Carlo Leget

January 7, 2019

Respecting moral diversity

Facing the death of other people, we are confronted with our deepest convictions of what makes sense and what does not.

A mother of four should not die of breast cancer in her mid 40s, for this runs contrary to whatever possible order of justice in the world. A beloved father in a vegetative state should not die a horrible death when feedings tubes are withdrawn. Even when he had always stated that he would not have wanted to live in this condition.

In most people, witnessing someone dying, evokes a multitude of emotions and thoughts, ranging from feelings of guilt or responsibility to sadness, anger or sometimes even joy. Emotions are important human reactions to situations, containing knowledge and appraisals of reality, and having an intelligence of their own.

Carlo Leget discusses in an editorial in the journal Palliative Medicine the importance of understanding and respecting emotions of family members of dying patients. It, for example, mentions the importance of culture in ethical issues, and how difficult it can be to respect cultural diversity, especially when it touches upon our deepest felt emotions and convictions.

“Ethics is a cultural product based on a shared legacy and lived experience reflected in a particular language, history, and traditions. “

Ethics, emotions and culture: Respecting moral diversity

The experience of being involved in the dying process of another person has an impact on almost every human being. Whether this involvement is that of a professional care giver, a relative or a volunteer seems of secondary importance.

The direct confrontation with a dying process is an experience that confronts us with the finitude and irreversibility of human existence. In most people, this evokes a multitude of emotions and thoughts, ranging from feelings of guilt or responsibility to sadness, anger or sometimes even joy.

Emotions are important human reactions to situations, containing knowledge and appraisals of reality, and having an intelligence of their own.

Read more »

Leget, C. (2018). Ethics, emotions and culture: Respecting moral diversity. Palliative Medicine, 32(7), 1145–1146. Doi: 10.1177/0269216318777905

September 4, 2017

Interview with prof.dr. Carlo Leget, Chair Care Ethics, University of Humanistic Studies, The Netherlands.

1. Where are you working at this moment?

Since 2012 I am a full professor in Care Ethics at the University of Humanistic Studies in Utrecht, The Netherlands. At the same university I hold an endowed chair in Ethical and spiritual questions in palliative care, established by the Association Hospice Care Netherlands.

2. Can you tell us about your research and its relation to care ethics?

My research is situated at the intersection between care ethics and spirituality or meaning, and my main area of expertise is in palliative care and end-of-life issues. In my view care practices are an important source for a meaningful life, and care ethics offers an excellent entrance to reflecting on meaning in a way that makes us aware of how the way we organize society has a great impact on what people experience.

One of my PhD-students e.g. interviewed older people who are tired with life – and who are the subject of a debate on euthanasia in my country – and was able to demonstrate that these people suffer from existential problems that are related to the way we have organized our society.

3. How did you get involved in care ethics?

I was trained as a theologian and during the writing of my PhD thesis on life and death in the theology of Thomas Aquinas I became more and more interested in ethics. I switched from theology to medical ethics, but I gradually became more and more critical to mainstream medical ethics. In 2009 I had the opportunity of switching to an associate professorship in care ethics and that has been a great inspiration ever since.

4. How would you define care ethics?

I see care ethics as an interdisciplinary field of inquiry to which many disciplines are contributing since the beginning of the 1980’s.

5. What is the most important thing you learned from care ethics?

I have a strong tendency to rationalize and abstract from the concrete messiness of life. That is why I was probably so attracted to the scholastic thinking of Aquinas – although getting to know him, I discovered that he is often misunderstood. What many people do not know e.g. is that he wrote the largest medieval treatise on emotions (passiones animae) in the Middle Ages.
When I was young, I was a typical ‘Jake’ kind of guy, and care ethics taught me to see the value of ‘Amy’s way’, to put it in terms of Gilligan’s book. Or to put it differently: epistemologically care ethics has turned my world upside down.

