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care in
healthcare
reflections on theory
and practice
Care in Healthcare
Reflections on Theory and Practice
Editors
Franziska Krause Joachim Boldt
University of Freiburg University of Freiburg
Freiburg, Germany Freiburg, Germany
© The Editor(s) (if applicable) and The Author(s) 2018. This book is an open access publication.
Open Access This book is licensed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits use, sharing, adapta-
tion, distribution and reproduction in any medium or format, as long as you give appropriate credit to
the original author(s) and the source, provide a link to the Creative Commons license and indicate if
changes were made.
The images or other third party material in this book are included in the book’s Creative Commons
license, unless indicated otherwise in a credit line to the material. If material is not included in the book’s
Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the
permitted use, you will need to obtain permission directly from the copyright holder.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or
the editors give a warranty, express or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional affiliations.
This book was devised on the basis of a summer school on care in health-
care held in Freiburg, Germany, in 2015. The editors of this volume who
were also the organisers of this summer school wish to thank the German
Federal Ministry of Education and Science (BMBF) for financing the event
and this publication (grant no. 01GP1485). We are glad that all of the
participants of the summer school were willing to contribute to this book.
We would also like to thank the Head of our department, Giovanni Maio,
to join the group of contributors; as well as Johanna Feuchtinger, nursing
quality management at Freiburg University Hospital, Annemarie Mol,
Professor of Anthropology at Amsterdam University; and Christof Veit,
Head of the Institute for Quality and Transparency in Healthcare (IQTIG)
in Berlin for presenting at the summer school and taking part in the group
discussions. Last but not least, we would like to thank Jonas Christoph and
Marlene Reincke for unifying bibliography and citation styles.
Freiburg, Germany
January 2017 Franziska Krause, Joachim Boldt
v
Contents
Framing Care 11
Index 293
List of Tables
xi
Understanding Care: Introductory
Remarks
Franziska Krause and Joachim Boldt
Defining Care
In order to understand care, one may start by attempting to devise a gen-
eral definition of this term. Such a definition of care must necessarily be
broad if it is to cover as many important aspects of the phenomenon as
possible. Care in healthcare comprises many elements including the
physical interactions between care providers and patients, the observation
of hygiene requirements and the completion of paperwork. Joan Tronto
and Bernice Fisher have offered an influential definition that classifies as
care all activities that help to “maintain, continue and repair ‘our’ world
so that we can live in it as well as possible” (Tronto 1993, p. 40).
This definition can be fruitfully adapted to the healthcare context by
replacing the term “activity” with “action”, which specifically indicates
goal-directedness and intentionality. Healthcare activities are triggered by
patient needs and requests; they follow professional obligations, and are
shaped by institutional demands. Thus, activities in this field are usually
goal-directed, which is to say they are actions rather than activities. In the
same vein, the verbs “maintain, continue, repair” may be changed to
“maintain, improve, restore”. While the first list describes the relations
between people and all manner of entities, the second is tailored to
actions that are directed towards humans and human health. On this
basis, care in healthcare can be defined as follows:
This definition brings to the fore three main aspects and characteristics
of care that are of specific relevance in the healthcare system:
4 F. Krause and J. Boldt
Well-being Care in healthcare is directed at those who are ill and at those
who are at risk of becoming ill. In some cases, caring for a patient may
simply mean curing that person, that is restoring health. In many other
cases, such as chronic diseases and situations at the end of life, caring
involves maintaining and improving the well-being of the patient to the
extent to which this is still possible. Maintaining well-being in these cases
is rooted in ongoing relational processes between caregivers and care
receivers. As part of these processes, the understanding of well-being
must be continuously adjusted, allowing caregiving to proceed in accor-
dance with the wishes of the care receiver. Thus in principle, respecting
patient autonomy does not conflict with caring for the patient’s
well-being.
At the same time, lending an ear to the patient might turn her initial
denial into a willingness to attempt a new therapy. Care, therefore,
inevitably involves the possibility of indirectly influencing a patient’s
will. What is more, there are instances of care where the current will,
for example, of a dementia patient does not correspond to his overall
well-being or his former will. In such cases, care might involve practices
that directly influence the patient’s will. In this context, it can be diffi-
cult to draw clear distinctions between manipulative actions that trans-
gress the boundaries of care and those actions that still fall within the
limits of care.
Understanding Care
As the aforementioned aspects of care make clear, a number of tensions
and ambivalences emerge within the notion of care. Although a general
definition of the term care can provide a better impression of the range of
actions that this term covers, it will not help identify and normatively
categorise these tensions, nor find ways to deal with them. However, the
fact that it is difficult to come up with a precise definition of care does not
imply that it is impossible to point out prototypical examples of care
practices or to delineate a spectrum of more or less typical instances of
care activities (Mol et al. 2010). To invoke a linguistics textbook example,
one can name prototypical examples of objects that fall under the term
6 F. Krause and J. Boldt
“bird” or “animal” and give less common examples, such as penguins and
corals, respectively, even if precisely defining these terms proves
impossible.
In order to gain a better understanding of the meaning of care in
healthcare in this sense, definitions must be supplemented by descrip-
tions and analyses of concrete care practices. Referring to the tensions
mentioned above, questions emerge that can only be answered with refer-
ence to concrete cases. For example: Can one’s actions still be understood
as being part of an ongoing communicative process with the patient?
When do daily institutional routines support adequate caregiving, and
when do they hinder giving care? Are one’s actions still in line with what
the patient wants and needs? This book supplies both reflections on gen-
eral characteristics and definitions of care, and case studies that point to
and analyse tensions within the notion of care in different healthcare
settings.
Framing Care
Part one of this book deals with traditions of care theory, philosophical
and anthropological approaches to care, and care as an overarching nor-
mative concept. Conradi highlights similarities between the notions and
intentions of today’s care ethics and those of Jewish social reform move-
ments of the late nineteenth and early twentieth centuries in Germany.
