Responsibility and otherness: ethics in healthcare in Jonas and Lévinas

Abstract

Healthcare practice faces challenges that go beyond the clinical and biomedical sphere. Despite technoscientific advances, resource scarcity, barriers to access, asymmetric power relations, and lack of humanized care persist, creating tensions in ethical practice. Overcoming such dilemmas requires not only investments, but also ethical, reflective, and socially sensitive professional training. In this context, this study analyzes how Hans Jonas’s ethics of responsibility and Emmanuel Lévinas’s ethics of otherness provide ethical knowledge to guide healthcare practices. First, their philosophical conceptions are presented; then, these frameworks are applied as ethical knowledge in care practices. It is concluded that both proposals broaden the understanding of professional responsibility, fostering more humanized, committed, and attentive practices toward the recognition of the other, transforming not only actions, but also the very way healthcare professionals relate to life.

Keywords:
Ethics; Moral principles; Humanization of assistance; Bioethics

Resumo

A prática em saúde enfrenta desafios que ultrapassam o âmbito clínico e biomédico. Apesar dos avanços tecnocientíficos, persistem a escassez de recursos, barreiras de acesso, relações de poder assimétricas e falta de cuidado humanizado, elementos que tensionam o exercício ético. Superar tais dilemas exige não apenas investimentos, mas também formação profissional ética, reflexiva e sensível às complexidades humanas e sociais. Nesse contexto, a pesquisa analisa de que modo a ética da responsabilidade em Hans Jonas e a ética da alteridade em Emmanuel Lévinas oferecem um saber ético para orientar práticas em saúde. Primeiro, são apresentadas suas concepções filosóficas; em seguida, aplicam-se esses referenciais como saberes éticos no cuidado. Conclui-se que ambas as propostas ampliam a compreensão da responsabilidade do profissional, favorecendo práticas mais humanizadas, comprometidas e atentas ao reconhecimento do outro, transformando não apenas ações, mas o próprio modo de ser do profissional de saúde diante da vida.

Palavras-chave:
Ética; Princípios morais; Humanização da assistência; Bioética

Resumen

La práctica en salud enfrenta desafíos que trascienden el ámbito clínico y biomédico. A pesar de los avances tecnocientíficos, persisten la escasez de recursos, las barreras de acceso, las relaciones de poder asimétricas y la falta de atención humanizada, elementos que tensionan el ejercicio ético. Superar tales dilemas exige no solo inversiones, sino también una formación profesional ética, reflexiva y sensible a las complejidades humanas y sociales. En este contexto, la investigación analiza de qué manera la ética de la responsabilidad de Hans Jonas y la ética de la alteridad de Emmanuel Lévinas ofrecen un saber ético para orientar las prácticas en salud. En primer lugar, se presentan sus concepciones filosóficas; posteriormente, estos referentes se aplican como saberes éticos en el cuidado. Se concluye que ambas propuestas amplían la comprensión de la responsabilidad profesional, favoreciendo prácticas más humanizadas, comprometidas y atentas al reconocimiento del otro, transformando no solo las acciones, sino también el propio modo de ser del profesional de la salud frente a la vida.

Palabras clave:
Ética; Principios morales; Humanización de la atención; Bioética

In daily medical practice, healthcare professionals deal with life and death dilemmas, suffering, pain, anguish, diagnostic uncertainties, institutional pressures, lack of resources, and work overload, among others. Facing such situation requires resorting to a set of technical and scientific knowledge, but also to ethical knowledge that guides them in decision-making, in providing care to others, and in preserving human dignity in contexts of high complexity and vulnerability. While technique indicates the “how,” ethics seeks to understand the “why” and “purpose” of acting, so as to guide health professionals toward a practice that is responsible and respectful to each patient’s history. Thus, ethics represents not just a complement in healthcare practice, but a true foundation, since all healthcare relationships are ethical acts.

When tracing in human history the most necessary virtues to face the greatest challenges of each historical period, it can be said that responsibility as a virtue has not played a significant role in the history of ethics and moral theories as a whole. This is mainly due to responsibility having never constituted an effective element in the constitution of the will, as its space was occupied by other virtues and feelings, such as love, respect, solidarity, and charity, which in Western culture can be summarized in the commandment “love your neighbor.”

However, in the context of the great technoscientific possibilities of the globalized society, capable of major achievements and interventions on life through the use of technique, responsibility has come to occupy a special place on the scale of values that are indispensable to our times. The power to transform and manipulate fundamental aspects of life, such as birth, health, death, and suffering, requires adequate ethics capable of guiding these actions.

In his major work, The Imperative of Responsibility: In Search of an Ethics for the Technological Age, Hans Jonas ¹ (1903–1993) gives the virtue of responsibility a central place in contemporary ethical reflection for the care of future human life and the biosphere in the face of increasing human power through technical advancement.

With the proposal of the ethics of otherness, Emmanuel Lévinas ²,³ (1906–1995) argues that care and responsibility for the other are inseparable dimensions, deeply articulated in his works Totality and Infinity and Otherwise than Being or Beyond Essence. According to the author, it is not possible to think of care without simultaneously assuming ethical responsibility for the other, just as all responsibility for the other person presupposes, first, a gesture of care.

