The notion of vulnerability in the philosophy of Emmanuel ...

The notion of vulnerability in the philosophy of Emmanuel Levinas
and its significance for medical ethics and aesthetics

© Lazare Benaroyo, January 2007

The starting point of my reflexions on the significance of the notion of vulnerability for
medical ethics is derived from my research on Emmanuel Levinas’ work on ethical
responsibility. While not hijacking Levinas into a project that couldn’t be more
abstract and totalizing, and more removed from his thought, I have tried to
understand to what extent his philosophy may help us to grasp the ethical core of
clinical responsibility. By exploring this aspect of Levinas’ thought, I could not help
but note that this intimate relationship of both notions of responsibilty and
vulnerability retains a powerful appeal for clinical ethics.

My argument is the following : exploring in depth how responsibility is correlated to
vulnerability in Levinas’ thought may shed some light on the very nature of clinical
care. This reverse understanding of the classical rational foundation of ethical
responsibility in clinical bioethics is precisely what Levinas’ philosophy can help us to
comprehend and implement in clinical care. Before going through this argument, let
us first briefly sketch Levinas’ life and work.

Levinas’ philosophy

Emmanuel Levinas was born in Kovno, Lithuania in 1906, of Jewish parents. In
1923, he went to Strasbourg (the closest French City to Lithuania) in order to study
philosophy under such teachers as Charles Blondel and Maurice Pradines. At this
time, the writings of Henri Bergson were making a strong impact among the students,
and Levinas in particular. He quickly made friends with Maurice Blanchot who
introduced him to the work of Proust and Valery. In 1928-29, he attended a series of
lectures given in Freiburg by Husserl on phenomenological psychology and
constitution of intersubjectivity. It was at this time that he began to write his
dissertation on Husserl’s theory of intuition. He also discovered Heidegger’s Being
and Time.

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His career started in the 1930’s with the completion of his excellent dissertation, a
translation of the Cartesian Meditations and several essays on Husserl’s and
Heidegger’s phenomenology. In the 1930’s, he took French nationality, married and
moved to Paris where he worked in the administrative section of the Alliance Israëlite
Universelle. At the outbreak of war, he was mobilized and was quickly made prisoner
of war. Meanwhile, most members of his family were murdered during the pogroms
that began in June 1940, with the active collaboration of Lithuanian nationalists.

Because Levinas was an Officer in the French army, he was not sent to a
concentration camp, but to a military prisoner’s camp, where he did forced labor in
the forest. By this time, he read Hegel, Proust and Rousseau in between periods of
forced labour. His book « De l’existence à l’existant », published in 1947 described
his anonymous existence, and the rates of insomnie, sleep, horror, vertigo, appetite,
fatigue and indolence - was begun in captivity. This book attracted little attention,
although Jean Wahl invited him in the same year to give a course for his students,
the text of wich was published soon after under the title « Le temps et l’autre ». This
situation changed however, when in 1961, Levinas published « Totalité et infini ».
Suddenly a master was revealed, who not only renewed twentieth Century
phenomenology but also combined a radical critique of Western philosophy with a
Platonizing retrieval of the pre-Platonic tradition of Judaism. Translations into many
languages spread his fame ; he was invited to give lectures in many countries, and
he received honorary doctorates from several universities. Levinas became then
prolific and the growth of secondary literature related to his work was overwhelming.
In 1967 he became appointed Professor of Philosophy at the newly establishment
University of Paris-Nanterre and in 1973, he was appointed Professor of Philosophy
at the Sorbonne.

The difficulty of Levinas’ language and revolutionary thought was such that widely
held agreement among scholars with regard to its interpretation and evaluation was
not immedialty possible. His publications after 1961 clarified certain questions, but
they also posed new ones since his thinking had continued to evolve. His second
major book « Autrement qu’être, ou au-delà de l’essence », which appeared in 1974,
represents a new stage in his thinking, one even more original than the former. The
philosophical work of Levinas became known in America through the early translation

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of his main texts, « Totality and Infinity » in 1969 and « Otherwise than Being, or
Beyond Essence » in 1987.

