Moving beyond the gap between theory and practice in healthcare ethics
The separation of theory (moral philosophy) and practice (clinical moral reality) remains under analysed in healthcare ethics. I shall dissect previous attempts to bridge the putative theory/practice gap and show why they fail. I argue that—either in their lack of political critique or attention to the political and economic reality of healthcare—the attempts conform to, when they should resist, such healthcare in which ‘the right thing to do’ has become a compromise between morality and the lost opportunities to act according to it.
In addition to offering a different way of understanding theory and practice, I shall revise current understandings of their relationship in healthcare ethics. I argue that the simple primacy of practice should be resisted but not in favour of ‘pure’ theory. Instead, as Adorno argues in Probleme der Moralphilosophie, because thinking is doing, it constitutes theory as a form of practice: so any claims for the purity of thinking are deceptive and the alleged contrast between theory and practice is mistaken from the outset. I suggest that the two should neither be divided nor united in such a way that, on the one hand, theory becomes impotent in relation to the material world and, on the other, practice becomes arbitrary in its lack of theoretical grounding. In other words, theory as a form of practice must aim at changing the existing framework for practice, rather than just action within that framework and genuinely practical moral practice cannot be subservient to falsely theorised practical ends or uses, let alone claim to be able to rid itself from all theoretical. However, I cannot claim to be able to fit theory and practice in neat unison as it cannot be guaranteed that such unity holds good in every time and place. Rather, an uncomfortable tension between them shall always remain but it can turn out to be more useful than any exercise of artificially adding the elements together. After all, a forced synthesis does not equal better moral practice unlike critical discussion that arises from the difficult marriage of theory and practice.
If Adorno is right to claim that no one is able to live the right life in our society today because life itself is so deformed and distorted then, if healthcare ethics is to be of any practical use, moral theory needs to address the material reality of healthcare and the extent to which moral action is possible in that context. Without this reflection moral philosophy remains a mere abstraction that conforms to the political and economic constraints to moral action. Moreover, because moral theory cannot simply assume a harmony between the public mores of a society and the moral life of an individual, it needs to address the question of whether normative ethics can guarantee good care, and if so, how it might achieve this? Or does normative ethics indeed lead to ‘ethical violence’ towards clinicians in conditions where abiding by ethical norms has become in reality impossible? Considering these questions, I shall suggest a care ethics in which ‘the right thing to do’ is no longer in the centre of attention but rather the resistance to whatever obstructs healthcare professionals from doing the right thing.
Rajala, Anna Ilona. "Pitkäaikaishoivan ruumiillisuuden arvosta [On the value of embodied long-term care]." In Ruumiillisuus ja työelämä: työruumis jälkiteollisessa taloudessa [Embodiment and working life: Working body in post-industrial economy], edited by Jaana Parviainen, Taina Kinnunen and Ilmari Kortelainen. Tampere: Vastapaino, 2016.
Rajala, Anna Ilona and Jenni Aittokallio. “Dikotomiat ajattelun kahleina. Mitä teorian ja käytännön erottelu merkitsee fysioterapeutin työssä? [Dichotomies shackle thinking. What does the separation of theory and practice signify in physiotherapy?]” Fysioterapia 61, issue 4 (2014): 27–31.
“Can theory already be a practice?” The 1st International ICE Observatory Future of Ethics in Care & 16th Nursing Ethics Conference, University of Surrey, July 2015
“Health technologies–for better or for worse? Critical theory and standardisation of care delivery.” 18th Annual International Philosophy of Nursing Conference, University of Nottingham, September 2014
“Adorno’s Negative Dialectics and understanding the patient–carer relationship in dementia.” Adorno: Impact and Influences, International Conference, Royal Holloway, University of London, November 2013
Anna joined University of Brighton and CAPPE as a PhD student in 2014. She graduated as a physiotherapist in 2008 after which she worked in the Finnish public sector until 2012. She gained an MA in Philosophy, Politics and Economics of Health in 2013 (University College London), with particular interest in history of medicine, mental health, disability, and political and moral philosophy. Her dissertation on Hegel’s dialectics of recognition and ethics in dementia was awarded with distinction. Anna is a member of the Critical Physiotherapy Network, a freelance columnist for the Finnish Association of Physiotherapists, copy editor for Thanatos (also in charge of layout), and research student representative in the College Research Ethics Committee, Arts and Humanities. She also writes a research blog.