Considering the need for ethical knowledge to guide healthcare practice, as protocols or standards are insufficient, this study seeks to analyze how Jonas’s concept of responsibility and Levinas’s concept of otherness can provide ethical knowledge to healthcare practice. This is an exploratory and analytical bibliographic research. The text is divided into three parts: the presentation of Jonas’s conception of responsibility, the analysis of otherness in Levinas, and, finally, the pursuit of the development of ethical knowledge that can guide healthcare practices.

The pursuit of ethical knowledge to guide healthcare professionals, based on the contributions of Jonas and Levinas, is not aimed at prescribing conducts, but at recognizing an irrecusable call to responsibility and care for the other.

Responsibility in Hans Jonas

By proposing responsibility as an ethical principle, Jonas promotes a change in how responsibility has traditionally been understood. If ethical tradition thought about responsibility for actions or omissions already done, that is, focusing on the past, Jonas states that responsibility does not concern the calculation of what was done ex post facto ⁴, but rather what will still be done. This is a responsibility that precedes action and is founded on the capacity to foresee, imagine, and evaluate the possible effects of decisions and actions, especially in contexts where the power of human intervention, boosted by technology, can jeopardize the authenticity of future life. In this sense, responsibility becomes an ethical duty of anticipation and care, which requires prudence, sensitivity, and awareness in the face of the fragility of life and the unpredictability of consequences. The responsibility in Jonas is not reactive, but proactive, that is, prior to action.

Responsibility as a principle does not refer to the idea of guilt or offense, since guilt requires intent or negligence of an act, or even violation of an established norm. Therefore, it is not a matter of holding responsible from the point of view of consequence, as something external, as tradition has stated that the effective responsibility of the author is made from the exterior ⁵, but by causal power ⁶, because, regardless of the consequence, the cause already makes us responsible, as causal power represents a threat and a risk.

Thus, it is possible to identify an internal principle in responsibility, called causal imputation of committed acts ⁷, not in the sense of imputability, but of precluding the very act. In other words, before a human being acts, there is an appeal, an ethical call for them to be responsible for their actions. This responsibility arises from our capacity to be able to act. Thus, responsibility is understood as a precondition of morality, but not morality itself ⁸.

The responsibility proposed by Jonas as a determination of what is to be done ⁹ leads us to recognize that it is being that finds itself threatened by the power of modern technique that demands my responsibility, that is, it is the object that claims my action ¹⁰. Thus, the reason for my being responsible is “outside of me,” but totally dependent on “my power” and my decisions. Jonas promotes an inversion in traditional ethical logic, because it is not I who decide to be responsible for something I want or to follow a norm, but the vulnerable, the threatened life that calls me to be responsible. In other words, the source of responsibility is outside the moral subject, but the realization of responsibility is in the human being itself.

With that, Jonas makes good itself the cause of the world, and, thus, the good that is practiced by human beings does not primarily aim at the individual self, but at good itself, constitutive of the end inherent in the thing. According to Jonas, it is not duty itself that is the object; it is not the moral law that motivates moral action, but the appeal of good itself in the world, which confronts my will and demands obedience according to the moral law ¹¹.

Jonas is based on the principle that responsibility is a correlate of power ¹², such that the dimension and modality of power become fundamental to determining the dimension and the very modality of responsibility. As there is a growing increase in power and its exercise, the nature and very quality of responsibility also change, because the effects of power generate the content of duty ¹³, and with this there is the usual inversion between duty and power. Thus, the starting point is no longer what human beings can be and do, whether they can achieve something or not, but what they are already actually doing, since duty arises from their actions.

Therefore, power for Jonas means releasing into the world the causal effects, which must then be confronted with the duty of our responsibility ¹⁴. That is, the greater the power of a human being, the greater their ethical responsibility for the consequences of that power. The fact that someone has the power to cause effects in the world and in life already makes them responsible for such effects. Thus, Jonas reinforces the thesis that responsibility precedes freedom, since we are responsible because we have power. According to Jonas, causal power is a condition of responsibility ¹⁵.

Jonas sought in ontology the foundation of his ethics of responsibility, in order to protect the authenticity of human and non-human life in the future, given that the ethics of the future forgoes reciprocity. The author sought to find a general affirmation that could serve as a characteristic of all living kingdoms, recognizing in this characteristic a part of being, that is, a guarantor of an ontological foundation. Although he acknowledges the controversial nature of his philosophy, for Jonas, biological ontology not only shows the reality of being, but also how much duty derives from it. By proposing an ontological basis for the ethics of responsibility, Jonas seeks a way to think about being (ontology) so it can derive a duty (ethics), that is, a “ought-to-be” rooted in “being.”

The first Jonasian imperative of the ethics of responsibility is, therefore, that humanity exists ¹⁶, making it impossible to transfer responsibility to nature, as the first rule sought for the mode of being comes from existence. Founded on this first imperative, that is, that humanity exists, Jonas adds that our responsibility for the idea of authentic man ¹⁷ in the future makes ontology the core of the guarantee of its existence, because the imperative guarantees us why and how future human beings should be.