6. Whom would you consider to be your most important teacher(s) in this area?

This is hard to tell, because I have learned so much from so many authors. In the Netherlands I think Annelies van Heijst has been a great inspiration. Internationally the three authors that have changed my way of looking of things are Carol Gilligan, Joan Tronto and Margaret Urban Walker.

7. What publications do you consider the most important with regard to care ethics?

Another hard question. For me personally the books of these four women have been very important: Professional Loving Care, In a Different Voice, Moral Boundaries, and Moral Understandings. After the impact of these books, authors I got to know afterwards seem to be less ground breaking. But I know that my thinking is also influenced by many others, like Maurice Hamington, Daniel Engster, Helen Kohlen, Fabienne Brugères and Sophie Bourgault, to name but a few.

8. Which of your own books/articles should we read?

I think I did a decent job in my paper ‘Analyzing dignity: a perspective form the ethics of care’ that was published in Medicine, Health Care and Philosophy in 2013. And more recently I wrote a paper with the colleagues of my department with the title: ‘Beyond demarcation: care ethics as an interdisciplinary field of enquiry’ which will be published in Nursing Ethics this year. And last week my latest book came out, Art of Living, Art of Dying. Spiritual Care for a Good Death. Although I am a little reluctant to call it a care ethics work, it is very much inspired by a care ethical approach.

9. What are important issues for care ethics in the future?

For me the great thing about care ethics is that it opens a space for interdisciplinary cooperation inspired by a common idea of the importance of creating a complex and life-sustaining web that makes the world a better place to live in, to quote freely from Joan Tronto’s and Berenice Fischer’s definition. Such a web involves all kinds of connections between disciplines and traditions, and for me the integration of empirical and theoretical research is very important. But also the possibility to connect different approaches like phenomenology, practice theory and political theory in order to create something that does justice to the richness of the concept of care.

10. How may care ethics contribute to society as a whole, do you think?

By taking part in societal debates in newspapers, radio, television and social media, and presenting people a different way of looking at the world. But also by educating students. I am very proud of the Master’s degree in care ethics we run at our university, where (mainly) professionals are introduced to care ethics. When they return to their jobs they are important ambassadors of a care ethical way of looking at the world.

11. Do you know of any research-based projects in local communities, institutions or on national levels, where ‘care’ is central? Please describe.

There are many projects that come to my mind, but not all of them have reflected well on what care is. One project I am involved in myself focuses at enabling patients and families who are involved in palliative care to share their thoughts and worries on an existential level. I think palliative care is a very interesting field for care ethical reflection, because it is all about dealing with relationships, corporeality, vulnerability, power relations and meaning or spirituality.

12. The aim of the consortium is to further develop care ethics internationally by creating connections between people who are involved in this interdisciplinary field, both in scientific and societal realms. Do you have any recommendations for us?

My recommendation is that it is important to travel and to meet people face to face. We cannot live by reading and writing alone: if we take central insights of care ethics like the importance of corporeality seriously, we must meet in person and experience the personal concerns behind our scientific work. Building a care ethical movement is about more than transporting ideas. It is also about building a living network of relations. From there we will develop further agenda’s and collaborations.

March 28, 2017

Late modern uncertainty and beyond demarcation

This week, two new papers of Dutch care ethicists have been accepted and published in peer-reviewed journals.

Rethinking

Frans Vosman and Alistair Niemeijer published their paper on ‘Rethinking critical reflection on care: late modern uncertainty and the implications for care ethics’ in Medicine, Health Care and Philosophy ((Vosman, F. & Niemeijer, A. Med Health Care and Philos (2017). doi: 10.1007/s11019-017-9766-1)). In their paper, Vosman and Niemeijer rethink care ethics through complexity and precariousness.

Late modern organizations, like the general hospital, codetermined by various (control, information, safety, account ability) systems are characterized by complexity and the need for complexity reduction, both permeating care practices.

By means of a heuristic use of the concept of precariousness, taken as the installment of uncertainty, it is shown that relations and power in late modern care organizations have changed, precluding the use of a straightforward domination idea of power.

