According to Nietzsche, to care for the vulnerable is to succumb to a restrictive enslavement to a Judeo-Christian petty bourgeois mentality (he always was a snappy writer). For Nietzsche the strong should exert their natural dominance over the weak.1
Fortunately, although Nietzsche offers many relevant insights into the human condition, most of us disagree rather strongly with him on this. And that’s the point. Call me a Judeo-Christian petty bourgeois thinker if you will, but I have always been rather glad of our own College motto: Cum Scientia Caritas — with science I care. And that is our job — to be rational carers. The unique perspective of the doctor that embraces both science and humanity.
As doctors we see both the robust and the vulnerable. By and large we doctors are a pretty robust lot, but we also know ourselves ultimately to be vulnerable. Unless we get run over by a bus most of us will experience what it is to be vulnerable in the end. But the good news is that, whatever Nietzsche might say, most people who have known security and care themselves will recognise that caring for others is a central part of what it is to be a flourishing human being.
How much of a duty of care do I owe to whom, and how often?
I drag Nietzsche into this discussion not just for a punchy opening line, but because he represents a distinctive position. Possibly a somewhat extreme position, but one that you will find represented often enough in our world.
Perhaps the opposite position could be represented both by the feminist tradition of the ethics of care, and the Christian/universalist tradition of our equal moral worth within the gaze of the golden rule: ‘Do unto others as you would have them do unto you.’ 2
But why a debate, as if it was a spectrum? If so, surely we should all squeeze up to the caring end, on the side of the angels? But life is not straightforward. I only have so much care that I can give. How much care should I give, and to whom? Should I spend as much time seeking to care for the poorest billion of the world’s population as I do in caring for my patients? What about caring for my family — and what about caring for myself? Most doctors are comfortably off, and on average we tend to be physically healthy, but mentally less so, where we sometimes resemble Shakespeare’s ‘... care-crazed mother to a many sons.’ 3 And this itself is a problem. And not just our problem, because a care-crazed doctor is less likely to be a compassionate and competent doctor.
So we must find our place within a spirit of rational and moderated care (and I’m not suggesting that the feminist or Christian positions suggest otherwise).
And this is where vulnerability fits in. One of Raanan Gillon’s great contributions to medical ethics is the concept of scope.4 How much of a duty of care do I owe to whom, and how often? We need to focus our care on those with the greatest need, and on those to whom we can do the greatest good. And these are not always the people who make the greatest noise. And they often do not have fashionable problems.
So let us listen for the voices of the vulnerable.
In this month’s BJGP we read of frailty and vulnerability, both physical, mental, and social. Our modern world has seen much technological progress, yet seemingly little progress in the human condition. But we can be grateful for a medical tradition that seeks to care for the vulnerable.
Nietzsche may be dead but Scientia and Caritas are not.
- © British Journal of General Practice 2021
REFERENCES
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Holy Bible (Matthew), 7, 12.
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