With regard to philosophical approaches, the book focuses on hermeneu-
tic and phenomenological theories. The characteristics of personal rela-
tions, their inherent normativity and interpretations of human interaction
have always been at the centre of these theories. Freter, in his contribu-
tion, follows the phenomenological tradition and focuses on the notion
of the “appeal” that a person in need unwittingly directs at a potential
caregiver, using the story of the Good Samaritan as a paradigmatic exam-
ple. Maio shows how care ethics can be connected to central themes of
the hermeneutic tradition, as exemplified by Paul Ricoeur. Care is often
assumed to be an antagonistic concept to respect for autonomy. Referring
to Ricoeur’s concept of the self, Boldt argues instead that an adequate
understanding of care necessarily incorporates respect for autonomy and
Understanding Care: Introductory Remarks 7
Situated Care
The second part of the book focuses on care in different healthcare set-
tings and analyses cases that do not initially seem to fit within the care
paradigm. Typically, these situations pose a challenge to any kind of clear
ethical solutions. For example, as Driessen discusses, caring for persons
with dementia in residential care homes may comprise elements of “work-
ing on the will” of the care receiver in order to align what the resident
wants with what the caregiver deems necessary for the person’s well-being.
Haeusermann also addresses dementia care, describing care practices in
the first German dementia village and analysing ambivalences between
regulation and freedom, and the constant oscillation between social
inclusion and exclusion. On the basis of the current Flemish regulation
on the use of seclusion cells in psychiatric institutions, Opgenhaffen sug-
gests that while caregivers should not be overwhelmed or blinded by
regulation, regulation should not prematurely impose a rational-objective
mode on care. Instead, he spells out how seclusion regulation and care
could fruitfully co-exist. Skeide describes witnessing as the relational and
environmentally structured strategy of midwives in Germany and France.
Being able to witness can be an integrating experience or have an alienat-
ing effect. In either case, Skeide establishes that clinical settings tend to
delimit witnessing as a midwifery care practice. Pei-Yi Liu’s chapter
focuses on providing care in the actual homes of diabetes patients. In
doing so, she traces the ethical dilemmas and challenges healthcare pro-
fessionals face when dealing with a chronic illness in homecare settings.
She shows that nurses’ care tasks alternate between notions of patient
autonomy and professional authority—two concepts that at times seem
unbridgeable. Kohlen contends that the specific care knowledge and care
perspective of nurses is underrepresented in the clinical institutional
communication, possibly resulting in harm for patients. On the basis of
8 F. Krause and J. Boldt
Note
1. This definition has been discussed and developed jointly by many con-
tributors of this book in the course of a workshop on care in healthcare
held in Freiburg in September 2015 (Joachim Boldt, Annelieke Driessen,
Björn Freter, Tobias Häusermann, Franziska Krause, Pei-Yi Liu, Tim
Opgenhaffen, Annekatrin Skeide).
References
Conradi, E. (2001). Take Care. Grundlagen einer Ethik der Achtsamkeit. Frankfurt
a.M.: Campus.
Groenhout, R. E. (2004). Connected Lives. Human Nature and an Ethics of Care.
Lanham: Rowman & Littlefield.
Held, V. (2006). The Ethics of Care. Personal, Political and Global. Oxford:
Oxford University Press.
Mol, A., Moser, I., & Pols, J. (2010). Care in Practice. On Tinkering in Clinics,
Homes and Farms. Bielefeld: transcript.
Pettersen, T. (2008). Comprehending Care. Lanham: Lexington Books.
Pulcini, E. (2013). Care of the World. Fear, Responsibility and Justice in the Global
Age (K. Whittle, Trans.). Dordrecht: Springer.
Understanding Care: Introductory Remarks 9
Open Access This chapter is licensed under the terms of the Creative Commons
Attribution 4.0 International License (http://creativecommons.org/licenses/
by/4.0/), which permits use, sharing, adaptation, distribution and reproduction
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The images or other third party material in this chapter are included in the
chapter’s Creative Commons license, unless indicated otherwise in a credit line
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the permitted use, you will need to obtain permission directly from the copyright
holder.
Framing Care
Forgotten Approaches to Care:
The Human Being as Neighbour
in the German-Jewish Tradition
of the Nineteenth Century
Elisabeth Conradi
I would like to express my high regard to Dominic Bonfiglio for his competent and careful
language revision from earlier drafts of this text into its final version.
E. Conradi (*)
Baden-Wuerttemberg Cooperative State University (DHBW),
Stuttgart, Germany
for these ideas but that their work was repressed by the Nazi regime and
obscured by its long shadow, preventing a modern reception.
In 1935, Martin Buber (1878–1965) published Der Nächste, a collec-
tion of four essays on what it means to relate to other human beings as
neighbours by the Marburg philosopher and neo-Kantian Hermann
Cohen (1842–1918). In the introduction, Buber discusses when and
under what circumstances assistance should be provided to others (1935,
p. 7). He defends the need for positive duties against the widely held view
in philosophy that restricts ethical duties to the ancient dictum ‘Do no
harm’. This position generally holds action to be mandatory only in very
exceptional cases (Conradi 2016, pp. 54–58). Even a philosopher like
Arthur Schopenhauer, who saw compassion as the driving force behind
ethical behaviour, believed that the need must be acute and the emer-
gency dire before action is required (2005, p. 101). For contemporary
philosophers following Schopenhauer’s lead, the main criteria for per-
forming individual assistance are an expectation of a significant effect, a
severe emergency, a limited duration of aid, and a minor effort required
for assistance (Mieth 2012, p. 243). Buber focuses on two other aspects
of positive duty: whether the recipient is a member of one’s own collec-
tive and whether the recipient is spatially proximate. Buber emphasises
that the person at the receiving end could be anyone and therefore no
distinction should be made between neighbour, stranger, friend, acquain-
tance, and enemy. But he believes particular attention should be paid to
any person who is within the helper’s immediate sphere:
‘Be loving to your fellow as to one who is like you’, is written in the
Scripture, and shortly thereafter, as if to avoid any misunderstanding at any
time, through special highlighting: ‘Be loving to a stranger as to one who is
like you’. Rea, the fellow, is someone I am dealing with, whom I met just
now, the human being so to speak, for whom I should be ‘concerned’ at
this moment, whether he is of my own people or a foreigner. I should, liter-
ally translated, ‘love him’: turn towards him tenderly, show him love, prac-
tice love; namely as someone who is ‘like me’: in need of love such as I, in
need of an act of love of a rea like me—as I know it just from my own soul.