Levinas’ philosophy starts by taking a critical distance from Heidegger to the extent
that he maintains that the significance of a question – any question – does not lie in
some possible answer or response, but in the question itself. That is, the question is
already a manifestation of our relationship with Being, of our astonishment at the
mere fact of existence. However, Levinas asks whether this is the only meaning or
content of philosophical wonder. Is the question of ontology – or why there is
something rater than nothing – the most fundamental philosophical question ? In
distinguishing his own project from Heidegger’s, Levinas writes that, if philosophy is
more than the questioning of Being, « this is because it permits going beyond the
question, and not because it answers it. What more there can be than the
questioning of Being is not some truth – but the good ? » This tension between
being and a good beyond being – between ontology and ethics – is constitutive of
Levinas’ mature philosophy and guides the unfolding of the ethical problematics of
his major work.

Through his reflection in his work on the absolute alterity of the other and on the
ethical relationship as an infinite, irrecusable responsability, Levinas proposes a
radical rethinking of the central categories of ethical life – self, other, subjectivity,
autonomy, rationality, freedom, will, obligation – and the very meaning of the ethical.

For Levinas, ethics is not merely one branch of philosophy among others, secondary
to the question of ontology, epistemology or theory of knowledge. It is not a
superstructure grafted onto an antecedent relationship of cognition. Rather, Levinas
maintains, ethics is « first philosophy ». As he himself makes clear, the aim of his
work is not to construct an ethics, or a morality, in the sense of a system of rationaly
justified of precepts or norms capable of guiding human action and behavior ; rather,
his work opens the question of the ethical as the « extreme exposure and sensitivity
of one subjectivity to another ».

It is a question here of how the other concerns me, or makes a claim on me – not in
the sense of a demand whose legitimacy I could recognize or refuse, but an exigency

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which takes the form of a radical patience, an extreme vulnerability and exposure to
the other to the point of expiation. This offering of oneself is not a role that is
assumed, but is a goodness that occurs despite oneself. The biblical « Here I am »
(Samuel 3 :4) which is offered as a responsibility for the other prior to commitment
does not involve the reduction of subjectivity to consciousness. Instead, it is
subjectum, subjectivity as substitution and expiation for the other. The philosophical
language of Levinas enacts a discourse in terms of « otherwise than being » that
frees the subjectivity from the ontic or ontological program. The individual is not just
Dasein, he is also the site of Transcendence, responding to the unfulfillable
obligation towards the Other : being-for-itself is conditional to the unconditioned
responsibility of being-for-the-other.

This moral combat, based on peace for the other, is an indication of the radical
challenge to thought posed by the philosophy of Levinas. In our age, Levinas shows
that to be or nor to be is not the ultimate question : it is but a commentary on the
better than being, the infinite demand of the ethical relation.

To sum up, Levinas endeavours to conceptualise the preconscious experienced
responsibility for the other, that is the fundamental ethical layer of the responsible
self. A responsibility that is a radical heteronomy – though not a principle of
heteronomy – but an inescapable preconscious subjection to the other.

The significance of Levinas’ philosophy for medical ethics

Now, to come back to our inquiry centered on the philosophical basis of medical
ethics, it is worth to note that this inescapable condition is, for Levinas, first of all
reflected in the human sense of corporeity that is vulnerability. The incarnated
subject, experienced as vulnerability - rather than as a detached game of
consciousness -, is for Levinas the place of the call for the other, an inescapable call,
before any choice, before the birth of liberty. Embodiment as vulnerability is the
cornerstone of Levinas moral approach : the body – might it be healthy or ill -
experienced as vulnerability, is the locus of my exposure to the others - of a call for

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responsibility. Again, not a responsibility assumed by conscious decision, but an
inescapable call, not a free choice, but the ethical condition of my own self.

For Levinas, this responsibility is revealed by the other’s face. The face of the other
reminds us that the ethical meaning of an encounter is not totally contained within the
limits of consciousness or with social superstructures of a world of moral strangers.