If ethics traditionally concerned human happiness in the present time, currently, as Jonas identifies it, there is a risk that this human happiness, in the future, may be threatened by the very uncertainty of the existence of a future. Thus, Jonas’s ethics of responsibility promotes a shift in the sense of not being limited to existence, but encompassing the form of that existence, since the guarantee of life in the long term is no longer taken for granted, requiring a foundation or principle that can guarantee it. According to the author: There would be no “you must” if there were no one who could hear it and who could be attuned to its voice ¹⁸.

An ethics of responsibility focused on the future does not mean an ethics to be practiced in the future, but a current ethics oriented toward the future, which deals with protecting it from the risks and consequences of our actions in the present ¹⁹. To think of an ethics that is directed toward the future but is effective in the present, Jonas resorts to comparative futurology ²⁰, that is, he projects the future with the aid of scientific and technical knowledge and imagination, so, in the face of negative probabilities, decisions are made in the present so what is announced does not happen. Faced with the optimistic and utopian possibilities presented by technological civilization through a futurology of imagined desire, Jonas counters with a futurology of warning, so human beings can apply voluntary brakes ²¹ to the impetus for progress present in homo faber.

The philosophical tradition conceived the category of responsibility based on the idea that my duty is the reflected image of the duty of others, which in turn is seen as the image and likeness of my own duty ²², that is, once certain rights of the other are determined, my duty to observe and promote them is also established. While, for tradition, those that do not exist have no right to a claim, the distancing promoted by Jonas’s ethics of responsibility is based on the premise that life claims life, and this right must be preserved; although the non-existent cannot make claims, neither can their rights be violated because of that ²³. Therefore, the point is thinking ethics without the idea of equality, symmetry, and reciprocity among those involved, as well as for those who do not yet exist but have the right to exist.

Jonas resorts to what he calls the heuristic of fear to show the importance of negative work, that is, of the threat that must be superimposed on the promise, which leads him to an ethical choice for a bad prognosis, because, thus, just as life affirms itself by denying entropy, its sustenance presupposes the permanent denial of its inevitable self-destruction. In other words, Jonas’s negativity regarding the future forces us toward responsible present, so the peril foreseen for the future does not materialize ²⁴.

According to Hans Jonas, we would not recognize the sacredness of life if there were no murders ²⁵, because it is precisely the commandment “thou shalt not kill” that reveals such sacredness. For the thinker, the revelatory power of the negative is superior to that of the positive, because, beyond manifesting itself more quickly, it also becomes more evident, unlike good, whose presence can often go unnoticed.

For Jonas, the anticipation of evil, in the form of loss or disappearance of a value, enables highlighting and preventing its occurrence. In other words, the risks that evil can cause make it easier to identify the good and the value that are initially invisible, as only by perceiving peril is it possible to protect oneself from that peril.

It refers to finding an antidote to the hope and utopia of technological civilization that jeopardize the continuity of authentic life. To this end, Jonas uses peril itself, present in the homo faber, as an antidote to overcome technical dominance, in order to ensure authenticity. In lieu of the optimistic and idealistic probabilities of modern world utopias, Jonas proposes fear as a form of learning, so as to make the projection of the possibility of negative prediction a condition for altering the human beings’ attitude toward life. It is necessary, Jonas concluded, to ensure that the predictions indicated by knowledge, both scientific and imaginative, are used as a means to anticipate the disastrous conditions foreseen if humanity does not change its actions. According to the author: it is necessary to pay more attention to the prophecy of doom than to the prophecy of salvation ²⁶.

Therefore, it is a principle of precaution, preservation, and moderation in the face of the future, guided by the pursuit of knowledge about still unknown principles.

Prioritizing the malum means to anticipate and promote a spontaneous reaction in defense of the fragile and the vulnerable. The in dubio pro malo criterion enables restituting to the metaphysical power of nature the ethical character of human conduct, that is, prioritizing the worst diagnosis signifies a yes to life ²⁷, making fear a substitute for the virtue of wisdom, in view of the perils arising from our action.

Jonas believes that fear, as a feeling, can promote changes in human actions in the present and thus avoid possible future harm. With that, the feeling of fear can no longer be considered a “weakness of the fearful,” but precisely the opposite, as it should be used as an ethical obligation. It is necessary to learn from this new kind of fear ²⁸, whose expression is not a paralysis of action, but an obligation and even a daily exercise of responsibility to avoid what is imagined with the most fertile fantasy. Fear, thus, would lead to responsibility, which would turn that into a daily task.

The fear heuristic results in the resumption of a classic concept of ethics: the concept of prudence, since it appears as an affirmative perspective of this heuristic principle. Prudence should be understood as a kind of middle ground between technically feasible possibilities and the continuity of what is symbolic, authentic to our nature. In other words, it refers, given the unpredictability of actions in the technoscientific field and their countless possibilities, to classifying what can be considered better in terms of values, expectations, and the preservation of what is authentic. Therefore, it should be primarily considered in relation to the side effects of actions.

