The empty-handed doctor : Responding to the suffering of patients approaching the end of life

Spruijt, Odette and Bingley, Amanda and Thomas, Carol and Hughes, Sean (2020) The empty-handed doctor : Responding to the suffering of patients approaching the end of life. PhD thesis, Lancaster University.

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Abstract

The relief of suffering is at the heart of palliative care practice. Yet there has been little exploration of how palliative care doctors, working in different countries and cultures, recognise and respond to their patients’ suffering. This research sought to develop a deeper understanding of suffering in the palliative care context, as witnessed by doctors in India and Australia. Through narrative interviews, 18 doctors spoke of how they recognised suffering, and what it meant to them to respond to suffering. The narratives chosen for analysis spoke to the dialogical encounter in which doctors sought to connect with their patients in common humanity, to recognise the particular nature of suffering and to meet in an intersubjective, relational space. The concept of intersubjectivity provided a lens for analysis of these narratives. Here, ‘intersubjective’ is used to describe the interhuman experience in which the subjectivities of ‘I’ and ‘Thou’, described in Martin Buber’s dialogical ontology, are brought to the encounter. I use the term ‘dialogical encounter’ to describe the meaningful connection between doctor and patient, as experienced by the doctor, where there is a sense of recognition of the ‘other’ and possible emergence of the ‘in-between’ realm (Buber, 1970). A key finding is that the relief of suffering in palliative care involves dialogical encounter between doctor and patient. In this in-between realm of interhuman encounter, suffering is transformed or relieved through the recognition and confirmation of the person who is suffering. Rather than being unidirectional, dialogical encounter is mutual, with the doctor also receiving from the patient, within the normative limits of the therapeutic relationship. The cultural differences apparent in suffering between India and Australia were unified in the experience of dialogical encounter by doctors in both countries. This thesis reinforces the primacy of the doctor–patient relationship in the relief of suffering and encourages renewed attention to preserving the conditions for the flourishing of this relationship in modern medical practice. Key words: narrative, palliative care, suffering, physician-patient relationship, encounter, intersubjective