Subjectivity and vulnerability: reflections on the foundation of ethical sensibility

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Ori

gina

l Art

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Blackwell Science, LtdOxford, UKNUPNursing Philosophy1466-7681Blackwell Science Ltd 2003

July 2003

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Original Article

Subjectivity and Vulnerability

Per Nortvedt

Correspondence: Per Nortvedt, Institute of Nursing Science,

The Medical Faculty, University of Oslo, PO Box 1120 Blindern,

0317 Oslo, Norway. Tel.:

+

4722850578; fax:

+

4722850570;

e-mail: p.nortvedt

∞

sykepleievit.uio.no

Subjectivity and vulnerability: reflections on the foundation of ethical sensibility

Per Nortvedt

PhD

Associate Professor, Institute of Nursing Science, The Medical Faculty, University of Oslo, Norway

Abstract

This paper investigates the possibility of understanding the rudimentaryelements of clinical sensitivity by investigating the works of EdmundHusserl and Emmanuel Levinas on sensibility. Husserl’s theory of inten-tionality offers significant reflections on the role of pre-reflective andaffective intuition as a condition for intentionality and reflectiveconsciousness. These early works of Husserl, in particular his workson the constitution of phenomenological time and subjective time-consciousness, prove to be an important basis for Levinas’ works on anethics of alterity and infinite responsibility for the other person. In fact,it is difficult to understand the core of Levinasian ethics, of vulnerabilityas proximity, of ethical sensitivity as passivity and a suffering for thesuffering of another, without understanding the influence fromHusserl’s work. Crucially, the paper will, on the basis of Levinasianethics, establish an understanding of sensibility as vulnerability andreceptivity that is fundamental also for understanding significant intui-tions in clinical nursing. Clinical sensitivity and carefulness in nursingare shaped by the concrete and also bodily expressions of vulnerabilitiesin a receptivity that is pre-reflective and pre-ontological.

Keywords:

intentionality, vulnerability, Husserl, Levinas, infinity,sensibility, nursing.

Introduction

This paper will not give a specific outline of clinicalsensitivity in nursing. Neither will it in detail explainthe relevance of Husserl’s and Levinas’s texts to nurs-ing. However, by outlining some essential ideas onsensibility offered by these philosophers, I will inves-

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tigate the constitution of ethical responsibility on avery basic level of sensibility. Hopefully then, I willilluminate how clinical wisdom and sensitivity innursing are fundamentally related to ethics. My argu-ment will be that a basic moral sense originates withina sense-forming intuition of pre-reflective conscious-ness. Hence I take moral obligation to have a specificmetaphysical background, a background that isessential for nursing to understand. We talk hereabout an awakening of moral obligation in theencounter with the other person.

My argument will be structured in three ways. FirstI want to display some shortcomings within promi-nent metaethical explanations about the sources ofnormativity (Korsgaard, 1996). Secondly, based onthe works of phenomenologists like Husserl and Lev-inas, I will address these shortcomings and try tocome to terms with them. Finally, I will briefly sketchhow these metaethical views display perspectives fora moral phenomenology of clinical nursing. My fun-damental idea is that clinical nursing in particular, bybeing so closely related to human vulnerabilities ofdifferent kinds, can give meaning to this discussionabout the origin and functional structure of moralobligation. A more detailed exposition of the rele-vance of moral phenomenology for clinical nursingwill be impossible in this paper. Some more detailedviews on this topic are presented, however, inNortvedt (2001).

Why is there a reason to care for the other person?

The American philosopher Kristine Korsgaard (1996,p. 47) argues that:

It is not because we notice normative entities in the course

of our experience, but because we are normative animals

who can question our experience, that normative concepts

exist.

This is true for normative ethics, but it is alsoimportant to investigate the basis for normative eth-ics and address the questions: How does moral senseoriginate? Why do we have moral experiences? Whydo we care for the other person?

As Hilary Putnam (2002, p. 37) says in a recentessay on Levinas and Judaism:

Levinas addresses this issue when considering the question:

Imagine you were in a situation in which your obligations

to others did not conflict with focusing entirely on one other

human being. What sort of attitude, what sort of relation,

should you strive for towards that other?

