This is the first part of a two-part series in which editor Tessa Roberts-Smorenburg explores the different connections between art and care from a care-ethical perspective. How they can enhance the ability of observing and perceiving in complex care situations, as found in her own clinical practice concerning oncology treatment in a specialized hospital.

This series takes as its starting point the international forum The art of observation. How art improves the skills of healthcare personnel in Rome 20-21 November 2024, which Roberts-Smorenburg attended. She reflects on the shared insights and connect them to the burning issues she perceived in her own clinical practice:

The international forum The Art of Observation: How Art Improves the Skills of Healthcare Personnel, hosted by Professor Dr. Vincenza Ferrara (Sapienza – University of Rome, Italy) ((1)), highlighted current research and experiences in the field of the humanities as applied to medical education and professional development.

Contributors emphasized that engagement with art can strengthen observational skills, complement active listening, enhance communication, foster empathy, and increase tolerance for ambiguity. This connection between art and care raises important questions about what this intersection reveals when examined from a care-ethical perspective.

In 2016, care ethicist Frans Vosman reflected on the introduction of art into care ((2)). He pointed out the fertile dynamics and new possibilities art can bring, but also the risk of just taking art for instrumental use and leaving out the aspect of intrinsic value that art may also offer.

Art can create space to perceive in ways that differ from the ordinary, ranging from the unsettling and alienating to the beautiful, and in doing so makes the invisible visible. In this way, it can support healthcare today, where attentive perception is increasingly under pressure.

Currently, the reflections and exchanges from the international forum in Rome remain pertinent to the challenges currently unfolding in healthcare. In this first part of the series, I articulate my position from a care-ethical perspective. In the second part, I will examine specific presentations from the international forum in Rome from a care-ethical perspective.

Perceiving under pressure in Late Modernity

Late modernity is a new intensified phase within Modernity, characterized by uncertainty and complexity and full of paradoxes and contradictions ((3)). Daily life is accelerating at an ever-increasing pace, and technological advancements are rapidly following one another.

At the same time, I witness an increasing esthetization of life itself, in which individuals are encouraged to design, curate, and optimize their own lives as meaningful projects ((4)). These changes have profound effects on how people work, interact, and live together.

I will outline three developments that put the capacity for careful perception under pressure in care practices. Attuned perceiving is a cornerstone of care ethics because it involves noticing what emerges within a specific situation and within the institutional space, where the broader ordering of social life resonates within care practices.

This includes discerning what is given a voice and what remains unspoken, what is explicitly named and what is left unmentioned, and how different actors, like patients, relatives, and caregivers, position themselves and relate to one another. By perceiving what emerges in these interactions, caregivers can respond in ways that are sensitive to the concrete, often fragile realities of care.

Increasing complexity and uncertainty of healthcare

The first development is the increasing complexity and uncertainty of institutional care. There is a noticeable shift in the telos of hospitals. Traditionally, all activities were directed towards providing care for the hospitalized person but now, alongside this traditional telos, we see the rise of a system-driven model of care.

This brings a different logic, one in which efficiency, measurability, and control dominate. Care institutions are now navigating multiple teloses, where the focus on the vulnerable patient coexists with the demands of process control, system management, and self-reliance within a framework driven by standardized protocols and digital systems. In practice, this means that nurses and other caregivers are increasingly working under the pressure of these competing teloses.

Shrinking space for ambiguity in an increasingly polarized society

The second development is the shrinking space for ambiguity in an increasingly polarized society. Social and political divisions are deepening, and complex realities are often reduced to simple, binary opposites. This tendency carries over into care practice, where dominant images—such as the autonomous, self-reliant patient or technological solutions as the ultimate answer—overshadow the inherent complexity and ambiguity of real care situations.

In a political and ethical climate where nuance is often lost in favor of fixed positions, it becomes increasingly difficult to perceive and tolerate the uncertain, contradictory, and intangible elements that are central to care. Careful observation, in this sense, requires not just attentiveness to the situation at hand, but the ability to hold and navigate this ambiguity with sensitivity.

Moral distress in a fragmented system

The third development is the exhaustion of compassion as an ethical driving force. Caregivers are called to respond to patients’ vulnerabilities, but this capacity is increasingly strained in a context where care is fragmented, and uncertainty is managed through rigid protocols, digitization, and system logic.

Especially in oncology care things have changed rapidly over the past few decades, where new developments have brought complexity and ambiguity, and organizational pressures to standardize, often downplay this uncertainty, leaving clinicians to navigate a challenging landscape.

Technological innovations, new treatment options, expanding knowledge about the consequences of cancer and its treatments, and a growing emphasis on the in principle welcome ideal of Appropriate Care ((5)) are making oncology care more complex.

Outcomes are often difficult to predict, and the balance between life prolongation and quality of life is rarely straightforward. As a result, caregivers must navigate increasing uncertainty and ambiguity, while policy continues to stress patient-centered care.

When these ideals are not supported by structural space for ethical action, they risk becoming hollow, leading to moral distress. Prolonged strain can transform compassion into compassion fatigue, suppressing the ability to observe attentively and respond ethically.

