Ethics of Care: Philosophical Propaedeutics as a Therapy for Emotional Burnout in Medicine

 
PIIS023620070020512-0-1
DOI10.31857/S023620070020512-0
Publication type Article
Status Published
Authors
Affiliation: National Research University Higher School of Economics
Address: 20 Myasnitskaya Str., Moscow 101000, Russian Federation
Journal nameChelovek
EditionVolume 33 Issue 3
Pages29-48
Abstract

The purpose of this article is to comprehend the reasons for the exponential growth and specificity of «burnout» of medical personnel during the Covid-19 pandemic and to substantiate the therapeutic potential of philosophy based on P. Ricoeur’s narrative identity theory. The pandemic has forced a new way of looking at the attitude to time, convincing us that in general we are not badly prepared for emergency medical care, but we are not coping with the problem in the long run. An example of this is the ineffectiveness of the treatment of many chronic diseases against the background of covid, which inscribe the disease in the time limits of the individual life. The temporality of patient care is partly determined by the nature of the organization of the health care worker's work — its routinization and the emphasis placed on individual performance evaluation. This artificially creates conditions for the actual dilution of professional teams, creating competition between doctors, between services and between patients. Time turns out to be fragmented, and treatment, developed mainly for the short term, is reduced to a certain sequence of actions, sometimes without any real coherence. As a result of the disruption of temporality, the identity of the subject caring for the patient is blurred, the “meaning of the profession” is also questioned. The risks of burnout associated with a decrease in the level of responsibility of a medical worker and an increase in the probability of professional errors, require an understanding of the causes of subjective suffering experienced by medical workers and the construction of a collective narrative. Its necessity is also explained by the need to ensure the protection of the medical worker in the face of both the administration and the patient community, which requires a return to the collective history and the creation of a system of internal and external protective mechanisms of the medical community. This requirement, based on the public recognition of the value of medical staff work, is well respected in several leading Western countries and completely ignored in Russia.

KeywordsCovid-19, burn-out of health care workers, worker well-being, distress, Narrative therapy, Narrative Identity, Narrative Ethics, self, vulnerability, Paul Ricœur
Received16.06.2022
Publication date24.06.2022
Number of characters36871
Cite  
100 rub.
When subscribing to an article or issue, the user can download PDF, evaluate the publication or contact the author. Need to register.

Number of purchasers: 0, views: 278

Readers community rating: votes 0

1. Artem'eva O.V. Etika zaboty: feministskaya al'ternativa klassicheskoj filosofii [The Ethics of Care: A Feminist Alternative to Classical Philosophy]. Ethical Thought, 2000. N 1. P. 195–215.

2. Borisenkova A.V. Teoriya povestvovaniya Polya Rikera: ot narrativnoj organizacii opyta k narrativnym osnovaniyam nauchnogo znaniya [Paul Ricoeur’s theory of narration: from narrative organization of experience to narrative foundations of scientific knowledge]. Sociologicheskoe obozrenie [Sociological Review]. Vol. 6. N 1. 2007. P. 55–63.

3. Kant I. Metafizika nravov [Metaphysics of Morals]. Kant I. Sobranie sochinenij v 6 t.[Collected works in 6 vol.]. Vol. 4. Moscow: Mysl’ Publ., 1965.

4. Rybnikov V., Kuznetsova O., Parfenov Y. Psihologicheskie mekhanizmy razvitiya sindroma professional'nogo vygoraniya u vrachej anesteziologov-reanimatologov [Psychologial mechanisms of development of burnout syndrome among anesthesiologists-resuscitators]. Uchenye zapiski universiteta imeni P.F. Lesgafta [Scientific notes of the University named P.F. Lesgaft], 2012. N 4 (86). P. 114–118.

5. Svistunov A., Osadchuk M., Mironova E. Vygoranie kak professional'naya problema sovremennogo zdravoohraneniya [Burnout as professional problem of modern public healthcare]. Consilium Medicum. 2019. N 21(12). P. 101–105.

6. Kholmogorova A., Petrikov S., Suroyegina A., Mikita O., Rakhmanina A., Roy A. Professional'noe vygoranie i ego faktory u medicinskih rabotnikov, uchastvuyushchih v okazanii pomoshchi bol'nym Covid-19 na raznyh etapah pandemii [Burnout and its Factors in Healthcare Workers Involved in Providing Health Care for Patients With Covid-19 at Different Stages of the Pandemic]. Russian Sklifosovsky Journal «Emergency Medical Care». 2020. N 9(3). P. 321–337.

7. Hudova I.YU., Ulumbekova G.E. «Vygoranie» u medicinskih rabotnikov: diagnostika, lechenie, osobennosti v epohu Covid-1 [Healthcare workers “burn-out”: diagnostic, treatment, particularities during epidemy of COVID-19], ORGZDRAV: novosti, mneniya, obuchenie. Vestnik VSHOUZ [Healthcare management: News, Views, Education. Bulletin of VSHOUZ]. 2021. Vol. 7, N 1. P. 42–62.

