Abstract

Levinas argues that the immediacy of pre-rational compassion is the source and the heart of ethical life. Such compassion finds one of its paradigmatic cases in the physician-patient, or caregiver-patient, relationship. Yet it is a strange relation, not only in that it reverses normal power relations, but also in how it carries within itself the seeds of its own betrayal. How is ethics built up out of these relations? What has the history of the physician-patient relationship to teach us about how ethics is generated and betrayed? This dissertation explores the nature, implications and limits of Levinas' thought for medicine, first by developing Levinas' thought in the context of Heidegger and Nietzsche, and second through a Levinasean analysis of ethics and personhood as applied to specific ethical issues at the beginning and the end of life. ;The dissertation then shifts from individual ethics to discussion of ancient medicine and of structural issues in the recent history of medicine in Germany and the United States. It takes up the question of why, if the physician-patient relationship is a "paradigmatic case" for ethics, German physicians were the largest professional group to join the Nazi party, both helping to bring the Nazis to power and then fighting turf wars with the regular civil service over who got to make the "selections" at the concentration camps. Why is it that we hold physicians in high moral regard, rather than viewing them as any other sort of contractor---some better, some worse---instead of considering immoral or marginal practices particularly heinous when engaged in by physicians? It cannot be denied that some of these expectations are rooted within our particular culture. But might not these tendencies also be rooted within, perhaps even founded by, the particular vulnerabilities of those who are weak or ill? Could this strange reversal reveal an origin of a uniquely "moral" power? If so, what are the nature, implications, and limitations of this "moral" power for ethics and medicine?