Medical Hermeneutics

Medical hermeneutics may include the interpretation of a variety of clinical data, such as a patient's medical history, family history, social history, present complaints, clinical symptoms, clinical signs, laboratory results, and radiological results. It may also include review of a patient's previous treatment, present medications, allergies, response to treatment, and compliance with treatment.

      It may also include the interpretation of various sociocultural aspects of the clinical encounter, such as the patient's and provider's interpretation of their own roles in the patient-provider relationship. 

      The provider's interpretation of their role may include a conception of their professional duties and responsibilities, as well as the patient's rights and responsibilities, the standard of care for the given clinical problem, the best way to fulfill the standard of care, and the best way to address the patient's concerns and expectations. The patient's interpretation of their role may include an expectation to be informed of the nature of their medical condition, as well as an expectation to be informed of the planned diagnostic approach, the possible burdens and side-effects of treatment, and the best course of treatment.

      Since a successful outcome of the clinical encounter depends on clear and effective communication, core competencies for clinicians include communicative competence, cultural competence, interpersonal skills, professionalism, medical knowledge, practice-based learning (including evidence-based care, and consideration of recent improvements in patient care), and systems-based practice (including accessing of healthcare system resources in order to provide the best possible care).¹

      Medical interpretation may also be a means of communicating with patients, e.g. through a medical interpreter or translator when a patient speaks a foreign language that isn't understood by the healthcare provider or has some other difficulty communicating (for example, due to speech, hearing, or cognitive disability).

      Correct interpretation of clinical findings may depend on consideration of epidemiological data such as risk factors for a given disease-process in a particular patient population.

      Correct interpretation of laboratory test results may also depend on awareness of their sensitivity, specificity, and predictive accuracy for the disease-process in question in the given patient group, community, or population. It may also depend on awareness of the possible causes of false-positive and false-negative test results.

      Radiological interpretation may include interpretation of radiological images and reports, combined with the ability to determine the diagnostic certainty of positive or negative findings, and the ability to determine an appropriate response to uncertain or indeterminate findings.

      Narrative interpretation in medicine may include interpretation of patient narratives (oral, written, and behavioral) and narrative reports, as well as illness-related and historical narratives presented by medical records, office notes, and procedure notes.

      Hermeneutics is traditionally defined as the art or science of interpretation. Friedrich Schleiermacher (1838) defined it as the art of correctly understanding the meaning of another person's utterance, and he contrasted it with criticism as the art of correctly determining the truth or falsity of another person's utterance.²

      Hans-Georg Gadamer (1975) explains that while traditional literary and theological hermeneutics attempted to be an art or science of interpretation, the hermeneutics he proposes is not a method of interpretation or understanding, but rather an attempt to describe the conditions under which interpretation and understanding are possible. A condition of understanding a text's meaning is that in order for understanding to occur, it must have a historical background. Our understanding of a text's meaning is always influenced by our own historical situation. A text to be interpreted always speaks to a situation that's conditioned by previous opinions and interpretations.³ The interpretation of a text therefore requires us to be aware of our preconceptions about the text and of how they may contribute to our understanding (or misunderstanding) of it. The hermeneutical experience also requires us to recognize that the nature of our understanding may change over a period of time, and that our interpretations of textual meaning are always situated within an ongoing hermeneutical tradition, to which we contribute.

      Paul Ricoeur (1981) defines hermeneutics as the theory of the operations of understanding in relation to the interpretation of texts,⁴ and he defines a text as any discourse fixed by writing.⁵

      However, as Gadamer showed, the meaning of texts is never fixed or unchanging, and it may depend on (social, cultural, and historical) context. The meaning of a text may be changed by the way in which we "read" or experience it. Our interpretation or understanding of a text may change each time we reread or reexperience it.

      Wolfgang Iser (1978) argues that every text may have "gaps" or "blanks" or "places of indeterminacy" in its meaning that the reader must try to fill in, by questioning the text and by determining its "projected" meanings, in order to fulfill the task of interpretation. What isn't said by the text is relevant to what is said. The implications of a text may be a key to understanding its meaning. Thus, the "gaps" in the text may function as a hinge or pivot of the whole text-reader relationship.⁶

      Umberto Eco (1979) explains that the interpretation of a text depends on the sharing of a code between author and reader that assigns content to the various expressions the author uses in the text. A code is a set of rules that determines how the expression of signs is to be correlated to their content. Because texts often have to be interpreted against a background of codes that may differ from those intended by the author, a distinction can be made between an "open" text that can be interpreted in a variety of ways and a "closed" text that aims for a precise response from the reader.

