What makes us human? Exploring the significance of ricoeur's ethical configuration of personhood between naturalism and phenomenology in health care

Abstract The aim of this article is to elaborate on how a distinct concept of the person can be implemented within person‐centred care as an ethical configuration of personhood in the tension between the two predominant cultures of knowledge within health care: naturalism and phenomenology. Starting from Paul Ricoeur's ‘personalism of the first, second, and third person’ and his ‘broken’ ontology, open‐ended, incomplete, and imperfect mediations, placed at the precise juncture where reality is divided up into two separate cultures of knowledge, is identified as crucial for what makes us human. Within this context, Ricoeur's distinct ethical configuration of personhood is based on the homology between the linguistic, practical, narrative, and moral determinations of selfhood—articulated as a hermeneutics of the self, without any methodological break. Person‐centred care is thus recognized as an profound ethical approach to health care based on mediations of ‘horizontal’ (teleological) and ‘vertical’ (deontological) readings of an ethical configuration of personhood by the use of practical wisdom.


| INTRODUCTION
The title I have chosen for my presentation brings to the fore one of the most crucial questions in our time, and a challenging issue within health care as well: what makes us human? In this text, I will mainly draw from the French philosopher Paul Ricoeur (1913-2005 to elaborate on how his concept of the person can be used and implemented within person-centred care when articulated as an ethical configuration of personhood in the tension between the two predominant cultures of knowledge: naturalism and phenomenology.
The concept person-centred care invites misunderstandings, and the tremendous success of person-centred care in Sweden and elsewhere (Britten et al., 2020;Ekman et al., 2011Ekman et al., , 2020 has only aggravated the problems associated with maintaining a distinct understanding of the concept. Furthermore, it is difficult to navigate and make clear distinctions in a conceptual landscape in which patient-centred care, personalized medicine, and personcentred care often collapse into each other in a very confusing way. Person-centred care has sometimes also been used to support an almost narcissistic approach when people who consider themselves as the ultimate experts on their own health status Nursing Philosophy. 2022;23:e12385.
wileyonlinelibrary.com/journal/nup 2 | THE ' TWO CULTURES' In a lecture given in 1959, C.P. Snow coined the phrase 'the two cultures', referring to a dramatically widening gap between what he identified as scientists and literary intellectuals: the former represented by forward-striving positivists (often holding up mathematicians and physics as paradigms), the latter by what he considered opponents of modernization (represented by intellectuals based in the humanities, scholars who did not regard natural scientists as worth engaging in conversation). Snow pointed to a worrying tendency for communication between these two groups to cease entirely, resulting in a disastrous division into what he recognized as two 'galaxies' that have lost contact with each other (Snow, 1959).
Today, this problematic has worsened and is more difficult and challenging than ever.
The historical background to this aggravated situation is the emergence of what might (anachronistically) be called two parallel 'scientific' projects, manifested by the causal explanations of the 17th century Scientific Revolution from which the natural sciences emerged, and the revised Aristotelian teleology of understanding in modern humanities stemming from the tradition of the Medieval university. Nevertheless, it was not until the 19th century that the contours of a dualistic order in which culture and nature, representing two discrete forms of reality, an 'inner' world defined by freedom and teleological purposes and an 'outer' world defined by necessity and causality, began to appear as a complex challenge to cope with.  (Ricoeur, 1965, p. 133).
It is amazing to note hos Ricoeur in this emotional presentation anticipated elements from his later text hermeneutics when claiming that 'books should be read, as the books of a dead person'. It might come as a surprise to some, but there is an inherent link between Ricoeur's philosophy of action and the death of the author in Ricoeur's dialectical understanding of the capable human being. Because to Ricoeur, the 'death of the author' (cf. Roland Barthes) never meant to be acknowledged as a theoretical antihumanism declaring the death of the subject in general (Foucault, 1973) recognition that 'distanciation is the condition of understanding' (Ricoeur, 2007a, pp. 75 and 88).
In Oneself as Another (Ricoeur, 1992a) is also the title of Ricoeur's most systematic presentation of philosophical anthropology. In this book the recognition of homo capax, the capable human being, reaches its highest significance in the conceptualization of the person as someone whose actions can be imputed to him or her. Here, Ricoeur argues for a philosophy of action where the capable human being is recognized by a profound dialectical approach: the acting human being who is always also recognized as a suffering human being-and this suffering human being is never only considered a victim but also recognized as a person capable of developing actions.
Within this dialectical understanding of personhood, disproportions stemming from the lack of foundations are present in every aspect of a vulnerable human life, thus indicating the inevitable fragility of everything human.

