LAUSR

This edition of the Journal of Bioethical Inquiry carries a symposium compiled in honour of the work of a distinguished pioneer of Australian bioethics: Miles Little. As the symposium shows, Little started to work on methods and subjects that seem obvious to us now (the patient experience, the sociology and anthropology of health issues) but this was certainly not fashionable or widely accepted in the 1970s when he started these explorations, especially here in Australia. One of the central concepts that his work badged and explored is that of liminality: a sort of unstable state between states of relatively greater certainly, being perhaps best seen as the interval (for non-sudden deaths) between “normal” life, due, for example, to a cancer diagnosis, and death. Normal in the sense of an “illusion” of settlement, where finitude is managed by aversion of the gaze as a result of good health, together with varying degrees of financial, social, and emotional security. Security but not necessarily safety, as we can never be completely safe, risks surround us every step of the way. But the relatively low risks throughout long western lives generate an emotional state of provisional reality that makes it very hard when there is a real threat of death. Provisional reality expresses a state of mind whereby an individual comes to terms with the realities of their situation and the beliefs and assumptions that allow day to day functioning. This state of mind might be constructed from religious belief, social custom, ideological position, and any number of political, social, psychological constructs that soothe anxiety and mask uncertainty. So Little’s work with cancer patients gives voice to the disruption of this provisional state and perhaps exposes us all to the fragile nature of these seemingly settled states that can change in the blink of an eyelid. It is also relatively new in human history for human beings to be so attached to such long and healthy lives, whereas in most histories earthly life is seen as brief and subject to broader spiritual and eternal landscapes. Epidemiology confronts the safe spaces inhabited for so much of modern life in wealthy developed countries and much of the disease and trauma is self-inflicted. Shocks from infectious disease outbreaks occur from time to time, such as AIDS, influenza mutations, SARS, Ebola, and COVID-19 has definitely brought the reality or threat of death to the whole world, distracting from the marauding chronic disease stalkers such as cancer, dementia, and cardiovascular disease. Michael Ignatieff puts the whole question of the illusion of humanmastery into sharp focus in a passage from his 1994 book about his mother’s dying with dementia,