Page 48 - Contribution To Phenomenology

PHENOMENOLOGY AND THE CLINICAL EVENT 41

the couple's puzzlement about the meaning of "statistically significant"
was central to their "agitation" and "anger," and thus indicated (at least
in part) what theme to be addressed. But these matters could not be
considered in abstraction from the actual circumstances: what each person
understood, what this led them to think about, etc.
(3) The ethics consultant enters into an already constituted, ongoing
clinical encounter between the couple and their physician (and others:
nurses, medical and radiological consultants, etc.). The couple was
responding to what they understood the physicians were telling them
about the fetus* condition, and the physicians to what they thought the
couple was saying. Thus, every situational constituent, including any moral
issue, is presented solely within an ongoing relationship between patient and
physician—at least, in its most minimal form. That relationship is not
itself the focal or primary theme for either patient or physician.^ The
physician is instead concerned to help the patient (or at least to do no
harm), and is accountable for whatever is and is not done and said. The
patient's concern, on the other hand, is to have distress relieved, injuries
healed, disease resolved, or at the very least to be comforted and cared
for.^ The clinical ethics consultant, however, has to address that relation-
ship itself, attending to each of its integral constituents within that tem-
porally ongoing contexture [39].

IL The Physician-Patient Relationship

Only a little reflection is needed, however, to realize that this relation-
ship is quite special. Consider, for instance, Eric Cassell's observation:

I remember a patient, lying undressed on the examining table, who said
quizzically, "Why am I letting you touch me?" It is a very reasonable
question. She was a patient new to me, a stranger, and fifteen minutes
after our meeting. I was poking at her breasts! Similarly, I have access
to the homes and darkest secrets of people who are virtual strangers.

^ Although it may become so at some point—^for instance, if the couple were
later asked how they got along with their physician, or if, after changing physicians,
their first physician were asked by the new one for pertinent information about his
relationship.
^ The issues posed by such phenomena as Munchausen's syndrome, factitious
illness, and hypochondriasis, must be considered on their own.