May 2024. Paquita de Zulueta
Human Values and Humanity in the 21st Century
What do we mean by ‘values’?
What do we mean by ‘values’?’ Values give life meaning and purpose: what really matters. They motivate us. Our values engage both emotions and cognitions – “heart, mind & soul”. They are ‘discovered’ during our lived experience. We become aware of them at important junctures of our lives – those ‘moral moments’ when we have to make a difficult decision that may be of profound importance to ourselves and to others, that define what kind of person we truly are. Values are usually reflected by what we do, not what we say. They are deep seated, but amenable to change. Shared values bring people together in a spirit of solidarity and can sustain and support collective wellbeing. When values collide, disharmony and even violence may ensue. Yet often in situations of conflict, peace can be accomplished by discovering and drawing upon common values. When individuals are working or living in an environment antithetical to their core values, this creates a sense of alienation and distress and undermines their flourishing.
Human Values and Human Rights:
The human values that we in the HVHF support include compassion, integrity (authenticity and honesty), inclusivity, wisdom and justice. Underpinning these is the belief that human beings carry inherent worth and dignity. Human values are closely linked to human rights. Shami Chakrabarti gives us a detailed analysis of this linkage in a Tanner lecture ten years ago. The preamble to the 1948 Declaration of Human Rights expresses this linkage:
Whereas recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world.
Martin Luther King in 1967 gave a powerful speech urging for social and racial justice and the end of war. He advocates for a new political and economic system – ‘a new life for mankind.’
I am convinced that this new life will not emerge until our nation undergoes a radical revolution of values. When machines and computers, profit motives and property rights are considered more important than people, the giant triplets of racism, economic exploitation and militarism are incapable of being conquered. A civilization can flounder as readily in the face of moral bankruptcy as it can through financial bankruptcy.
Values in healthcare and why they matter:
The late Aidan Halligan, a compassion champion and surgeon, wrote an article (findable in our ‘resources’ page) in 2008 on the importance of values in healthcare. He proposes that the attitudes of kindness, caring, good communication, honesty, reliability and trust are built on critical personal values, but these are being eroded by the preoccupation for scientific medicine and bureaucratic targets. Presciently he says that unless there is an ”unequivocal commitment to a clear set of mutually accepted shared values, organizations tend to become unhinged during stress.” This preoccupation on targets, with the concomitant neglect of patient care, was commented on in the Mid-Staffordshire NHS Foundation Trust Public Inquiry report (the Francis Report) in 2013 following the hospital scandal: “Finances and targets were often given priority without considering the impact on quality of care.” (p.65).
A large study in New Zealand by Pavlova et al. in 2023 shows how working in value-discrepant environments inhibits clinicians’ ability to provide compassion and reduces well-being. The researchers also found that a correlation with increased burnout, absenteeism and early retirement intention. This led to lower productivity, higher costs and worse patient care and outcomes. Other studies have shown similar results.
The conclusion is that organisations have to ensure that the values that they purport to support are actually enacted – not just empty slogans. Leadership, and in particular compassionate leadership, is crucial here.
The value of Relational vs Transactional care:
Compassion is inexorably relational and relational care is valued both by health professionals and by patients. It is not unidirectional either but flows between and within people. There is real concern, backed by evidence, that the trend is towards industrialised, bureaucratised, transactional care, with ‘remote’ encounters becoming more the norm .
General practitioners (GP’s) are particularly aware of the value of relational care and in 2021 the Royal College of GP’s brought out a document entitled The Power of Relationships: what is relationship-based care and why is it important? General Practice and COVID-19 recovery. In the foreword, Professor Martin Marshall tells us:
“Yet the evidence for the benefits of trusting relationships is compelling – better patient experience, better adherence to medical advice, fewer prescriptions, better health outcomes, better job satisfaction for doctors and even fewer deaths. Indeed, the relationship between a patient and their GP is as important as a scalpel is to a surgeon. If relationships were a drug, NICE would mandate their use.”
