Understanding Healing Relationships in Primary Care

Healing: An art or simply the ethics of care?

In this recent Annals article on healing relationships, Scott et al. put forward three relational outcomes that result from key processes of healing relationships, these were, trust, hope and a sense of being known. Authors of the article identified clinical competencies and concluded that healing relationships have an underlying structure, but that the locus of healing was neither in the patient or healer but in the space created by connections; ‘the between’ as referred to by philosopher William Desmond. I wonder if this ‘between’ space signals a call for primary care to reinvigorate a focus on ethical medical care and whether the growth of research into suffering and healing suggests an absence of humanity or humane care more broadly? As research into healing, vulnerability and suffering often evokes notions of transcendence, or a sense of a spiritual encounter or relational connection that is hard to articulate, the between can be difficult to locate. These between spaces are, however, important to consider in terms of representing points at which crossing over occurs. I suggest that it might be useful to consider these crossings by the application of sociologist Zygmunt Bauman’s notion of forms of togetherness. In his discussion of contemporary post modern state of relations, Bauman suggested three forms of togetherness as being-aside, being-with and being-for.[1] We have probably seen or read various manifestations of these kinds of relationships within medical literature. Those who are against the paternal dominance of the clinician might mis- interpret the idea of being-for as one where decisions are made for the individual rather than with or by them. This is not the case. The ideal ethical relation being-for has different characteristics to those of being -aside and being-with. The latter are fragmentary, momentary and episodic encounters, being-aside representing an on the side encounter where the other person is not recognized as human even but as an entity. Being-with signals the beginning of recognition of others, entities move into the realm of persons, they have a co-presence but only in so far as they are recognized for the resources that need to be shared. Bauman suggests that being-with is still a mis-meeting where no more of the self is encountered than the topic at hand permits. The ideal relation is one of being-for, this is a relationship that occurs in the act of transcendence from being- with something to being-for someone. Being-for recognizes the preciousness of the other, their full properties and their identity. Coming to see another in this way is the act of transcending from an in- between space of staying at a distance to embracing fully the relationship one has with another.

We might ask what forms of togetherness the organization of health care systems allow for and whether there can be crossing over from being- with to being-for? Primary care has the opportunity to reinvigorate a sense of ethical pursuit in the delivery and practice of health care and what Scott et al., (and Egnew previously) have illustrated in their exploration of the in-between spaces are how relationships can transcend those which are solely characteristic of being-aside or being-with, to those which represent being-for. This ideal is relevant for all human encounters and provides a basis from which to develop a relational ethic in primary care research and practice. Healing forms an important part of this but it is part of a broader and much required ethic of care needed for clinical practice.

References [1] Bauman Z. Postmodernity and its Discontents: Essays in Postmodern Morality. Oxford: Blackwell Publishers 1995.

Competing interests:   None declared