Making the Invisible Visible

In response to the growing complexity of healthcare and the thoroughly studied the constraints of rigid, system-driven models ((3)), there is increasing interest in creative approaches that engage with the nuanced realities of care. Within this context, the intersection of art and care reveals multiple forms of connection.

Chronos
In 2017 I interviewed Frans Vosman, who highlighted the unique contribution of art to care. Art can make visible what is often overlooked and give voice to experiences absent from dominant narratives. He refers for example to the painter Max Kaus (1891-1977): “This painter had been painting his sick wife for years. There were dozens of portraits of her, in her chair, in her bed, he painted her continuously until her eventual death; and then I thought, he created very beautiful paintings, but this artist also understood something… to keep following someone over time.

Turu, Krankheit und Tod, Max Kaus (1891-1977)

That brings an exponential power and an eloquence that goes far beyond that moment. It is not a mirror of something wildly strange, but in a certain sense it does leave something alienating or forgotten, and that can also be confronting. Caring is paying attention to the long term. Now that everything is deliberately planned, all done in segments and divided into programs, the natural sense of “chronos” can fade away into the background”.

Giving voice and a face
Other contemporary examples illustrate this capacity of art. Gluklya’s Carnival of the Oppressed Feelings gives voice and a face to refugees confined in an old prison in Amsterdam ((6)).

©Vika Ushkanova

Nan Goldin’s photography captures the hidden, often harsh realities of 1970s and 1980s counterculture, portraying both beauty and suffering: “Whenever outsiders disparage this hidden life… No one who has not been down there themselves in that life has the right to pass judgement. It has a dark, ugly, seedy side and it has another side.” ((7))

Drawing attention to vulnerability and human fragility
Similarly, Berlinde De Bruyckere, through her sculptures and installations, draws attention to vulnerability and human fragility, highlighting the lived experience of suffering during the COVID-19 pandemic ((8)).

During the first wave of the corona pandemic, amidst the shock, fear and the endless stream of distressing images, she found solace – unexpectedly – in a traditional image. A renaissance painting depicting an angel, archetypically as the bringer of comfort, relief and deliverance.

Her subsequent inquiry into this motif, both poignant and tender, resulted in her work titled: Sjemkel and Arcangelo which was presented at her exhibition Angel’s Throat at the Bonnefantenmuseum (Maastricht, NL) in 2021.

In today’s highly structured care practices, where attention is fragmented and organized into discrete programs, art can reintroduce space for ambiguity and voices that often remain unheard.

Berlinde De Bruyckere, ARCANGELO III, 2020 ©Mirjam Devriendt

It is essential, however, to safeguard this space as one that remains receptive to multiplicity and ambiguity. The aesthetic dimension of art should not serve solely to beautify suffering, nor to glorify or render it meaningful as a life project, but rather to make visible the full spectrum of human experience. From discomfort and vulnerability to beauty and delight, including all that lies in between.

By fostering new ways of perceiving, art enables caregivers to attend more closely to what is present, what is silenced, and what emerges within care encounters. These tensions constitute both the challenge and the potential of art as a companion in care. In the next installment of this two-part series, I will examine a few specific presentations from the international forum in Rome from a care-ethical perspective.

Notes
((1)) Ferrara V, Pozzilli P, De Gara L, Mancuso T, La Torre G, Guarino M. The Art of Observation – How Art Enhances Healthcare Professionals’ Skills. La Clinica Terapeutica 2025 Sep- Oct; 176(5):672-674. doi: 10.7417/CT.2025.5280. PMID: 40996017.

((2)) Vosman, F. (2016) Taking Refuge in the Arts, lecture at a symposium called ‘Heelmeester. Kunst en zorg’ (‘Physician. Art and Care’) at the University of Humanistic Studies on 2 November 2016.

((3)) Vosman, F., & Niemeijer, A. Rethinking critical reflection on care: Late modern uncertainty and the implications for care ethics. Medicine, Health Care and Philosophy 2017; 20(4), 465-476.

((4)) Kamp, J. van de, (2025) Disguised suffering. A care ethical inquiry into the late modern ideal of a ‘succesful life’.

((5)) The concept of Appropriate Care is described as the political approach to care delivery in the Netherlands, aimed at maintaining good care, accessible and affordable for all. Appropriate Care intends to ensure that everyone can continue to receive the care they need and to enable healthcare professionals, patient organisations, health insurers and the government to improve how care is delivered and paid for. It refers to care that works at a reasonable price, is organised as closely to the patient as possible, is based on joint decision-making between doctor and patient, and focuses not only on illness but also on health and what the individual is capable of doing. Appropriate care | National Health Care Institute

((6)) Roberts-Smorenburg, T. (2019) Carnival of the Oppressed Feelings – Ethics of care website

((7)) Kamp, J. van de, (2023) All the beauty and the bloodshed – Ethics of care website

((8)) Roberts-Smorenburg, T.  (2023) Berlinde De Bruyckere’s Art in Coronatimes – Ethics of care website