A proposition is made how to rethink the care ethical inquiry in order to take late modern circumstances into account: inquiry should always be related to the concerns of people and practitioners from within care practices.

Abstract

Care ethics as initiated by Gilligan, Held, Tronto and others (in the nineteen eighties and nineties) has from its onset been critical towards ethical concepts established in modernity, like ‘autonomy’, alternatively proposing to think from within relationships and to pay attention to power. In this article the question is raised whether renewal in this same critical vein is necessary and possible as late modern circumstances require rethinking the care ethical inquiry. Two late modern realities that invite to rethink care ethics are complexity and precariousness. Read more >>

Beyond demarcation

The newest paper on ‘Care ethics as an interdisciplinary field of inquiry’ of Carlo Leget, Inge van Nistelrooij and Merel Visse has been accepted for publication by Nursing Ethics and will appear soon. This paper is a contribution to the ongoing discussion about the status and nature of care ethics.

Responding to ‘Demarcation of the ethics of care as a discipline’ by Klaver et al. (2014)((Klaver, K., Elst, E. van, Baart, A. Nursing Ethics, Vol. 21-7, 755-765 (2014). doi: 10.1177/0969733013500162)) and ‘Three versions of an ethics of care’ by Edwards (2009)((Edwards, S. Nursing Philosophy, Vol.10-4, 231-240 (2009). doi: 10.1111/j.1466-769X.2009.00415.x)), Leget et al. propose to conceive care ethics as an interdisciplinary field of inquiry, incorporating a dialectical relation between empirical research and theoretical reflection.

Departing from the notion of caring as a practice of contributing to a life sustaining web, they argue that care ethics can only profit from a loosely organised academic profile that allows for flexibility and critical attitude that brings us close to the good emerging in specific practices.

This asks for ways of searching for a common focus and interest that is inherently democratic and dialogical, and thus beyond demarcation.

Please check the website of Nursing Ethics or email the authors via info@care-ethics.org.

Abstract

For many years the body of literature known as ‘care ethics’ or ‘ethics of care’ has been discussed as regards its status and nature. There is much confusion and little structured discussion. The paper of Klaver et al. (2014) was written as a discussion article to which we respond.

We propose to conceive care ethics as an interdisciplinary field of inquiry, incorporating a dialectical relation between empirical research and theoretical reflection. Departing from the notion of caring as a practice of contributing to a life-sustaining web, we argue that care ethics can only profit from a loosely organized academic profile that allows for flexibility and critical attitude that brings us close to the good emerging in specific practices. This asks for ways of searching for a common focus and interest that is inherently democratic and dialogical and thus beyond demarcation. Read more >>

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March 23, 2017

Art of Living, Art of Dying

Spring 2017 a new book by Carlo Leget was published, Art of Living, Art of Dying. Spiritual Care for a Good Death, by Jessica Kingsley Publishers in London/Philadelphia. Care-ethics.org had an interview with the author.

A new book about spiritual care, why did you write it?

For some time I had been thinking that it would be good to publish a book on the art of dying in English. The two Dutch books that I had written, Ruimte om te sterven and Van levenskunst tot stervenskunst, have been reprinted many times and every time when I was giving a lecture abroad people would be very interested to read them.
Last year I gave a lecture in San Diego at the annual conference of the Health Care Chaplaincy Network, and a Publisher came to me offering to make a book with me. This is when I took my chance.

When does a professor find the time to write a book nowadays?

Last summer I spent some time in Germany and I had given myself 4 weeks. I had already thought out what I wanted to write. Every morning I stood up early, searched for a spark of enthusiasm in myself about the subject I wanted to write about, and when I had reached 3000 words, I would stop. That should be enough for that day.

“Expertly grounded in an academic theological and philosophical discourse, Professor Leget guides the reader through a contemporary reading of the medieval Ars moriendi, blending the wisdom of the past with a real-world understanding of the present.” ~ Philip Larkin

Did you succeed in writing down everything in such a short period of time?

