Perspective Chapter: Last Questions – How Philosophical Practice Contributes to Developing Death Literacy

Abstract

Dealing with existential questions is a constitutive part of palliative care. Interestingly, if we admit that borderline situations at the end-of life give rise to philosophical questions, in the contexts of practice, these questions are perceived (nearly) without any reference to explicit philosophical traditions or to Philosophical Practice. Philosophical Practice is a modern movement for a non-elitist philosophy. It aims to enable people—in the Socratic tradition—to reflect on their experiences in a philosophical way in everyday life. In the recently launched research project Philosophical Practice in Palliative Care and Hospice Work, we are investigating the opportunities and limits of Philosophical Practice for the development of death literacy. Building on previous theoretical work, we analyse, discuss, and illustrate concrete models of Philosophical Practice in this chapter. Our conclusions refer to practical indications for relating Philosophical Practice productively to relevant contexts of death literacy development, such as caring communities, Last Aid courses, and everyday ethics.

1. Introduction

In the context of end-of-life care, there are many questions which lead directly to action and concrete solutions, for example, which care services are missing in our community? And how can we communicate and consider concrete wishes for the end-of life? Some everyday questions can be answered through “empirical” knowledge, i.e., through information or e.g., palliative medical expertise. For instance, those questions can be: How can pain and symptoms be treated? Or what complementary options are there? Finally, there are several questions arising around the end-of life, which neither require immediate solutions and action nor can they be answered by experts. These questions demand responses from us in contexts of end-of-life care, but also in life generally. There can be questions such as: What makes a “fulfilled” life and what does it mean to not live it? What does it mean to need help and to “accept help” (from a friend, from a stranger)? What is trust—how is it built, how is it lost? In what ways am I responsible for others?

The latter kind are examples of ultimate or last questions, on which everyone has to personally develop an opinion or has (implicitly) already developed one. The philosopher Immanuel Kant characterises them by an unsurpassed articulation: “Human reason has the peculiar fate of being harassed by questions which it cannot reject, but which it also cannot answer” [1]. Still, last questions can awaken a desire to delve into them deeply, which is an expression of philosophical interest in everyday life.

Attempting to formulate last questions is itself a first philosophical act. Usually, it is not obvious to us what moves us at a deeper human level. Thus, targeting our conversations and (joint) thinking towards last questions is more than an exchange of words. As we tell each other about what moves us and articulate associated feelings, such “conversations” may bear clarity and deeper insight into the issues of our last questions. We may then together engage in gathering concepts of life and their critical examination. Formulated simply, this kind of engagement is the sphere of philosophy and the pursuit of the philosophical interest.

The philosophical interest and desire to philosophise is particularly likely to arise in “borderline-” or “ultimate situations”. Following Karl Jaspers, becoming aware of ultimate situations is the deeper origin of philosophising. They are “[s]ituations we can’t get beyond, we can’t change […] I have to die, I have to suffer, I have to fight, I get inevitably entangled in guilt […]. In mere existence we often avoid them by closing our eyes and living as if they weren’t there. We forget that we have to die” ([2], p. 18). But does Jaspers refer to academic studies when he speaks of philosophising? In this context, Jaspers refers to ancient philosophy, especially to the Stoics and Epictetus, for whom, philosophising springs from the experience of finitude: “The origin of philosophy is awareness of one’s own weakness and powerlessness” ([2], p. 17). Thus, when we think of limits, we do not necessarily think of death alone: “To philosophise is at once to learn to live and to be able to die. Because of the uncertainty of existence in time, life is constantly trying” ([2], p. 18).

The interrelationship between philosophical traditions of thought and society’s approach to death and dying is reflected in the Lancet Commission on the Value of Death [3]. It makes clear how much society’s approach to dying, death, and mourning is reflected in philosophical traditions of thought. Moreover, it emphasises that end-of-life care, which wants to (re-)integrate dying and death into life and society, indispensably has to take philosophical and spiritual dimensions into account in its practices and cultures. For a life-integrating approach to dying and death (“bringing death back into life”), the following element of a realistic utopia is formulated: “Conversations and stories about everyday death, dying, and grief become common” ([3], p. 870). Strengthening death literacy and also rooting end-of-life care in philosophy and spirituality is considered significant. The question of which everyday care practices could succeed in building bridges here is answered above all with references to conversations about dying and loss, to Death Cafés and/or the Last Aid courses. However, Philosophical Practices are not considered—which marks the beginning of our research interest.

