The Ethics of Powerlessness (EoP) is an interdisciplinary research project of philosophers at the University of Essex. The project started in July 2015 and will run for three years. Its aim is to investigate the distinctive ethical challenges that arise from human experiences of powerlessness. The work of EoP is funded by a major grant from the Arts and Humanities Research Council of Great Britain, for the investigation of the ethics of powerlessness and the theological virtues today.
In our ethical thinking, we often rely on a sharp distinction between agents and patients. An agent is someone empowered to act; a patient is someone who is acted upon. Standard ethical theories then teach the empowered agent something about how to act well. But human lives are often visited by circumstances where the power to act is profoundly diminished. Such circumstances include serious illness, depression, addiction and aging. They also include situations in which carers find themselves powerless to improve the circumstances of those for whom they care. In all these cases, we find ourselves beset by acute feelings of powerlessness.
Standard ethical theories are ill-equipped to address these challenges. How do I act ethically when there is little or nothing that I can do to change my circumstances, or those of someone for whom I care, and yet feel there must be something I can and should do? Does ethics have anything to say to persons who find themselves in these situations?
The need for an ethics of powerlessness has been set in sharp relief by recent crises of public policy and public trust, particularly in connection with care for the aged and the terminally ill. Until 2012, the so-called “Liverpool Care Pathway” (LCP) provided guidance to doctors and other carers regarding ethical treatment at the end of life. Following several months of public controversy, the Department of Health confirmed in July 2013 that the LCP will would be phased out over the next following twelve months. Since then, The National Institute for Health and Care Excellence (NICE) has worked on two successor documents to the LCP: ‘Care of the dying adult’ (published December 2015), and ‘Improving supportive and palliative care in adults (update)’ (expected January 2018). Events such as the Mid-Staffordshire NHS Trust crisis have highlighted the ethical dangers in this area; but what would it be to get things right? From the perspective of the patient, standard injunctions to self-reliance, self-control and will-power are often counter-productive because they presuppose exactly the sort of robust agency that has been lost. From the perspective of carers, emphasis on such terms as ‘ableness’, ‘empowerment’, ‘vulnerability’, ‘compassion’, and ‘spiritual care’, which feature prominently in the relevant guidelines and policy documents, is often insufficient because these concepts are difficult to pin down. We need a fresh approach.
A new approach
In developing a new approach to these challenges, EoP draws on two main theoretical resources:
Phenomenology and medio-passive agency
We draw on the resources of phenomenology to bring to light a distinctive form of human agency that is available even in circumstances of powerlessness. This is what we call medio-passivity. Informally characterised, medio-passivity is a form of agency whereby a person recognises her powerlessness in relation to a particular situation, and exercises her agency precisely by opening herself to the circumstances she cannot control. Such exercise of agency is a ‘letting-go’ which differs both from trying to wilfully resist (or deny) the grip of such circumstances on the one hand, and from giving up altogether on being an agent on the other. The medio-passive agent is both active and passive in some way, but neither category is by itself sufficient to capture this form of agency. Thus the letting-go of control is not something that an agent can do at will; but neither is it something that happens to her from the outside. When ethically successful, medio-passivity allows the very recognition of her powerlessness to become empowering for the agent.
We find traces of this alternative form of agency, for example, in twelve-step addiction programmes such as Alcoholics Anonymous or Anorexics Anonymous. The first step in these programmes involves the acknowledgement that ‘we were powerless over alcohol / food and our lives had become unmanageable’. The further steps then build on that core acknowledgement in ways that empower the individual to rebuild their lives. Medio-passivity cuts across standard distinctions between agents and patients and between ‘things that I do’ and ‘things that happen to me.’ But we believe both that medio-passivity is an important form of agency in its own right, and that it provides a promising approach in developing an ethics of powerlessness. For even when an agent’s power is profoundly compromised, opportunities for the exercise of medio-passive agency remain.
Virtue theory and the ‘theological’ virtues
Our second theoretical resource comes from the history of virtue theory within the tradition of Christian ethics. Our point of departure here is the Thomist distinction between the cardinal and theological virtues. The cardinal virtues comprise the virtues of justice, prudence, temperance and courage. As Aristotle made clear, these virtues are decisively shaped by ideas of voluntary action and self-mastery. But in the Christian tradition these stand alongside a second set of virtues, the ’theological’ virtues of faith, hope and love (or charity: caritas). Aquinas thought that what unifies these virtues, and sets them apart from the cardinal virtues, is precisely the way in which they express and demand a proper recognition of human powerlessness. None of them is under our direct control: while we can successfully apply ourselves to be prudent or just, we cannot make ourselves have faith, hope or love by sheer strength of will. And unless we recognise that these are not under our control, we cannot develop the forms of receptivity, such as attention or prayer, which will allow faith, hope or love to grow.
Taken together, these two resources hold promise for developing an ethics of powerlessness for our time. By recognising the possibility of medio-passivity, we identify a form of agency that is available even in circumstances of powerlessness. By recovering an understanding of the theological virtues, we can learn something about what is involved in exercising such agency well.
Our aim is to develop a framework for understanding and responding to circumstances of profoundly diminished agency, from the perspective of both the affected individuals and those who care for them. We focus on three interconnected clusters of issues:
- (a) How CAN we act in circumstances of powerlessness? Do such circumstances still allow for human agency? How should we understand medio-passive agency? Is medio-passivity a genuinely distinct form of agency?
- (b) How SHOULD we act in circumstances of powerlessness? Can faith, hope and love be virtues of powerlessness? How dependent are the theological virtues on their original theological context? What would a viable secular reinterpretation of these virtues look like?
- (c) What ethical guidelines are appropriate to circumstances of powerlessness in NHS contexts, in particular in palliative and end-of-life care? How are health-care practitioners to understand and apply key terms in guidelines and policy documents, such as ‘ableness’, ‘empowerment’, ‘vulnerability’, ‘compassion’, ‘spiritual care’? Can the virtues of faith, hope and love help patients and carers to navigate experiences of powerlessness?
In taking up these issues, EoP advances fundamental theoretical debates: in virtue theory, the philosophy of action and the medical humanities. The contemporary revival of virtue theory in ethics, for example, has tended to take Aristotle as its point of departure and to focus mostly on the cardinal virtues; by contrast, our project starts from the Christian tradition and brings the theological virtues back into view. Furthermore, many contemporary virtue theorists recognize the need for an alternative to traditional accounts in which virtue is too closely tied to the idea of voluntary action. EoP helps to answer this call by developing a model of medio-passive agency and by testing the hypothesis that faith, hope and love are medio-passive virtues.
It is also a major part of our aim to help improve care delivery in contexts of palliative and end-of-life care. For example, the so-called theological virtues are often invoked in the charters of Christian hospices, but it is has been unclear how they can be applied in guiding concrete practices of care. Some healthcare professionals also express unease about applying these Christian ideas in our multicultural society. This makes our inquiry into the conditions under which faith, hope and love can be construed as secular virtues all the more important to help policy-makers and practitioners in the face of the pressing demand for improved end-of-life care.
Research on EoP is conducted in large part through a series of Medical Humanities Workshops, academic presentations and international conferences, many of which are open to the public. Among the research outputs for the project will be ‘Green Paper’ technical reports and a module on The Ethics of Palliative Care. In addition, there will be a series of more conventional academic outputs. Above all, we aim to cultivate an interdisciplinary network of researchers and practitioners with advanced expertise on the ethical challenges that arise from human experiences of powerlessness.