      Stephen L. Daniel (1986) proposes that the interpretation of medical signs, symptoms, and other clinical data may be analogous to the interpretation of a literary text and may therefore be described by a hermeneutical model of clinical decision-making. The patient is the primary text, while the secondary text is provided by the healthcare provider's documentation of the clinical encounter, including the case summary, diagnosis, treatment plan, and progress notes in the patient's record.⁷ From a multiplicity of possible meanings of a patient's clinical signs and symptoms, the provider must determine the true meaning so that appropriate diagnostic modalities can be employed and appropriate treatment can be provided. The hermeneutical process may therefore proceed on four levels: (1) interpretation of the patient's history and physical findings, (2) interpretation of the diagnostic data, (3) clinical decision-making regarding treatment, and (4) change in both the patient's and provider's life-worlds (including the experience of healing for the patient) as a result of the clinical encounter.⁸

      Drew Leder (1990) explains that medical hermeneutics may include the interpretation of a variety of "texts." He accepts Daniel's definition of a text as any group of signs or set of elements that constitute a whole and that take on meaning through interpretation.⁹ While the "person-as-ill" may be the primary text, there may also be secondary texts, such as (1) the "experiential text" provided by the patient's experience of their own illness, (2) the "narrative text" provided by the patient's account of their symptoms and medical history, (3) the "physical text" provided by the physical findings on patient examination, and (4) the "instrumental text" provided by diagnostic technologies. All of these texts may define or shape the encounter of the patient with the provider and healthcare system. One of the tasks of the provider may then be to "read" or understand these texts in such a way that they have a coherent meaning. The patient and provider may collaborate in this activity. Careful listening, mutual dialogue, and explanation are therefore fundamental aspects of the clinical encounter.¹⁰

      It may be noted that the intertextuality or transtextuality of the clinical encounter may be defined by the fact that the primary and secondary texts described by Leder may all be in dialogue and may communicate with one another.

      It may also be noted that a particular kind of understanding may be required for each of the kinds of secondary texts that Leder describes: experiential understanding, narrative understanding, physical understanding, and instrumental understanding.

      Richard J. Baron (1990), however, questions "textual" interpretation as a metaphor for the clinical encounter between patient and provider. He argues that the shifting nature of the clinical "text" leads to the question of whether there is actually any text at all. The text (which is actually the patient-provider relationship) is dynamic and changing, rather than fixed and static, and it's mutually created by the participants. Thus, patients and providers shouldn't distract themselves by looking for, or trying to define, a text to be interpreted; they are the text.¹¹

      Baron seems to assume, however, that if something is a text, then it must be fixed, and its meaning can't be uncertain or indeterminate. He acknowledges that "patients are busy interpreting themselves all the time, and any presentation to the doctor is only one frame in a very long movie,"¹² so he recognizes that interpretations may change, just as our presuppositions about, and experiences of (clinical, social, and cultural) texts may change.

      Fredrik Svenaeus (2000) also argues that it's false to assume that medical hermeneutics must be a method of textual interpretation. He says the metaphor of "reading a text" may be inadequate as a theoretical model, and that medical hermeneutics is a dialogic activity rather than one consisting of textual interpretation. He also explains that the methodology of textual interpretation may be replaced by "an ontological and phenomenological hermeneutics in which understanding is a necessary feature of the being-together of human beings in the world."¹³

FOOTNOTES

¹Accreditation Council for Graduate Medical Education, "The Milestones Guidebook," Version 2020, online at https://www.acgme.org/globalassets/milestonesguidebook.pdf

²Friedrich Schleiermacher, Hermeneutics and Criticism, and Other Writings, translated and edited by Andrew Bowie (Cambridge: Cambridge University Press, 1998)

³Hans-Georg Gadamer, Truth and Method (New York, The Seabury Press, 1975), p. 429.

⁴Paul Ricoeur, Hermeneutics and the Human Sciences (Cambridge: Cambridge University Press, 1981), p. 43.

⁵Ibid., p. 145.

⁶Wolfgang Iser, The Art of Reading: A Theory of Aesthetic Response (Baltimore: Johns Hopkins University Press, 1978), pp. 167-169.

