Assisted suicide is a very topical issue in our time. It has been dealt with diversely in different countries, and in the US differently in different states. My own response here is to step back and philosophically explore some of the ethical presuppositions at work, presuppositions often not in focus in terms of explicit self-consciousness; presuppositions often in tension with ethical views that are enunciated and held more in the foreground. For one can foreground ethical commitments in a manner which hinders more nuanced exploration of hidden philosophical depths to the issues at stake. Among other things, I do not understand ethics as a technical discipline where, if you have the technique, you can apply it to issues in question. In Ethics and the Between I have tried to practice ethical reflection as requiring mindfulness of the ethos of being, of our distinctive participation in this ethos, of the ethical potencies that are constitutive of our being ethical and that enter into the formation of ethical selving and being in diverse forms of ethical community. In addition, this topical issue is made more complex and urgent by technological and medical developments. At the level I want to consider the matter, these turn out to be derivative, not original.
People are sometimes perplexed about the difference of (physician) assisted suicide and euthanasia. Very broadly, in the first the person kills himself or herself, with the help of another – the suicide is in that sense physician assisted, though not necessarily directly in the sense of the doctor administering an injection, say. The doctor might make available the means of death but not administer them. The doctor is not directly but perhaps indirectly the cause of the death, otherwise said to be chosen voluntarily by the person. The second is the direct administration of death by the physician or designated killer of the means of death. It is often more effective, in the sense that a medical expert is thought competent to administer, say, the right dose that works. And euthanasia might be said to be needed, if a sick person cannot administer the lethal agents himself or herself – cannot directly kill himself or herself. In practice, it is not always possible to separate absolutely the two. But in both cases, the matter is in question for both parties, the assister/doctor, and for the assisted/the person who would die.
By way of personal introduction, I should say I live in Belgium which perhaps has the most liberal laws on euthanasia in the world, outdoing the Dutch. There has been recent talk of possible euthanasia for children. There have been some controversial, not to say notorious cases: for instance, an employee of KU Leuven was phoned after his mother was subject to euthanasia; though she was not entirely stable mentally, the family were not informed by the medical authorities till afterwards. There was a case of twin brothers who were suffering from progressive blindness and the thought that there would come a time when they could no longer see each other was deemed cause by them and the medical authorities for euthanasia – though otherwise they were not in bad health. The euthanasia of the famous writer Hugo Claus was covered as a kind of cultural celebrity’s death. I have notice in my time how euphemisms match euthanasia. Once what was zelf-moord – self-murder, sui-cide – becomes taking a stap uit het leven, a step out of life, as if life were a stream, or merry-go-round, and you go out or got off. There is also a kind of bureaucratic routinization of euthanasia in Belgium: a friend tells me, the office for euthanasia is nearby the office for papers for foreigners: the latter for papers of the stranger to remain in Belgium, the former for papers for quitting Belgium and life altogether.
Chattel of the gods
The phrase comes from Plato’s Phaedo which is the dialogue that recounts the vigil of the execution of Socrates. There are peculiarities to this execution. Socrates has been found guilty of capital crimes and awaits capital punishment. This means, in this instance, that the hemlock which will kill him, though prepared by the jailer, will be administered by Socrates himself. Is all of this suicide? Suicide assisted by the jailer?
Socrates could have escaped but he refused exile for various reasons. One very important one was his piety with respect to the Laws (Crito). The Laws of Athens nurtured him like parents: they grew him ethically. He has no quarrel with them or his parents. He has a non-oedipal relation to his own polis.
Socrates’s death offers one of the exemplary death scenes in Western civilization. It is sometimes presented as a paradigm of how one should face death and die. Is it a matter of assuming one’s own death? Is it not, in one sense, a result of choice? Would his death then not be the outcome of what he wills? Is it then a suicide? Or perhaps a sacrifice? It seems at one level to be self-inflected. Does not Socrates himself speaks of philosophy as a life-long preparation for death, indeed a practicing of dying? Is the life of philosophy then a matter of assisted dying? But our question: Is there a practice of death that is life affirming?
Comparisons have been made with the death of Christ. But think of the horror of the latter, by contrast. There is a kind of spooky serenity about Socrates. Nevertheless, a refusal of suicide is loud and explicit. This seems coupled with the trust in something more than death – something beyond. And then the phrase occurs: “We are the chattel of the gods.” The Greek word is KTEMA: loosely translatable as property, possession in a broad sense; moveable goods. In any event: the gods own us.
An aside: in the New Testament ktema occurs in connection with the rich young man who asks Jesus about salvation and he is told to sell all – he goes away sad because he is rich, he has many chattels…he owns much, and could not, would not sell his property and give it away, give it to the poor (Math 19:22: Mark 10: 22).
Chattel has the meaning of disposable goods but also other meanings, including that of servant: a chattel is one who is at the service of, one who indeed is the slave of, an other. In any event, I would say the meaning is clear: being chattel is a matter of subordination to an other; and if one is movable goods, one is at the disposal of the owner; one is not free to dispose of oneself. We understand the suggestion that humans are property, as slaves are property. Apparently the word “cattle” is derived from “chattel,” and these words are related to “capital,” itself related to “caput” (head). See the chain: capital – caput (death) – capital crime – and Socrates’s crime is capital, deserving of capital punishment.
