Page 66 - Contribution To Phenomenology

PHENOMENOLOGY AND THE CLINICAL EVENT 59

inquiry serves to make prominent the contextual themes essential to every
clinical encounter. Of course, much has been left out: the intentionality
of experience, the differences among the ongoing, merely operative
mental processes (Bewusstseinserlebnisse) and active awarenesses {Ich-
erlebnisse), and inner-time consciousness, to mention but a few. A full
phenomenology of the clinical event has thus been merely suggested.
(2) More specifically, making sense of the moral dimensions of cases
such as the one discussed, requires primary focus on the complex,
multiple relationships constitutive of each encounter—at the core of which
is the physician-patient relationship. To consider but one facet of this, to
engage in dialogue with the patient the clinician needs to encourage the
patient (and, where they are significantly involved, others in the circle of
intimates) to articulate her own narrative. In Kleinman's terms, this is a
sort of "mini-ethnography" ([16], pp. 248-250, 285) that, interlacing
continuously with the clinician's narrative, helps her to express what things
mean for her, a narrative that may "remoralize" her experience and in
that sense help to vahdate it.
The clinician's conduct here seems very much like what I have
elsewhere termed "affiliation" ([30]; [43], pp. 315-319). The idea is that
by placing oneself in the lived experience of the patient—in everyday
terms, "putting yourself in her shoes"—a fundamental moral cognizance
is achieved. This act does not signify that the clinician is supposed to
think about the woman's situation as if it were his own: '"what would you
do if you were me?" is not the issue. For the clinician—^whether
physician, nurse, or ethicist—is precisely not the woman. But that is not
the point anyway. It is rather that the clinician must make the effort to
understand the woman's circumstances from her own perspective, as she
lives and understands it—disclosed contextually through her discourse,
word-choice, paralinguistic features, bodily demeanor, etc.
Phenomenologically, the patient wants the clinician not merely to
understand (competence), but just as importantly, to be understanding (to
take care of, to care for). In this respect, the basic clinical method (for
physicians, nurses, or ethicists) is a specific form of dialogue ([41]; [44];
[45])—not merely "mini-ethnographies," as this notion fails to capture the
crucial interactions characteristic of clinical encounters. It is not, that is,
simply a matter of a patient telling her story, the physician then giving
his interpretive version of what's going on, etc. It is rather a matter of
shared talking and listening (asking and responding), whose point is to find
out what's wrong, what can be done about it, and, fundamentally, what