No, I didn’t. When I was writing the last chapters my brother-in-law called me from the Netherlands. My eldest sister appeared to have come back from her holiday in a very bad condition. She had been admitted to the hospital immediately and she died a week after her return in the Neterhlands, 50 years old.
I travelled back to the Netherlands and I was lucky to be able to say goodbye to her. It was hardly conceivable what had happened. Suddenly I was painfully cast from theory into practice. There are no words for how bizarre this was. The world stood still. From that moment on also my writing had been interrupted for a while.

Did what happened have any impact on the content of your book?

When I began to write again after a couple of weeks, I was afraid that I would look with new eyes at everything I had written so far, and that it would no longer be in tune with my feelings. This appeared not to be so, luckily. I could still agree with what I had written. At that moment I knew that I would dedicate the book to her.

You have written two books about the art of dying already. Is there for the people who are familiar with your previous work anything new to discover in this English book?

Yes, definitely. The first version of my book Ruimte om te sterven was written almost 15 years ago. Since then my thought has developed further and care ethics has had a great influence on the way I look at the world. But also the many lectures and presentations on the art of dying, and the many contacts with care givers of various disciplines have changed my way of thinking. I have learned to think in a more concrete and practical way. At the same time I remain someone who loves to analyze and think theoretically.

Can you give concrete examples of what is new in this book?

The book is crafted better and the development of thought is done more thoroughly. Also the idea of inner polyphony has been developed further. I call this the ‘polyphonic self’. For this I was inspired by the work of Gettie Kievit-Lamens, who has been chaplain at academic hospice Demeter in De Bilt, The Netherlands, and who wrote a dissertation in which she brings my central metaphor of ‘inner space’ in resonance with the work of Hubert Hermans on the ‘dialogical self’.

But also the work of my PhD-students Eric Olsman and Els van Wijngaarden have put me on this track. Finally, things that have happened in my own biography these past few years have confronted me with the importance of listening to this inner polyphony.

Does this mean that the new book is more complex than the previous ones?

I don’t think so in the end. I have tried to keep the balance between simplicity and complexity by creating space for this complexity on the one hand, but keeping complex issues accessible and concrete on the other. In this way I have summarized the core of the art of dying in five essential questions that every human being could ask him- or herself sooner or later.

“I recommend this book not only for chaplains and clergy, but also for others on the healthcare team, including counsellors, doctors, nurses, allied healthcare workers and other professionals who come into contact with patients in hospitals and hospices.” ~ Christina Puchalski

What adds this book to all that has already been written about spirituality in palliative care?

I think my approach is one of the few that considers the art of dying as a practice that is shaped by the people involved in their interaction, and that in the end it is the art of the one who is dying. Much literature aims to put the severely ill or dying person at the centre, but ends with writing what care givers can or should do. Moreover I have tried to not tell people what is wrong and what is right, aiming to open up a space that enables one to listen what really matters in life.

Finally: how is this book related to the rest of your scientific work?

The book has helped me to retrieve a number of central thoughts, thinking them through and articulating them better. It is part of the theoretical framework of a research project funded by the government that I am going to do in collaboration with Saskia Teunissen, professor in hospice care at Utrecht University. Next to this I have further plans for the next round of the state funded ZonMW programme Palliantie. But this summer I will take four weeks of vacation.

Carlo Leget

Chair holder, full professor in Ethics of Care and Spiritual Counseling and extraordinary professor Palliative Care at the University of Humanistic Studies.

His academic works focuses on ethics and spirituality in palliative care, and he is involved in many discussions in the Netherlands about end-of-life issues. He wrote, edited or co-edited 20 books and published more than 50 refereed papers and more than 40 contributions to books. He is in the editorial board of a number of international and Dutch journals.

He chairs the national working group on ‘Ethics and spiritual care’ in his country and is first author of the first national consensus based guideline on spiritual care in palliative care (2010). He also co-chairs the EAPC-Taskforce on spiritual care, is a board member of Palliactief, the Dutch Association for Professional Palliative Care. He takes also part in the Global Network on Spirituality and Health.