That this is to be understood in this way arises from the words following
the second sentence: ‘Because you’ve been strangers in the land of Egypt’—
or, as it says more clearly elsewhere: ‘You know the soul of the stranger,
Forgotten Approaches to Care: The Human Being as Neighbour... 15
because you’ve been strangers in the land of Egypt’. You know this soul and
its suffering, you know what it needs, and therefore, those to whom it was
once refused, deny them not! Let us dare, from there, to put the justifica-
tion of the first sentence in words. Be loving to your fellow human being as
to one who is like you—you know the soul of the co-human [Mitmensch],
who is in need, so that one is loving to him, because you are people and you
suffer yourself the plight of man. Such is a message of the ‘Old Testament’
(1935, pp. 6–7).
Buber stresses the equal ranking of human beings in one’s proximity. For
all of them, the same personal support is mandatory, regardless of whether
they are neighbours, mere acquaintances, or strangers. Buber makes the
impression that the act of assistance is less important than the act of turn-
ing our attention towards others. What ethical behaviour is truly about is
the decency, attention, warmth, and kind-heartedness that accompany it.
We should view others as in “need of love” [liebesbedürftig], we should
“turn towards them tenderly” [liebend zuwenden], “show them love” [Liebe
erzeigen], and “practice love to them” [Liebe antun] (1935, p. 6).3
Martin Buber was by no means alone in his focus on what it means to
relate to other human beings as neighbours. In the long nineteenth cen-
tury, religious philosophers, writers, and rabbinic scholars widely reflected
on social justice, companionship, consolation, and cooperation. Around
30 texts written between 1837 and 1913 on this subject matter were
recently republished under the title Nächstenliebe und Barmherzigkeit
(Brocke and Paul 2015). Few of these texts were likely to have been writ-
ten as contributions to contemporary philosophical debate. Many came
in response to vehement attacks against the authors, with some critics
even questioning their right to citizenship and societal belonging. What
is more, the authors of these texts geared them towards lay readers in an
effort to expand their knowledge and perhaps to equip them with argu-
ments against common criticisms. The majority of these treatises were
dedicated to defending Jewish ethical teachings against popular misrepre-
sentation. They explicitly rebutted legends and obvious simplifications—
such as the claim that the code of conduct Jews followed among themselves
was different from the one they followed among non-Jews—and rejected
the mischaracterisation of Jewish ethical teachings as small minded and
petty. Jobst Paul argues that Jewish ethics ties the institutional social
16 E. Conradi
The main accusation against Judaism was that it was spiritually and practi-
cally surpassed by … Christianity’s unconditional neighbour love.
Theologians and antisemites are in agreement on this point. Theologians
like Rudolf Kittel and Franz Delitzsch concluded from it Christianity’s
morally superiority; antisemites concluded from it Judaism’s inferiority.
Vulgar antisemitism alleged and still maintains that Judaism’s ethical
principles applied only to Jews and urged immoral behaviour towards non-
Jews. (Cohen 1935a, pp. 82 f.)
Forgotten Approaches to Care: The Human Being as Neighbour... 17
The afterword notes that Cohen’s papers were directed against past
arguments—the theologian Rudolf Kittel died in 1929—but in deciding
to republish four of Cohen’s texts in 1935, Buber was addressing his own
contemporaries. The Protestant theologian Gerhard Kittel (1888–1948)6
published a brochure in 1933 titled “The Jewish Question” (“Die
Judenfrage”), in which he invited Christians to endorse a piece of legisla-
tion enacted by National Socialists that permitted government authori-
ties to fire Jewish professors, judges and other public servants at short
notice (Kittel 1933).7 Kittel asked whether such a radical legislation was
still justifiable from an ethical, Christian standpoint (1933, p. 7).8 His
answer—the question was merely rhetorical—is clear: “We have estab-
lished the unconditional demand that the struggle against Judaism must
be led on the basis of an international and clear Christianity” (1933,
p. 8).9 Kittel expressly denied “the equal social ranking of Jews and their
basis civil rights” (1933, p. 20) and unambiguously legitimises the revo-
cation of their citizenship by assigning them the status of “guest” (“Gast”)
and “stranger” (“Fremdling”) (1933, p. 46).10 In lending credence to his
point, Kittel observed that over 3000 years ago Jews had lived as strangers
in Egypt, and hence should continue to do so today. Grotesquely, Kittel
tried to justify his position by quoting Mosaic law: “‘You shall give the
poor his wages on the same day, before the sun sets: whether he belongs
to your people, or whether he’s a stranger who lives in your country and
behind your gates’ (5. Mos. 24,14; 27,19)” (1933, p. 57).11
Martin Buber immediately replied to these arguments (particularly the
fallacious interpretation of the stranger’s status in Mosaic law) in his 1933
“Open Letter to Gerhard Kittel”, which appeared in the journal
Theologische Blätter (Buber 2011). In the second edition of his brochure
Kittel published a response to Buber, where despite the usual academic
modus operandi he elected not to publish Buber’s text alongside his own
(1934, pp. 87–100). Buber’s 1935 collection of essays by Cohen can be
understood as a rejection of Kittel’s absurd arguments. In fact, Gerhard
Kittel did not think up his positions entirely on his own. Other theolo-
gians had already paved the way. For example, Adolf Stoecker (1835–1909)
published a collection of speeches where he notes that “modern Judaism
seems to pose a major threat to German national life” (Stoecker 1880,
p. 5). In 1880, Stoecker signed an “antisemite petition” submitted to the
18 E. Conradi
Prussian Prime Minister Otto von Bismarck. Its purpose was to undo the
legal emancipation of the Jews of 1869, and demanded that the German
nation rid itself of Jews’ domination, limit their immigration, and exclude
them from official posts (Conradi 2014, p. 231; Krieger 2003). Cohen
rebutted arguments like these—specifically addressing those presented by
the historian Heinrich von Treitschke [1879, p. 574]—in his 1880 “A
Statement on the Jewish Question” (Cohen 2014). A few years later,
Cohen published his expert opinion for the Royal District Court of
Marburg, in which he discussed the treatment of strangers in the Jewish
ethical tradition (Cohen 1888).