The alternative of Jonasian prudence is not in the use of prudence in a weak sense of prevention, but in prudence as an heir to the Greek virtue, phrónesis, that is, the ability to recognize among various consequences those for which we can be legitimately held responsible. Therefore, it is prudence in the Aristotelian sense, understood as the true and practical rational disposition regarding what is good or bad for human beings, as a criterion of moderation for human life, because not everything that can be done should be done ²⁹.

Progress with prudence is the formula chosen by Jonas to refer to the need for technological progress to expand while at the same time not posing a threat to life in general. If in other times and realities prudence was classified as an optional virtue, it has become, according to Jonas, the core of our moral action ³⁰, as it must remain alert to technoscientific progress, as in the sense of care for and precaution with life. With that, Jonas’s prudence does not represent an obstacle to the ideals of technoscientific progress, but rather seeks to evaluate them so they do not constitute a threat to humanity.

There is no way to have progress without risks, and the challenge proposed by Jonas is to manage these risks with prudent criteria. This is not about wanting to promote a technological renunciation, because a society without technoscientific development becomes more susceptible to health problems, catastrophes, among others. Thus, Jonasian prudence advises accelerating the process when necessary, in order to avoid greater evils, and also knowing when to retain its advances when they become real threats. With this understanding, Jonas makes prudence the first duty and commandment of his ethics of responsibility, and humility the necessary virtue and remedy to the technological impetus.

Otherness in Emmanuel Levinas

Lévinas’s proposed ethics of otherness can be considered a lens ³¹, a way of seeing and confronting life sciences, namely, bioethics, medicine, among others. This notion shifts the center of ethics from universal principles to the singularity of the other’s face, which calls out and summons to responsibility.

That requires understanding Levinasian otherness based on two perspectives associated with human subjectivity, according to Levinas’s proposal: one that understands subjectivity as the care for the other, expressed in the notions of “home,” interiority, “enjoyment” or fruition of life, affectivity as the self’s ipseity, sensibility and face, fecundity and paternity, as found in the work Totality and Infinity ². The second notion, in turn, stems from subjectivity founded on responsibility for others, involving notions of vulnerability, proximity, substitution, maternity, contact, and affection as a gift of being for others, as can be seen in the work Otherwise than Being, or Beyond Essence ³.

Our objective, therefore, consists in the defense of responsibility as the fundamental structure of human subjectivity, to the point where we can affirm that “I am myself” when I am responsible for the other. Contrary to what is commonly thought, that is, that the ethics of otherness is based on the primacy of the other, Levinas encourages us to think that otherness is only possible starting from me. But what does this “from me” mean?

A careful reading of the work Totality and Infinity ² allows us to understand that Levinas uses various metaphors, in his philosophy, to express the primacy of the relationship. There is no otherness without relationship. Apropos, we were born from a relationship. Our lives are guided by relationships, from the bread that arrives at the table, to what we buy, everything comes to us through the hands of another. No matter how much someone wanted to live alone, it would be practically impossible, as we need others, from the most playful practices to moments of fragility, including in illness. We then ask, “how” is the relationship of otherness constituted based on the terms the self and the other.

Revisiting some notions from the work Totality and Infinity ², we understand that the self—in need of the other—also opens itself to care for them, without possessing them nor letting itself be captured by the egoism of the self. It is understood the need to open up to a third party, initially conceived by us, as the figure of the child with the advent of the familial relationship. The term “third party” is used by Levinas to express that which is beyond the “I-you” relationship. In Levinas’s work, this relationship becomes the embryonic and constitutive cell for thinking about society as well, beyond the merely consanguineous.

The from me helps us understand the meaning of the self ³², in the movement of ipseity, namely, the “oneself” as an essential element of otherness. As Levinas states, the self is identical even in its changes, in yet another sense. Indeed, the thinking self finds itself thinking or is amazed by its depths and, in itself, is another ³³. Lévinas also adds: if the same were identified by simple opposition to the other, it would already be part of a totality encompassing the same and the other ³⁴. In this sense, there is the relationship of the same and the other that originally takes place as discourse in which the same, withdrawn in its ipseity of self, comes out of itself, for, as Levinas affirms, otherness is only possible starting from me ³⁵.

In Levinasian terms, the “starting from me” is therefore not consistent with the defense of the self understood as the Cartesian “cogito,” nor with the defense of the Kantian “transcendental subject” or the Hegelian “absolute subject,” nor even as the Husserlian “pure ego” or the Heideggerian “Dasein.” Unlike these positions, which focus on the defense of the modern subject’s freedom, Levinas gives primacy to otherness understood on the basis of the relationship of responsibility between the self and the other.

From the Levinasian ethical perspective, the self is seen as the “support” of the other, so that “starting from me” means “starting from” the one who was called, the “elected one”—summoned—to answer for another, to the point of substituting for them. Lévinas prefers to speak of election ³⁶, a category of the Jewish world, in which the self is understood not in the nominative, but as “vocative” that, in the face of the divine call, responds: “Here I am.” Send me” ³. Therefore, it is not the selfish defense of the self, but the “relationship” with the other that calls to me.

