Remembering Unanswered Care: The Gate of Medicine and the Question of Humanity

Medical ethics and humanities often face two common reactions: that they explain the obvious or unnecessarily problematize issues. The former questions the need to deeply understand the 'human' element in medicine, while the latter suggests that problems are manufactured. The second reaction, in particular, prompts reflection.

Treatments inevitably involve discomfort. Medical language can be alienating, hospital tools intimidating, and the overall environment unsettling. Illness itself is painful, and the healing process cannot be expected to feel like resting at home. To then claim "modern medicine neglects patients" or "medicine is lost in technology, forgetting people" can seem like exaggerating difficulties by blaming patients or humanity. As a specialist, this feels unfair. Medical ethics and humanities do not demand that medicine do everything; they don't insist hospitals be hotels or staff always be kind. They simply ask what it truly means for medicine to serve patients.

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When faced with illness, it's often difficult to know what constitutes care for a person without resorting to medicine.

Yet, even I sometimes wonder: can medicine fully provide the care a patient awaits in a hospital? While medicine is designed for patient needs, it interacts with patients on its own terms. Can this interaction ever be truly 'human'? This leads me to recall Franz Kafka's short parable, 'Before the Law.'

In 'Before the Law,' a man from the countryside approaches a 'Law' guarded by a gate and a doorkeeper. He asks to enter but is told he cannot yet. He waits, believing permission will eventually be granted. The gate is before him, but he never enters. As he dies, the doorkeeper reveals the gate was meant only for him and will now be closed. Superficially, this is a critique of power or bureaucracy, showing how systems meant to serve individuals actually exclude them. However, this interpretation is too simple. Why was the gate there at all? The gate signifies possibility. Its existence suggests one might enter. Without it, the man might not even know the Law was calling him. Yet, the gate's presence doesn't guarantee entry. Instead, the possibility it represents paralyzes him, leaving him stuck.

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Medicine is the gate that enables care while simultaneously making care a continuous question.

Philosopher Jacques Derrida, in 'The Force of Law,' focused on this aspect, contemplating the relationship between law and justice. Law exists in statutes, procedures, and rulings, ostensibly to implement justice. Yet, we often say we seek justice *before* the law. Law does not guarantee justice. But without law, the space to demand and dispute justice disappears. The gate is not a door to a room where justice resides; rather, it is a space that continually brings justice into question. The gate, instead of promising a complete answer within the law, places us before the law, prompting questions and demanding patience.

I see medicine and care in this parable. Care is possible without medicine. But when faced with illness, it's often difficult to know what constitutes care for a person without resorting to medicine. Diagnosis names the illness, tests reveal bodily functions, and treatment intervenes in suffering. In this sense, medicine enables care. However, medicine can also hinder care. Diagnostic criteria, treatment guidelines, and clinical pathways are designed to care for patients. But they are not created for 'this specific person.' Medicine groups similar bodies, judges based on average responses, and makes decisions according to procedures. This is necessary for treatment. Yet, a part of this person's suffering always 'remains before the gate.' This means medicine, while serving patients, does not guarantee the care they request. This doesn't imply medicine is wrong. Quite the opposite. Without medicine, care would remain mere goodwill or comfort. Medicine is the gate that enables care while simultaneously making care a continuous question. Therefore, medical humanities is not a field advocating for abandoning medicine for something more 'human.' It is an attempt to ask how care becomes possible and difficult within medicine. Just as Kafka's gate places someone before the law, illness places a patient before medicine. Yet, without medicine, we cannot conceive of care for them. I call the refusal to abandon one side in this contradiction the essence of medical humanities.

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Just as Kafka's gate places someone before the law, illness places a patient before medicine.