Our research interest is based on two elementary observations. First, the notion “to philosophise is to learn to die” has been at the core and heart of philosophy ever since its beginnings [4]. Secondly, philosophy or Philosophical Practice is virtually absent in the context of palliative care and hospice work—at least not as a structurally anchored practice or as a self-evident conceptual reference.

In this chapter, we, therefore, illuminate how strongly last philosophical questions shape dying and end-of-life care and outline forms of Philosophical Practice for addressing last questions. Our contribution aims to provide exemplary insights and a general orientation on this topic.

2. What is Philosophical Practice? Attempting an overview

All philosophical questions are preceded by the question of philosophy itself: What is philosophy? What at first translates as “love of wisdom” is nevertheless much more than reserved for “the wise”: philosophy deals with the fundamental questions of being human.

2.1 A short introduction to philosophy in general

In the history of philosophy, various theses can be found at the beginning of philosophising or philosophy. The ancient philosophers Plato and Socrates identified wonder as the beginning of philosophy. Today, academic philosophy is organised as a scientific discipline amongst others, i.e., it is oriented towards scientific standards and disciplinary frameworks of relevance. This orientation makes it difficult for lay people to access philosophical insights and reflections. Without mediation, insights of relevance to everyday life rarely reach beyond university walls—let alone individual persons. It is not surprising thus that philosophy is often experienced as something irrelevant and not very useful for everyday practice. Yet, it is the original idea of philosophy that philosophising emerges from and is located in everyday life experience.

To capture the various ways in which philosophy can be practised and to define the characteristics of Philosophical Practice, Ute Gahlings [5], inspired by Georg Boehme, differentiates four categories. These build on Boehme’s concepts of four manifestations of philosophy: philosophy as a science, as worldly wisdom, as a way of life, and as a Philosophical Practice. Table 1 gives an overview.

Philosophy	Denotes
Science	An academic subject at university and in organisational form of scientific research and teaching, with corresponding publications, specialist jargon, the social role of the professor, etc.
World wisdom	An intellectual who contributes intelligently and wittily in public to current issues of the time, society, and life, for example, in the feuilleton, on television, as a well-known speaker, or “in the street”.
Way of life	The orientation of one’s own life in confrontation with philosophical sources of inspiration and philosophical exercises. The philosophical life teachings and communities of the Stoics and Epicureans, for example, stand for philosophy as a way of life.
Philosophical Practice	A relatively new, semi-institutionalised offer of thought and discussion for people who want to place their life questions in a broader context and do so in encounter and discussion with a philosopher in concrete forms that are philosophical counselling in the “practice” of a philosopher, philosophical cafés, and more.

Table 1.

Manifestations of philosophy, based on Gahlings [5].

The fact that philosophy does not only belong to academically trained persons becomes particularly visible in the development of philosophy as a form of life since antiquity [6]. The ancient philosophers, especially in the Hellenistic era way before the Christian pastoral care, understand philosophy as care for the soul and the community at the same time, as the art of living and dying, as practising a personally sustaining attitude to life, and a common culture of life. The great role model Socrates philosophises in the marketplace, does not write any lines and is known for the fact that his thinking corresponds to his actions. So, in an elementary and original sense, philosophy is not necessarily an elitist affair. It is simply the expression of thinking about and discussing essential questions of life, of questioning one’s own and collective principles and attitudes to life, and of subjecting them to a thoughtful examination.

2.2 Philosophical Practice in the present day

The kind of philosophy which aims at continuing the Socratic tradition today is frequently summarised by the umbrella term “Philosophical Practice” (“Philosophische Praxis”). Sometimes, the term “philosophical counselling” is used. It is based on the view that philosophy is relevant to everyday life and that it is a certain form of care for the “soul” and “community”.

Historically [7, 8, 9, 10], the movement’s beginnings are often ascribed to the initiative of Gerd Achenbach who opened his Philosophical Practice in Bergisch Gladbach, Germany, in 1981. Between the late 1980s and early 2000s, Philosophical Practice flourished. The inaugural International Conference on Philosophical Practice took place in 1994 in Vancouver. Since then, various international and national associations of Philosophical Practice have been founded whilst the body of literature has remained modest still. It has been growing more recently, however, since more and more philosophical practitioners are beginning to discuss and publish their approaches [5, 7, 11, 12]. Regarding actual practices, the café philosophique initiated by Marc Sautet in Paris in the 1990s, and various approaches to “philosophy for children” are forms of Philosophical Practice which are known to a wider public today.