⁷Stephen L. Daniel, "The Patient as Text: A Model of Clinical Hermeneutics," in Theoretical Medicine, Volume 7 (1986), p. 202.

⁸Ibid., p. 195.

⁹Drew Leder, "Clinical Interpretation: The Hermeneutics of Medicine," in Theoretical Medicine and Bioethics, Volume 11, Issue 1, March 1990, p. 11.

¹⁰Ibid., p. 17.

¹¹Richard J. Baron, "Medical Hermeneutics: Where is the "Text" We are Interpreting?", in Theoretical Medicine and Bioethics, Volume 11, Issue 1, March 1990, pp. 27-28.

¹²Ibid., p. 27.

¹³Fredrik Svenaeus, "Hermeneutics of Clinical Practice: The Question of Textuality," in Theoretical Medicine and Bioethics, Volume 21, 2000, p. 180.

OTHER SOURCES

Umberto Eco, The Role of the Reader: Explorations in the Semiotics of Texts (Bloomington: Indiana University Press, 1979).

Keith DeRose, on Single Scoreboard Semantics

Keith DeRose (2004) describes a conversation in which two interlocutors disagree about whether one of them knows something. The first argues that the second doesn't know something, but the second insists that she does. Their ability to convince each other of the truth of their claims may be determined by how many "points" they score in a "language game." For agreement to be achieved however, they must to some extent share the same "conversational scoreboard," and it may be more difficult for them to agree if they each have their own personal scoreboard. If they don't share the same understanding of what it means to "know" something, then they may not be able to agree on whose claims to knowledge are true.

      Single scoreboard semantics, according to DeRose, proposes a single scoreboard for a given conversation, on which the knowledge claims of each interlocutor can be recorded. He explains that epistemic contextualism requires that the knowledge claims of each interlocutor be evaluated according to their context. If the first interlocutor has established a higher standard for what it means to "know" something than has the second interlocutor, then the first may be correct in saying that the second doesn't actually know what she says she knows. Epistemic invariantism, on the other hand, is the position that the truth or falsity of knowledge claims doesn't depend on the epistemic standard of the context (whatever is true in a low standard context will also be true in a high standard context).   

      DeRose supports the contextualist position that the truth or falsity of knowledge claims varies according to the epistemic standard of the context. He notes that his use of the term "conversational scoreboard" differs from that of David Lewis (1979), insofar as Lewis uses the term to describe the mental scoreboards of each interlocutor (who may not agree on the actual score), while DeRose uses the term to describe a single scoreboard that by definition gives the right score.¹

      According to Lewis, there may be constitutive as well as regulative rules regarding how a language game is played and how the score is recorded. If each interlocutor has their own mental scoreboard, then for each of them the score may be whatever their mental scoreboard says it is. But score keeping is also governed by rules, so the interlocutors may also sometimes disagree if one of them has broken the rules. On the other hand, they may also accommodate each other by allowing for some flexibility and variation in the interpretation of the rules, so that agreement can be achieved.

      DeRose therefore doesn't address the question of whether it is or isn't the case that there are sometimes or always multiple personal (or mental) scoreboards in a given conversation. Presumably, the mental scoreboards of each interlocutor must agree to some extent or at least partially coincide if the interlocutors are to agree on the comparative validity of each other's knowledge claims. But to what degree must they agree? 

      Conversational markers of agreement, such as "Yeah," "Sure," "Uh huh," "I see," "okay," and "I suppose so," may enable interlocutors to recognize that they are in fact sharing the same or similar conversational scoreboards. Interlocutors may also employ a variety of conversational strategies (such as back channel utterances, response tokens, requests for clarification, continuers, repetitions, collaborative finishers, and nonverbal responses) in order to manage and support communication.

      DeRose addresses the case in which the conversation between two interlocutors is observed or monitored by a third party who keeps their own scoreboard. In this case, it may not matter whether each interlocutor has their own personal scoreboard, as long as they agree to arbitration by the (presumably neutral, fair, and impartial) third party. Disagreement can then be resolved by a "binding arbitration" model of conversational score keeping, in which the third party decides which interlocutor's arguments are more compelling and reasonable.

      DeRose also describes the case of the "exploding scoreboard," in which there's no correct conversational score and the knowledge claims of each interlocutor cannot be judged as true or false.