the human being as neighbour and fellow human comes to be and rein-
terprets the “love of strangers” as a “creative moment” in this development
(1888, p. 8). In this respect, there is no doubt for Cohen that the benevo-
lence that accompanies co-humanity is directed at strangers and acquain-
tances in equal measure (Hollander 2012, p. 106). Whether someone
counts as a ‘co-human’ [Mitmensch] depends only on whether the person
is in difficulty and currently within one’s own sphere. “Neighbour love,
benevolence towards the stranger as defined by nationality and religion”, he
concludes, “is a commandment of Judaism” (1888, p. 8).
From the first sentence of this long passage, it is clear that Cohen
understands the active support of others as a positive duty, not a negative
duty limited to the omission of harmful acts. Cohen’s sense of ethics goes
beyond the individual; it encompasses the awareness that people are con-
nected and gives reasons for solidarity among them.
Leo Baeck is another thinker who considers social equality to be a
fundamental ethical idea. Like Cohen, Baeck does not believe that com-
passion is a feeling: “In complete fidelity to the sense and the actual con-
tent of the word, he says: ‘Love your neighbour, he is like you’. The whole
emphasis is located on this ‘like you’. It expresses the unity of all that is
human, a unity that makes life on Earth meaningful and which means
much more than the indefinite word love. The social idea of one human-
kind and one human right and not merely a fleeting feeling has formed
this idea” (2007, p. 11 f.). For Leo Baeck, to treat your fellow human
being decently and kind-heartedly is not a question of feeling or indi-
vidual decision. It is required of the individual and structures social life
and interaction.
The German rabbi and writer Ludwig Philippson also argues against
describing co-humanity as a feeling. He sees the commandment of neigh-
bour love as a social duty to take action. In Die That (“The deed”)
Philippson writes, “Religion has not just brought God closer to people; it
has also brought people close to the fellow human being” (1845, p. 250).
Philippson distinguishes between two types of ethics. He claims the bibli-
cal injunction “Thou shalt love thy neighbour as thyself ” for Judaism and
reads it as the active support of fellow human beings. The other type of
ethics appropriated the concept of neighbour love, mimicked it, and
“embellished it with many other words, with lots of beautiful words, with
many lovely sayings; people revelled in the feelings of love, of peace—but
where was the deed?” (1845, p. 250). Placing the biblical quote in the
context of rabbinic writings, Philippson contrasts this second type of eth-
ics with Jewish assistance of others [Wohltätigkeit], which he describes as
“the most beautiful, the most noble side of neighbourly love, wherein the
word has fully become deed” (1845, p. 250). Philippson sees two branches
of Jewish Wohltätigkeit. Tzedaka, which is often translated as “charity”,
refers to the aid we give those in need (1845, p. 250). It is mainly a ques-
tion of financial support and donations in five cases: (1) freeing innocent
Forgotten Approaches to Care: The Human Being as Neighbour... 21
prisoners; (2) funding weddings that people otherwise could not afford;
(3) feeding and educating orphans; (4) providing food and lodging for
travellers who have been displaced, are sick, or have an urgent reason to
leave their homes; and (5) treating the poor with a kind heart and com-
forting words (1845, p. 251). The second branch of Wohltätigkeit is the
gemilut chassadim. It consists (1) in the participation in wedding celebra-
tions; (2) in prayer for and visit of the sick; in (3) unpaid volunteer clean-
ing, clothing and burial of the dead; and (4) in the “consolation of the
bereaved and grieving” (1845, p. 252).
Tzedaka and gemilut chassadim are key ideas in Jewish ethics. Gemilut
chassadim can perhaps be considered as ‘lending a helping hand’ or as in
person social engagement (Zeller 1997, p. 117). In the Jewish Encyclopaedia
of 1928, the entry for gemilut chessed translates it as a “demonstration of
love” and as an “active participation in the joys and sorrows of the fellow
human being”. But it also involves assisting others (Elbogen et al. 2008,
p. 1007). Philippson explains that both tzedaka and gemilut chassadim are
to be exercised according to the extent of one’s own powers and abilities,
yet no one is exempt: “And behold, this is the deed! This is deed and real-
ity! This is not only a word and a sweet sensation, but a strong deed. The
wise say that even the poor person who live on alms should sometimes
give alms!” (1845, p. 252)
Gemilut chassadim is a central concept in understanding the notion of
common humanity’s place in Jewish ethics. In Samson Raphael Hirsch’s
(1808–1888) translation of the treatise Chapters of the Fathers [pirkei avot],
a part of the Mishnah, it is said that “the world relies on three things: on the
Torah, on worship, and on deeds of love”. Hirsch’s translation was pub-
lished posthumously in 1895. In his comment on the passage, he writes:
Torah: the knowledge of the divine truth and the divine will for our whole
inner and outer self and world life; avoda: the duty of obedience to God in
fulfilling His will with our whole inner and outer self and world life; gemi-
lut chassadim: the selfless deeds of love for the salvation of fellow human
beings. These three things make up and complete the human world and
what it encompasses depending on size and type; where they are missing,
and if they are missing, and to the extent that they are missing, there is a
gap that cannot be replaced by anything, a part of being is missing. …
Without gemilut chassadim, humans lack the first part of being similar to
22 E. Conradi
God, and instead of bearing a likeness to God in saving and blessing their
contemporaries, their hearts are frozen in senseless selfishness and hard-
ness, and mankind lacks the bond of brotherhood and love, where the joy
of life and happiness will thrive. In studying the Torah, human beings do
justice to themselves; in avoda, to God; in gemilut chassadim, to their co-
humans (1994, pp. 6f.).13
There are other interpretations of this line from the same decade. Isaak
S. Bamberger (1863–1934) translates gemilut chassadim as ‘‘Wohltätigkeit’’
(contributing to wellbeing) and not, like Hirsch, as ‘‘selbstlose
Liebestätigkeit’’ (selfless action out of love). Below Bamberger explains
his decision:
The world rests on three things—the world in its entirety as well as each one
was created for the purpose of performing these three things: the Torah; the
study of the Torah for one’s own spiritual perfection is a duty for a human
being unto himself. Divine worship, first in the sacrificial service in the
Tabernacle and in the holy Temple of Jerusalem, and since the destruction
of the latter, in prayer. This brings with it obligations toward God. And
assisting others, through personal bodily assistance (visiting the sick, funer-
als, consoling the bereaved, sharing the joy of bride and groom, making
peace and the like) and support of the needy and poor, which is suited to
the duties toward the fellow human being (1981, pp. 2f.).
