In her essay, Uncovering the Ethics of Suffering, Maj-Britt Raholm applies Hans-Georg Gadamer’s hermeneutical approach to the health care professional’s task of ethically responding to suffering.  Gadamer pointed out that humans are situated within traditions formed by family, society, and state.  The prejudices or traditions in which we are thrown are the means through which we encounter the world.  They constitute the “historically effected consciousness” with which we live.  As Raholm writes, “What we hear depends on the kind of questions we ask from our vantage point in history.” Each individual has a unique horizon, which Gadamer defines as “the range of vision that includes everything that can be seen from a particular vantage point.”

“A fusion of horizons” (Horizontverschmelzung) occurs “when our horizon of historical meanings and assumptions fuses with the horizon within which the narrative is placed.” Raholm applies the idea of Horizontverschmelzung to the clinician’s work of understanding their patients’ stories.  Health care professionals encounter patients through certain orientating preconceptions or prejudices.  Indeed, as Gadamer would remind us, these preconceptions are a necessary port of entry.  They help form the reason that the doctor or nurse attends to the patient in the first place.  But to understand their patient’s situation, health care practitioners must allow their preconceptions to be challenged, humbly opening themselves to realities they might not expect or anticipate.

Geriatric psychiatrist Marc Agronin illustrates this process in a story from his book How We Age.  He describes meeting a ninety-three year woman shortly after the death of her husband of seventy-three years.  Agronin writes, “I was overwhelmed by the thought of her loss and wanted to offer some words of comfort.  I leaned in close and spoke, ‘I’m so sorry.  What has it been like for you losing your husband after so many years of marriage?’  She paused for a moment and then replied, ‘Heaven.’  I flinched for a moment, hoping that I had misheard her.  Seeing my bewilderment and understanding immediately the irony of the response, she smiled at me and proceeded to describe how she had endured decades in an unhappy marriage, with a gruff, verbally abusive man. . . In my misguided empathy, I had committed what William James described as the psychologist’s fallacy—assuming incorrectly to know what someone else is experiencing.”  Agronin approached his patient with certain preconceptions about what she must be feeling as a new widow.  His presumption that she would be sorrowful served as a useful initial guide for their interaction. But Agronin listened openly enough to have his prejudice challenged and replaced by the different reality he received.