In fact, there is no otherness without relationship. The relationship between the self and the other becomes a primary element for escaping the sameness or egoism of the self. And, thus, it is understood that identity and otherness presuppose an “ipseity,” namely, the movement of the self toward the other. And the author further emphasizes that this movement is toward the other—“absolutely other”—using as a prototype the figure of Abraham, who goes toward a foreign land, unlike Ulysses, who returns to Ithaca, his native island.

In Abraham’s exodal movement, Levinas intuits the existential meaning of his philosophy: “exit from being” toward the other. Hence the meaning of his critique of Western philosophy, which, most often, consisted in a return to the same, due to a “horror of the other,” an insurmountable allergy ³⁷.

For his proposal of an exodal philosophy, in addition to the inspiration from Judaism, Levinas also resorts to Russian literature, especially Dostoevsky, who expresses the drama of human existence in terms of responsibility. Inspired by Dostoevsky, the ethical knowledge proposed by our author becomes that of responsibility for all, and not that of culpability. We are all responsible for everything, and I, more than anyone. Here we find a fundamental clue to the ethical knowledge that can orient relationships and practice in the healthcare world.

There are at least two senses of care in Levinas: based on the dimension of interiority suggested by the figure of the “house” as “interiority and economy,” in the relationship with the beloved—the feminine—and which expresses the promise of the future through fertility; and there is also care through the face that calls to me and teaches me, opening us to another notion of knowing, that of hospitality.

Caring for others in one’s home is an expression suggested by the feminine figure that is not reduced to a matter of gender, but rather is an intrinsically human dimension. When I am able to care for the other, I am also expanding my inner home and, metaphorically speaking, I begin to gestate the other in me, something proper to motherhood. Now, the “home” is, par excellence, a place of meeting, rest, tenderness, and affection ³⁸. By providing space to care for another, the home emerges as the meaning of fertility, of the promise and the hope for the child that announces an ethical event of otherness.

In fact, the arrival of the other is seen by Levinas ² as an ethical event. Let us imagine the birth of a child. The whole family moves to make space for the new one that arrives. The roles are reversed at home: the spouse becomes a father/mother, uncles and cousins are born, and other relationships are evoked. The other who arrives always opens us to the dimension of the novel, of the mystery of life.

In the world of life and relationships, the arrival of the other happens unexpectedly. Without introducing themself, the other person stands before me. Most often, I do not even have time to ask their name, where they come from, or why they are knocking on my door. And, most often, the other comes to me as a beseecher, pleading for help and support. According to Levinas ², the other, in their misery, is also the one who teaches me—differently from Socratic maieutics, which conceives the relationship between master and disciple in such a way that the one who teaches is always the master, and the disciple is always the apprentice. Levinas’s ethics also revisits the wisdom originating from the Jewish world, as it brings a dimension of height, a meaning that can be expressed by revisiting the biblical quaternity—the countenance of the poor, the stranger, the widow, and the orphan ²—as expressions that demand care.

On the face of each of these ones mentioned, there is a lesson. The face of the one who pleads with me and asks for help also commands me “you shall not kill!”. The lesson that comes from the face is the primacy of Levinasian ethics. In other words, the author states, it is the relationship of man to man—signification, teaching, and justice ³⁹. And thus, in the world of life, I encounter these faces that plead with me and bring me a lesson, an invitation to exteriority—being for the other.

Unlike an intrusive stance one might take, in which the different, the foreigner, is expelled, Levinas’s ethics introduces a new dynamics: the knowledge of caring for the other, opening space for hospitality. It is ethical knowledge that demands from us a differentiated stance, translated in terms of inclusion and opportunity. Care, beyond being an attitude of hospitality, means giving the other, the guest ²—the foreigner—the possibility of being another. Therefore, care implies taking risks and sheltering the novel. Public policies are challenging, but they require us and governments to adopt policies for the care of foreigners.

In Otherwise than Being, or Beyond Essence ³, the notion of otherness is broadened with the advent of proximity, which opens us up to thinking about humanity. Proximity, understood ethically, does not concern what is next to us, in a sensitive way, like a neighbor who shares space with me, nor is it governed by the spatial contiguity of geometry and physics, but presupposes humanity. Thanks to the entry of the third party, a relationship in which the foreigner, society, other institutions, and politics are considered, the meaning of justice can be questioned. But, after all, how can we understand that the foreigner becomes close?

In Totality and Infinity, Levinas states: “The third party observes me in the eyes of the other” ⁴⁰. The eyes here indicate humanity. In fact, with the entry of the third party, in the relationship with the other there arises the question, for example, of justice and the ethical commandment Thou shalt not kill ⁴¹. This may cause some strangeness, but without openness to the third party, we understand that even the “I-you” love relationship is at the risk of becoming a two-person selfishness ⁴². With the entry of the third party into the relationship, moral consciousness is born, a situation in which my freedom is called into question ⁴³.