The forms of personal assistance described here were no mere lip ser-
vice. They were practiced by cooperative associations, known as hevrot in
Hebrew (Auerbach 1969, p. 19).14 These non-profit groups had been
active in large numbers and identifiable in every form in Europe since the
sixteenth century (Farine 1973, p. 17; pp. 19f.; Baader 2001, p. 17).
Benjamin H. Auerbach, who wrote about the hevrot operating in
Halberstadt in the nineteenth century, interprets such associations in the
context of Jewish ethics:
It is a fact that the first characteristic sign of the presence of a pious Jewish
community is the existence of associations in their midst; they secure
within the community the three pillars on which, according to the words
of the wise, the world rests: knowledge of the Torah, religious and human
personal service, and giving alms (Torah, avoda, and gemilut chassadim);
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From old Pietro’s canvas freshly sprung,
Fair face! that thus so sweetly can combine
The maiden and the mother ever young—
(The reader will perceive that Oswald’s verses were not of the highest
quality.) He had got just this length when a sudden shriek disturbed him.
The little procession was crossing a side street, and one of the younger
children had made a rush from her companion, and in a moment, before
anyone could draw a breath, had been knocked down and apparently
crushed by a cart which came lumbering slowly up the street, too slow and
too heavy to alarm anyone. Oswald, to do him justice, was not given to
mooning when there was any need for active service. He rushed across the
street, reaching the scene of the disaster before anyone else, except his
Perugino, who had flown with one small cry, and was herself half under the
heavy cart, pushing it back with all her force, while the others stood aghast
and shrieked, not knowing what to do. Nothing could be more swift, more
ready, than the Perugino novice. She had already drawn the child half into
her arms before Oswald reached the spot, and was feeling the little limbs all
over, with a little panting cry, half horror, half want of breath. ‘Let me carry
the child to the nearest doctor,’ cried Oswald. The colour had all gone out
of the Perugino face—the big wheel of the cart touching her delicate
shoulder made a background for her; she was a St. Catherine now. ‘There is
something broken; she must go to the hospital,’ the girl said, looking up at
him with that sudden acquaintance and confidence which comes in such a
moment. Her shoulder brushed against him as she transferred the little
burden to him. The child had fainted. He took the poor little crushed
creature in his arms. They were within a stone’s throw of the great hospital,
and there was nothing to be done but to carry it there. The elder Sister by
this time had joined them, sending the curious, anxious, crying girls away
under the charge of the remaining governess. ‘Agnes, you ought to go back
with them. You are as white as a sheet. You will faint,’ said the Sister,
putting an arm round the girl.
‘Oh, no; I am better. Let me go and see what it is,’ she said.
Agnes? Was that the name? It was one of the saints, he had felt sure.
CHAPTER XVIII.
TELLING TALES.
‘Roger has been to pay dear Cara a visit,’ said Mrs. Burchell. ‘He was in
London on Sunday with his kind aunt, at Notting Hill, and he thought he
would call. I don’t approve of Sunday visits, but I suppose exceptions must
be made sometimes, and Roger went; knowing her all his life, you know, he
felt interested. Do you know a family called Meredith, Miss Charity? I
should not think, from what he tells me of them, that they can be people you
would care to know.’
‘Meredith! but of course you know them, Aunt Charity—poor Annie’s
friend, whom she was so fond of—the only person who was allowed to
come in when she was ill—the most delightful, kind woman.’
‘People change as years go on; and Cherry is always enthusiastic—
gushing, as my young people say. But do you know, Miss Charity, that poor
Mr. Beresford is always there? dining there on Sunday; sitting till one does
not know how late; and she is a woman separated from her husband,’ said
Mrs. Burchell, lowering her voice. ‘I am sure that is a thing of which you
cannot approve.’
‘Of women separating from their husbands?’ Miss Charity was sitting in
her dressing-gown, in her bedroom, by the fire. She had been laid up by
‘one of her attacks.’ This was how everybody spoke of it; and though she
was completely out of danger, it was necessary to take care. The
consequence was that she lived in her bedroom, and chiefly in her dressing-
gown, and was sometimes fretful, hard to manage, and a strain upon Miss
Cherry’s powers. Almost any visitor, who would come and bring a little
variety, and particularly a little news, was an advantage; therefore Cherry
was very reluctant to interfere with what Mrs. Burchell said, especially as
she was hungering for news of the child who, though she wrote so regularly,
did not say half what Miss Cherry wanted to hear.
‘I can’t pronounce on such a question without knowing the
circumstances,’ said Miss Charity. ‘Women are fools, but then so are most
men as well.’
‘Oh, Miss Charity! that is one of your quaint ways of stating things. Mr.
Burchell always says you have such quaint ways of expressing yourself; but
always judicious, quite above what could be expected from a woman.’