Now, what do Levinas’ fundaments of an ethics of response mean in the realm of
clinical activity ?

Following Levinas thought, it means that the physician’s first order responsibility
consists in patiently accepting the « visitation » of his patient, without too hastly
closing the encounter of a specific rational and technical kind. In other words, it
means that the physician’s first ethical task is to accept the extraordinary
« otherness » of the ill person who is in front of him, that is expressed by his
vulnerable face, and that constitutes an ethical call for help and care.

To better understand the depth of Levinas’ insight, let us now look what the
expression « vulnerable face » means in this context. In Levinas’ thought,
vulnerability does not mean frailty, dependency or loss of social autonomy.
Vulnerability, that is increased in suffering, is for him intimately tied to « sensibility ».
In turn, sensibility does not mean reception of information or knowledge. Rather,
sensibility is a kind of signifying. That is an opening to others, a nearness, the one-
for-the-other, precisely vulnerability to others.

Thus, for Levinas the other’s vulnerability, particularly in the case of illness, is the
very incarnated locus of ethics, eliciting one’s own vulneralibity and therefore
responsibility-for-the-other human being.

In the clinical realm, this means that the health care giver should be able to listen to
the otherness first in himself before opening himself to the radical otherness of the
patient. This understanding of hospitality paves the way of the creation of a trustful
caring environment. In this environment the healer’s welcoming of the other can
express itself and be perceived by the patient as a sign of common and shared

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meaning – of ethical community - that is not a response but a question, a question
always open.

This question rests on a preconscious levinassien order of ethical awareness to the
human breadth of responsibility–for-the-suffering-other, meaning that the face of the
suffering other always inescapably lends itself to a welcome.

And to go a step further, I could argue with Derrida : « [The health care giver] must
first think the possibility of the welcome in order to think the face and everything that
opens up or is displayed with it : ethics, metaphysics or first philosophy, in the sense
that Levinas gives to these words. The welcome determines the receiving, the
receptivity of receiving as the ethical relation. » In other words, ethical discourse
starts with the interruption of the self by the self.

In this sense, one might call this moral stance, ethics as hospitality

Epilogue

Hence, in the realm of clinical medicine we are now facing the paradox that lies at the
ground of the unfolding of ethical responsibility and vulnerability in the sense that
Levinas gives to this word. The responsible healer has a double face of Janus : on
the one side, the naturalistic rational attitude, to recall Husserl terms, is necessary to
observe the patient with objectivity in order to master his disease processes, and on
the other side, the personal pre-rational attitude entails hospitality to welcome the
other’s vulnerability as an ethical calling. It is out of an elusive synthesis of both
opposite attitudes – which respectively call on radically different goals – that
responsability-for-the-other, guided by practical wisdom, may be implement in clinical
medicine.

In my view, this is the inescapable ethical challenge awakened by Levinas ethics,
that every clinician should face and to which he should be prepared by practicing
clinical practice.

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Against this background, ethical medicine hinges then on the necessary
complementarity of both sides of the Janus face : I would suggest that both sides
may take one intermingled with the other the following ethical steps blazing the
trail for pratical wisdom :

• First, an ethical awakening to the vulnerability of the suffering other in his
radical otherness – ethics as hospitality and love

• Second, elaborating, on the basis of the first step, a pact of care based on
trust - ethics as justice and care

• Third, performing the technical step leading to healing and curing – ethics
as social norms regulating applied science

• Forth, reaching to completion the prudential jugement drawing on practical
wisdom that chooses and decides what is the right individualized treatment
in this case – ethics as practical wisdom.

I would suggest that these different steps are articulated – each at his own
epitemological and anthropological level – to build together a practical jugment in
clinical medicine ; they constitute the pillars of a philosophy of medicine grounded
in medical practice offering the ressources needed to construct an ethics of
responsible care echoing the ethical requirements proper to clinical medicine.]

The ethical professional gaze enlightening this philosophy looks at clinics and
ethics as the two sides of the same coin.

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