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Normativity unbound: Liminality in palliative care ethics

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A man who is awake in the open field at night, or who wanders over silent paths, experiences the world differently than by day. Nighness vanishes, and with it distance; everything is equally far and near, close by us and yet mysteriously remote. Space loses its measures. There are whispers and sounds and we do not know where or what they are…. There is no longer a distinction between what is lifeless and living; everything is animate and soulless, vigilant and asleep at once.

Walter F. Otto [1, pp. 118–119].

Abstract

This article applies the anthropological concept of liminality to reconceptualize palliative care ethics. Liminality possesses both spatial and temporal dimensions. Both these aspects are analyzed to provide insight into the intersubjective relationship between patient and caregiver in the context of palliative care. Aristotelian practical wisdom, or phronesis, is considered to be the appropriate model for palliative care ethics, provided it is able to account for liminality. Moreover, this article argues for the importance of liminality for providing an ethical structure that grounds the doctrine of double effect and overcomes the impasse of phronesis in the treatment of the terminally ill.

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Notes

  1. See for example [6–8].

  2. Even though liminality generally refers to a social structure characterizing pre-industrial societies, the related concepts of liminality and communitas apply so readily to the hospice and palliative care contexts because they resuscitate a pre-modern form of care. Turner was aware of the problem of applying concepts derived from the study of traditional societies to modern post-industrial society. He distinguished, therefore, between “liminal” for less complex societies and “liminoid” for modern symbolic inversions and expressions of disorder. See, for example, Turner [15].

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Acknowledgments

I would like to thank palliative care physician Martin Chasen for the invitation to present an early version of this paper at the 18th International Congress on Palliative Care, and Matthew Hunt for his valuable comments.

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  1. Faculty of Religious Studies, McGill University, 3520 University Street, Montreal, QC, H3A 2A7, Canada

    Hillel Braude

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Braude, H. Normativity unbound: Liminality in palliative care ethics. Theor Med Bioeth 33, 107–122 (2012). https://doi.org/10.1007/s11017-011-9200-2

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