‘Mr. Burchell is a good judge; he has means of knowing what may be
expected from a woman,’ said the old lady, sharply. ‘And so you think
badly of Mrs. Meredith? But make your mind easy; she is not separated
from her husband.’
‘Not!’ Mrs. Burchell echoed the negative in a tone which was faint with
disappointment. ‘Oh, but pardon me, I fear you must be mistaken, for Roger
says——’
‘I thought that boy was a nice boy. What have you done to him to make
him a gossip? Cherry, that was the one I thought well of, was it not? The
others were naught, except Agnes; but this was a nice boy.’
‘Agnes is very self-willed,’ said Mrs. Burchell; ‘she is gone to that
mission, though I am sure there is plenty to do at home and in the parish. I
don’t know what to say to her. But as for the others being naught, I don’t
think it is very kind of you to say so,’ she added, looking as if she meant to
cry.
‘It is only one of my quaint ways of expressing myself,’ said Miss
Charity, grimly. ‘I hate a boy who is a gossip. It is bad enough in girls; but
then one is sorry for the poor things that have nothing better to do. What
does this boy of yours say? If he was my boy, I’d whip him for tale-telling.
And what was he doing in the Square?’
‘My children have always been brought up to confide in their mother,’
said Mrs. Burchell, on the verge of tears; ‘they have always told me their
impressions. Thank Heaven, though my lot is not luxurious like some
people’s, I have always had comfort in my children.’
‘That is a hit at you and me, Cherry, who have no children,’ said the old
lady, who was sharp and keen after her illness. ‘My dear, we are quite
willing to admit your superiority. What did the boy say?’
‘I am sure there was no boasting in my mind. I have very little occasion
to boast. A poor clergyman’s wife, with so large a family to bring up! but I
am proud of the confidence of my children. Dear Roger went to see Cara
out of kindness. He has always had a kind feeling to her, and the poor boy’s
heart was quite touched to see her among such people. They seem to live in
an ungodly way, with dinner-parties on Sunday, and that sort of thing—no
regard for poor servants or for the bad example they are setting. And as for
the lady, Roger did not tell me all; but he says Mr. Beresford stays—stays
after Cara goes home, and, in short, is never out of the house. I felt that you
ought to be told. Gentlemen have very peculiar ideas, I know—they don’t
follow our rules; but for a man to take his daughter, his young daughter, into
such society——’
‘Maria!’ Miss Cherry was speechless with horror and dismay. She
managed to get out this ejaculation, and no more. But the old lady was less
easily moved. She put on the spectacles to which she had taken quite lately,
and looked into her visitor’s face.
‘Here is an odd thing now,’ she said, ‘a very odd thing. I am willing to
suppose you are an innocent sort of woman, Maria Burchell. You never did
anything very bad—for one thing, you have never been tempted—and yet
you are ready to believe any evil, at the first word, of another woman whom
you know nothing in the world about. It is the oddest thing I know. If you
had been a wicked person, one could have understood it. But a clergyman’s
wife, as you say, in a quiet country place, out of the way of temptation—
why, you ought to think well of everybody! You ought to be the sort of
person who could be taken in, who would not believe harm of anyone, an
innocent woman like you!’
‘Am I an innocent woman?’ said Mrs. Burchell, shaking her head, with a
sad smile. The distinction, if flattering to her moral character, was
derogatory to her dignity. ‘Ah, how little we know each other! and what is
called charity is so often mere laxness of principle. I hope I know the
depravity of my own heart.’
‘In that case, my dear, there’s nothing more to be said,’ said Miss
Charity, briskly, ‘only that you ought not to come here under false
pretences, taking us all in, and looking respectable, as you do. But, however
bad you may be, Mrs. Meredith is not bad. I don’t know much about the
husband; perhaps they don’t get on together very well. Perhaps it is health.
She lives here, and he lives there—that is all I know; but she is a better
woman than I am; that I’ll answer for. How she can put up with that fool of
a nephew of mine, I can’t tell. He is very learned, I grant, and a fellow of
half the societies. Well, and so your boy said——? What is the woman
crying for, I would like to know?’
‘Oh!’ wept Mrs. Burchell, ‘I never thought to have lived to be so spoken
to; and by an old friend. Oh, Cherry! you that have known me from a girl,
how can you sit still and do your knitting, and hear me talked to so?’
‘She does not mean it,’ said Miss Cherry, softly, ‘dear Maria! She has
been ill. She can’t help being a little irritable.’
‘Stuff!’ said Miss Charity. ‘She brought it on herself. Go away, Cherry;
if I were irritable, it is you who would feel it first. Now, Maria, don’t be
more of a fool than you can help. What did the boy say?’
Miss Cherry went back to her knitting, with a suppressed sigh. It was
very true that it was she who paid the penalty first; but to see anybody
crying troubled the kind soul. She gave a kind little pat as she passed to
Mrs. Burchell’s fat shoulders. She was knitting a huge white shawl in thick
wool, to keep the old lady warm, and her own slight person was half lost in
its folds.
But there was not very much more to be got from Mrs. Burchell. The
boy had not, indeed, said any more, nor so much as she had reported. He
had been betrayed by the sore state of his feelings, poor Roger, to give a
very slight sketch of his uncomfortable Sunday—how he did not think the
lady to whom Mr. Beresford talked so earnestly, who had a husband, and
yet had no husband—who asked people to dinner on Sunday, and who—but
Roger did not say this—had two sons who interfered so uncomfortably with
his own inclinations—was at all a good friend for Cara. This was the extent
of Roger’s confidence, and he regretted bitterly having given it before the
evening was out; for it is one thing to disburden your heart of a grievance,
and quite another to have that grievance enlarged and embittered by
constant reference and repetition. He heard so much of it before he left the
Rectory that evening that he was furious with himself for having betrayed
his wound, and felt ashamed of it, and guilty so far as Cara was concerned.