Being named as chattel might seem a gross insult to our modern sense of dignity if we think of the contrast with our cherished notion of autonomy. To be chattel of the gods – this is an affront to autonomy, an insult to our self-esteem. Is not this to divinize the heteronomy we moderns have tried zealously to assassinate? But here arises an essential question: Does not modern freedom as autonomy/self-determination necessitate an essentially equivocal place for the other, to heteros. And one could well ask also about our own lives: do they not have an intimate otherness, even when they are our own, intimately our own. Is autonomy too much the univocalization of freedom: ours alone and nothing but ours? Should we perhaps think of freedom as an endowed freedom: sourced in a release beyond self-determination, something given enabling our efforts before it is something achieved through our own efforts? Does not endowed freedom ask that we make freedom, and its release, more plurivocalized rather than just univocalized? To whom does freedom belong? To whom do we belong?
The word “chattel” makes us ask about the meaning of “owning” our lives, questions about what does it mean to say that one’s life is one’s own. Clearly to own is also related to the responsibility we experience to own up to one’s being, to own what belongs to us in our deeds and thoughts. But still the question persists: Is this all just a matter of owning oneself? And if we don’t own ourselves, who owns us? Perhaps there is an endowed ownness where what is most our own is not our own? Would granting such an endowed ownness not mean our being was also marked by a received owness? That we are already in receipt of the promise of freedom – and everything of life’s promise and its gifts – before we can set out to achieve anything through our own efforts – efforts that now must be seen as differently our own?
Such questions begin to surface when we reflect on what it means to be chattel of the gods. There seems to be no ownness of ourselves that we could assert in an entirely univocal way. Similarly, the question of what it means to dispose of what is one’s own is also no longer quite univocal. It might be asked if one is to be at the disposal of what is not one’s own – what is not our own in what is most intimately one’s own?
Care: Between Intervening and Receiving
Let me now suggest that such questions can be connected with I take to be a certain doubleness central to an understanding of “care,” whether considered in an ethical light or in terms of health care. First “to care” for someone or something can refer to an active intervention which takes steps to benefit the other. Second “to care” can be a recognition or granting of something in the other whose worth we care for, and that occasions us to care for them. We witness here a certain doubleness of patience and endeavour, of suffering and acting. “Care” looks like a word of doing, but “care” is also a witness to patience. Thus this doubleness: care as active in the “taking care of a person”; care as more patient in our offering receptive attention to the other in our “caring for the person.” How does this doubleness square with the politics of (health) care, given that politics foregrounds an order of power aiming to effect social concerns and policies? How relate a politics of social power to those within the social order who are patient, and most vulnerably so when they are (health) patients? The language of “action” and “doing” reaches certain thresholds on which there strikes home the patience of being that is constitutive of what we are. This patience is most perplexing at the thresholds that are most extreme in human existence: being born and dying. Needless to say, these are frequently the most fraught thresholds in health care. Assisted suicide is sometimes asserted as our right to claim active control of ourselves in our mortal condition. And yet our mortal condition shows an extremity of receiving and patience, both at its beginning and its completion. Is a politics of patience, then, a contradiction in terms or does it suggest a paradoxical politics beyond politics in which care for the person is most put to the ethical test? Must we think of an ethical community whose concern is a care for this patience of being, beyond (political) power?
Let me elaborate on this doubleness of “care.” As a word of doing, do we not think of “care” as anticipating our active response to a situation that calls for our intervention? A situation calls for a response, and the response activates in us our powers of acting, of doing. Consider this way of talking: “we take care of the children; we take care of ill people; we take care of old and dying people…” These ways are not quite the same as taking care of one’s motorcar, for instance: this latter form of care is keeping the machine in the best condition possible, in tip-top shape. But “taking care” of children or the sick, or the dying is an ethical care beyond instrumental sustaining: there is something about our activity responsive to something of promise, something perhaps of unconditional worth in the ones cared for, something that exceeds the instrumental care of a good mechanic. In any case, a situation calls forth our intervention: a child falls and we care for it by picking it up and binding up its wounds. “Taking care” brings forth our initiative and with a view to altering the situation in accord with the exercise of our powers. When the child falls we do not let things be.
And yet already insinuated in this world of active intervention(s) is the other side, the more receptive side that brings to the fore something of our patience rather than endeavour. Think here about how we use the word “care” when what is at issue is a certain kind of appreciation of the other. “Appreciation” is itself a word related to “price”: it is a matter of prizing something, but something that is not quite a matter of price (see pretium, precious). My beloved asks me: “But do you care for me…?” The beloved is looking for a word of appreciation: not an intervention to change a situation, but a word of confirmation, a word to confirm a worth already present. “Caring for someone…” is responding to something in the other relative to which we are in the position of receivers rather than actors – and this even though our word of confirmation will be our act, will be a deed not to change the reality but to acknowledge a reality already there (albeit elusively).
I have been explicit in using the example of a beloved asking for this word of confirmation, but often this second kind of “caring for” never receives explicit wording. How we are, and how we act, in relation to what we love, or who we love, is our word, or our wording of this caring for the other. A smile, a gesture, a softness of tone in the voice by which I address the other may be the word of “caring” that does not itself care to call attention to itself.