Next to the wider known forms of Philosophical Practice, it can be found in a variety of formats and contexts (Table 2):

Philosophical Practice is found in the following formats: Individual offers of Philosophical Practice; Philosophical Counselling “Philosophical counselling”, Philosophical Supervision, Philosophical Biography Work, Philosophical Correspondence, etc. Group offers of Philosophical Practice; Philosophical Cafés, Philosophical Salons, Philosophical Workshops, Philosophical Walks, etc.

Table 2.

Formats of Philosophical Practice.

The formats of Philosophical Practice (Table 2) indicate that it is—by its very name—oriented towards being active. In the case of Philosophical Practice, this means in-depth thinking together. Philosophical Practice can become visible wherever there is a concrete, active encounter between philosophers. However, the pursuit of philosophical interest can also glimmer in everyday life and in everyday conversations.

2.3 Philosophical Practice and end-of-life care: observations and reflections

Although Philosophical Practice is far from being structurally anchored or established in the practice of end-of-life-care, palliative care, and hospice work (in contrast to, for example, psychotherapy, supervision, coaching, ethical case discussions, pastoral care, or concepts such as spiritual care), there are approaches in which it can be found within these contexts too.

Some philosophical practitioners report experiences with issues typical in palliative care and hospice work: they reflect the possibilities of Philosophical Practice in the context of “illness as an inevitable life topic” [13], use Socratic dialogue to empower rehabilitating cancer patients [14], discuss personal examples of “how philosophy can help us grieve” [15], or have long-term experience in creating “Socratic communities” working with professionals in the field such as nurses, priests, and social workers [16].

Birnbacher [17] reports potentials and limitations of the Socratic method in teaching medical ethics. “Ethics-from-the-bottom-up” [18], our own project from previous research, experimentally explored various aspects of the transition from ethics consultation to philosophical conversation.

Schuchter [19] observes that in spiritual care discourse, philosophical traditions and approaches to spirituality hardly occur at all and consequently describe four philosophical exercises appropriate to the context. An example of “philosophical care” in the context of spiritual care can be found in Krüger [20]. Schuchter et al. [21] furthermore develop “Speed-Philo”, a model that is intended to facilitate elementary philosophising. The model has been established in the children’s hospice and family support service of Malteser Berlin.

Wegleitner et al. [22] elaborate on the relevance of philosophical settings in the reflection of Caring Community model projects—both in “existential” (spiritual) terms and in a participatory political dimension. This largely corresponds to the Lancet Report mentioned at the beginning of our article [3]. In this context, Leonard et al. [23] define different knowledge dimensions of death literacy, each of which is connected to a philosophical deepening. Philosophical knowledge can prevent death literacy from becoming too “technical”.

There is furthermore a remarkable initiative which does not originate in the “hospice and palliative scene” at all but is significant as a way of organising Philosophical Practice within the development of Caring Cities and thus of death literacy. The DenkZeitRaum (literally: “thinking-time-space”) is a project based at the Institute of Philosophy at the University of Graz, which started in 2011 [24]. The events link the university with the public space and the professional discourse with informal learning processes of citizens. In 2019 and 2020, the DenkZeitRaum was dedicated to the question: “Who or what does Europe belong to?”. Due to the Corona pandemic and related crises, two philosophical cafés were organised on the topic of death. The DenkZeitRaum organises events on three levels: firstly, in the form of academic discourse at the university; secondly, in the form of opening the university to a broad public; and thirdly, in public space. The Philosophical Practice is thus embedded in a cooperative, communal network. Network partners are primarily the city of Graz (mayor’s office, cultural office), various institutions depending on the topic (museum, society for political education and others) and, in the case of the philosophical café, the “Grätzeltreff” (neighbourhood meeting place, district office). In this context, the topic of death is not addressed from within palliative care, which has the potential of generating surprising perspectives on end-of-life issues. The DenkZeitRaum thus realises a participatory, networked structure in the sense of the Compassionate City idea for democratic, philosophical impulses that promote death literacy from the bottom up [25].

It must be said, however, that not all activities of Philosophical Practice relevant to end-of-life care are published. On the contrary, Philosophical Practitioners usually do not operate in the field of philosophy-science and therefore do not necessarily publish. To give examples from the German-speaking world: the philosophical practitioner Judith Tech (together with Bernd Groth) has been offering philosophical cafés and talks as “philosophising in the hospice” and in nursing homes for years [26]; Dietlinde Schmalfuß-Plicht engages in Philosophical Practice in the context of hospice volunteering and mourning work [27].