Coming close means to touch and allow oneself to be touched by another. In a text titled “Language and Proximity,” Lévinas affirms: proximity is in itself signification. (…) The subject’s orientation toward the object becomes proximity, the intentional becomes ethics ⁴⁴. Now, this sentence helps us assign new meanings to the “starting from me” mentioned at the beginning of this text. Ethics is understood based on this movement: being for the other.

The “for the other” indicates the ethical sense of proximity, also taking into consideration the vulnerability of relationships. The self becoming close is also exposed, like an open wound in relationships. The signification of the sensitive takes on an ethical dimension, translated as fruition (enjoyment) or wound, which are the terms of proximity ⁴⁵. Lévinas translates ethical sensibility with the following words: the immediacy, under the skin, of sensibility—its vulnerability ⁴⁶.

Beyond the element of vulnerability, which is inherent to humans, there is also the passivity of the relationship, that is, the condition of being for-the-other of sensitivity and its vulnerability as exposure to the other ⁴⁷. I am called to the gratuitousness of relationships. Levinas resorts to the Jewish world and uses an expression from the prophets to express the radicality of his ethics: breaking bread, which indicates the consciousness of the one-for-the-other. Only the self can assume such attitude, for I am one and irreplaceable—one as irreplaceable in responsibility ⁴⁸. Thus, we understand the orientation of Levinasian subject when intention becomes ethics.

In proximity, there is still another element of ethical knowledge that occurs in the inversion of the nominative (subject) into the accusative, to the point in which the self becomes a hostage (otage) of the other⁴⁹. And thus the author concludes: It is thanks to this hostage condition that there can be mercy in the world, compassion, forgiveness, and proximity ⁵⁰. In ethical terms, we understand the condition of “hostage” as the radical responsibility we assume for the life of the other. This happens because the self is the bearer of this unjustifiable identity of ipseity ⁵¹.

We conclude by affirming with Levinas: Coming close is to touch [toucher] the other beyond the data apprehended at a distance in knowledge, it is to approach the Other. This transformation of data into proximity and representation into contact, knowledge into ethics, is human face and skin ⁵². The proposed reflection could be titled archaeology of touch, translated in terms of ethical proximity, caress, and sensibility. And thus we understand that the ability to respond for the other occurs when the self becomes close, responsible for the other.

Ethical knowledge related to healthcare practice

Although the development of Hans Jonas’s and Emmanuel Levinas’s philosophical theories occurred in distinct historical contexts and with different problematics, and their reflections were not originally directed at the field of healthcare, at this stage of reflection, we propose to transpose the concepts of responsibility and otherness as ethical knowledge related to healthcare practice.

The concept of responsibility proposed by Jonas, when applied to the sphere of healthcare, can constitute relevant ethical knowledge capable of guiding actions and decisions in the sanitary context, because it proposes a distinct way of thinking about responsibility. If ethical responsibility has been traditionally conceived based on human action already done, Jonas proposes a meaning for responsibility in which it occurs prior to the action proper. In healthcare practice, this way of thinking about responsibility ensures that those responsible for decisions have the capacity to assess the consequences of their decisions before acting. Jonas even defends responsibility for unpredictable consequences.

This way of thinking about responsibility is not intended to paralyze or hinder decision-making, but to ensure that healthcare professionals make prudent decisions with the ability to foresee future implications. The knowledge required to apply Jonas’s concept of responsibility is not only technical knowledge, but also moral knowledge, sensitivity, and care for consequences. Thus, Jonassian responsibility significantly broadens the traditional scope of ethics in healthcare, often limited to the immediate context of clinical decision-making, as it reinforces an ethical commitment that transcends the present time.

The practical implications of this concept of responsibility require healthcare professionals to recognize that there is a moral duty that precedes the practice proper, which extends beyond what we call the formal contract, of scheduled appointment, of the end of the workday, or of working hours. In other words, the healthcare professional is ethically challenged even before their formal practice, even before being in contact with their patient, since their responsibility is unconditional in relation to the exposure of the other to their technical competence.

Thus, responsibility ceases to be voluntary and even contractual, as it emerges from the realization that the other is within the reach of my power. In the prologue to Hans Jonas’s Memoirs, Rachel Salamander states that one of the German bookstores, on the occasion of the release of The Imperative of Responsibility: In Search of an Ethics for the Technological Age, created a poster with the following phrase: man is the only living being that can assume responsibility for what he does, and with this “can” he is already in fact responsible ⁵³. According to Salamander, people were delighted to read the phrase.

This way of conceiving responsibility in Jonas is present in his ethical imperative which states: act in such a way that the effects of your action are compatible with the permanence of authentic human life on Earth ⁵⁴. The imperative thus places life as an unconditional good and confers a new ethical status upon healthcare professionals, as they become responsible for the continuity of life with quality, with respect for dignity, and with the preservation of what Jonas calls the authenticity of human life.

