an ethical ideal in relation to the ethics of care [50], as well as for romanticizing nursing practice [17]. She has been criticized for toning down the importance of research and the need for scientific knowledge in nursing [46]. The use of Løgstrup’s ethics and phenomenology as the main source for health care ethics also has been criticized [20]. A more substantial elaboration of this critique is found in my forthcoming PhD thesis.
 
11
The epistemic potential of care also is underscored by the conception of sensibility as explicated by Nortvedt [47]. Nortvedt argues that sensibility, understood as the affective part of moral sensitivity, has significance for the health care workers’ moral motivation and clinical understanding: “To be emotionally affected by the expressions of illness, of bodily weakness and pain, opens up for a medical gaze that both can capture clinical signs of pathology while at the same time being able to care for the human condition of the patient and sick individual,” he argues (p. 218).
 
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Metadata
Title
Care for Nurses Only? Medicine and the Perceiving Eye
Author
Elin Håkonsen Martinsen
Publication date
01-03-2011
Publisher
Springer US
Published in
Health Care Analysis / Issue 1/2011
Print ISSN: 1065-3058
Electronic ISSN: 1573-3394
DOI
https://doi.org/10.1007/s10728-010-0161-9

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