In these two wordings of care, we find something that is active but not only active. This is true of the first form of “taking care,” even though the receptive side seems more in recess. In the second wording (responding to: “Do you care for me?”), there is more clearly something of a kind of patience, but it is not quite that. At issue is not patience only in the sense of a unresponsive passivity, but rather a kind of unnamed exposure to something other to oneself; and this something calls forth not doing, but being there with the other, and being there in the appropriate or fitting mode. Essential to that fitting mode is a patience that cares.
An important instance: Listening might be taken as an exemplifying of such a patience that cares. Listening shows patience but is not simply passive. A person who listens to one is, as we say, “not all over one.” There is a person who is “all over one,” and thus seems to take care; but it a taking care that does not care in the mode of patient attention, patient listening. Consider this in respect of health care: “listen to your body” – advice to athletes, runners, training for maximal performance; obviously much activity in training is needed to bring the body to a peak of performance, but if this patient listening is not present also the work of training breaks down. One thinks of the manner a doctor listens to a patient: this is mindful attention that is both actively energized and patiently receptive. Of course, in emergencies the doctor may move into the mode of being “all over one,” but unless the doctor receives what the patient communicates in receptive attention, there is no fitting intervention.
How connect this with ethical care? At issue in ethical care is the good of the other, and of oneself, and of the being together of selves and others; it is the good of an ethical community in that sense. The mingling of patience and doing comes out perhaps more evidently if we speak of ethical communication. For once again we need to grant the doubleness – evident here in the mingling of speaking and listening, an uttering of oneself that is a doing, and an opening that is a listening porosity between oneself and others.
When we think of the ethics of health care, we must think of this necessarily from the side of the patient (here now used in the more normal sense); and the side of the care giver (again in the more normal sense). In truth the doubleness is not just on one side, but on both sides, even if differently inflected on the different sides. Say I am a giver of care. It is the good of the other that is at issue overtly in “being taken care of” – in that respect the patient other is the beneficiary of the active care offered. In fact, the agent of care is also beneficiary to the extent of having to activate modes of selving and being with the other that might otherwise not come to expression. Inherent in that activation is allowing porosity to emerge in which patience as ethical is also potentially a benefaction to the doer of the deed.
And so the good of the doer, of oneself as intervening ethically, is also at issue. To take care ethically, one has to be a certain kind of self, and taking care of the other does not preclude that one also is involved in taking care of oneself. Benefiting the other, one can also be a beneficiary, just in the act of being a benefactor. “Benefaction”: this is a word mingling the (being) good (bene, bonum) and making (facere). The doing, the acting, the making are always twinned with a patience of being that is never just a doing, or acting or making. And this patience of being has huge significance for “caring for” more in the second sense above.
Politics, power and patience
How view politics in relation to this doubleness? On the whole politics is concerned with the more active side of the doubleness. It is concerned with the sources, the expression and the ordering of human power, in its capacities to effect policies that concretize and channel and regulate these sources of social power. This regulated ordering of power can take many forms, from the democratic to the autocratic, from the aristocratic to the tyrannical, and yet it is always concerned with the communal circulation of social power.  This circulation or intermediation is effected through institutions, and through mediating representatives who do not simply possess power for themselves but are enablers of the communication of social power. We know, of course, that the (inter)mediating representatives can take on a life for themselves, and the wider circulation of social power is not fully allowed but rather serves the turn of social power back to the supposed mediators themselves. These then become powers for themselves rather than for all and for others – “the powers that be,” as we put it in common parlance. This turn to self-mediating power is itself a univocalization in the essential twofoldness of the social circulation of power. This twofoldness suggests an intermediation not only for the self-affirmation of a community but also for the enabling of others whose powers are otherwise socially stymied.
Think of the health system in these terms: its point is not to serve itself, but to enable the communal broadcast of social powers that have the care of the healthy flourishing of the people as a whole. And yet it can be an intermediary that turns too much into a place of self-mediation; and hence becomes excessively concerned with its own internal power, its own self-preservation and the politics of its self-perpetuation. The managers of health make themselves the focus rather than serving as enabling intermediaries of the social circulation. They and the system they serve can be tempted to perpetuate themselves rather than simply serve the patients in their care.
Be that as it may, the social circulation of power is with ends in view, and indeed with the deliberation about means, and the supplying of the resources needed to move from means to ends. Such a regulated order within which circulates social power concerned with ends in view and with social deliberation about means – this is, of course, intimately connected with political order. But such engagements can especially bring to the fore the sense of “concerns” – for instance, a health system as a “going concern” – and here the connection with the first sense of “care” comes to the fore. The same point applies to concern about means. In either case, we are dealing with some tilting towards a more activist view of policies and their practical implementation. We seem to meet with the predominance of the language of social action(s), so how then could there be anything like a politics of patience(s)? And yet is not something like the latter is required, if the doubleness pictured above has some truth, that is, if care itself is neither active nor passive but patient with an activity which is receptive or receptive with activity that attends on the patient?
Politics as the social intermediation of communal power is not first in the order of patience but of social action and social enactment. But patience brings us back to what is on the other side of action. There is in patience an undergoing; we are in the position of being subjected rather than being subject. There are many kinds of patience, of course, from the enforced to the released. In all of them in the undergoing there is required some waiting; waiting on what might turn out to be our benefactor or our detractor; waiting on our being a beneficiary or being a victim. In the waiting there is also a degree of letting. Letting does seem to entail a retraction from intervention and endeavour. If we see this in a negative light, we might think it recalls us to an impotence, on the other side of the social circulation of power.