Christine Korsgaard and Thomas Nagel are philos-ophers who both take the sources of moral motiva-tion to be determined by moral reasons (Nagel, 1978;Korsgaard, 1996). In The

Sources of Normativity

,Korsgaard (1996, p. 148) poses the question: Whenyou see a person in pain, and you feel pity for him,or his pain causes some kind of empathic distress, whydo you want to help him? Why does his distress strikeyou as a reason to help him? Why don’t you just takea tranquillizer?

Both Korsgaard and Nagel answer that this is sobecause pain is a perception of a reason, a reason for

you

to change the person’s condition. Nagel (1978, p.80), for instance, argues that: ‘Sympathy is not in gen-eral just a feeling of discomfort produced by the rec-ognition of distress in others, which in turn motivatesone to relieve their distress. Rather, it is the painedawareness of their distress as

something to be

relieved

’. Korsgaard (1996, p. 149) concurs: ‘Pity ispainful because it is the perception of

another’s

pain,and so the perception that there is a reason to change

his

condition’.But nothing is explained here about how a moral

reason can be painful, or how the perception ofanother person’s painfulness can generate motivatingbehaviour in any moral sense. Nothing is said that canmake us understand the painfulness when confrontedwith another person’s pain that is so essential formoral perception and moral responsibility (Vetlesen,1994: Nortvedt, 1996). If moral reasons are painfulreasons and hence reflecting another person’s pain,to understand the enigma of moral motivation, onehas to explain how a reason can be painful. But thenwe have the following question: If pained awarenessis a reason, how does it divert from reflective reasonsin general? A pained reason must be an affectivereason, but then it must be a peculiar kind of reason,because what is an affective reason? Trying to explain

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this strange structure of a sensibility that groundsmoral motivation, I will build my case on the work ofEmmanuel Levinas’ ethical metaphysics.

The late French phenomenologist and ethicistEmmanuel Levinas develops a central idea in Hus-serlian phenomenology, elucidating a sense-formingintuition that differs from the intentionality displayedin the theoretical attitude of consciousness (Husserl,1998; Drabinski, 1999). As Husserl recognized, thereis a pre-reflective passivity in consciousness that pre-cedes the reflective intentional act (Husserl, 1998).Husserl’s theory of intentionality in its broadest senseincludes different attitudes of consciousness, theoret-ical as well as affective. Husserl argues that the startof reflection presupposes

warnehmung

, an intuitiveand spontaneous experience of the object in question(Husserl, 1998; Zahavi, 2001). To state this more pre-cisely: reflection is characterized by a thematizationand articulation of something that existed in con-sciousness before reflection (Zahavi, 1999, 2001).

This kind of spontaneous valuing, named axiologi-cal intuition by Husserl, is developed by Levinas intoan ethical metaphysics that elucidates the awakeningof moral consciousness by the vulnerability of theother person, as a suffering for his suffering (Levinas,1991b). In fact, Levinas, in comparison to Husserl,much more radically argues that the intuition of val-ues transcends intentional consciousness.

It is in outlining this non-cognitive, impressionalnature of moral responsibility that Levinas has animportant position. But as will be evident, Levinas’argument is neither psychological, nor phenomeno-logical, but metaphysical. He gives an account of sen-sibility in which the Good takes hold of the personprior to any judgement or actual feeling about thesituation. Levinas talks about an ethical sensibilitythat is irreducible to knowledge, when the subject andconsciousness itself in passivity, is shaken by the alter-ity of the other person. This suffering for the other’ssuffering, for Levinas shows up in a paradoxical rela-tion with something that signifies without revealingitself, something that Levinas calls the ‘face’ (Chalier,2002).

While first clarifying this metaphysical explanationof moral sensibility, the final parts of the paper willbe transformed into a language more familiar to clin-

ical experiences in nursing. Nursing as a discipline,illustrates how ethical sensitivity is deeply linked tointuitive expressions of vulnerability. Therefore I pre-sume that a Levinasian ethics can contribute tounderstanding the basic ethical intuitions that shapenursing practice.

From what has been said so far then, there are twoessential questions for a moral metaphysics toanswer. First, how can moral value be conceived inthe first place, if it is not cognitive, i.e. represented inreflective consciousness? Even further, how can oneconceive of a pre-reflective intentionality in whichconsciousness is paralysed by the affect, by the vul-nerability of another person? How can we conceiveof an upheaval beyond reflective consciousness thatis the origin of an ethics?

