REVIEWED BY SR. LOUISE LEARS, SC, PhD
The Lost Art of Caring: A Challenge to Health Professionals, Families, Communities,
and Society
Leighton E. Cluff, MD, and Robert H. Binstock, PhD, Editors
Johns Hopkins University Press, Baltimore
2001, 288 pp., $48 (hardcover)
In his famous essay on medicine, Francis Peabody spoke eloquently about the
human side of patient care and made the often-cited statement, "One of the essential
qualities of the clinician is interest in humanity, for the secret of the care
of the patient is in caring for the patient."1 The Lost Art of Caring: A Challenge
to Health Professionals, Families, Communities, and Society, edited by Leighton
Cluff, MD, and Robert Binstock, PhD, draws attention to the integral role of
caring in health care, as well as to the contemporary forces that seem to downgrade
caring or make it difficult to undertake.
The editors have organized the book's 11 essays in three sections: Part one
deals with the nature and meaning of caring and the populations requiring it;
part two describes changes in the provision of health care, both in context
and content; part three is concerned with assessments of caring. The editors
have intended the book for a broad audience, including health care professionals
and students, administrators of health care institutions and programs, family
and friends of patients, members of voluntary organizations that provide care,
and policy-makers concerned with shaping a humane and caring society.
On the whole, this volume deepens our understanding and appreciation of the
importance of caring for all who are in need of personal attention and assistance
when ill and disabled. The contributors seem to have given much thought to their
chapters, weaving together personal stories, clinical experiences, research
findings, and proposals for change. They recognize that caring is primarily
a moral endeavor, but also requires much technical competence. Caring demands
knowledge of a particular person, as well as knowledge of the body. Most important,
caring takes time-time that is, unfortunately, often squeezed out by the grip
of reductive technology and economic pressures.
The opening chapter, by Daniel Callahan, is especially compelling. Callahan
observes that caring, to be meaningful, must have a goal that is both general
(bearing on what we need as human beings) and particular (bestowing what we
need as individuals). If caregivers treat us only as needy human beings, overlooking
our particularity, their caring may fail. If they address us strictly as individuals,
our sharing in the human condition may be slighted. Good caring addresses not
only the psychological, social, or spiritual needs of patients and their loved
ones but also the particular person in whom those dimensions are found. As Callahan
notes, we who are caregivers need to know what the person most needs and what,
in our relationship to the person, is in us to give. Caring demands that the
person, rather than the disease, be the object and subject of medicine.
The Lost Art of Caring is most substantial in part two. These
six essays address the provision of caring in multiple settings, including the
hospital, nursing home, outpatient facility, hospice, home, and community. The
writers insist that caring must not depend on especially compassionate clinicians;
it must be part of the practice of all caregivers — nurses, volunteers, housekeepers,
physicians, family members, and dieticians, among others.
Part three is too short-it contains only two essays — to satisfactorily appraise
the success of efforts at caring. The authors appropriately point out that caring
procedures have all but disappeared from medical and nursing education. As Alvan
Feinstein notes, we need new approaches that identify, appraise, and teach the
constituents of the art of caring.
This volume would benefit from substantive attention to the ways in which
race, ethnicity, class, and gender are related to needs for caring. One chapter
includes two paragraphs on the impact of race, ethnicity, and culture on caring.
Several chapters briefly acknowledge that caring is often considered a second-rate
activity that we either expect female family members to perform without compensation
or hire others (often the poor) to perform for a minimal wage. An essay that
places race, ethnicity, class, and gender at the center and delves into the
significance of those differences would only strengthen this excellent treatment
of caring.
The Lost Art of Caring effectively makes the argument that, although
nothing can change a person's fragile situation in the world, the moral enterprise
of caring can make it more bearable. We should always provide care as a measure
of respect for others, a way of recognizing their humanity and our shared human
condition.
Sr. Louise Lears, SC, PhD
Coordinator, Center for Theology and Social Analysis
St. Louis
NOTES
- Francis W. Peabody, "The Care of the Patient," JAMA, no. 88, 1927,
pp. 882.
Copyright © 2001 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.