8. Bakker A.B., Van der Zee K.I., Lewig K.A., Dollard M.F. The relationship between the Big Five personality factors and burnout: a study among volunteer counselors. The Journal of Social Psychology. 2006. N 146(1). P. 31–50.

9. Blume L. Gilligan and Kohlberg: Implications for Moral Theory. Ethics. 1988. Vol. 98, N 3. P. 472–491.

10. Brooks S.K., Webster R.K., Smith L.E., et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020. Vol. 395. P. 912–920.

11. Butler C.R., Wong S.P.Y., Wightman A.G., O’Hare A.M. US clinicians’ experiences and perspectives on resource limitation and patient care during the Covid-19 pandemic. JAMA Netw. Open. 2020. Vol. 3, N 11. Article ID e2027315. doi:10.1001/jamanetworkopen.2020.27315

12. Dutheil F., Aubert C., Pereira B., et al. Suicide among physicians and health-care workers: a systematic review and meta-analysis. PLoS One. 2019. Vol. 14, N 12. Article ID e0226361. doi: 10.1371/journal.pone.0226361

13. Freudenberger H.J. Staff burnout. Social Issues. 1974. Vol. 30(2). P. 159–165.

14. Garrau M., Le Goff A. Care, justice et dépendance. Introduction aux théories du care. Paris: PUF, 2010.

15. Honneth A. La réification. Paris: Gallimard, 2005.

16. Kröger C. Shattered social identity and moral injuries: work-related conditions in health care professionals during the Covid-19 pandemic. Psychol. Trauma. 2020. Vol. 12, suppl. 1. P. S156–S158. doi: 10.1037/tra0000715

17. Li Z., Ge J., Yang M., Feng J., Qiao M., et al. Vicarious traumatization in the general public, members, and non-members of medical teams aiding in Covid-19 control. Brain, Behavior, and Immunity. 2020. Vol.10(20). doi.org/10.1016/j.bbi.2020.03.007

18. National Academies of Sciences, Engineering, and Medicine USA. Taking action against clinician burnout: a systems approach to professional well-being. Washington, DC: The National Academies Press, 2019. [Electronic resource] URL: https://www.nap.edu/catalog/25521/takingaction-against-clinician-burnout-a-systems-approach-to-professional (date of access: 10.03.2022)

19. Ricœur P. Autonomie et vulnérabilité. Dans: La philosophie dans la Cité: Hommage à Hélène Ackermans. Bruxelles : Presses de l’Université Saint-Louis, 1997 (en ligne). [Electronic resource] URL: http://books.openedition.org/pusl/18960 (date of access: 10.03.2022)

20. Ricœur P. Du texte à l’action. Essais d’herméneutique II. Paris: Seuil, 1986.

21. Ricoeur P. Parcours de la reconnaissance. Paris: Stock, 2004.

22. Ricœur P. Soi-même comme un autre. Paris: Seuil, 1990.

23. Ricoeur P. La souffrance n’est pas la douleur // Souffrances : corps et ames, épreuves partagés. Paris: Editions Autrement, 1994. P. 58–69.

24. Ricœur P. Temps et récit. T. 1: L’intrigue et le récit historique. Paris: Seuil, 1983.

25. Ruddick S. Maternal Thinking: Toward a Politics of Peace. Boston: The Women's Press, 1989.

26. Shanafelt Т., Ripp J., Trockel M. Understanding and addressing sources of anxiety among health care professionals during the Covid-19 pandemic. JAMA. 2020. Vol. 323, N 21. P. 2133–2134. doi:10.1001/jama.2020.5893

27. Tei S., Becker C., Kawada R. et al. Can we predict burnout severity from empathy-related brain activity? Translational psychiatry. 2014. Vol. 4: e393. doi: 10.1038/tp.2014.34.

28. Tronto J.C. Du care, L’amour des autres, care, compassion et humanitarisme. Revue du Mauss. 2008. N 32. [Electronic resource] URL: https://www.revuedumauss.com.fr/Pages/S32.html (date of access: 10.03.2022)

29. Tyssen R, Vaglum P, Grønvold NT, Ekeberg O. Suicidal ideation among medical students and young physicians: a nationwide and prospective study of prevalence and predictors. Journal of affective disorders. 2001. Vol. 64(1). P. 69–79. doi: 10.1016/s0165-0327(00)00205-6.

30. Velut S. L’Hôpital, une nouvelle industrie: Le langage comme symptôme (E-book). Paris: Gallimard, 2020.

31. West C.P., Dyrbye L.N., Erwin P.J., Shanafelt T.D. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. Lancet. 2016. Vol. 388 (10057). P. 2272–2281.

32. Wu A.W. Medical Error: The Second Victim: The Doctor Who Makes the Mistake Needs Help Too. British Medical Journal. 2000. Vol. 320, N 7237. P. 726–727.

Система Orphus

Loading...
Up