Intentionality and sensibility

According to Edmund Husserl, intentionality is theway in which consciousness operates as a meaning-ascribing way of always seeing facts in the world

as

something

, i.e. invested with meaning. Consciousnessis relational

sui generis.

When Husserl developedBrentano’s thesis of intentionality, it soon becameclear to him that intentionality is the relational rep-resentation of the objective world by subjectivity. Inother words, intentionality describes how the objec-tive world, constituted as a meaningful reality, pri-mordially relates to human subjectivity and howconsciousness is representational, i.e. conceptualizingand interpreting what is present to it. Human con-sciousness is always the constant flux of meaningascribing activity.

Husserl did more than elucidate the theoreticalintentionality of consciousness, however. He also illu-minated a non-theoretical and sense-forming inten-tionality created by impression (Drabinski, 1999).This impressional sense, or sense-forming intuition,he argued, is not the same as the reflective act ofconsciousness in its formation of intentions. Aestheticand ethical attitudes displayed in human conscious-ness are of a different kind. Husserl says: ‘Thus wearrive in each case at pregiven objectivities which donot spring from theoretical acts but are constituted inintentional lived-experience imparting to them noth-

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ing of logo-categorical formations’ (Husserl, 1998, p.9). Also, ‘We find those sensuous moments (pleasure,pain, tickle, sensations) [Husserl’s examples] overlaidby a stratum which, as it were, ‘‘animates’’, which

bestows sense

(or essentially involves a bestowing ofsense) – a stratum by which precisely the concreteintentive mental process arises from the

sensuous,

which has in itself nothing pertaining to intentionality

(Husserl, 1982, p. 203)

.

The American philosopher John Drabinski (1999,p. 57), in a recent book on the influence of Husserl inLevinas’ ethical philosophy, argues that it is impor-tant not to comprise these affective attitudes with thereflective attitude of consciousness:

This peculiar sort of intuition grasps desire or sentiment as

the feeling itself, and therefore does not grasp such modal-

ities under the reflective activity of judgement. Reflective

judgement is improper; it compromises the living immediacy

of desire or sentiment. The reflective disposition fails to

consider desire as desire, sentiment as sentiment.

Husserl, as early as

Logische Untersuchungen

(Husserl 2000), recognizes the role of impression inoriginating consciousness and develops his idea ofphenomenological time being constituted by impres-sion, a primary impression, a

now

that originates con-sciousness. Levinas (1998, p. 77) comments on this:

The origin of all consciousness is a primary impression,

an ‘

Urimpression

’. But this original passivity is at the same

time an initial spontaneity. The primary intentionality in

which it is constituted is the present. The present is the

outflow of mind itself, its presence to itself. But it is a pres-

ence that does not bind it; the impression passes. The

present is modified, loses some of its acuteness and actuality,

and is only retained by a new present that replaces it, and

that in turn moves away and remains attached, in a new

retention, to a new present. This retention is also an inten-

tion. It thinks the moment, as it were, which it retains at the

edge of the past into which it is about to sink, to be subse-

quently found again by memory, and it identifies that

moment with self-evidence. Thus, duration, which is renewal

and freedom in each of its instants, is constituted. The mind

is already free vis-à-vis its outflow. It is open onto the future

through a protention – as Husserl calls it. Thus, time is not

a form which consciousness assumes and that comes from

the outside. It is truly the secret of subjectivity itself, the

condition for a free mind. Like intentionality directed upon

a transcendent object, time expresses freedom itself.

Levinas discovered the idea in Husserlian phenom-enology of a pre-reflective intentionality, named byHusserl axiological intuition (Drabinski, 1999). In hiscommentary on Husserl’s

Ideen II

, Levinas discov-ered the potential for developing this Husserlian ideaof a primal impressional sense into an ethics. Heargues that ethics breaks with Husserl’s thesis ofintentionality altogether. Levinas’ idea is that theencounter with vulnerability surely calls for reflec-tion, but reflective intentionality is always too late onthe scene. When reflection starts, what motivatesreflection has already ceased temporal existence.Thematizing

erlebnis

‘originates before the moment Iintentionally focus my attention on the object’(Zahavi, 2001, p. 132). For Levinas, this primary inci-dence, of being shaken,

the Urimpression

, can be con-ceived neither as a pre-reflective act, nor as amovement within consciousness. For Levinas thecharacter of value comes from a specific attitude out-side consciousness altogether, a vulnerability for theother person that is straightaway irreducible toknowledge.