      He also considers the case in which interlocutors disagree and there's a divergence or  "gap" in the truth conditions of their relevant claims. This "gap view" may help to resolve disagreement between interlocutors when there's vagueness or uncertainty in their knowledge claims.

     Would the single scoreboard versus multiple scoreboards model be subject to question if one of the interlocutors simply imposed their knowledge claims on the other by force, threat, or intimidation? Perhaps in this case there wouldn't be any social space for disagreement.

      Verena Gottschling (2004) asks what happens when there's a change in epistemic standards during the course of a conversation and only one of the participants accepts the change. If only one participant agrees with the method of score keeping, then how do we evaluate the knowledge claims of the other participants? Gottschling explains that Lewis, in his article "Elusive Knowledge" (1996), says that the epistemic standards of a conversation may be lowered if one of the participants says something that's true under a lower epistemic standard and the other participants don't disagree. On the other hand, the epistemic standards of a conversation may be raised if one of the participants calls the attention of the others to some remote possibility that they must account for because of the context, such as when jurors must decide whether a defendant is guilty beyond a reasonable doubt. 

      Gottschling criticizes the notion that conversational participants can each have their own personal scoreboard, because then our intuition that their views may actually contradict each other seems to be violated. She also criticizes the notion that there can be a single scoreboard, because then our intuition that each participant may actually have their own persisting individual standards seems to be violated. She therefore concludes that we should reexamine our intuition of contradiction, since contextualism should be understood as recognizing that a change in the content of knowledge claims by conversational participants may cause us to feel their claims contradict each other when in fact they do not.²

FOOTNOTES

¹Keith DeRose, "Single Scoreboard Semantics," in Philosophical Studies, Volume 119 (1-2), 2004, p. 19.

²Verena Gottschling, "Keeping the Conversational Score: Constraints for an Optimal Contextualist Answer?", in Contextualisms in Epistemology, edited by Elke Brendel and Christoph Jäger (Dordrecht: Springer, 2005), p. 168.

OTHER SOURCES

David Lewis, "Scorekeeping in a Language Game," in Journal of Philosophical Logic, 8, 1979, pp. 339-359.

David Lewis, "Elusive Knowledge," in Australasian Journal of Philosophy, 74, 1996, pp. 549-567.

Philippa Foot and Jonathan Harrison, on the Nature of Moral Principles

In a dialogue between Philippa Foot and Jonathan Harrison (1954) regarding the question of "when is a principle a moral principle?", Foot seems to be rather evasive in her response to the question. She describes the following sentences as examples of what we might mean when we talk about moral principles: (1) "To me, it is a matter of moral principle," (2) "I don't know much about his moral principles," and (3) "He seems to me to be a man without moral principles."¹ She says that a moral principle may be a special case of a principle of conduct. It may be a principle through which we come to understand what a person feels about what is right and wrong. However, in order for a principle to be moral, it must have some kind of background that distinguishes it from other kinds of principles (although Foot doesn't say exactly what that background might be). She also suggests that if we call a principle moral, then it must have some connection with other principles that we call moral or must have some connection with modes of conduct that we call virtuous. She concludes that the comparison of a moral principle with a moral imperative is fundamentally misleading, and that we won't be able to find suitable criteria for moral principles if we try to base our inquiry on this model.²

      Harrison responds by saying that some principles that we may hold as obligatory may not actually be obligatory. Thus, there may be a difference between what is subjectively a moral principle and what is objectively a moral principle. We may hold a principle as a moral principle without its necessarily being universalizable (applicable to everyone). However, ultimate moral principles may be applicable to everyone, while derivative moral principles may not be. Derivative moral principles may be derived from ultimate moral principles; they are contingent and variable in a way that ultimate moral principles are not.³

      Harrison explains that Foot's assessment of moral principles is rather circular, insofar as she doesn't address the question: "If the "background" of a moral principle consists of other moral principles, then what can we say about those other principles?"  Moreover, if a principle can be moral only if it has a connection with other moral principles, then how can we establish that those other principles are moral?⁴

      He also notes that we may not always act on our moral principles. Moral principles are not laws of nature; they can be disobeyed. Nor are they rules of skill, since acting morally is not the same as acting skillfully (although moral obligations may be fulfilled skillfully or may not be fulfilled through sheer ineptitude).⁵

      He also claims that a hypothetical imperative can't be a moral principle, although he admits there may be hypothetical non-moral imperatives or duties (such as the duty to practice a certain skill if it will make us better at that skill). He says the difference between a hypothetical and a categorical imperative is that a hypothetical imperative is necessary as a means to some end, while a categorical imperative is not.

