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Edited by L E Cluff and R H Binstock. The Johns Hopkins University Press, 2001, £32.50, pp 260. ISBN 0–8018 6591–3
“Doctors cure and nurses care” was a phrase used to differentiate between medicine and nursing. Even though rhetorically we may well agree that doctors and nurses have their equal share in caring, literature on caring so far has been produced mainly from the perspective of nursing.
Now there is a book containing 11 essays on caring written or coauthored by seven medical doctors, two nurses, four social scientists, and two philosophers. The impressive list of authors is headed by the editors of the volume, Leighton Cluff (medical doctor and gerontologist) and Robert Binstock (political scientist and gerontologist). The volume includes authors who are well known scholars active in the field of medical ethics as well as clinicians and educators in various areas of health care facilities. The foreword by Rosalynn Carter, wife of ex President Jimmy Carter, gives the book its political and social weight.
As the title promises, the issue of caring is addressed from a variety of perspectives. The division into three main parts provides a logical structure for the vast field of caring: The first part Caring and the Population in Need of it gives an overview from broader perspectives. The first essay by Daniel Callahan takes us directly into the centre of the human condition, discussing the ethical imperative for caring which needs to be accepted in spite of medical and technical progress.
. . . the challenge of caring will be to show that there is no inherent loss of human dignity in dependence upon other. . . . More than empathy is required; it is more like helping to convey a different way of thinking about the worth of a life (page 17).
This quote provides a framework for understanding the approach to which the book aspires.
The second essay by A E Benjamin and Leighton E Cluff provides an erudite overview of the health care situation in the USA. Together with its comprehensive literature list (up to the year 2000) it helps readers to understand the current situation in the states. The third essay in the first part of the book addresses caring and mental illness. It is based on recent research and offers a broad perspective of caring in different situations.
The second and most extensive part explores The Provision of Caring. It starts with a historical overview and includes the dimension of palliative care. Further essays treat political issues, modern medical science, and caring from the physician’s perspective, the perspective of medical education, and the perspective of institutional settings. The dilemma of nurses and nursing is addressed, where inadequate power structures prevent professional approaches to attain what has been proven to be a satisfactory level of caring. Two essays look at the community and home based side of caring both within and outside of the health care systems, focusing on the impact and meaning of the voluntary sector.
The third part, entitled Assessment of Caring, presents two essays on the evaluation of care. The essay by Alvan R Feinstein grapples with the issue of quality assurance in the area of care in light of the fact that quality in medical settings generally aims at curing. This essay provides a good overview of quality of care assessment options. The last essay, by Robert Binstock, focuses on political aspects of caring and analyses the USA situation from a politicohistorical perspective, showing that an incremental trajectory of increased caring as expressed through governmental action is part of American ethical tradition, which still faces the challenge to ensure that all American citizens have access to health care “which the contributors of this volume hope will become more caring than it is today” (page 249).
The final sentence from the introductory essay by Daniel Callahan opens new perspectives for interdisciplinary efforts to humanise our health care systems and to give a realistic perspective to professionals in all areas where caring is central.
Quote Nothing can finally rid us of our fragile situation in the world. That we must experience alone. But it is caring, well and properly given, that can make it more endurable” (page 24).
This is a timely, readable, well informed and thus useful book for the interested scholar and practitioner in the field of health care provision.