Three passions simple but overwhelmingly strong have governed

“Three passions, simple but overwhelmingly strong, have governed my life: the longing for love, the search for knowledge, and the unbearable pitying for the suffering of mankind. ” Bertand Russell English philosopher 1872 - 1970

THE PATIENT AS A PERSON Humanizing Care

CALL FOR HUMANISTIC CULTURE OF CARE A culture where there is a spirit of concern for the centrality of human values in every activity and encounter. A culture with a concern for the freedom, dignity, worth, and belief systems of the person, and that offers a sensitive, nonhumiliating, and empathic way of helping.

PATIENTS ARE ENDS… NOT MEANS Our patients are ends in themselves, not just means to our ends. A practitioner who uses and manipulates patients; to whom patients and their oral health is valued because it enables the practitioner to achieve his/her ends, that is, uses a patient’s oral health as a means to personal goals rather than patients being an end in themselves, is not an ethical practitioner.

CATEGORICAL IMPERATIVE “Act so that you treat humanity, whether in your own person, or that of another, always as an end, and never simply as a means. ” Immanuel Kant German philosopher 1724 -1804

REIFICATION • Is the objectification of human beings, that is, making a person…a thing: thingifying. ” (from the Latin “res” meaning object. ) • Reification is a particularly debilitating form of alienation. • Examples: a social security number, a test score, a student number, a statistic • Transforming a patient into a: complete denture, an amalgam, a board case.

OBJECTS… NOT SUBJECTS As “things” people are viewed as objects of action, rather than subjects. They are done to, not the doers. An obvious implication is that they are powerless, and do not have the ability to participate in the relationship in a reciprocal fashion. In fact, the root word for the English word patient, means passive, thus suggesting the historical view of patients as objects.

PATIENTS HAVE FEELINGS Viewing patients as things leads to insensitivity; seeing patients as objects without feelings, e. g. , a tooth to be restored, not as a human being to be cared for. Patients have feelings. They suffer anxiety, fear, pain, and joy. Reducing patients to “things” rapidly results in developing an insensitivity to the human being we are treating.

“I AND THOU” • Famous expression of the Jewish philosopher/theologian Martin Buber • “All real living is meeting” • Two fundamental responses to the world: “I - THOU” “I - IT”

“I - THOU” • Engagement of the whole self • “subject” to “subject” • mutual and meaningful encounter • a genuine experiencing of the other

“I - IT” • Attitude of detachment • “Subject” to “Object” • No or little reciprocity or meaning in the encounter. • The other viewed as a means to an end.

FOUR ATTITUDES OF HUMANE DENTIST • • CARE RESPONSIBILITY RESPECT KNOWLEDGE

CARE • We must care for our patients. • Care is a state in which something matters. • Has come to mean” handle” or “manage, ” as in “you take care of it. ” • Care is the opposite of apathy or indifference.

“When we do not care, we lose our humanism. . . our being. ” Rollo May American Psychiatrist

COMPASSION • To care is to have compassion • To be compassionate is to be disposed to see, as well as feel, what a trial, tribulation, or illness has wrought in the life of a person’s here and now suffering. • Latin: com (together) and pati (to suffer) • “suffering together with one another; fellow feeling. ”

EMPATHY • To care is to be empathic. • Empathy: the capacity to imagine oneself as another; to project one’s personality into another’s life sufficiently to feel and understand the other’s feelings. The capacity to experience vicariously the feelings of another. • Empathy enables one to enter the emotional world of another. • Role reversal

EMPATHY • Social psychologists define empathy as an emotional response elicited by and congruent with the perceived welfare of someone else. • To be congruent with the perceived welfare of someone else means that empathy involves experiencing positive emotion when the other’s lot is desirable and negative emotion when it is undesirable.

EMPATHY • Empathy does not involve experiencing the same emotion as the other, only a congruent reaction to that emotion. Some else’s triumph is not likely to evoke a sense of triumph but a more subdued sense of joy; another’s suffering and distress is not likely to evoke the same sense of suffering or pain, but feelings such as compassion or concern.

