Abstract
The onset of acute illness may be accompanied by a profound sense of
disorientation for patients. Addressing this vulnerability is a key part
of a physician’s purview, yet well-intended efforts to do so may be
impeded by myriad competing tasks in clinical practice. Resolving this
dilemma goes beyond appealing to altruism, as its limitless demands may
lead to physician burnout, disillusionment, and a narrowed focus on the
biomedical aspects of care in the interest of self-preservation. The
authors propose an ethic of hospitality that may better guide physicians
in attending to the comprehensive needs of patients that have entered
“the kingdom of the sick”. Using philosophical methods, the authors
explore what compels people to present to emergent medical attention and
why altruism may not offer physicians a sustainable way to address the
vulnerabilities that occur in such situations. They then present the
concept of hospitality from a Derridean perspective and use it to
interpret a narrative case of an on-call paediatrician caring for an
infant with bronchiolitis to demonstrate how this approach may be
practically implemented in the acute care hospital context. Hospitality
allows physicians to acknowledge that clinical presentations that are
routine in their world may be disorienting and frightening to patients
experiencing them acutely. Further, it recognizes that the vulnerability
that accompanies acute illness may be compounded by the unfamiliarity of
the hospital environment in which patients have sought support. While it
is unlikely that anything physicians do will make the hospital a place
where patients and caregivers will desire to be, hospitality may focus
their efforts upon making it less unwelcoming. Specifically, it offers
an orientation that supports patients in navigating the disorienting and
unfamiliar terrains of acute illness, the hospital setting in which help
is sought, and engagement with the health care system writ large.