Posted on January 18, 2016 at 8:00 AM
by J.S. Blumenthal-Barby
Ms. Clara [name changed] is one of our patient partners on a PCORI funded project. PCORI is unique in that they aim to include patients and other stakeholders in all stages of research—from conceptualization of projects and their aims to the dissemination of results. We’ve been working closely with Ms. Clara and other patient partners for almost two years now. A few months ago, when visiting Ms. Clara in the hospital, her eyes became teary and she exclaimed, “I love you guys. I just feel like you really care, and you mean so much to me.”
This gave me a great deal of pause: can we tell one of our patient partners that we love her in return? Do we love her? What would that mean? I relayed this story to one of the members of Ms. Clara’s health care team, who replied, “Oh yes, everybody loves Ms. Clara.”
This was the first time I had ever encountered the language of love in the professional setting of health care. And I wondered: Can doctors or other health care providers really love their patients? And is that appropriate?
Perhaps the contemporary philosopher who has thought the most about and developed the most robust account of love is Harry Frankfurt. This account is outlined in his book, The Reasons of Love. According to Frankfurt, love is a particular mode of caring that is defined by several characteristics.
- Love involves a concern for the existence of the beloved and for its wellbeing (for its own sake).
- Love is particular. There is no substitute for the beloved.
- Love involves identification. As Frankfurt writes, “the lover is invested in his beloved: he profits by its successes, and its failures cause him to suffer” (61).
- Love, as a form of caring, is diachronic. Meaning that the person desires to continue loving the beloved—it matters to the person that their love continues, and they take steps accordingly.
- Love is not up to us and is not established by reason. Love is, as Frankfurt puts it, a “volitional necessity”—what we find ourselves loving is a bare fact (due to nature or circumstance) that gives content to and makes commands of what we will and what we do. In other words, love gives reasons and not the other way around. Love sets “final ends” for us.
Given this account, how plausible is it that a health care provider could love a patient? It seems that characteristics 1 and 3 are probably fairly commonly satisfied in the context of a provider-patient relationship. Characteristic 2 may be satisfied, though it might also be the case that the situation is best described differently (e.g., as caring for the patient in front of him/her who could easily be replaced by another patient). Characteristics 4 and 5 are more difficult. It may be quite unlikely that a health care provider have any desire to continue loving the patient and feel that they need to take steps to foster that continuation. Likewise, though the provider may feel that their caring for the patient (along with their professional obligation) gives them reason to do certain things, it may be a stretch to conceptualize this as involving any final end setting.
And then there is the normative question of whether it appropriate for a health care provider to love a patient or to tell a patient that they love them. According to Frankfurt, there is a way in which this normative question does not make sense given that love is not something we do (or should) have much control over. But setting this point aside, certainly providers can to some extent shape their thoughts and emotions and as such shape what they care about or love. The central ethical question seems to me to be whether loving Patient A would give rise to unfair treatment to other patients. In that case, such love becomes problematic given that the professional and ethical norms of medicine (which lean towards non-partiality) are fairly distinct from the norms of private life. Given the nature of love, this seems to be a significant moral concern. Some patients are simply more lovable than others—but the less loveable deserve equal amounts of care and attention.
Although, as Frankfurt also says: