Hospitality
Derrida discusses hospitality in a way that is both connected to, and distinct from, more familiar understandings of the concept. As in more everyday ideas and practices of hospitality, Derrida’s understanding of hospitality is about receiving people, or creating the conditions for their reception, whether they are invited guests or unfamiliar strangers. However, where everyday ideas and practices of hospitality are concerned with the kinds of things a host can and should do in order to satisfy the cultural codes and moral demands of hospitality, Derrida presents it as a necessary response that cannot be perfected and will always fall short. “The other may come, or he may not. I don’t want to programme him, but rather to leave a space for him to come if he comes. It is the ethic of hospitality.”28 Offering a hospitable welcome means that one should prepare for the other’s arrival, but with the understanding that this other may never arrive, or not at the time they were expected or the host was best prepared, or with needs that are not aligned with the host’s preparations.
Hospitality is altruistic in the sense that it is other-directed and it puts the needs of the other first. In fact, Derrida goes a step further and positions the host as dependent on the guest or stranger: “…the welcoming one is welcomed. He is first welcomed by the face of the other whom he means to welcome.”29Without a guest or stranger to receive, one cannot be a host; without patients, one cannot be a physician. Hospitality has similarities with beneficence but is much less confident about its ability to get it right. The person in the position of host must make an effort to ascertain the needs and interests of the other, but may discover that even a well-intentioned gesture of hospitality does not actually enable the other to find a place.
What a Derridean concept of hospitality allows us to see more sharply for medical practice and education than other ethical concepts and frameworks is that the place where a patient is received is not mere background, but is an integral part of the experience of the experience of receiving care. In the experience of patients and their families, medical diagnosis and treatment are not stand-alone interactions; rather, they are parts of a longer or shorter sojourn in the kingdom of the sick, a place with which physicians and other health care providers may be thoroughly familiar, but that for many patients is impersonal, incomprehensible, alienating, and perhaps even threatening.
While hospitality in the everyday sense means typically that one offers hospitality from one’s own home, or perhaps a space one has rented for the specific purpose of receiving one’s guests, the hospital is a work environment that physicians do not own or control. Is it still appropriate to speak of “hospitality”? Ruitenberg discusses an ethic of hospitality in education, which involves teachers offering hospitality from classroom and school spaces they do not own or control. She writes that this situation may be more conducive to hospitality because there can be no illusion of ownership or control.30 Derrida cautions that making the gesture of hospitality may confer a sense of ownership on the host that can get in the way of other-centeredness: “To dare to say welcome is perhaps to insinuate that one is at home here, that one knows what it means to be at home, and that at home one receives, invites, or offers hospitality, thus appropriating for oneself a place to welcome … the other….”29 Similar to a teacher’s welcome into an educational space, a physician’s welcome into a medical space must be “a more humble gesture made by a host who knows that she herself has been received and that she is not truly in possession of her home.”30
As discussed earlier, there is an irreconcilable tension between the limitless demands of altruism, and the interests of self-preservation. An ethic of hospitality is similarly limitless but its purpose is not to be fulfilled. Rather, it serves as a corrective aspiration and a reminder that ticking the boxes of codified professional ethics is insufficient for an ethical response to patients and families. Hospitality in this Derridean sense cannot be hospital policy, but a policy that “does not maintain a reference to this principle of unconditional hospitality” is a policy that cannot do justice to its patients.31