Therefore, Mrs. Burchell was rather glad of the personal offence which
concealed the fact that she had very little to say. It had given a great zest to
her visit that she had Roger’s news to tell; but there was much less detail
than she could have desired, so she dropped into her own personal
grievance about Agnes, who had insisted on going to the mission-house to
teach, when there was plenty to do at home; but neither of the ladies entered
warmly into it, Agnes being a greater favourite with them than her mother.
When she was gone, however, Miss Charity fell into a musing. Age had
crept a little, just a little, upon her. She was no longer the vigorous woman,
of no particular age, whom Dr. Maxwell had commended as a type of
womankind. Winter is unfavourable to the human frame when it approaches
seventy. With a soft, perpetual summer, never blazing, as it is in the south,
and chequered by no chilly gales, would it be necessary that threescore and
ten should be man’s limit, or that we should ever die? Miss Charity felt the
unkindly influence of the winter. When summer came back she would be all
right again—or so, at least, she thought.
‘It as amazing, the ill people have in their thoughts,’ she said, at last.
‘That woman, with her “laxness of principle” and her depraved heart, and
her indignation, to be taken at her word! Now, Cherry, that was an
inoffensive girl enough. When she was Maria Thompson there was no
particular harm in her. I believe we ought all to die at twenty. What a deal of
mischief it would save the world.’
‘And good, too,’ said Miss Cherry, in her soft voice.
‘Good! not so much good. Do you know, I don’t feel comfortable about
Mrs. Meredith. I know she’s a nice woman; but, bless my soul, the number
of nice women I have known, who have been—no better than they should
be! And Cara, you know—Cara is our business, Cherry; we are her nearest
relations. I do believe she would be better here. Nobody can say that you
are—no better than you should be. You don’t form friendships with men. I
daresay that’s all Mrs. Meredith’s sin at bottom.’
‘But that is only,’ said Miss Cherry, composedly, ‘because there are no
men to form friendships with. You may laugh, Aunt Charity; but I say quite
what I mean. I am not a young girl—neither is Mrs. Meredith. If she is good
to my poor brother James, shouldn’t we be grateful? And as for Cara—
though Heaven knows how much I would give to have her back again——’
‘Who is that at the door? I won’t see any more people—that woman has
put me out for the day. Though I know it is nonsense, I can’t get it out of
my head. She is a great deal too fond of being popular. She is——. Whom
do you say? Mr. Maxwell? to be sure, it is his day. Well, I suppose he must
come in, of course. And just as well; we can ask him, and set it to rest.’
Mr. Maxwell came in, as he had done regularly every week for no one
knew how many years. He was redder and rustier, and perhaps a trifle
stouter; but that did not show to familiar eyes. Otherwise, the five years
which had elapsed since Mrs. Beresford’s death had made no alteration in
the doctor. He was on that tableland in the middle of life when five years
tell less than at any other period. He came in with the slight bustle which
was characteristic of him, and sat down by Miss Charity, and got through
quickly that little confidential talk which is necessary between a doctor and
his patient, during which Miss Cherry took her big piece of work to the
window, and stood there, holding the mass of white wool in her arms, and
knitting on, with her back towards the others. When this formula had been
gone through she returned to her chair. Her interest in the matter was too
great to allow even her aunt to open it. ‘Have you seen my brother James
lately?’ she said.
‘Your brother James!’ The question seemed to startle and confuse the
doctor. ‘We have seen very little of each other these five years.’
‘Ah! I thought you were not so intimate,’ said Miss Cherry, whom the
suspicion had pained. ‘Is there—any reason? I should like so much to
know.’
‘Well! I suppose there always is some reason or other. But no—
estrangements come by accident constantly, Miss Cherry. I can’t tell what is
the reason. I don’t suppose I know. We have drifted apart, that’s all; people
do so every day without knowing why.’
‘People know when it begins,’ said Miss Cherry, eagerly; but here she
was interrupted by her aunt.
‘Never mind about estrangements. What we want to ask you, Mr.
Maxwell, is whether you have seen Cara, little Cara, you remember? and
also something about their neighbours. There is Mrs. Meredith, for instance.
We hear she sees a great deal of them. Eh! why shouldn’t I tell Mr. Maxwell
exactly what we have heard? A doctor isn’t a tale-bearer; he’d lose all his
practice in a week. We’ve been disturbed by hearing (especially Cherry; she
is more particular than I) something about Mrs. Meredith. You, that know
everything, tell us if it is true.’
‘I have seen very little of Mrs. Meredith. I don’t know much about
James. Cara would be a great deal better here. What does he want with the
child in London? he doesn’t require her; he has done without her all these
years. I’d have her back, Miss Charity, if I were you.’
‘It is very easy to talk of having her back. She is his child after all.
Come, speak out; they say James is there constantly—and that this lady—
she isn’t separated from that husband of hers, eh?’
‘Not that I know of.’
‘Not that you know of! Of course you know whatever there is to know.
What is the matter? A woman should not let herself be talked of.’
‘Mrs. Meredith is not talked of, if that is what you meant but I have
heard that James is constantly there. He oughtn’t to do it. If he is fond of
her, as I don’t doubt he is fond of her——’
‘Mr. Maxwell, how can you speak so of my brother?’ said Miss Cherry,
agitated and blushing, with the tears ready to come. ‘A married woman! I
am sure he has no more thought of anything of the kind. What has his life
been since Annie died? That speaks for itself; he has thought of no one but
her.’
‘Hold your tongue, Cherry, my dear. You are an old maid; but you have a
foolish young soul. What do you know of such things? Let us talk it over
quietly. Now, Mr. Maxwell, you need not be upon p’s and q’s with me. If he
is fond of her? that is the question. Nothing but what is innocent, you goose.
We don’t think James a bad man, do you suppose? Now, doctor, we must be
at the bottom of it, now we have opened the question. What do people say?’
