Excerpt

“. . . Attention, for Weil, is the beginning of all ethics, because one cannot know how to act toward another person if one has not first understood that person. Yet, according to Weil, we cannot understand others through sheer efforts of attention. She believes that the mind is constantly at work projecting its own imagination and valuations on itself and the world around it, and that these projections inhibit true knowledge. To translate her thoughts into the language of medicine, we could say that a clinician is always at risk of projecting their assumptions and biases, implicit and explicit, onto the patient.

But because the clinician’s mind is the source of these projections, it cannot of its own strength counter them with a truer perception of the patient’s reality. In other words, attention is not something that you create through conscious effort. A squinting of the eyes, a tightening of the muscles, a serious face: all these images of the concentrated individual leave us only more aware of ourselves. The goal is to become aware of the patient, and so we reach a clinical paradox: attention is a core component of our work in palliative care because it allows us to see others more clearly, but this attention cannot be willed in the same way as, say, the movement of one’s arm.

The resolution of this paradox is to say that attention does involve effort, but a special sort of effort. According to the Stanford Encyclopedia of Philosophy, Weil’s concept of attention is not “a ‘muscular effort’ but a ‘negative effort’ … involving … a growing receptivity of the mind” (Rozelle-Stone and Davis, Reference Rozelle-Stone and Davis 2021). It is not an action but something we position ourselves to receive, “less a moral position or specific practice and more an orientation” (Rozelle-Stone and Davis, Reference Rozelle-Stone and Davis 2021). To say that attention is a negative effort is to claim that our effort is used largely to empty ourselves of internal noise and narratives, and to allow the patient to fill in the gap. We forget about ourselves without forgetting our knowledge or our role as healers, and this new orientation consists “of suspending our thought, leaving it detached … empty … holding in our minds, within the reach of this thought, but on the lower level and not in contact with it, the diverse knowledge we have acquired which we are forced to make use of” (Rozelle-Stone and Davis, Reference Rozelle-Stone and Davis 2021).

When we pay this sort of attention, we undergo something similar to what poets experience in the process of composing a poem. “The poet,” Weil writes, “produces the beautiful by fixing his attention on something real. It is the same with the act of love. To know that this man who is hungry and thirsty really exists as much as I do — that is enough, the rest follows of itself” (Weil, Reference Weil 1997). Not only does attention help me to understand the human being toward whom I want to act ethically; attention is itself an ethical act because it grants dignity and autonomy to a person who exists independent of my own mental constructs. The more I attend to the patient, the more my own mental image of them is replaced by a truer reality, and the more I recognize — “the rest follows of itself” — my professional and moral obligations toward them (Weil, Reference Weil 1997).

An honest perception of the patient in front of me will, therefore, involve an honest recognition of what I feel and think around them; and the constant reorientation toward that patient will remind me to leave those feelings and thoughts to the side, allowing me to be morally and professionally shaped not by my own agenda but by the needs of the patient. One writer claims that “only such a move makes it possible to recognize the fundamental equality and identity of all people, which means it is also the only chance for justice” (Rose, Reference Rose 2022). Through Weil’s philosophy, then, we see that compassion, ethics, and justice in medicine “are the result of one and the same act, a certain application of the full attention” to the patient. In that case, educators in palliative care could have few greater aims than “to prepare, by training the attention, for the possibility of such an act” (Weil, Reference Weil 1997). . . .”

Palliative & Supportive Care (April 25, 2022) (published online by Cambridge University Press).

Aldis Petriceks is an MD Candidate at Harvard Medical School.