But must this be so, or does it only tell half the story? What if the politics of doing and endeavour were itself just the exercised half of an endowment whose ineluctable givenness always refers back to a patience of receiving? And not only back but also forward to a future threshold when the patience of our being comes more and more to the fore once again. One might say that in the middle of life we meet the social intermediations of power that support the flourishing of active life, but that at the extremes we meet a threshold of original givenness, and there also an elemental patience, and that at the threshold of passing beyond all endeavour, we are asked a patience where all doing is done, where all doing is also undone, in being brought to an end. It seems clear that the appropriate response here speaks less of the actor than of the beneficiary; and all this in an original undergoing, original receiving, in waiting for what we cannot completely effect through ourselves, of letting what has a constitutive otherness, and before which affirmation is possible but not just self-affirmation. Short of something like the latter, we are not beneficiaries but necessary victims, and life is only grooming us for death.
The Patience of Being, the Endeavour to Be
I want now introduce a distinction, central in my own philosophical thinking and relevant to the issues at stake here: the distinction between the passio essendi and the conatus essendi, the patience of being and the endeavour to be. This distinction has bearing on the intimacy of being which has both ontological and ethical significance. And of course, concern for health is a very intimate matter but also bound up with this doubleness. Health systems are very much turned to the public commons, while yet called upon to care for the intimate body. It is the latter care that raises questions about the politics of ethical care, and in what sense there can be a politics of patience.
By the passio essendi I mean a certain ontological patience signaled by the fact of our first being recipients of being, our being received in being, before we flower as being active. There is ontological receiving before there is existential acting. As something ontological, the receiving is constitutive of our being but it is not self-constituted. To call it passio is not, however, to imply a mere chunk of dead thereness, devoid of its own energetic life. Nevertheless, its own life is not first owned by it. It is given to be its own on the basis of a giving that is not its own. The nature of this giving and this receiving is such that the being that is thus received is freed into its own being for itself. The passio essendi shows given being as mine, but it is not given to me by myself. The doubleness in the description is significant.
Think of passio in the usual sense: from source(s) immanent in ourselves we are moved and even carried beyond ourselves by passio – there is a surge of life and we are thrown on it, thrown beyond ourselves on its wave. There is the element of the involuntary, but this does not imply the absence of all self-mastery but rather an energy at work in us prior to our taking control through choice. The passio first moves as an affirmation of being in us and it is not that we decide to affirm but that we are first given into being as an affirmation of being.
Think of the child crying on coming to the world. We might be inclined to see this as a howl of dismay, but it is the lust of life itself, and there is something inexpressibly good about it that conquers dismay. That is why we are relieved on birth when we hear the crying out, the outcry of life. It shows the very health of life giving expression to itself before any interventions of itself or of others. The howl makes us thankful for this first lived affirmation of the offspring. There is an implication with regard to what is beyond ourselves, revealed in the unself-conscious anticipation that our crying-out will be met by something of hospitality in the world beyond us, be this the world of (caring) others, or the world of sustaining material resources.
The passio tells against every autism of being. In it is already an intimate mark of being in community. That communicability surges up in our passion of being means it is already given as an active promise of being in relation in our very being at all. The doubleness of relativity (self-relation never being without other-relation) is expressed in the fact that we are conatus essendi as well as passio essendi. We are an endeavour to be as well as a patience of being. One notes how in modern political thinking the conatus has a side turned to the intimate, a side turned to the more public and universal. I am thinking of how in early modern thinkers like Hobbes and Spinoza beings are their conatus, their particular self-assertion that knows no limit except a countering conatus. This is matched by a sense of the social whole as coming to be – whether by contract, the over-aweing of the dominant conatus, or otherwise – as the (resolved) sum of forces of such particular endeavours (Spinoza). The sense of this striving self-assertion also haunts the dominant forms of liberalism and economic capitalism where rational self-interest and enterprising exploitation shape the public space of the commons and insinuate themselves into the reserves of privacy.
These views tend to project us forward, close off retreat into significant reserves of ontological intimacy, and produce a mutilated picture of self-interest. Self-interest: inter-esse is a being between; hence self-interest too is also a being-between, qualified to be sure by selving, but as an inter-esse, necessarily more than just selving. Self-interest is parasitical on the surplus endowments of the community of being; but it is wrongly taken as original, not derivative. Co-natus: properly speaking this is not an endeavour to be but a being “born with.” Conatus refers us to a more original birth (natus), a being given to be, which is always with or from another (co, cum). The pluralization is there but occluded in the ordinary way of thinking of self-interest and conatus.
Nevertheless, the endeavour to be is the often more evident and noted aspect of our being because it defines us as a doing of ourselves. Selving in community with others is being in act, is activity. But notice a fertile doubleness about the endeavour to be. This is covered over by the modern usage of conatus as expressing the self-affirmation of a being’s will to be. More truly, in the conatus we are referred back to the patience of being, and indeed to a coming to be, a birthing. And while this might be the birth of selving, it is not a simple self-birthing – it is a being from an other, and in relation to another. In the patience there is an extremity of receiving; and indeed secreted in any forward movement of the conatus, its becoming, there is reference to an awaiting. There is a “receiving from,” that is to say, a birthing; and there is an “awaiting on” that secretly anticipates a fullness of realization, and in this also a coming to an end, perhaps a coming to be in the end.