      Contrary to his view, however, it can be argued that if I hold it as a moral principle, all things being equal, that I should perform some action that's morally advisable, even though that action may not be morally obligatory, then I may believe in a principle that's a hypothetical, but not categorical, directive. A categorical directive might take the form: if I see someone suffering, then I should try to alleviate that suffering and comfort the person who's suffering. This would be an example of a directive to perform an action that's obligatory, universally applicable, and not contingently a means to some end other than itself.

      Harrison notes that actions that are based on principle may not necessarily be moral actions, and that moral actions may not necessarily be based on principle (rather than the contextual variables of a particular situation). We don't always act on our moral principles, but we must do so at least occasionally if we're going to truthfully say we hold them as principles. On the other hand, if we're lacking in conscience or false to our sense of moral duty, then we may not act on our moral principles and may not feel any remorse for doing so.⁶ But we may also act on principles that we don't feel a moral duty to act on. Merely acting on principles doesn't necessarily make them moral principles. So our acting or not acting on a principle can't be an adequate criterion of whether we regard it as a moral principle. Nor can our feeling of obligation to follow a principle be an adequate criterion of whether we regard it as a moral principle. He therefore dismisses as a "terminological question" whether there may in fact be any adequate criteria for a moral principle.

FOOTNOTES

¹Philippa R. Foot and Jonathan Harrison, "Symposium: When is a Principle a Moral Principle?," in Proceedings of the Aristotelian Society, Supplementary Volumes, Vol. 28, 1954, p. 98.

²Ibid. p. 110.

³Ibid., p. 125.

⁴Ibid., pp. 112-113.

⁵Ibid., pp. 117-118.

⁶Ibid., pp. 127-128.

Fragments III

Gilbert Harman, in Moral Relativism and Moral Objectivity (1996),¹ defends moral relativism (the position that moral claims are always relative to the choice of a moral framework, and that what is right according to one framework may not be right according to some other framework), while Judith Jarvis Thomson defends moral objectivism (the position that moral claims have objective truth conditions that aren't relative to moral frameworks, and that it's possible to find out about some claims whether they are objectively true or false). Harman argues that moral diversity and the apparent intractability of moral disagreements justify moral skepticism (the position that the truth conditions of moral claims are relative to moral frameworks, or that moral claims don't have objective truth conditions, or that it's not possible to determine the objective truth of moral claims), and that moral relativism is therefore also justified. Thomson, on the other hand, argues that what is morally right or wrong isn't simply a matter of what it's rational for an agent to want or what is relative to what an agent might want, and that we can therefore reject moral relativism.

Onora O'Neill (2003),² distinguishes between constructivism and contractualism in ethics. While constructivism may be the theory that moral justification is provided by constructed criteria or principles, contractualism may be the theory that moral justification is provided by general agreement among individuals.

      O'Neill says it may not be possible to completely separate constructivism from contractualism, since constructive reasoning may be a way of achieving agreement, and agreement may provide a basis for constructive reasoning.

What about constructivism vs. contractualism in epistemology?  Constructivism may be the theory that knowledge is constructed, while contractualism may be the theory that knowledge is agreed upon. These two theories may be mutually compatible.

Jennifer Lackey (2008) asks, "What should we do when we disagree?" She explains that if we disagree with someone and we are (1) evidential equals (there's no argument or piece of evidence bearing directly on the question that one of us is aware of and the other is not), (2) cognitive equals (there's no cognitive capacity or incapacity that one of us possesses that the other does not), and (3) epistemic peers (we've fully disclosed to each other all the reasons and arguments for our own views), then the nonconformist response is that we can continue to maintain our own views, without revision, despite the disagreement of our epistemic peers, as long as we have justified confidence in our own views, while the conformist response is that we should give equal weight to the views of our epistemic peers and should therefore revise our views if our epistemic peers disagree with us. A problem for the nonconformist view is the One against Many Problem, that the more epistemic peers disagree with us, the more implausible our own views become. A problem for the conformist view, on the other hand, is the Many against One Problem, that we may initially have only a low level of justified confidence in our own views, but those views may be bolstered if they're shared by our epistemic peers. While the nonconformist view may underemphasize the epistemic importance of disagreement, the conformist view may overemphasize it. Lackey therefore explains that her justificationist view avoids both problems: it holds that the epistemic importance of disagreement depends on the degree of justified confidence with which the belief in question is held, combined with the presence or absence of relevant symmetry breakers between our own epistemic position and those of our epistemic peers.³

FOOTNOTES

¹Gilbert Harman and Judith Jarvis Thomson, Moral Relativism and Moral Objectivity (Malden, Massachusetts: Blackwell, 1996).

