The ethics of Zuhandenheit in nursing

It may be said that Gadamer’s emphasis on phronesis in his philosophical hermeneutics is, in terms of the history of being (Seinsgeschichte) in modern times, a type of fulfilment of Heidegger’s fundamental ontology (Fundamentalontologie) when the latter is commonly faulted for his lack of a theory of ethics in his major work Being and time. Gadamer emphasises that in the Aristotelian tradition, philosophers prove their mettle through phronesis – the wisdom gained from philosophy is put into good action for the benefit of humanity. Aristotle himself came from a medical family – his father Nicomachus was a court physician to the king of Macedonia – and received some training in Greek medicine.

Nursing theory is an exemplary form of phronesis in that its philosophical import is matched with the actual praxis of caring for the sick and the dying. Nurses have a unique form of presence (Anwesen) as the source and the provider of caring (Pflegen). Being caring, a nurse’s presence has the spatial significance of nearness and availableness. A nurse cannot do his or her job by being remote and unavailable. The clearing of being (Lichtung des Seins) of a nurse’s being-there (Dasein) takes place in the disclosive (erschloßende) mode of nearness (Nahe) and availableness (Zuhandenheit) in a hermeneutic circle of caring that involves the patients as well. In essence, caring involves access (Zugang) that is reciprocated in the being-with-one-another (Mitdasein) of nurses and patients in a clinical setting of care. An insightful phenomenological study in this aspect of nursing can be found in McKenzie et al (2008).

Heidegger never used the word Pflegen as a key concept, despite the fame he gained in Being and time by grounding the temporal phenomenon of care (Sorge) as a principal existential feature of what Dasein is as being-in-the-world (In-der-Welt-sein) or thrownness (Geworfenheit) in the world. Coming from the wisdom of nursing theory, it can be argued that Pflege, no less temporal and bound up with the fundamental mode of being that is being-towards-death, is an eminent form of Sorge. Among its many expressions – Heidegger picks Angst in Being and time -, care fulfils the real and metaphysical virtue of phronesis when it is nursing care.

Bibliography

McKenzie, Heather, Maureen Boughton, Lillian Hayes & Sue Forsyth. (2008) Explaining the complexities and value of nursing practice and knowledge. In Ian Morley & Mira Crouch (Eds), Knowledge as value: illumination through critical prisms (pp. 209-222). Amsterdam, the Netherlands: Rodopi.

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