This doubleness is related to birth and death: the two extremities that cause us the greatest perplexities with respect to the ethical care of health. Much of ethical care is in the middle where the endeavour to be is relatively at home with itself. “Being healthy” often means that the endeavour as such is relatively mindless of itself; its surging on the energy of healthy life is such that the more original patience is in recess. Of course, when obstacles are met, say in an accident that injures us, and we suffer explicitly, we become patients. Or we become sick and in being laid low, the surge of the endeavour retracts from its more extroverted self-assertion, returns to itself, unwillingly, and to its own patience of being. The patience is more or less in recess, or at least, not to the fore when the healthy surge of the endeavour affirms itself. But being in recess does not mean out of play. The meaning of this middle does not mean that beginning and end, birth and death, are just extrinsic extremes. Rather the doubleness of patience and endeavour, receiving and doing are there twinned in every deed in the between, even granting we mostly do put the stress on the forward movement of the conatus, to the forgetfulness of the passio.
Politics and Patience
Coming back then to the question of politics: Can one, how can one order this doubleness in a politics in the sense outlined earlier? The fact is that these extremes bring us to what is beyond will, beyond power – beyond will to power – and thus to something that is beyond politics as normally understood. Suppose one proposes that these extremities really do not count in the end, since they are outside the space of power and will: the beginning is a mere indeterminacy and we live forward and become more and more self-determining – more empowered through our actions and ours alone; and likewise the end, simply is a limit where there is only the cease of self-determination and not a threshold to the beyond of self-determination. I would say this response is entirely to evade the constitutive nature of the patience of being. There is nothing provisional about this patience. Every endeavour of the conatus is itself the vessel of that patience – it is what it is by virtue of its original endowment and receiving. To neutralize that or evade it is to mutilate what we are.
How then can this patience of being become ordered in a political way towards the beyond (of will to) power? Everything about political ordering seeks to shape itself within the communal circulation of social power, but this patience is not so simply “within.” I think a response to this issue of power and its beyond is to contemplate a form of (social) freedom, coming out of the doubleness of patience and endeavour that is not defined either by servility or by sovereignty. There is a freedom beyond servility and sovereignty. Servility can reduce the patience of being to something that is closer to an inert passivity. Sovereignty can inflate the endeavour to something that is unbridled self-activity, ballooning hollowly. There is a freeing of human power, neither defined by the sovereign thus nor by the servile thus, that is at home with the patience of being. It is intermediated in a community of service that is truly a service of hospitality.
When we think of the hospital we do not often enough see the intimate bond with hospitality. Nor do we see that hospitality, and the hospital both are carriers of the stress of the doubleness. A hospital is hospitable to the politics of patience. Why is this? Because it is, after all, a communal organization of power that yet is orientated to the exigencies of what takes us beyond our power. This is not a matter of mere powerlessness but a mutation in will to power that releases power differently into the service of particular human beings – the young, the sick , the old, especially – who themselves are powerless or threatened with powerlessness.
The surging vitality of youthful and healthy conatus is often blithe about the patience – blithe about the fact that its own surge is always twinned with the patience. In the social space of the hospital, the recessed twin comes home to us in suffering. A dominant response, of course, is to seek to reiterate the conatus as a powerful surging endeavour – to carry on life, by whatever means. This will to life is undeniably worthy, and now we are acutely aware of the possibilities of medical interventions that prolong life in a manner impossible to envisage not long ago. Technologies and medicines make prolongations possible, but the prolongations do not always make allowance for the patience of being. Even the last passio of dying can be denied – in the name of what looks like a compassion that would preserve life, no matter what. We have become reluctant to let be, to let.
By contrast, I would say that the “will to life” itself is the carrier, indeed embodiment of the patience. To deny that patience is not to be true to the “will to live.” Something must be released in the “will to live” for that will itself to surge forth further in living – even if living means the acceptance that living will now immanently come to an end. What is this release? This is very hard to say, but it is something intimately to do with an ultimate acceptance of the patience of being, and willingness to undergo exposure that radically re-opens the porosity of our being. We can see a paradoxical manifestation of this sometimes: the endeavouring conditions of health all seem to be present but the “will to life” can become so obsessed with itself that it closes off this release. It clogs on itself and hence paradoxically its self-obsession with the “will to live” kills the “will to live.” Only with a release, a release that grants and allows the patience, is the energy of health itself renewed for itself. It must be emphasized that the “for-itself” does not come just “from itself.” The release comes from secret sources of strengthening that pass beyond the self in passing into the self; and that pass beyond the self in the passing away of the self.
If I were to describe more fully this politics of patience where the space of hospitality is shaped I would have to talk about what I call a community of agapeic service (Desmond, 2001, chapter 16). We see it in how hospitality is neither passive nor active; it is patience and it is endeavour, but its release of energy is also a kind of ethical diffidence, or reserve, where a way for the other is enabled by our making way. We make a way by making way. Making way is not “making” in the simpler sense of constructively intervening, but a kind of doing by not doing – an allowing that loves. When I make way, I do nothing. And yet a promise is enabled. The nothing I do makes a way.