Here there is a Husserlian possibility

which can be developed beyond Husserl himself

(Lev-inas, 1992).

As Husserl himself claims in

Ideas II

, the sensationin its primal functioning affects the Ego as foreignand is thereby fundamentally and originally pre-given. The

affecting

moment of the sensation pre-cedes its givenness (Husserl, 1998). The givenness ofthe primal sensation in lived-experience is thenmerely a

clue

to what has already passed. The possi-bility of a language for describing this ‘already passed’lies in the phenomenological reflection on time andgenesis, and it is this problem that Levinas turns to(Drabinski, 1999).

While for Husserl in his philosophy of time-consciousness (Husserl, 1964), the primal impressionis retrievable within the retentional-protentional

1

flow of consciousness, Levinas takes the ethicalimpressional

now

to be outside the living presentaltogether. It is anterior to retention and hence pre-phenomenal. The primary impressional sense of oth-

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erness is always absent, it is only as a trace it renderspresent. The relation or passivity is prior to and con-stitutive of the phenomenal relation that structuresand makes possible the initial presentational clue(

Leithafen

) (Drabinski, 1999, pp. 201–202).To state this point more precisely: Husserl

addresses what encounters the subject as part of livedexperience. According to Levinas, however, ethics asan experience of otherness, of alterity, is a peculiarsort of

wahrnemungen

irreducible to experience, anexperience that is beyond experience, i.e. alien toconsciousness itself. It is here that Levinas breakswith Husserl. Husserl always sees the experience, alsothe non-thematizing, non-reflective act of conscious-ness prior to the reflective act, as part of intentional-ity. Levinas, on the other hand, places the ethicalexperience of otherness (alterity) outside intentional-ity in total. Ethics is what grips hold of you, withoutthe source of this affection ever being a mode ofrepresentation, a theme (Levinas, 1996).

Levinas will surely agree that to be moved byanother person’s pain means to be shaken by his pain,that his vulnerability in some sense reveals one’s ownvulnerability. But this might seem like a rather trivialpsychological fact. The important question to answeris: What does this fact of relational vulnerability tellus about the origin of moral obligation? According toLevinas it is in this time-gap between the upheavaland intentionality that ethics takes place. Ethics is aparalysis of consciousness created by the intrusion ofotherness, and it is in investigating this relationbetween impression (when consciousness in a primor-dial receptivity is marked by the vulnerability of theother) and intentionality that ethics must be under-stood (Drabinski, 1999).

It is in this move of primordial awareness thatNagel’s question about the sources of morality can beaddressed properly. This answer is metaphysical. It isnot because you understand what it means foranother person to have pain that you are pained byhis pain. Painfulness is originary here. You can neverbe alert to the pain of another person if his pain doesnot affect you in a primordial sense. The feeling ofpain in you by the pain of another person’s body doesnot reflect an activity within reflective consciousness.Levinas would say that reflection presupposes a con-

sciousness that already is accused and made respon-sible in its sensibility. Sensibility itself in the upheaval,reflects a consciousness that is paralysed, passive andlaid open to an assignation. It is in this passivity ofconsciousness that ethics is born. It is a passivity inwhich sensibility is possible and the other person iswelcomed.

The primordiality of the ethical sense

Levinas’ bold claim is that ethics cannot be reducedto comprehension (Critchley & Bernasconi, 2002).We have the idea that consciousness is affected with-out the source of affection possibly becoming a rep-resentation. How can this be possible? Here, Levinastalks about a peculiar form of human experience. TheEgo is not conscious about itself in an experience thatis not an autonomous experience, but is what Levinasinstead calls a

heteronomous

experience. Heterono-mous experience is an experience without the contentof the experience being known to the subject orreturning to the subject’s intentional efforts (Drabin-ski, 1999). It is an experience of radical alterity, orwhat Levinas in later works also calls radical absence(Levinas, 1991a).

But how can the other who addresses the subjectbe a source of affection without this affectionbeing known, i.e. being representable within con-sciousness, being a theme? How can the encounterwith the other become an ethics if this otherness isincomprehensible?

Here it is essential that Levinas speaks about oth-erness as infinity and later in

Otherwise than Being

,as vulnerability. Levinas draws excessively on an ideain Descartes’ third meditation, the idea of infinity

1

Central to Husserl’s philosophy of time is the idea of a primal

impression, the now, that stretches into the past as well as the

future. The impressional now is also already a past, but a past

that still is retained in consciousness as a now (retention).