Many other GP’s (primary care physicians) in the UK as well as other countries call for a holistic, compassionate, relationship-based care and reflect how modern healthcare is undermining this. For example, Carl Rudebeck in Sweden, Michelle-Lynh Nguyen and Victor Montori (founder of the Patient Revolution and a champion for ‘kind and careful care’) in the USA. Also in the UK, Iona Heath in her book The Mystery of General Practice and in her many articles, and more recently Rupal Shah (core team member of the HVHF) and Jens Foell in their book Fighting for the soul of general practice – the algorithm will see you now, all make the same urgent plea for more humanity and less bureaucracy. Nurses are also strong advocates for relationship-based care and caring relationships.
Unfortunately the widely used term ‘value-based healthcare’ defines ‘value’ in health care as “the measured improvement in a person’s health outcomes for the cost of achieving that improvement.” This depressingly utilitarian quantitative concept only focuses on the ‘measurables’ and does not reflect the values (often not measurable) that we are concerned about.
Linking values, moral injury and burnout:
Moral injury, a term originally coined in the military context by Jonathan Shay in 2002, occurs when we perpetrate, bear witness to, or fail to prevent an act that transgresses our deeply held moral beliefs – in other words, our values. Surveys show that high levels of burnout in the healthcare professions is a global crisis, particularly after the pandemic. But viewing burnout as a disease and/or as an individual failure (not ‘resilient’ enough) prevents one from addressing the organisational issues that cause it. As Montgomery and colleagues point out in their article Burnout in healthcare: the case for organisational change “The problem is not the workforce but the way that the environment is becoming toxic.” Wendy Dean and colleagues go further and argue that clinician distress is moral injury, not burnout. They describe moral injury as “the challenge of simultaneously knowing what care patients need but being unable to provide it due to constraints that are beyond our control.” Differentiating between burnout and moral injury is important as it reframes the problem and the solutions. “Moral injury locates the system in a broken system, not a broken individual”… addressing the drivers of moral injury on a large scale may be the most effective preventive system for its cumulative effects among health care providers.”
Is the dominance of the left hemisphere’s values in today’s world threatening human values (and humanity)?
Broadening the scope – the polymath psychiatrist, neuroscience researcher, philosopher and literary Scholar Iain McGilchrist in his book The Master and the Emissary, and later in his weighty tome The Matter with Things, argues persuasively that the dominance of our left brain (left hemisphere), rather than the required subservience to the right, has led to an ‘inversion’ of our values with disastrous consequences. The hemispheres have a different kind of attention, both necessary for survival, but mutually incompatible. The right brain has a broad attention and views the world in context, interconnected and as a whole, yet receptive to the unique. The left views the world as decontextualised, inanimate parts, to be grasped and exploited. It has a narrow utilitarian stance and sees itself as disconnected from the world. It excels in abstract, reified thought and at categorizing and schematizing. It relates best to tools and machines rather than to living things, and only comprehends the explicit rather than the implicit.
According to McGilchrist, backed up by an impressive synthesis of ancient and indigenous wisdom, philosophy, modern physics as well as neuroscience, psychology and poetry, the ‘functions’ of the right hemisphere are significantly related to imagination, creativity, intuition, the capacity for wonder, music, dance, poetry, art, love of nature, moral sense, humour and openness. Social understanding, empathy, connectedness, moral sensibility, the need for self-discipline rather than self-indulgence, embodiment, are all understood better by the right hemisphere. These underpin the values that we cherish and would wish to develop and sustain for human and planetary flourishing. In contrast, the main value of the left brain is power, and its focusis to control and manipulate the world.
“Unfortunately the left hemisphere, knowing less, thinks it knows more. It is a good servant, but a ruinous – a peremptory – master. And the predictable outcome of assuming the role of master is the devastation of all that is important to us – or should be important, if we really know what we are about.”
An interesting study by Tabore, synthesising research literature from neuroscience, psychology, sociology and anthropology underscores the corrupting effect of power.
The ‘Machine Age’
Robert Skidelsky, a distinguished economist-philosopher, also expresses his fears of the extinction of human values (and humanity) in his book The machine age – an idea, a history, a warning.
