Three modes of presence in the context of end-of-life accompaniment an original perspective on relational ethics in healthcare

In this article published in Medicine, Health Care and Philosophy on 20 June, researchers from the Psychology department of the University of Quebec in Montreal (Canada) and from the Anesthesiology, Pain and Palliative Medicine department at Radboud university medical center (the Netherlands) offer an in-depth understanding of clinician presence in the context of end-of-life accompaniment, using an original perspective on relational ethics in healthcare.

Inspired by the philosophy and ethics of palliative care, the authors elaborate on three modes of presence that can support the accompaniment of suffering and dying patients.

1. Being present to oneself and the other: Presence is a way of being that refers to an awareness of the self, the other, and the relationship between self and other. The authors encourage clinicians to cultivate a self-reflective mode of presence in their clinical practice in order to deepen the quality of their presence. In this way, it is possible to better acknowledge our preconceptions and representations about end-of-life. This movement should open the possibility to be present to others and to the world in return.
2. Being in the present moment: Drawing on hermeneutical phenomenology, being in the present moment not only refers to the here and now, but also to elements of the past and the future. This mode of presence compels us to be attentive to the way we experience the present moment with the patient, but also how it changes over time, with each encounter.
3. Receiving and giving a presence (in the sense of a gift): In contrast to the usual vertical relationship in medicine where the clinician gives and the patient receives, presence can help rebalance the initial dissymmetrical position (and power) of the patient and the clinician through a movement of giving and receiving.

This article invites us to reflect on our own preconceptions about end-of-life, and death and revisit our modern Western approach to suffering and dying as clinicians in the hope of offering a better and deeper quality of presence to our patients at the end of their life. 

Read the study here.

Full reference: Guité-Verret, A., Vachon, M., & Girard, D. (2023). Intentional presence and the accompaniment of dying patients. Medicine, health care, and philosophy, 10.1007/s11019-023-10161-z. Advance online publication. https://doi.org/10.1007/s11019-023-10161-z