Similarly with protention, which is the future anticipation of an

event, of the new now anticipated within the already past hap-

pening. Of course Husserl sees this flow of present modified by

future (protention) and past (retention) as the constant flux,

flow of consciousness (Husserl, 1964).

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(Levinas, 1996). According to Descartes we have ininfinity an idea that exceeds the thought that thinksit. To think infinity is to think the unthinkable. Theidea of infinity transcends human comprehension, hasits source outside being, is

Otherwise than Being.

Butwhile Descartes locates the sources of infinity in God(because it is only a divine person who can haveplaced this thought of infinity in the human person),Levinas locates infinity in the face of the other per-son. To encounter the face is to encounter alterity, aparticularity that escapes any comprehension. To seea face is to gaze into infinity. The face is more thanthe expression of the eyes, the wrinkles in the fore-head. It is more than the totality of its expressiveparts. Rather the face is a pure expression that over-whelms consciousness. The nudity of the face, itsexpression of vulnerability, shatters the subject, beinga power without power, the ethical power (Levinas,1996). This expression of vulnerability makes the Ivulnerable for the other’s vulnerability. The face is animpression of infinity, a manifestation of responsibil-ity, without this manifestation being assumed by cog-nition. One can never fully comprehend what it is thattells us to be responsible for the other person. Thetrue source of ethics then, is not cognition, under-standing (

erkennung

), but recognition, respect(

anerkennung

) (Critchley & Bernasconi, 2002).This experience of alterity, of otherness in the

other, is for Levinas an experience with radical impli-cations, because it means the detronization (defeat)of egoism. The cognitive and representational impe-rialism of the Ego is rejected. In the ethical impres-sion, in the encounter with the Other, consciousnessand egoism loses its first place, the I is paralysed,passive, addressed, accused.

Ethics is the awakening of subjectivity in the absence

of interpretational consciousness.

In the ‘here I am,take care of me’, the subject becomes an I. Subjectiv-ity is born in responsibility. Ethics for Levinas is whenthe subject loses his grip on the world, being appealedto by the other. Ethics is the awakening of conscious-ness in the concrete experience of vulnerability. Eth-ics is the traumatic awakening of a consciousness nolonger for itself, but before the other. The only wayto know the otherness of the other, this always incom-prehensible otherness, is by taking responsibility for

the other person. In the foreword to

Otherwise than

Being

, Alfonso Lingis (1991a, p. xviii) says thatordinarily:

The sensibility affected by alterity is not that sensibility,

where identification is already at work. Precisely alterity is

the unidentifiable. Its sense is the unilateral direction of an

approach, caught in a being ordered, an obedience.

It is the idea of infinity shown in the face then,which makes it possible for Levinas to explain anaffection that is truly ethical and that only can beunderstood as unconditional responsibility for theother person. But why is this kind of

hetero-affection

(as Levinas calls it) bound to be understood ethically?The answer to this question is best explained in per-haps Levinas’ most important and certainly most dif-ficult work

Otherwise than Being or Beyond Essence

(Levinas, 1991a).

Sensibility and the passivity of consciousness

In this work Levinas articulates ethical sensibility ina non-ontological and expressive language. He triesto answer an important critique from Derrida in theaftermath of publishing

Totality and Infinity.

Derridacritiqued Levinas for articulating an ethics thatattempts to break with ontology, but does so withinthe framework of ontology itself (Derrida, 1997). Inanswering this critique, Levinas now attempts todescribe the non-objective, non-theoretical and sen-sual aspects of ethics. He seeks to articulate the eth-ical

saying

, the non-thematizable event of being in amovement from oneself to the other, of being shakenwithout the source of affection ever being a theme forconceptualization:

Saying is the reason why it is difficult to remain silent/indif-

ferent in the proximity of the other, even of strangers. Say-

ing is explained as a primordial openness to the other upon

which the other forms of language are grounded. Saying is

also held to be passivity

par excellence

, the openness of the

subject towards the other, the abstention of the subject,

the postponement of judgement, my dedication to

otherness. (Paulsen, 2002, pp. 181–182)

In Levinas’ own words:

