Insights (Essays)

Insights (Essays) November -0001

Mensch Ethics

Neil Seeman

With Father's Day in our home comes talk of what makes a Mensch. A friend was sporting a Mensch T-shirt: "You open doors, walk old ladies across the street, and donate 10% of your salary to charity. There's a word for men like you - Mensch".

One company sells a "wooden mini baseball bat that reminds him with every stroke that he's a Mensch." Menschlichkeit is Yiddish for moral sensibility, or, simply, "being a good person." So I've been thinking about Menschlichkeit in parenting and in healthcare - both rewarding, if at times challenging, service professions.

Most of us think of healthcare ethics as morals encapsulated in four injunctions: "Do unto others as you would have them do unto you." "Do no harm." "Don't impose your values on others." "Treat everyone equally." Bioethicists speak of the principles of beneficence, nonmaleficence, autonomy, and justice. Beneficence is considered paternalistic nowadays; autonomy has assumed pride of place.

Yet another way of looking at ethics is not through the lens of principles but through the intentions of the doers - good means leading inevitably to good ends. Well-intentioned healthcare providers can, of course, make mistakes but if they are virtuous - kind, truthful, compassionate, selfless, dedicated to their craft - then their actions are more likely than not to lead to good.

Aristotle and the Mensch

So-called "virtue ethics" has much to recommend it. These are Aristotle's virtues: courage, moderation, generosity, pride, gentleness, agreeableness, truthfulness, and wit. Aristotle enumerated five intellectual virtues: knowledge, art, prudence, intuition, and wisdom. Prudence, or phronesis, meant behaving according to the golden mean. I always found Aristotle a tough slog, but I figure he was basically talking here about being a Mensch. We all know a Mensch when we see one: an individual to whom we turn for sound advice. By corollary, those who believe themselves to be wise seldom are, since being a Mensch demands humility.

To be a Mensch is also to help others without expectation of payback. How might this work in healthcare? My research scan bore little fruit. Begun in 1900, the Workmen's Circle in New York has as its longtime motto: "Hamishkeit, Varemkeit, Menschlichkeit" - which has been translated to "hominess, warmth, and humaneness." This is the only formal organizational reference I could find.

So: To consider how Menschlichkeit might be operationalized in healthcare, I turned to a specific example - mental illness.

Mental Illness and Menschlichkeit

One in five Canadians experiences a form of mental illness at some point during their life. Last summer, the Canadian Medical Association commissioned an attitudes survey in which several thousand Canadians took part. It showed that only one in 10 would be willing to have a GP with a mental illness; only one in three would hire a landscaper with a history of mental illness. Only half of respondents indicated that they would even socialize with a co-worker with a mental illness. This means that people need to keep their experience of mental illness a secret because others will back away, not to speak of offering any support. In 2004, a survey of working Canadian women with a history of mood disorder indicated that they saw their mental health issues as greater barriers to career success than pregnancy, raising children, sexism, or the obligation of caring for elderly relatives.

The Limits of Aristotle

So commonplace are the stigma and sting of mental illness - touching every Canadian family - that we should all, in response to this manifest suffering, nurture patterns of thought and behaviour that are virtuous. But most of us do not possess the devotion and dedication of a Florence Nightingale or a Norman Bethune, and, even if we aspire to that, Aristotle doesn't help us get there.

In a chapter on ethics in the Canadian Health Law Practice Manual (edited by Mary Jane Dykeman), Laura Shanner notes that "Aristotle's advice is tautological: the right actions are those done by virtuous people, and we can recognize virtuous persons as those who reliably do the right thing."

So what do we do? How do we set better examples for our children? Or instill a culture of Menschlichkeit? Maybe the T-shirt slogan can teach us what Aristotle couldn't. Open doors for those under your care, walk in their shoes, and donate 10 percent of your time to random acts of kindness. There's a word for you - Mensch.

About the Author(s)

Neil Seeman is Director and Primary Investigator of the Health Strategy Innovation Cell at Massey College, University of Toronto.

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