How to Make Sense of Suffering in Complex Care Practices?

This chapter focuses on the tension between complexity of caring practices and the normative dimension of providing good care. The question we raise in this chapter is whether practice theory provides conceptual space for the good of the patient, being a vulnerable person, longing for cure and support in dire times, receiving care under conditions of complexity? Our answer is that this is possible, by considering the epistemological and moral position of a patient as someone dealing with illness and social vulnerability as well (‘precarity’). The very character of being a patient is that he or she is suffering. Suffering, however, is not specific to patients. As the French philosopher Paul Ricoeur puts it, suffering and more broadly being the subject of forces displays what is common to all humans. People are ‘passible’: they constantly undergo processes, they are subject to time and material circumstances, such as heat, light and air pressure (Ricoeur, 1986: 125). People also constantly undergo acts of other people (pep talk, admonishments, putting a needle in one’s back for diagnostic reasons, caressing fingers). And people undergo diseases. Of course some diseases are self-inflicted. But even then, when the disease is raging or slumbering in the body, people undergo it: they feel the contractions, the throbbing pain, the itching. People are also actors but with the constant reality of being ‘passible’. Thus Ricoeur balances his idea of human agency with his observation that people are sentient beings undergoing situations, time and space; they are both subjects and objects and often at the same time. The neologism passibilité points at something different than passivity. When passivity means remaining without action, passibility does indicate movements: inner movements, even if people are not always consciously aware of them. Undergoing evokes inner movements: repulsion, attraction, contraction etcetera. In ethics this interplay of action and undergoing realities is a major shift: what if human acts are not just reigned by intention, decision, will, by principles, by duty, by rational accounts of consequences but by mere passibility as well? We thus propose that it is not evident that a patient is an actor in care practices similar to the acting roles of nurses, physicians, care managers; patients should not be seen as co-players in this field.