Caring and uncaring in medicine and beyond 

As healthcare professionals, we take oaths and vows—sometimes literally and sometimes figuratively—to care for others. Given our epidemic of burnout, compassion fatigue, and loss of soul in medicine, I’ve come to expand this vow of caring for others to include caring for self. Practicing this, I’ve come to question our tendency to make a sharp distinction between self and other. When it comes to a deep commitment to caring, individual boundaries break down and your pain is my pain, until, like mystics, we see not just interconnection, but oneness instead of separation.  

In the institutional practice of medicine there are a few forces that remind us to care, but there are many forces that can distract us from our mission of caring. Scientific objectivity, emotional distancing, and the fragmentation of a whole human being into the many medical specialties and sub-specialties can be dehumanizing for both clinician and patient. Dehumanization is related to uncaring, because only the human can care for another human.  

It’ the human being, the whole human being, who carries the possibility and responsibility of caring. Institutions aren’t moral beings, they’re org charts and protocols, incapable of caring because caring is a human function, not an institutional one. To take a vow of caring is to become a moral agent of caring. 

A human being can never be a number. Reductionism, the process of taking a whole and reducing it to parts, is a technique, but it’s not an act of caring. There’s power in our model of biomedicine in which we turn human beings into numbers (diagnostic and procedure codes, lab values) and then intervene and manipulate numbers to try to treat disease. But turning a human being into a number is dehumanizing if we care more about the number than about the human. If we, the human beings in the institution, do not have an ethic and a practice of caring, we become agents of uncaring.  

I wrote a book on “Re-humanizing Medicine” and another on “Caring for Self & Others,” and I realize our commitment to caring faces forces of dehumanization and uncaring that are from beyond the four walls of the consultation room or our modern medical campuses. In the world we face a pandemic of uncaring sweeping through our institutions. Around the world us/them thinking is taking hold, infecting us like a plague where we turn against one another—like an auto-immune disorder of uncaring. 

When we base society and human interaction only on the profit motive, on increased “performance,” productivity, and “efficiency,” we become dehumanized and dehumanize those who are processed through the system of the institution. Human beings become objectified objects and consumers of a “product.”  

If we’re not basing society on caring, then it means that our foundational values are based in uncaring. When we base society and interaction style on efficiency and productivity, rather than on caring and compassion, we degrade ourselves and others and become less than the human beings we’re capable of being.  

The uncaring attitude is based on enhancing the difference and distance between self and others. Uncaring creates the category of “them,” “other,” and “others” who are fundamentally distinct from “me.” Us/them thinking creates a feeling of insecurity as the self is disconnected from its social roots, from its social ecology. The self is no longer seen as existing within the matrix of caring and connectivity that’s the essence of human being.  

Martin Buber described two possible attitudes and relationships between self and other: 

1. The I-It relationship between a subject and an object who can be used as a number or a material.

2. The I-Thou relationship between two subjects, based not in materialism, but in a recognition of the inherent sacredness of the “other.”

In medicine we strive for clinical objectivity, but objectivity is an I-it relationship, the subject of the human being is turned into a patient, an organ system, a set of variables and numbers. Clinical objectivity takes the subject apart and creates a collection of objects that can be moved around and manipulated. This can be dehumanizing both for patients and healthcare professionals.  

Burnout may be partly due to being treated like an object rather than a person, like a production agent rather than a moral agent. Psychoanalyst Robert Stoller warns us that the act of dehumanizing another “dehumanizes the dehumanizer,” (Robert Stoller, “Observing the Erotic Imagination”). We must treat an aspect of ourselves like an “it” to create an I-it relationship with an “other.”  

The I-it relationship can lead to a “me first” attitude, whereas an I-Thou relationship fosters a relationship in which what happens to you happens to me. The concept of ubuntu captures this intersubjective ecology of human being. Archbishop Desmond Tutu explains ubuntu as follows: 

“Ubuntu says that we cannot exist as a human being in isolation. We are interconnected. We are family. If you are not well, I am not well. When Ubuntu is your core value you recognize your shared humanity. You cannot live in Ubuntu and violate the dignity or humanity of another. The two are irreconcilable.”

Archbishop Tutu further explains ubuntu in regard to dehumanization:

“I am human because you are human. My humanity is caught up in yours. And if you are dehumanized, I am dehumanized.”

 

In “Caring for Self & Others,” I have wrote about other ways of describing this concept of interconnectedness, such as “the beloved community” of Martin Luther King, Jr., and “interbeing,” a mode of relating described by Thich Nhat Hanh:  

“I am therefore you are. You are, therefore I am. That is the meaning of ‘interbeing.’ We inter-are.”

 

It’s no accident that ubuntu, the beloved community, and interbeing are terms valued by spiritual leaders, because to see self in other and other in self is what the mystics call nonduality—the state of consciousness in which there is no separation, but only oneness. And just as we, as individual healthcare professionals take on vows and oaths of caring, so too, we as humanity could take on vows or oaths of ubuntu, of creating the beloved community, and of interbeing. 

So how do we respond to dehumanization in institutional medicine and in the pandemic of uncaring in the world? 

We can remember who we are, first and foremost—healers.  

We can remember the formal and informal vows and oaths we’ve taken—we’re here to attend to the suffering of others because we recognize that human suffering is all of ours to bear. Suffering isn’t isolated within the borders of an individual human body or the borders of a country.  

We can recommit to our oaths and vows of healing and caring.  

Here is a vow I offer from my book “Caring for Self & Others”:

Caring for Self & Others Oath 

I vow to care for my Self & Others, recognizing that Self includes Others and Others include Self. Therefore, I vow to care for All. 

I vow to care for my body and the bodies of others: caring for embodying, animating, and nourishing. 

I vow to care for my emotions and the emotions of others: caring for feeling, connecting, and flowing. 

I vow to care for my mind and the minds of others: caring for thinking, minding, and evolving. 

I vow to care for my heart and the hearts of others: caring for compassioning, loving, and relating. 

I vow to care for my creativity and the creativity of others: caring for wording, drawing, and creating. 

I vow to care for my intuition and the intuition of others: caring for dreaming, visioning, and receiving. 

I vow to care for my spirit and the spirit of others: caring for integrating, unifying, and transforming. 

I vow to care for my context and the context of others: caring for harmonizing, sustaining, and communing. 

I vow to care for my time and the time of others: caring for growing, transitioning, and becoming who we are. 

I vow to care for All, coming full circle and becoming caring: caring for returning, interbeing, and leading caring. 

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.