Page 56 - Contribution To Phenomenology

PHENOMENOLOGY AND THE CLINICAL EVENT 49

The point might be expressed somewhat differently. In trying to
understand the issues presented within any clinical encounter, it is critical
to be mindful of the highly complex set of biographical situations and
situational definitions this involves: the multiple people variously involved
and their respective experiences, meanings, truths, interpretations,
attitudes, relationships with other people, life-plans, values, etc.—each of
which must be weighed and respected for its own sake and in its own
terms even while attempting to enhance understanding of the context.
The ethicist's task is to identify, weigh and deUberate, eventually to reach
reasonable, defensible judgments about every aspect of the context:^^ the
patient's, family's, significant others', as well as the providers' (physicians,
nurses, etc.). This must be done by attending strictly to "the things
themselves," the situational participants and their specific circumstances,
in their own terms.
As Kleinman emphasizes, helping patients and families develop a more
valid, "remoralized" narrative understanding requires "the clinician to
place himself in the Uved experience of the patient's illness . . . to
understand (and even imaginatively perceive and feel) the illness
experience as the patient understands, perceives, and feels it," and to do
the same for the family ([16], p. 232). It is critical to understand the
ways in which situational participants themselves talk about their
respective experiences, for the moral issues they face are presented and
must be worked out solely within the context of their actual occurrence.
Sick or impaired people experience, interpret, and talk about their
illnesses, typically couching their narratives in their own commonsense
categories (in part personal, in large part socially derived). These
narratives include and are invariably shaped by the person's under-
standing of the clinician's words, gestures, and conducts; similarly, the
physician's work as such includes and is shaped by the patient's narrative.
The relationship is thus a special form of mutuality ([39], pp. 199-216):
the intimate, reflexive interrelating of persons within an experienced
asymmetry designed to help those who are unable to help themselves.

^^ The ancient empirics and, later, the methodical skeptics termed this critical
act epUogismos, which is based on interpretations of patient discourse, bodily
symptoms, life-styles, etc. They vehemently rejected the dogmatic's focus on
analogismos—causal reasoning designed to connect the inner bodily pathologies
("invisibles") with outer physical symptoms alone (**visibles"). Where the former were
guided by semeiosis, the latter were led to diagnosis ([43], pp. 130-176).