In a context where blind confidence in technical capability predominates, healthcare professionals must be able to recognize which technical interventions can dehumanize patients or even treat them as mere material subject to being manipulated. To act accordingly, healthcare professionals cannot be guided solely by the criterion of effectiveness, as it is necessary to consider, above all, the quality of life and the meaning of life that such procedure provides. Only with the recognition of the other and their fragilities is it possible to make an ethical decision of this magnitude.

Ethical knowledge, therefore, present in Jonas’s theses to guide healthcare practice, is not limited to technical protocol or even legal normativity, as it requires a stance of listening, care, humility, prudence, and commitment to life. By committing to Jonas’s ethical imperative that “humanity exists,” healthcare professionals are called to act based on values that go beyond the utilitarian, recognizing in the life of the other, present and future, a good in itself that needs care and protection.

This sense of responsibility proposed by Jonas makes instrumental rationality—which often dominates protocols, procedures, norms, contracts, and the logic of productivity and market—lose its centrality. The conduct of healthcare professionals, faced with the fragility of another’s life, requires that the other be treated not merely as a number or an automated routine, but rather as a unique being, bearer of history and values, a fragile being of dignity. This implies rethinking decisions about the use of invasive technologies in terminally ill patients, avoiding unnecessary procedures that prolong pain without the prospect of cure, or even considering the psychological and social impact of each clinical conduct, among other situations.

If traditional ethics presupposed reciprocity and symmetry between rational and autonomous subjects, the ethical responsibility proposed by Jonas demands unconditional duty also in relation to those who cannot respond, argue, or reciprocate, such as the unconscious patient, the unborn, the frail elderly, the profoundly disabled, or even future generations who have not been born. This has profound implications in healthcare practice, as professionals are called to account for those who, due to their condition, are radically exposed to the decision-making power of others. The lack of patient voice or consciousness does not diminish the ethical responsibility of healthcare professionals, but rather intensifies the responsibility for life, with even more attentive care.

Jonas’s ethics of responsibility can therefore transform the moral horizon of healthcare, as it shifts the center of ethical obligation from the contract between equals to the response to the silent appeal of life. It is precisely in listening to this appeal that the moral greatness of the healthcare professional is revealed: not as a mere executor of procedures, but as a guardian of life in its most fragile and unprotected form.

By using the heuristic of fear as a methodological principle for his proposal of an ethics of responsibility, Jonas claims the use of moral imagination not to project technical utopias, but to anticipate risks. In a context where contemporary medicine is seduced by promises of human enhancement, genetic manipulation, and indefinite life extension, the ethics of responsibility offers a principle of restraint: it guides action by the criterion of risk to the greater good of life, so as to promote an attitude of permanent ethical vigilance. In this sense, prudence ceases to be a secondary virtue and assumes the status of a central requirement of moral action.

The progress of technological civilization has become a permanent challenge for healthcare professionals, as technical possibilities are constantly and very rapidly improved, often driven by economic interests, competitiveness, and even promises of miraculous solutions. Faced with this utopia of progress where the novel is always considered better, Jonas states that true progress cannot be simply evaluated by technical advancement, as it is necessary to consider the ethical implications, risks, and responsibilities that follow each innovation.

In this expanded horizon, every healthcare decision requires careful reflection on its consequences, considering not only immediate benefits but also the impacts on future generations and the vulnerability inherent to the human condition. In other words, true ethical progress is not measured by what we are technically capable of achieving, but by the critical and moral capacity to assess whether our actions put at risk the life and well-being of the other. In other words, it is not enough to ask if something can be done technically, but whether it should be done, and what consequences it can imply for human life.

Thus, the ethical responsibility proposed by Jonas goes beyond offering criteria for action, as it enables a new way of understanding the place of healthcare professionals in relation to the power they exert over the other, as well as the unconditional value of life.

If we add Levinas’s concept of responsibility to Jonas’s thought, we have an even more valuable ethical panorama that can be applied as ethical knowledge to healthcare practice.

According to Levinas, responsibility is the result of an “election,” distinct from something chosen by the self. Thus, when called, the self becomes responsible, which precedes its freedom, that is, it responds without prior commitment. By being responsible, the self shows itself to be human. In this sense, both thinkers lead us to reflect that ethics in healthcare unquestionably involves understanding that healthcare professionals are responsible for the health promotion process even before any contact with the patient. It is an asymmetrical responsibility; that is, I am responsible for the other even before any contract or reciprocity ⁵⁵.

Otherness in Levinas is posited as an awakening to responsibility. Thus, the self’s attitudes need to be considered, giving due priority to the other’s conditions, to their subjectivity. Considering the healthcare context, professionals must keep in mind the therapeutic care and plans for the patient, but must, first and foremost, understand the patient and consider them in their decision. In this sense, responsibility functions as the fundamental structure of human subjectivity, because “I am” when I am responsible for the other. In this context, otherness, understood as the openness of the self to the care for the other and as the foundation of the ethical relationship through dialogue, enables the construction of healthcare based on respect, care, listening, and responsibility.