²Onora O'Neill, "Constructivism vs. Contractualism," in Ratio, Volume XVI, 4 December 2003, pp. 319-331),

³Jennifer Lackey, "What should we do when we disagree?", in Oxford Studies in Epistemology, Volume 3, edited by Tamar Szabó Gendler and John Hawthorne (Oxford: Oxford University Press, 2008), pp. 274-293.

Perspectives on Servanthood

As a teenager I went to a school whose motto is cui servire est regnare, which can be roughly translated as "whom to serve is to reign." This phrase is from a prayer attributed to St. Augustine: "O God...teach us how to know you--and live, where to serve you--and reign, when to praise you--and rejoice..."

      The phrase "whom to serve is perfect freedom" is also from a prayer attributed to St. Augustine: "Eternal God...grant us so to know you, that we may truly love you, and so to love you that we may fully serve you, whom to serve is perfect freedom."

      Servanthood is an ideal promoted by a variety of religious traditions, including Christianity, Judaism, Islam, Buddhism, and Hinduism.

      In the gospels, Jesus says he came not to be served but to serve, and to give his life as a ransom for many (Matthew 20:28, Mark 10:45). He also washes his disciples' feet as an example of his servanthood (John 13:1-17).

      True servanthood may be found when we can freely choose to serve others. To serve is to help, to fulfill the needs of others, to obey, or to be useful to others. Perfect freedom may be found in serving freely. The true servant helps others to fulfill themselves as human beings. The true servant doesn't serve in order to be rewarded by others, because serving others is rewarding in itself. The true servant acts to promote the happiness, fulfillment, and well-being of others, and acts to promote peace and justice in society.

      In order to truly serve others, we must have humility. We can't serve others if we put our own needs before the needs of others. Humility enables us to respond to the needs of others before responding to our own. When we know the importance of humility, we can serve others without using others to serve our own needs.

      The true leader is also a servant. The true leader serves those whom they lead. True leadership is servanthood. When we freely serve others, we show our concern for them. If we love others, then we truly care about them. If we love others, then we also feel the need to serve them.

      Robert K. Greenleaf (1970), a management researcher and consultant who coined the term "servant-leadership," says that a servant-leader is a servant first, whose primary motivation is to serve, rather than a leader first, whose primary motivation is to lead. The servant-leader takes care to ensure that the highest-priority needs of others are always being served.

      Ken Blanchard (2001), a management consultant and leadership expert, explains that most organizations are hierarchical or pyramidal in nature. Leadership is from the top down, and new approaches to management can't emerge from those at the bottom of the hierarchy who have the closest contact with the organization's clients. A solution for this problem is servant-leadership, in which the organizational hierarchy or pyramid is inverted or turned upside down, so that employees at the ground level who have the closest contact with clients can better contribute to the organization's goals.

      However, Jacquelyn Grant (1993), an American theologian, scholar, and minister, criticizes the language of servanthood as having undergirded structures of power and domination that have caused suffering for oppressed people. She says that, historically, women have been seen as servants of men, and politically disenfranchised peoples have been seen as a servant class for the wealthy and powerful. Servanthood language has camouflaged servitude and subordination, instead of promoting empowerment and liberation. She therefore prefers a language or model of Christian discipleship, in which justice is seen as an integral part of the quest for unity and community.¹

      Theresa Corbin (2022), an American writer and editor, who converted to Islam at age 21, says that an Islamic perspective on servanthood is that we can serve God by following the example of the Prophet Muhammad (PBUH) and serving others, whether they are our children, parents, neighbors, or other members of our community. We all have leadership roles to fulfill by serving others. Servanthood is the meaning of leadership as it was exemplified by the Prophet Muhammad (PBUH).²

      Ibn 'Arabi  (1165-1240), an Arab Andalusian Islamic philosopher, poet, and mystic, says that we're created by God to be servants of God, and that we should never abandon our servanthood (ubûdîya). The servant loves God, and God loves the servant. Servanthood is our true reality, whereby the face of God is revealed to us.³  Through servanthood, we attain humility and recognize that we depend on God for our being.