‘I say—if he is fond of her, he oughtn’t to compromise her, Miss
Charity; that is all about it. Innocent! of course it’s all innocent enough; but
the woman is married, and her husband is thousands of miles off, and he
ought to have more sense than to go there every evening, as he does. Yes,
we’ve talked of it among ourselves; not to let it go any further; not to make
any scandal, Heaven knows. No one thinks of any scandal; but he oughtn’t
to do it. I am not blaming your brother, Miss Cherry; he has fallen into it,
poor fellow, without knowing. He and I are not such friends as we were. I
have thought I had reason not to be quite pleased with him; but I don’t do
him injustice here. He means no harm; but he oughtn’t to do it. The more he
is fond of her, the more he ought to take care. And there you have my
opinion, and that’s all about it. I don’t think anyone has ever ventured to say
more.’
‘It is too much to have said,’ said the old lady, ‘and she ought to know
better. I don’t put it all on him. She ought to have put a stop to it. Women
see these things better than men; and besides, it is the women who suffer,
not the men. She ought to have put a stop to it. I don’t put it all on him, as
you seem disposed to do.’
‘How could she put a stop to it?’ said the doctor, warmly. ‘She is good to
everybody. She opened her house to him when he was miserable. How is a
woman to say to a man, after she has been kind to him, “Don’t come any
more; people are beginning to talk?” Good Lord! it would be like supposing
they had some reason to talk. If any woman said that to me I should feel
that she thought me a brute bad enough for anything. No, no; everybody
says women are hardest upon each other——’
‘Everybody says a deal of nonsense,’ said Miss Charity, sharply. ‘A
woman does not need to speak so plainly. She can let the man see when he
is going too far without a word said. How? oh, there’s no need to tell you
how. We know how, that’s enough. She could have done it, and she ought to
have done it. Still, I don’t think any harm of her; and it must simply be put a
stop to, now we know.’
‘Ah!’ said the doctor, drawing a long breath, ‘but how?’
‘How, again? Why, what kind of people are you who call yourselves
their friends? It’s your business to do it. Cherry, my dear, I am a deal better;
the bronchitis is all gone, and Barbara is as careful of me as a woman can
be. You’ll go off directly to the Square. If I were well enough, if it were not
for this stupid bronchitis, I’d go myself; but it isn’t worth a life; is it,
doctor? See how things are going on. Of course you won’t make any fuss,
Cherry; but whatever ought to be done you’ll do.’
Maxwell turned, as the old lady made this address to her niece, and
looked at her. What would poor old Cherry do? he said to himself, watching
her with curiosity and wonder. Was she a person to face this dilemma,
which had kept various and more determined persons in difficulty? She let
her work drop upon her knee, and looked up with an agitated face. She
grew pale and red, and pale again.
‘How am I to speak to James?’ she said, hurriedly catching her breath
—‘a man!’
Then she made a pause and an effort, and the doctor, astonished, saw a
soft light of resolution come into the mild old maiden’s face.
‘Of course,’ she said, still a little breathless, ‘I will not think of that if
there is anything I can do.’
‘And of course there is something to do!’ said the more energetic old
lady. ‘My patience! what do people get old for, doctor? I should do it
without thinking twice. What do they say about a sound mind in a sound
body? I wish, for my own part, when an old woman gets bronchitis, she
could get it in her soul as well, and be all bad together. But for this old
body, I’m as strong as ever I was; and Cherry was always weakly, poor
dear.’
‘Do not vex yourself, Aunt Charity; I will go,’ said Miss Cherry, with
only a slight faltering in her voice. ‘Mrs. Meredith is a good woman, and
my brother James is a good man too, though I wish he was more religious.
When a thing is plain duty, that makes it—easy; well, if not easy, at least
——. I will do my best,’ she said softly. Mr. Maxwell watched her quite
intently. It was all very well to say this here; but would she venture to do it?
He had always taken an interest in Cherry, more or less. All these years,
during which he had come weekly to the Hill, he had been always sensible
when Cherry was not there, and had a way of looking round for her grey
gown when he came in. Everybody knew his way of looking round, but no
one, much less the chief person concerned, had ever divined that it was that
grey garment which he missed when it was not there. Poor faded, fluttering,
nervous Cherry; he had always taken an interest in her; would she really
have the courage to take this bold, independent step, and do the thing which
not one of James Beresford’s friends had dared to do?
CHAPTER XIX.
THE PERUGINO.
Oswald Meredith had a new direction given to his thoughts. He was not,
as may be easily divined, so clever as Cara gave him credit for being, nor,
indeed, as his family supposed, who knew him better than Cara did; but he
was full of fancy and a kind of gay, half-intellectual life which might be
called poetic so far as it went. His head was full of the poets, if not of
poetry; and a certain joyous consciousness of existence and of well-being
which made his own pursuits and enjoyments beautiful and important to
him, was in all he did and said. He was not so much selfish as self-
occupied, feeling a kind of glory and radiance about his youth, and
conscious freedom and conscious talents which elated him, without any
absolute vanity or self-love. Naturally all the people who were equally self-
occupied, or whose temperaments ran counter to Oswald’s, took it for
granted that he was vain and selfish; and those who loved him best were
often impatient with him for this happy contentment, which made him
pleased with his own aimless ways, and indifferent to everything that
demanded any exertion which would interfere with the smooth current of
his enjoyable and enjoying life. For himself he was too good-natured to
criticise or find fault with anyone—having no ideal himself to derange his
satisfaction with his own circumstances and behaviour, he had no ideal for
others, and was quite content that they, too, should enjoy themselves as they
pleased, and find each for himself the primrose paths which suited him best;
but he did not inquire into the primrose paths of others. He was so pleased
with his own, so ready to tell everybody how delightful it was, how he
enjoyed it, what pretty fancies it abounded in, and pleasant intercourse, and
merry sunshiny ways. For Edward, who worked, he had the kindest
toleration, as for an odd fellow who found his pleasure that way; and his
mother, who sympathised with everybody, he regarded also with half-
laughing, satisfied eyes as one whose peculiar inclinations laid her open to a
charge of ‘humbug,’ which, perhaps, was not quite without foundation. Let
everybody follow their own way: that was the way in which, of course, they