Relational ethics in healthcare

Modern ethics since the Enlightenment has long focused on presenting universal principles and directives to legitimate which course of action is the right one to take in a certain situation. It aims to present guidelines for acting that are applicable regardless of the specific context. For example, Kantian ethics, a very influential approach, prescribes that we should always treat people as ends in themselves, and never just as means. Utilitarian ethics, another dominant theory in ethics opposed to the Kantian approach, states that the ‘right thing to do’ is the choice that results in ‘the greatest happiness for the greatest number of people’. Modern bioethics, dominant in many medical ethical approaches, presents four principles (autonomy, non-maleficence, beneficence, and justice) that need to be weighed in making legitimate medical decisions. All of these principle-based ethical theories have the aim of offering universal guidelines that avoid the pitfalls of bias, partiality or favouritism.

Relational ethics, on the other hand, sees ethics in terms of relationships rather than directives. It is a radically different view of what ethics should be about: not primarily about acting in the right way, but about being a good person (or professional). Acting in an ethically legitimate way should be embedded in – and based on a fabric of relations that are characterised by virtues such as empathy, beneficence, truthfulness, courage, humility, justice etc. This approach to ethics as philosophy of the good life, rather than philosophy of legitimate action, goes back a long way in Western history, to Aristotle and other Greco-Roman philosophers. It emphasises a lifelong learning trajectory towards practical wisdom that requires constant practice of relevant attitudes.

When applied to the context of healthcare, relational ethics implies constantly attuning to patients’ needs by being in relation with them, supported by the development of attitudinal dispositions or virtues that ground professional acting. Relational healthcare requires a modest and attentive listening to what people express (both verbally and non-verbally) in their reports about their health and well-being, and a genuine interest in the life stories that represent their intersectional identities. Decisions about treatment need to be made in dialogue with the patient and sensitive to their stories and identities, although this does not imply downplaying professional responsibility.