Health care as participatory sense-making: an enactive perspective on relations between patients and health care providers

Participatory sense-making is already an established concept within enactivism. It is used to define the participatory nature of cognitive relations, designating that humans and other organisms make sense of their surrounding environments not just on their own. They build cooperative networks, working together, to create ways of making sense of the world. However, so far little attention has been paid to how enactive concepts, such as participatory sense-making, may apply to the field of bioethics, understood here as health care ethics. In this paper, I examine health care practices cases of participatory sense-making. The paper aims to show that relations between patients and health care providers (HCPs) can be understood as participatory sense-making relations. To make my case, I discuss the so-called phenomenological interview, as proposed technique in health care. I argue that this interview technique has essential features that can be viewed also as features of participatory sense-making. More specifically, the phenomenological interview is an open-minded, a critical, and pro-active dialogue between patient and health care provider that is meant for the patient to raise self-awareness of their body and medical condition, as well as of the social conditions that may affect that experience and condition. I will argue that phenomenological interviews are exemplary cases of patient-health care provider relations in which both parties actively work together to make sense of what the patient is going through and to find adequate medical responses to that experience. I will conclude by proposing normative guidance based on my analysis of health care practice as participatory sense-making. I argue that viewing patient-HCP relations as participatory sense-making may be helpful for both patients and health care providers in that it shows that health care practice is not just a technical exercise or routine task, but essentially relational and patient-oriented.