      Ernest C.H. Ng (2019), a professor of Buddhist Studies and Economics at the University of Hong Kong, explains that a Buddhist perspective on servant leadership is that the Buddha(s) and Bodhisattvas are "the embodiment of profound compassion and wisdom in their selfless mission and unrelenting effort to teach and heal all sentient beings."⁴ We can become servant leaders by following their example, and by acting in accordance with the Buddha's teachings.

      Robert Greenleaf (1977) also says that servant leadership may be characterized by such capabilities as listening, understanding, imagination, empathy, intuitive knowledge, foresight, awareness, perception, persuasion, action, conceptualizing, and healing.⁵ 

      Andrey Shirin (2014), a professor of divinity and Director of Transformational Leadership at the John Leland Center for Theological Studies in Arlington, Virginia, notes that some workplace settings may be more receptive to servant leadership than others. Some leaders may have a greater desire to serve than others, and workers may vary in their receptivity to servant leadership.⁶ He explains that the modern model of servant leadership may truncate the nature of leadership by making service the single determinative criterion aligned with Christian spirituality, and that St. Augustine viewed service as just one dimension of his leadership approach.⁷

      Mitch McCrimmon (2010), a Canadian management consultant and writer, argues that servant leadership is a bad idea, because the reality in the business sector is that all managers must serve business owners if they want to keep their jobs, and they must also serve customers. If servant leadership is the idea that traditional, autocratic, and hierarchical modes of leadership should yield to newer modes of leadership that are more inclusive and that are based on teamwork and community, then it's a true but trivial idea, and it presents nothing new or distinctive. It may also have paternalistic overtones. McCrimmon therefore argues that it's possible for managers to develop collaborative, supportive, empathetic, engaging, and empowering relationships with employees without taking on the servant model.⁸

FOOTNOTES

¹Jacquelyn Grant, "The Sin of Servanthood: And the Deliverance of Discipleship," in A Troubling in My Soul: Womanist Perspectives on Evil and Suffering, edited by Emilie M. Townes (Maryknoll, NY, Orbis Books, 1993), p. 214.

²Theresa Corbin, "Prophet Muhammad: Leader & Servant," at aboutislam.net, 23 December 2022, online at https://aboutislam.net/reading-islam/about-muhammad/muhammad-pbuh-prophet-leader-servant/

³Stephen Hirtenstein, ""Ibn 'Arabi's Bequest" and Two Other Passages from the Kitab al-Wasâ'il by Isma'il Ibn Sawdakîn," (Newsletter of the Muhyiddin Ibn Arabi Society, Spring 1977), online at https://ibnarabisociety.org/ibn-arabis-bequest-stephen-hirtenstein/

⁴Ernest C.H. Ng, "Servant Leadership Beyond Servant and Leader: A Buddhist Perspective on the Theory and Practice of Servant Leadership," in Servant Leadership, Social Entrepreneurship and the Will to Serve, edited by Luk Bouckaert and Steven van den Heuvel, (London: Palgrave Macmillan, 2019, online at https://link.springer.com/chapter/10.1007/978-3-030-29936-1_3#citeas

⁵Robert K. Greenleaf, "The Servant as Leader" [1970], in Servant Leadership: A Journey into the Nature of Legitimate Power & Greatness (New York: Paulist Press, 1977, pp. 30-49.

⁶Andrey V. Shirin, "Is Servant Leadership Inherently Christian?", in Journal of Religion and Business Ethics (Volume 3, Article 13, Oct 9, 2014), p. 7.

⁷Ibid., pp. 21-24.

⁸Mitch McCrimmon, "Why servant leadership is a bad idea," in Management.Issues, August 16, 2010, online at https://www.management-issues.com/opinion/6015/why-servant-leadership-is-a-bad-idea/

OTHER REFERENCES

Ken Blanchard, "Servant-Leadership Revisited," in The Sixth Annual Worldwide Lessons in Leadership, 2001, online at online at https://new.svdpusa.org/Portals/1/Servant-Leadership%20Revisited.pdf.