There is something here beyond instrumentalizing. The limits of the instrumental are reached,  and not simply in an activity that goes beyond means/ends calculation. What is at issue is beyond even the ethics of action in which human beings are seen as ends in themselves (Kantianism, especially). Rather in the patience of being, it is not in virtue of what we do or can do that the good given is acknowledged. The person is not so much an end in themselves but an original for itself. It is so in such a manner that its originality is an endowed originality, hence refers to what is other to itself in an origin through whose letting be it is given to be. If one were to use theological language, one might speak of being created, and being a creature before being creative after one’s own kind. In being both creature and being creative we come again on the doubleness. Something in the most intimate origin of our being is beyond instrumentalizing. There is something idiotic about this most intimate being given to be. It is prior to all politics of action and power in the beginning; in the end, it is beyond them also. Always in an incognito way, it is the secret companion of whatever happens between beginning and end. It cannot be instrumentalized, even when it is instrumentalized.
The fact that we are suffering beings nowhere comes home to us more than in regard to health care. But the health care can stress the doing rather than the suffering; or a doing that deals with suffering, in order to do away with suffering. If what I have said has truth, there is something in our ontological situation that cannot do away with suffering, since this is what we are. Our being at all is a suffering, not simply in the sense of a painful condition, but of our being granted to be. This suffering is especially evident in the thresholds of receiving life and giving life up. While long-standing medical traditions of health care, reflecting the Hippocratic oath, recoiled from the prevention of life at the threshold of coming to be, that is to say, of being conceived and being born – thus abortion was deemed ethically unworthy – now in the proliferation of abortion, the stress has surely shifted from the receiving of life to our conatus as self-affirming, in the form of a self claiming its own choice, claiming itself as the source of its own choice, claiming the life of another as the product of its own choice (or will), and hence the patience of being that goes with being conceived and being a parent is deemed secondary to an ethics of choice. If I am right in the analysis of the passio and the conatus, something is not right in the stress only on choice as the primary issue at stake. This would be to understand conatus so as to downplay the depth of the “with” reserved in the con-natus.
It is no surprise that equally fraught ethically is the question of giving up on life, or perhaps giving up our lives. It is here that one thinks of the politics of patience in connection with palliative care by contrast with assisted suicide or euthanasia. “Giving up on” entails a “turning away from” the patience, while “giving up” seems to be a surrender. But notice how surrender is saturated with the doubleness. Consider first surrender to an enemy, as a failure of power, of courage, or striving, of trying: notice how surrender in that sense goes very much against the grain of many medical practices. Consider then surrender to love or to a lover: now there is a release from constraint into a relation beyond self; a giving over that enables one in being in relation in which one gives to the other and receives from the giving of the other. Can one absolutely separate the surrender to love from surrender to death, and this not simply as defeat by an enemy, but release on a mysterious threshold?
As we become more familiar with the technological means of extending life, we also become familiar with interventions that are intrusions and that run roughshod over the patience of being. The results are sometimes not the alleviation of suffering but the intensification of a suffering that is meaningless. A technology of prolongation substitutes for a shelter of agapeic service, neither servile nor sovereignty, but patiently attentive in a space of release beyond will to power. It is here too that assisted suicide and euthanasia are proposed as solutions to a problem over which the conatus now at the last can exert its final control. But are we here dealing with a problem or a mystery, in Gabriel Marcel’s sense – a sense that I would claim bring the ontological porosity of our being to the fore, and the primacy of the passio over the conatus. Closer to death the time of life comes to the threshold that asks us to learn, re-learn something of the elemental patience of being. At this threshold the letting is more important that the doing, the allowing more important than the endeavouring. Were one to become more mindful of the constitutive patience of being, then our relation to dying would have to regain an inspiration transcending the technologies of health, the technologies of death.
A Politics of Patience beyond a Politics of Power?
Can there, then, be a politics of patience? If there is, would it not be beyond a politics of power? Might the patience of being be empowering of a politics which ministers to powerlessness? If so, must there not be a trans-political dimension to this? Would this not witness to the doubleness noted in “care” at the outset? Would it be, not a politics mediating power to itself, but one intermediating what is beyond self-mediating power? Would it not be, paradoxically, a politics beyond politics?
Let me in conclusion address such questions in relation to the ethical, the economic, the familial and the religious. First, is “a politics beyond politics” just another way to speak of the ethical dimension of (health) care? For one might say that there is something to ethical community that is political and trans-political at once. I think this is true; yet it is a complex issue how the political and the trans-political are connected. We still have to ask if there is something trans-ethical about the community of care suggested here. Is the ethical care of health and sickness just a matter of ethics? Does the patience of being suggest an ethics that is also more than ethical? One might answer yes, there is something trans-ethical at stake, not in the sense of an amoral practice but in terms of a practice of patience that exceeds ethics as defined by our self-determination. For the patience of being is not defined by our self-determination but is presupposed by it, and secretly enables it. It is not beyond good and evil in Nietzsche’s sense, for he stresses an amoral will to power that exhibits a sovereign self-willing will. It is an ethical care of the weak in a trans-ethical generosity that gives for the helpless other qua other. This is a trans-ethical generosity also in a sense exceeding virtue. For we often think of virtue relative to the degree that our powers are actualized, self-actualized; whereas this is exceeding virtue bound up with power beyond power.