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Saying is this passivity of passivity and this dedication to the

other, this sincerity. Not the communication of a said, which

would immediately cover over and extinguish or absorb the

said, but saying holding open its openness, without excuses,

evasions or alibis, delivering itself without saying anything

said. (Levinas, 1991a, p. 183)

In

Otherwise than Being,

ethics is this vulnerabilityfor the suffering of another, his naked skin, his desti-tution. Ethics traumatizes consciousness of the Ego,and in its awakening speaks about a time before itsbeing. The human subject in the ethical encounter isaccused by the other, assigned by him, made respon-sible beyond imagination, even for its own responsi-bility. Levinas speaks about the birth of subjectivity,in which the sensible subject is awakened by the otherand constantly thrown back on itself.

What we have is an idea of something that breakswith the constant flow of reflective and interpreta-tional consciousness. We have an idea of a sensationalimpression, not captured by cogito but which stillaffects consciousness. Returning to Nagel then, thepain of ethical awareness is the pain that creates theawareness. This pain is an impression best describedas the passivity of consciousness, described by Levi-nas as a passivity more passive than the passive. Thisis not a passivity that is intended or originates fromthe Good Will (Kant, 1964), but a passivity that isvulnerability itself. This relation to the other is notepistemic in character. It is a relation in passivity inwhich consciousness is paralysed, set out of play,made quiet and set outside the constant flux of time.The event of ethical impression can never be retainedin consciousness because it has never been intention-ally grasped. Therefore Levinas in his later worksarticulates the ethical impression in words of a trace.The other passing by or encountering is only markedas a trace of what has never been present. The ideaof

trace

can best be understood by conceiving of animpression striking the subject without ever beingmodified by intentional consciousness. Levinasspeaks about the trace as an absence of what hasnever been present within consciousness, somethingpointing back to diachronic and immemorial time, atime pointing back to the prehistory of the Ego. Thistime is a time of sensibility:

This responsibility accrues to a subject that is marked, at the

deepest level of its experience, by its sensibility, which brings

into the other’s proximity, or by its vulnerability with respect

to the other. This vulnerable sensibility is thus an affectivity

that is already inhabited by the other, and delivered up to

the other. (Berget, 2002, p. 90)

Levinas is here in great debt to the Platonic ideafrom

The Parmenides

dialogues about the Good thatis beyond being (Plato, 1997). The Good transcendshuman consciousness. Moral obligation is found in aprimordial sensibility in which the I never can recap-ture or comprehend the sensual object, the face in itsvulnerability. It is therefore that Levinas speaksabout sensation-time as a time before the Ego, the Ibeing responsible before it is even conscious of itsown responsibility.

Body, sense and ethics: implications for nursing

Here we have an idea that ethical subjectivity asresponsibility for the other is composed by theexposed and vulnerable body and the singular mate-riality of the face of the other (Drabinski, 1999, p.213). Recent thinkers on Levinas find in the Levina-sian idea of vulnerability for the other person a pri-mordial ethical sense, which is located in a non-verballanguage of bodily expressions (Levine, 1999; Man-ning-Scheffler, 2001).

Levine (1999, p. 279) for instance says:

What I think he means is that obligation first takes hold of

us bodily – in the flesh – in a time that is, at each and every

moment, i.e. both synchronically and diachronically, prior to

thematizing consciousness, prior to reflective cognition, and

therefore prior to the ego’s construction of a worldly tem-

poral order.

The ethics of Levinas is concrete in how it locatesthe moral imperative in corporeal expressions of vul-nerability, the nudity of human destitution displayedin the eyes of the human other. Levinas argues thatethics actually locates the moral imperative, theimperative of unconditional moral value in sensibil-ity: a sensibility awakened by an alterity shown up in

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the concreteness of the face being an expression notof finitude but of infinity.

It is essential to say that the ethics of Levinas isneither a moral psychology nor an articulation ofmoral reasons. Rather than seeking an ethics, it seeksthe sense of ethics. Ethics in the Levinasian sensedoes not focus on how moral consciousness reliesupon a direct perception of value as in empathicvision (Vetlesen, 1994) or discovers the moral imper-ative within the constraints of human reason (Kant).Rather it seeks the sense of ethics in how humanconsciousness when encountering the infinite meetsthe limits of reason, the limits of its representationalimperialism.