| AN ETHICAL CONFIGURATION OF PERSONHOOD
Ethics is in general considered as something that is externally addeda naturalistic approach to human beings and to an existential understanding of personhood. It might seem strange that a philosopher who constantly raised ethical issues never presented a separate book with a systematic presentation of his ethical thinking.
Instead of a large comprehensive moral philosophy, we must settle for a minima moralia, une petite éthique-a 'little ethics', presented as an integral part of a wider investigation of personal identity and personhood. Therefore, we need to carefully consider the wider implications of the fact that Ricoeur's ethical aim is not presented in splendid isolation, but as an integral part of a fourfold determination of the self (who speaks?; who acts?; who narrates?; and who is responsible?; later also memory and promise were included).
The homology between the linguistic, practical, narrative and moral determinations of selfhood, described without any methodological break, implies that each of these are integral parts of Ricoeur's hermeneutics of the self. Furthermore, this remarkable continuity is intensified by the fact that their order may be reversed: one may as well start with the ethical determination of the self, continuing with narrative, action and finally language, without losing sight of the dialectic approach to the capacities and incapacities of acting and suffering human beings, possibilities which Ricoeur also elaborated on in other publications (Ricoeur, 1992b).
Ricoeur's first articulation-his 'horizontal' reading-of ethics, in terms of an aim at 'the good life' with and for others in just institutions (Ricoeur, 1992a, p. 172), is closely connected to a 'personalism of the first, second and third person' (Kristensson Uggla, 2020, pp. 92-99), and 'vertical' readings was not present in Ricoeur's original articulation of ethics (Ricoeur, 1992a) but was developed only later (Ricoeur, 2007b;Kristensson Uggla, 2017). It is important to notice that ethics begins as a wish before it becomes a moral imperative. But the ethical aim really needs to be critically evaluated, and therefore must pass through an examination of the norm, duty and interdiction. Thus, the 'vertical' dimension of ethics, that is, morality (Kant), is for Ricoeur at once subordinated and complementary to the 'horizontal' dimension of ethics, that is, Aristotelian ethics (Ricoeur, 1992a, pp. 170-171). convictions' (Ricoeur, 1992a, p. 289) (Ricoeur, 1984, p. 3).
Poetry is a also powerful tool if we want to understand and communicate what an ethical approach to person-centred care means in concrete situations, where the profession encounters the patient. Therefore, it seems appropriate to conclude this presentation by refering to the Swedish poet Tomas Tranströmer, using his poetic language for a better understanding of the necessity of establishing a 'meeting' that might give us a chance to catch sight of human beings (Tranströmer, 1972, p. 45): Two truths approach each other. One comes from inside, the other from outside, and where they meet we have a chance to catch sight of ourselves.
In other words, we cannot develop robust self-understanding and scientific thinking solely on the basis of 'inner truths' grounded in our own understanding. We also need 'outer' truths in terms of explanations that are based not on ourselves but on distanciated and abstract explanatory models, systems, and theories. In the healthcare sector in particular, the number of 'outer' truths seems to have increased exponentially. But to cope with the major challenge to bring about a 'meeting' between 'inner' and 'outer' truths successfully, avoid exclusionary binaries and open up to a fruitful conflict of interpretations, we need to refigure and transform 'truths' into 'interpretations'-that is, hermeneutics.
10 | CONCLUDING REMARKS I consider the poetic quote above as the most distinct articulation of a person-centred approach. In contrast to a traditional humanistic view focused on a centred self, Tranströmer's poetic phrase invites interpretations originating from 'outside' according to a de-centreing of the self. The experience of being de-centred has multiple meanings: first, the profound experience of receiving life as a 'outer' gift; second, the openness to the productive distanciation of different explanations. From the perspective of a 'broken' ontology and an ethical configuration of personhood, this kind of 'meeting' also indicates the necessity to establish connections linking naturalism and phenomenology together. Human life is instable and fragile, built on heterogeneous syntheses. And when facilitating this kind of 'meetings', to be able to cope with the wider conflict of interpretations of a human life where personhood is evitably associated with the capacity to recognize oneself as another, practical wisdom is required. To sum up, what actually makes us human seem to be something equivalent with the capacity to establish a meeting-place between intepretations coming from both 'inside' as well as 'outside'-and thus simulateneously recognize others as human beings.

CONFLICTS OF INTEREST
The authors declare no conflicts of interest.

DATA AVAILABILITY STATEMENT
Data sharing is not applicable to this article as no new data were created or analyzed in this study.