CONTRASTED WITH SYMPATHY Sympathy is a form of empathy in that it is a sharing of the feelings of another; but sympathy has the specific connotation of feelings of distress, sorrow or pity; commiseration; the emotional response to another’s pain or distress.

“We must be dedicated to behaviors that reflect sincere concern and care for our patients, a caring that respects the freedom, dignity, and belief system of the individual; and a caring that manifests itself in a sensitive, non-humiliating and empathetic way of helping. ” Edmund Pelligrino in Humanism and the Physician

RESPONSIBILITY Caring for patients implies another imperative attitude--that of responsibility. In its truest sense responsibility denotes duty, but duty that is an entirely voluntary act. It is a voluntary act in response to the needs of another human being. To be responsible means to be able and ready to respond.

RESPECT Responsibility could easily deteriorate into domination were it not for another necessary disposition (attitude) toward patients--respect. Respect is the ability to see the person as s/he is; to be aware of their unique individuality. Respect means a concern that the other person should grow/develop/unfold as s/he is. Respect implies the absence of exploitation.

KNOWLEDGE It is not possible to respect a person without knowing the person. Care and responsibility would be blind without knowledge. Knowledge would be empty if not motivated by care or concern. Knowledge of another is seeing the other in his or her own terms. Understanding where they are; who they are; to what they aspire; and what they need.

CARE, RESPONSIBILITY, RESPECT, AND KNOWLEDGE are mutually interdependent. They are a constellation of attitudes (dispositions) that are found in the mature person…and the mature dentist.

ASSUMPTIONS NECESSARY FOR HUMANE HEALTH CARE

Patients Are Human Beings… People of Inherent Worth Human beings are people of value. We implicitly recognize this by trying to reduce pain and suffering and restore health, function, and aesthetics to our patients. People are to be valued, just because they are people.

Patients Are Human Beings… Unique and Irreplaceable Humans differ from inanimate objects, from animals, and from one another. We are each unique and irreplaceable. When people are stereotyped and treated in terms of commonalties, dehumanization occurs. Humane practitioners regard all patients as equally worthy of time, skill, and interest. Differentiation is based on health problems, not personality or sociocultural-economic attributes.

Patients Are Human Beings… Holistic Selves Human lives are complex, with the sum total of a person’s life experiences influencing their perceptions, feelings, intentions, and actions. To focus on the oral health problem to the exclusion of the patient as a human being is dehumanizing. Our commitment must be to care for people with problems, not to repair teeth incidentally connected to a person.

Patients Are Human Beings… With Autonomy Humane relationships are based on freedom, on personal autonomy. There are factors that restrict freedom: ignorance of dentistry, ignorance of the problem, deprivation of status in the relationship, protocol of the dentist, and anxiety. Dentists committed to humane practice are dentists who work to encourage and gain as much autonomy for the patient as possible.

Patients Are Human Beings… With Equal Status Humane relationships are relationships between equals. If either dentist or patient sees him/herself as superior or inferior, the relationship has difficulty being humanizing. The expertise of the dentist tends to stratify the relationship with a patient. The dentist must work to overcome the loss of status of the patient in the role relationship.

Patients Are Human Beings… Responsible For Deciding For Self Patient participation in decision making, shared decision making, naturally follows from the facets of a humane relationship. Patients have a right to participate in deciding what their care will be. It is their life and well being

Patients Are Human Beings… Requiring Empathy Humane practitioners are able to empathize with their patients; to identify with their whole experience to place themselves in their patients’ position; to think with them, to feel with them, and to understand the experience they are having. They respond to their patients by treating them in the way they would want to be treated under similar circumstances.

Patients Are Human Beings… Requiring Affirmation Feelings toward others may be positive, negative, or neutral. While neutrality can project objectivity, neutrality is depersonalizing. Harnessed feelings give the impression of indifference. Successful practitioners display positive attitudes of affirmation toward their patients. Genuine feelings of warmth and tenderness demonstrate sincerity and concern.