The care for the other, understood by Lévinas ² as an original and unpredictable ethical event, demands from the subject a disposition of hospitality, that is, the capacity to offer shelter to the otherness that is presented in the form of suffering, fragility, and vulnerability. In the context of healthcare, this implies recognizing the patient not just as a body to be treated, but as an other who ethically calls us to a singular and responsible response. Care, in this context, is not just acting upon the other, but, above all, being with the other, sustaining their presence and safeguarding their dignity in the face of diagnostic uncertainties, pain, and risk. It is, therefore, a care that is rooted in listening, respect, and unconditional responsibility, and that seeks not only clinical recovery but the affirmation of the other as an ethical and human subject, worthy of care and proximity ⁵⁶.

In Levinas ², the self is responsible for the other not because of a choice to be so, but because of a call by the other. In the context of healthcare, this call occurs concretely in the encounter with the patient, often anonymous, vulnerable, voiceless, or lacking social recognition. Therefore, responsibility does not arise from a contract, but from the simple presence of the suffering other. Care, therefore, is welcoming the other as an unexpected guest, someone who arrives without asking permission and who demands space, time, and attention. The application of this ethics to the field of healthcare implies, first and foremost, recognizing that there is no true otherness without relationship. Healthcare professionals are called to coming out of themselves, their stabilized knowledge, their functional identity, to be dedicated to the other ⁵⁷.

This welcoming care proposed by Lévinas ²is not reduced to a functional gesture, but assumes the meaning of hospitality: opening space in one’s “interior” for the other. This opening, often invisible, occurs in how professionals listen, touch, name, or remain silent in the face of suffering. Proximity, contact, and caress, which Levinas ² understands as sensitive expression of responsibility, become central elements of an ethical knowledge that, more than guiding conduct, transforms the way of being of the caregiver.

By stating that I am when I am responsible for the other, Levinas ²proposes a subjectivity founded not on autonomy or freedom, but on unconditional responsibility. This inversion is particularly fruitful for the world of healthcare, in which the vulnerability of the other is not an exception, but a permanent condition.

It is, in short, an ethics that not only guides care, but founds it, an ethics that transforms knowledge into hospitality, and clinical practice into an ethical gesture of recognition and preservation of human dignity. Levinas’s ethical knowledge provides no rules, but rather provides profound ethical guidelines.

The idea of a “third party,” proposed by Levinas ², represents a fundamental ethical knowledge for guiding healthcare practice by introducing the dimension of justice into the relationship between professionals and patients. While the encounter with the face of the other calls for an unconditional and singular ethical responsibility, the presence of the third party, a symbol of plurality and collectivity, demands that this responsibility be mediated by criteria of equity and justice. In healthcare practice, this means that care cannot be limited to individualized attention but must also consider other patients, institutional limits, and the principles that regulate the common good. Thus, the “third party” obliges the professional to coordinate the ethical commitment to each patient with the need for fair decisions in the face of the complexity of clinical and social contexts, expanding the ethics of care to an ethics of collective responsibility.

Final considerations

Finally, based on this reflection—which sought to examine how Hans Jonas’s ethical proposal centered on responsibility and Emmanuel Lévinas’s proposal grounded in otherness offer ethical knowledge to guide healthcare practice—it is concluded that, given the growing complexity that permeates healthcare practice, marked by uncertainties, human suffering, and increasingly intense ethical challenges, it is imperative to rethink the foundations that guide the practice of healthcare professionals. The present reflection sought to show that well-founded technoscientific knowledge is not enough, also requiring ethical knowledge that offers not automatic answers, but sensitive, prudent, and responsible criteria in the face of human vulnerability.

Jonas’s proposal, by emphasizing responsibility as a fundamental ethical principle in the technoscientific era, calls us to a stance that anticipates the consequences of action, values prudence, and upholds the dignity of life in the face of humanity’s immense power of intervention. Consistently, Levinas proposes an ethics of otherness that shifts the center of moral action to the face of the other, calling healthcare professionals to engage in unconditional listening, ethical care, and sensitive presence that recognizes the suffering of the other as an irrefusable call to responsibility.

By combining these two horizons—Jonas’s anticipatory responsibility and Levinas’s unconditional otherness—it is outlined an ethical knowledge, which is not limited to formal normativity or technical efficacy, but which transforms the way of being of healthcare professionals. This knowledge is, above all, a way of being with the other, of recognizing their fragility, their dignity, and their right to care as an end in itself.

Beyond offering a new moral theory, this proposal indicates the urgency of cultivating an ethics of care rooted in listening, responsibility, and hospitality. In times of accelerated technical advancement, institutional pressures, and often dehumanized practices, rediscovering these ethical foundations is both a challenge and a necessity. This rediscovery constitutes the foundation of a truly human healthcare practice, capable of sustaining care as an ethical gesture, transforming the healthcare professionals’ way of being in the face of life, and reaffirming life as a non-negotiable value.

References

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Edited by

• Editor in charge:
  Dilza Teresinha Ambrós Ribeiro

Data availability

Publication Dates

• Publication in this collection
  07 Aug 2026
• Date of issue
  2026

History

• Received
  24 Oct 2025
• Reviewed
  27 Feb 2026
• Accepted
  2 Apr 2026