The painter and the cameraman: boundaries in clinical relationships

The issue of boundaries in clinician-patient encounters is considered through narrative analysis of four clinical stories in which boundaries crossings are a self-conscious topic. One story is by a physician as patient, two are by physicians, and one is by a palliative care nurse. The stories are discussed using Walter Benjamin's distinction between the painter, who maintains distance and sees the whole, and the cameraman, who uses technology to penetrate realities and then reassembles fragments. The essay argues that distance and closeness are ethical issues that constitute the possibility of clinical encounters but the encounter also changes the clinician's sense of boundaries. The relevant ethics of boundary decisions in most clinical encounters are not procedural ethics but an ethics of self-creation: in orienting to boundaries as doctors do, they create themselves in their relations to others.