But how does ethics originate outside the limits ofhuman reason, when the other, not as a concept or atheme, but as an enigma, shatters the Ego and subor-dinates it to infinite responsibility for the other per-son? The key ethical issue here is that consciousnessloses its ‘first place’. The controlling and dominatingforce of human consciousness trying to reduce allotherness, and infinite particularity to conceptualunderstanding (what Levinas calls the Same) is calledinto question.

The ethical shows up in the fact that the

human other knows that otherness can only be com-

prehended as obligation and hence as responsibility, as

ethics. This is the fundamental core of a Levinasian

ethics.

Still this otherness, this infinite particularity thataddresses the moral subject, has empirical connota-tions. This enigma of ethics is carefulness itself. Care-fulness in nursing is this concrete manifestation ofbecoming vulnerable by another person’s vulnerabil-ity. Being shaken by another’s subjectivity as condi-tional for understanding the human impact of hisexperience is the issue here (Nortvedt, 2001). I haveargued elsewhere that the clinical encounter is mor-alized by the concrete encounter of vulnerabilities,that an awareness of a patient’s vulnerable body is avulnerability itself, a vulnerability that modifies andhumanizes the clinical encounter. Touching an injuryis not merely the senseless and distant reflection ondestroyed and bleeding tissue. It is also profoundly anaffection, revealing ethical significance

.

The careful-ness when the hand touches the wound and whenobserving its structure signifies an inhibition. The

inhibition present in the skilful touch of the nursewho dresses the wound is an ethical inhibition whichsays: ‘Do not hurt, be careful!’ ‘Do not cause unnec-essary pain!’ Ethical responsibility has a phenomeno-logical background in the way the nurse clinician ismoved by the reality in the patient’s condition(Nortvedt, 2001).

In hospital care, in many cases, the patient’s sub-jective experience in itself is not seen as an indepen-dent reason influencing medical treatment. Thereseems to be a reduction of subjectivity to measurablesigns, discrediting the validity of subjective experi-ence itself. The medical objectification of illness tendsto discard subjective experience as a valid reasonitself for care and treatment and as an ethical reasonitself. It is this understanding of subjectivity as vulner-ability, a sensibility in which you are shattered by theother’s vulnerability and try to understand and accepthis subjectivity, which Levinas seeks to understand asthe primary ethical event. It is in the concrete affec-tion of the particularity of the other that ethics isborn. Levinas tries to give a plausible philosophicalexplanation of this event. In nursing we see this as theprimary fact of the clinical experience, when you areshaken by the stiffness of the aching body, when youare worried about the redness of the wound orexcited by the joy of recovery. It is in this movementof being affected by clinical experiences not merelyas pathophysiological facts but as concrete vulnera-bilities that careful nursing is shaped and the clinicalencounter becomes a concrete awareness of theother’s humanity.

Husserl’s main concern was to understand theenigma of subjectivity and how subjectivity as inten-tionality is a manifestation of how knowledge is rela-tionally constituted. Levinas develops an ethics inwhich it is the particularity of the other person thatis the sovereign source of subjectivity, obligation andhence humanity. To be sensible to the subjectivity andotherness of the other person is then the

sine qua non

of humanity and also the basic foundation for a caringservice such as nursing. The intricate metaphysics ofLevinasian ethics can teach us the lesson that sensi-bility is vulnerability itself and that it is this vulnera-bility for the other person’s vulnerability thatestablishes and fuels the caring relation itself. Ethics

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is the awakening of consciousness in the suffering ofanother’s suffering.

This fact of affective intentionality is what origi-nates the moral predicament of clinical nursing. It isalso this bodily felt sympathy and upheaval that spon-taneously induces intuitive careful and attentivebehaviour so central to good nursing, and it is alsothis affective awareness, what Levinas calls the rup-ture of the subject’s equilibrium, passivity, wakeful-ness and vertigo induced by emotion, which refinesclinical sensitivity and clinical observations.

‘Emotion puts into question not the existence, butthe subjectivity of the subject; it prevents the subjectfrom gathering itself up, reacting, being someone.What is positive in the subject sinks away into anowhere. Emotion is a way of holding on while losingone’s base’ (Levinas, 1992, p. 121).

In the end, it is this gathering up of subjectivity, ofoneself in front of the experiences of alterity (theOther), of losing one’s base while holding on that isthe true wonder of enigmatic humanity, expressed inour fragile ability to care for the other human being.

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