What of the economic dimension of the matter? In our time economic life is often under the dominion of serviceable disposability, as I call it (Desmond, 2001, chapter 14). Things and persons are to be made serviceable for us, and having served their usefulness, they are disposable. Nothing is worthy for itself fully and we are hurried from means to means with no intrinsic worth to arrest us and care for it, for itself. In assisted suicide and euthanasia we now treat our own lives as disposable, all the while inconsistently exploiting ethical words that suggest that the worth of our lives is not disposable at all. Has the person who demands assisted suicide or the system which enables euthanasia extended into death itself the dominion of serviceable disposability? Does not this extension cast a dark shadow back into life itself such that the still living are more inclined to think of themselves as disposable lives in the dominion of serviceable disposability? One no longer cares for oneself as worthy of life because this dominion reflects one back to oneself no longer serviceable in a worthy way in this dominion. The patience of being, however, returns us to a givenness that is not first defined by serviceable disposability. Even if this givenness is made useful, there is this deeper dimension such that, so to say, use is subtended by gift. Thus, for instance, a person is not to be denied health care, even if they are a criminal. The Nazi spoke of those “life unworthy of life,”(Lebensunwertes Leben) but the attitude is not confined to them. I think of the way persons convicted of certain crimes in China are executed and their organs harvested. This is making the criminal patient to the instrumentalizing will to power of those claiming the power of life and death. The organs of a human being have a price. The person is put to death in the dominion of serviceable disposability. Beyond serviceable disposability, what grounds the infinite value of the person – in sickness, and in health? It is not self-grounding? Does not the patience of being communicate a trans-political and trans-ethical sign, beyond the dominion of serviceable disposability and also an ethics of self-determination.
What of the family and ethical care? There is indeed something trans-political about the family (see Desmond, 2001, chapter 13). In many traditional societies, the family was the space of an ethical (health) care, not only in relation to children but also of older people. And a good politics of patience will surely allow a space where the intimacy of the family can provide as much as possible for the care of the person. Most people want to die at home. Unwanted, unloved older people are more likely to internalize the lack of appreciation and deem themselves worunthy of continuing life. This tells us something about the politics of patience. At home one can give oneself up; give oneself up with loved ones besides one. Think of the way the Victorians pictured death-bed scenes. The cynics scoff, but something elemental is here touched. In recent decades more people are dying in hospitals rather than at home due to life prolonging technological means to be found in the hospitals. The question of the hospital and hospitality come back to haunt us (see Gawande, 2014).
What of the religious community and this politics of patience beyond politics? One could claim that human communities have always felt the pull of this beyond of ethics and politics, and not as a mere ideal. Granted in many contemporary quarters this pull is denied. There is a strange mixture here of an assertion of the autonomy of the human and an instrumentalizing of the human: end in self relative to the conatus, means to an end relative to the making of the other patient. But the instrumentalizing can boomerang and come back to haunt the one who erstwhile gloried in their autonomy but now, in sickness or in ageing, one must relearn the patience of being. When we are ill we cannot rely entirely on ourselves; we rely on others, on the goodness of others, on generosity beyond serviceable disposability. In the past the trans-political communities and trans-ethical communities were the religious communities. Remember how in many respects the hospital as a Christian invention. That the trans-ethical and trans-political points to the religious community was known certainly in Christian cultures, and explicitly so in so far as hospitals were very much in the care of religious sisters.
If my analysis of the patience of being holds true, there is a constitutive dimension here that cannot be entirely answered by the politics of power, understood in a more normal sense. And it does seem a serious question what ethical character the care of the sick will have if and when our sense for this community of agapeic service is weakened or disappears. Questions about the trans-political and the trans-ethical are unavoidable in respect of how we behave towards the sick and ageing, and urgently so in societies where the dominion of serviceable disposability is in the ascendant: What grounds the infinite value of the person – in sickness, and in health? It is not self-grounding. And yet the quality of true care testifies to this value. If we are not its source, how make sense of it?
All of this, though, as pointing to a community of agapeic service, is not simply beyond ethics. It asks for a transformation of the ethical. And it might well be true that a good politics of power, in more normal senses, will make a space for this other dimension. There is no reason in principle why this should not be so. But then it would ask for a kind of metanoia in how we often now look to politics, as asked to solve all problems, or offer the means to do so. It would ask a metanoia in the practice of politics itself: the beyond of political power internalized in the very exercise of political power itself.
Of course, there is the temptation from the other side also, namely, the politics of self-affirming power. If the politics of patience is beyond the politics of self-affirming power, there has also been the temptation to mingle the trans-political and the political, the patience of the agapeic with the endeavour of the erotic will (to power) – mingle in such a way that the other dimension is domesticated and even corrupted. This might seem to be to the good effect of the former, but in the long run it tends towards its corruption.
