Axis 3 | Ethics and politics of recognition

Keywords: subject, alterity, sustainable medicine, ecosystem

Person-centred care is based on the recognition of the other, as is suggested by the encounter of Levinas (1961), the subject of Canguilhem (1968), the listening of Rogers (1996), or even the hospitality of Derrida (1997). It’s in recognition that the self acquires its full value, and it’s in the relation that it acquires its consistence. Recognition is to be understood here in the Hegelian sense: Anerkennung means both knowing the identity of, and according value to, someone. These two elements inform the relation to others, the intersubjective relation. This conception of recognition, developed by Fichte and Hegel, is both “relational (in that it refers to the relations of recognition between individuals) and evaluative (in the sense that recognition means recognizing the value of a person or of their acts)”. This concept applies both to the persons being cared for and to the persons providing the care. Thus it is that consideration has been spoken of as a “professional value” of carers. Care work and caring about work are, indeed, intimately connected. In a context in which under-recognized recipients and providers of care tend to perceive themselves as insufficiently considered, it is important to rethink the conditions of possibility of their respective and mutual recognition. To think about the ethics of recognition in the context of care is thus to effectuate a transition from rationality to relationality. This transition gives rise to two paths.

The first consists in transposing the notion of capability, as defined by Martha Nussbaum as a way of evaluating and comparing quality of life, and establishing a theory of fundamental social justice for the health sector. The notion of capability recognizes in the subject their status as a person. It provides ethical markers for the definition of objectives in a politics of care. The concept of “relational goods” that Nussbaum defines in The Fragility of Goodness, taking inspiration from Aristotle, makes it possible to bring to light the value of relations as a condition in the flourishing of each human being. This relational dimension of goods must be understood both over time and according to a collective logic. This contribution of moral philosophy could be fecund for questioning and bringing perspective to the criteria or principles that structure and orient health institutions. More generally, the work of the Chair will aim regularly to revisit the great thinkers relevant to the field of care (from Canguilhem to Levinas, passing by Derrida, Rogers, and Ricoeur, from Nussbaum to the philosophies of care, from literature to Goffman or Schütz, etc.) in order to make them resonate with respect to the theme of the values of care.

The second path invites us to consider an ethics of recognition from a societal and environmental perspective. This involves elevating reflection into the care relation above the interpersonal level in order to examine our collective representations of care. The perspective of so-called “sustainable medicine” seems to us an appropriate point of entry. This notion was formulated initially with the idea of sustainability of costs in mind, in an American context of rising health costs. It is possible to give the concept an ethical and ecological extension. The triptych, “evidence, ethics, economics”, put forward by the Swiss Academy of Medical Sciences involves an enriched version of the 3 E’s of management: “efficiency, economy, effectiveness”. But can one imagine an even more global vision based on a 4 E formula: evidence, ethics, economy, ecology? And how can the economic value of the care relation be shared out and rethought as a value imbricated in and dependent on not only the quality of the social link, but also on the links between humans and the environment? The sustainability angle makes it possible to establish links between economics, anthropology, and ecology. We start from the postulate that to reconnect humanity to its ecosystem is a fundamental parameter for a politics of recognition, viewed from the perspective of the philosophy of care. Two research paths will be explored:
  1. Specific attention will be paid to the “One Health” imperative in a context in which large-scale health risks are multiplying and the vulnerability of the living increasing. To think an economic model of health, is it not necessary to start by examining the ecological models on which our health depends, faced with an unprecedented planetary and global crisis (climate chaos; resource depletion; environmental pollution, epizootic diseases, antibiotic resistance, etc.)?
  2. We will also pay close attention to technologies, in the context of the e-health boom. What is the sustainability of long-term medical technologies (notably 4P medicine)? In order to emphasize the value of the relation, we formulate the hypothesis that these technologies are only sustainable if they make it possible to hybridize distance and presence in the context of care.

Further reading

  • Valérie GRESIN, Le sujet à l’épreuve de la guérison. Une intégrité affective au fondement de notre consistance, thèse pour le doctorat de philosophie, Université Lyon 3 / Université catholique de Lyon, 2016, 370 p.
  • Jean-Philippe PIERRON, Prendre soin de la nature et des humains, Paris, Les Belles Lettres, 2019.