In this article, the author examines the undervaluation of caregiving—taken to be the day-to-day provision of material and emotional support necessary to enable life and alleviate suffering—in contemporary biomedical training and practice. Taking a crosscultural approach, the author highlights the institutional structures, practices and values that support an increasingly technocratic and bureaucratic model of care in biomedicine as it is organized in China and the United States. Drawing from personal experience as caregiver to his wife, who suffers from Alzheimer’s disease, as well as from ethnographic research into local moral experiences of illness, suffering and healing in varied contexts, the author shows that this biomedical model of care fails to attend to the basic, socially grounded conditions, needs and concerns of—that which matters most to—patients and their loved ones as they suffer, endure and confront the genuine existential reality of the human condition. The author concludes that caregiving, or recognizing and addressing those conditions, needs and concerns that shape suffering and illness experience, must be a central component of training and practice if clinicians are to realize a more humane, just, and ethical model of biomedicine. He points to the success of global health leaders who simultaneously address the local biological, socio-structural and cultural facets of suffering among the world’s poorest to illustrate what can be accomplished when biomedical practitioners implement the caregiving model.
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This essay builds on work by medical social scientists and humanists as well as critical theorists and practitioners of medicine. Cited references and other salient publications include:
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This is a revised version of the Cleveringa Lecture I delivered at University of Leiden in November 2007.
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Kleinman, A. Caregiving: Its Role in Medicine and Society in America and China. Ageing Int 35, 96–108 (2010). https://doi.org/10.1007/s12126-010-9054-3
- Medical humanities
- Local moral
- United States