“Unless we understand technology as a system of ideas rather than a necessity, we will be powerless to choose which technology is best suited to our needs and purposes…Technology is itself inhuman… The opposition is not between capitalism and socialism, but between humans and humanity. Economic redundancy is just one aspect of human redundancy. The bigger problem arises from a mechanical philosophy which neutralizes culture and history and justifies control not just of nature but of society. Nature, including human nature, came to be seen as a machine, to be optimized. What started as a metaphor became, in the eighteenth century, a project. (P. 269).
He proposes that there is a direct link between technological utopianism and the degradation of culture. Human imperfection, he believes , creates culture. “Fallibility is a necessary feature of human nature, therefore success in ‘straightening the crooked timber’ would lead to the extinction of humanness as we know it…The Machine threatens to make infants of all those who do not control it.”
These concerns regarding human hubris and the drive to conquer the natural world were raised by the ancients in the myth of Prometheus, by the Romantic poets of the late 18th and early 19th centuries, including William Blake, William Wordsworth, and by Mary Shelley in her extraordinary novel, Frankenstein. We also see something akin to von Goethe’s fable of the sorcerer’s apprentice in the exponential rise of uncontrollable fake news, science and porn created by AI.
To quote Martin Luther King again: “But our moral lag must be redeemed; when scientific power outruns moral power, we end up with guided missiles and misguided men.”
Human values and caregiving:
We are social creatures and need good, trusting relationships throughout our lives to flourish as research has shown. We are not atomised selves. At various stages in our lives, we need to be cared for or to care for others. In this age we have mass communication and connectivity yet, as Robert Waldinger tells us based on decades of research, loneliness is a modern spectre.
The philosopher and virtue ethicist Shannon Vallor in her book Technology and the Virtues argues that if we abandon the need to cultivate the excellence of human caring – the skillful and loving service to the needs of others – we will lose our humanity.
“Once the bonds of human care are not merely frayed but severed, once our ideal ethical selves as caring beings are forgotten, ethics itself dies at the root.” (p.229)
Arthur Kleinman, the medical anthropologist, makes a passionate and eloquent plea for caregiving to be central to the practice of medicine. In his article in The Lancet 2012 entitled caregiving as moral experience he writes:
“Caregiving is one of the foundational moral meanings and practices in human experience everywhere: it defines human value and resists crude reduction to counting and costing….The great failure of contemporary medicine to promote caregiving as an existential practice and moral vision that resists reduction to the market model or the clarion call of efficiency has diminished professionals, patients and family caregivers alike.”
Conclusion:
In conclusion, those of us who cherish human values and humanity espouse a world view that resonates with that of the right brain. We find ourselves at odds with those who favour the left brain view – mechanistic, controlling, reifying, homogenising. The deep discordance creates suffering and alienation. The centre will not hold.
As humans, albeit deeply flawed, we are privileged with the mystery of consciousness, and as embodied, vulnerable creatures we are capable of transcendence and the ability to appreciate and create beauty, to give meaning to our lives and to the world, to love and to care. If we find ourselves depending entirely on machines, deifying the artificial over the natural, what happens when the machine stops as in EM Forster’s terrifying dystopian tale?
I end with a verse [Book II, v 10] from Rainer Maria Rilke’s Sonnets to Orpheus (1922) translated by Robert Temple:
The machine threatens all we have gained
Only so long as it is imagined, rather than obedient.
It no longer flaunts magnificent gestures of exquisite hesitation
But resolutely works the mine, and polishes the gem more precisely.
Nowhere does it lag, that we might for a time escape it
And leave it behind in a quiet factory oiling itself, as is proper.
It has become our Life, – and best assumes this power
When with one resolve it orders, produces, demolishes.
But still our Existence enchants us; from a hundred sources
Being wells up. A play of pure energies, which
No one encounters who does not kneel and marvel.
Words even now go forth with tenderness into the inexpressible …
And music, ever renewed, from the most tremulous of stones
Constructs in waste spaces her deified dwelling.
Paquita de Zulueta May 14th 2024.
Footnote: This text reflects my own views and was not produced in part or in whole by ChatGPT or any other LLM.