And yet the two must mingle. If one thinks of Caesar and Christ, there is no, there can be no, “Caesar with the soul of Christ,” as Nietzsche seems to suggest. Caesar rules empire but Caesar is also war or agent of war. The endeavor, the striving to be, becomes strife – war on those who hinder or stand against the preservation or expansion of power. There is no patience for the patience of being – these are for the merely weak, and to be despised. The politics of patience is love of the despised, the rejects, the outcasts. Perhaps only a divine politics could communicate this patience. Nietzsche in The Anti-Christ (section 2) asks: “What is good? – Everything that enhances people’s feeling of power, will to power, power itself. What is bad? Everything stemming from weakness. What is happiness? – The feeling that power is growing, that some resistance has been overcome. Not contentedness, but more power; not peace, but war; not virtue, but prowess (virtue in the style of the Renaissance, virtù, moraline-free virtue).” Nietzsche goes on to add: “The weak and the failures should perish: first principle of our love of humanity. And they should be helped to do this. What is more harmful than any vice? – Active pity for all failures and weakness – Christianity…”
I return to the chattel of the gods. Now I would say that the stress should be less of possession than on dispossession. Remember the Greek word again: ktema. Recall the reference in the New Testament to the rich young man, asking about eternal life, and Jesus’s reply to follow the way of dispossession: the rich young man went away sad because he had many possessions. I would say that as there can be a release of being, a release into being at the beginning, there can be a release of being into being at the end. I recall the scream of life at the beginning, but is it all to end with a howl at the end? The Irish have a curse: “May you die howling!” I take this as an imprecation against the blessing of final release. Recall again Socrates’s radiation of a kind of serenity, and indeed the quiet anticipation of a release. There is a marvelous eschatological myth in the Phaedo where the earth is seen as if from above. We dwell in hollows and see what is above through a film, but sometimes we are like those fishes who lift their heads above water and see what is above. Everything there is more beautiful, and most beautifully there are sacred groves where the gods actually dwell, not just images of them.
Between us and Socrates there is Christianity. Nietzsche notwithstanding, here we find a stress on the singular human being as of unconditional worth for itself. The human being is not a possession but a creation of inviolable worth – beyond price – and beyond violation, even by itself. There is an intimacy of being to the human being that is in the dimension of the absolute while not being the absolute. I note how Hegel does recognize the world-historical importance of Christianity in this regard: the individual is marked by a certain infinity and infinite value. But Hegel philosophically parses this matter finally in terms of rational self-determination, indeed the social self-determination of the modern state. There is no passi essendi, there is no porosity of being; there is “the free will that wills the free will,” socially come to self-determination in the modern state. What Christianity brings to manifestation is one of the sources of the modern ethics of autonomy, though these are secularized and dispossessed of any divine grounding – and this without porosity, without passio, to the detriment of the patience of being, and the promise of the politics of patience. Christianity may be beyond Socrates yet, I suggest, there is a sense in which pagan piety is superior to our evacuated post-Christianity for this is hardly even pagan since it voids the original sources of reverence.
At the beginning the release – into the otherness of finite being for self: this is agapeic origination. And at the end? Patience for the gift of agapeic community? Offered perhaps too in the community of patience that surrounds the dying one in its mortal hour with a love, beyond all instrumentalizing, hyperbolic to all autonomy. The letting at the origin can be redoubled by the letting at the end. If there is a kind of “precautionary principle” here, this cannot be so in any merely “passive” way. It has to do with a vigilance – a “being with” – an assisting that does not find itself at home in the form of assisted suicide. The latter easily slides into the assisting of serviceable disposability. This other assisting is the assisting of agapeic service – beyond servility and sovereignty. From its perspective, assisted suicide can look like the perversion of agapeic assistance – a counterfeit double of it. Christianity is intimate with the horror of death, and most horribly in the criminal death of the innocent one. And yet the divine is intimate to the horror, intimate with the horror. The divine one does not die howling.
Our ending thoughts bring us to the threshold of an intimation of eschatological community. Things eschatological have to do with the ends or end. It is interesting how the word eschaton in Greek can also mean something like “edge.” An edge is an ending – think of the edge of the world, the edge of the table, the edge of a knife. There is a threshold in being on the edge. One can fall over the edge. One can be cut by the edge. One’s appetite can have an edge. A sharp voice has an edge to it. The politics of patience can have an edge to them. Death has the sharpest edge. Agapeic patience for the dying is a secret witness to the eschatological community: loving in death itself, sometimes loving more in death. We know then: not that we love life, but that love is life. Love as life is intensified in the face of a patience over which we have no final mastery. The beloved is revealed all the more in their frail precariousness, in their infinite preciousness.
On the Threshold: Afterword
Can a word be offered on what might come afterward? Is death like the underside of a one-way ticket for passage that we receive on being born – destination unknown, or to be announced – perhaps on the threshold of passing? Can the poet sometimes offer words that address the threshold of passing? What think of Dylan Thomas’s raging at the dying of the light? Too much unresolved endeavor, not enough passio emptied into released porosity? I listen for poems that touch the edge of prayer. As an afterword, then, perhaps more fitting is something closer to Tennyson’s poem, surging on the companioning tide on the threshold of the last porosity that releases one out to sea, though one is no longer, at the end, just at sea. I mean his late poem: Crossing the Bar.
Sunset and Evening Star
And one clear call for me!
And may there be no moaning of the bar,
When I put out to sea,
But such a tide as moving seems asleep,
Too full for sound and foam,
When that which drew from out the boundless deep
Turns again home.
Twilight and evening bell,
And after that the dark!
And may there be no sadness of farewell,
When I embark;
For tho’ from out our bourne of Time and Place
The flood may bear me far,
I hope to see my Pilot face to face
When I have crost the bar.
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