3. Paradigmatic styles in Philosophical Practice with examples

If we take a closer look at the field of Philosophical Practice, at least three paradigmatic styles can be distinguished. We speak here of “styles” because, in practice, the distinction is not always clear. Our overview is therefore not comprehensive but attempts an initial systematisation with regard to end-of-life care.

To describe each style, we add experiences from our own Philosophical Practice, i.e., from a series of philosophical cafés from the field of hospice and palliative care. These experiences illustrate a particular focus of the different basic styles of Philosophical Practice and build a bridge to the thematic field of palliative care.

Authors of this paper have offered philosophical cafés (or other similar formats) in very different contexts. We focus here on a series of philosophical cafés at the Kardinal König Haus in Vienna [28]. The Kardinal König Haus is an adult education institution with a significant role in the development of hospice and palliative work in Austria. Since 2020, it has offered the “Philosophicum”, a philosophical café, at irregular intervals but on an ongoing basis. The café takes place in the evening and lasts about 2 hours. The basic idea of the “Philosophicum” is to philosophically explore and discuss topics that arise in end-of-life care but may also relate to other social fields. The “Philosophicum” has taken place 14 times since 2020.

3.1 The dialogical style

3.1.1 Description

It is typical of the dialogical style that its representatives refuse to ascribe to one single method: “[…] the idea that what is happening can be approached programmatically-methodologically is misleading” ([5], p. 138). Philosophy stands for the freedom of thought, from which methods develop if necessary, and the methods cannot and must not be determined in advance. Therefore, the Philosophical Practitioner plays a special role. “The strength of Philosophical Practice lies in the fact that it is an art […]”, the Philosophical Practitioner is therefore challenged in their creativity. Emphasis is therefore placed on the dialogical relationship, which Gahlings calls “solidary participation” ([5], p. 62). As already described by Plato, the spark of thinking between people arises through continuing community of life and thought. A guest (a person attending Philosophical Practice) talks with the Philosophical Practitioner about their history, experiences, and questions. The Philosophical Practitioner listens and helps the guest with recognising their own concepts of life and with thinking and clarifying their thoughts by reference to philosophy. Gerd Achenbach [8] understood Philosophical Practice in this way. In this style, people do not seek out the Philosophical Practitioner with ready-made questions, but share their experiences, often in the form of stories from life. It is then the responsibility of the Philosophical Practitioner to identify together with the guest the philosophical part in the stories. What is told becomes the subject of the conversation. This conversation does not proceed in a psychological or psychotherapeutic manner, but strives for universality, for increasing the understanding of what is experienced, for approaching a shared truth. Philosophical Practice is hence strongly characterised by the art of listening.

On the basis of wonder, philosophers try to identify the life theme [9, 29] that moves the guest in their narrative. Life themes are unavoidable themes—they are of such generality and so fundamental that the experience of the themes cannot be avoided. Lindseth [9] reports that one theme recurs in his own Philosophical Practice, namely the themes of reconciliation. Reconciliation is also a common end-of-life theme that sufferers and carers encounter multiple times in the context of palliative care.

The Philosophical Practitioner and the guest are on a completely symmetrical level in front of the topic of life. That is why the person, the listening, and the wondering play such a role—the Philosophical Practitioner asks themself the question that is at stake in the guest’s story. Gerd Achenbach describes the basic dialogue-philosophical situation like this [8, 30]: “One puts a question before me. What do I do? I take it up and ask it to myself as if I had asked it myself […]. By accepting his question as a question to me, I make it my own […]. And now he [the guest] may watch what his question does to me” [31].

It is often stressed that Philosophical Practice is an offer for people seeking support in crises. Nevertheless, the conversation itself is not oriented towards help. According to Achenbach, this ambivalence is to be understood in this way: help is not sought, but often results from the Practice ([8], p. 21).

3.1.2 An example

In the “Philosophicum” titled “What does dignity mean?”, a participant tells a story. When he was a child, his father beat him with a belt because he thought his son broke a clock. But that was not true. Despite the beatings, the little boy does not betray his truth and sticks to it, insisting that he is innocent. The story moves the participants of the Philosophical Café; it is empathically received. Sharing the story makes the group that is listening a community (at least for the moment). Then they explore what dignity means in this example—it is no longer about the narrator, but about the theme of life using his story as an example. The participants try to name characteristics of dignity. All sentences are to be understood as attempts to grasp the phenomenon of dignity. It is important not to react too quickly whether this is true or not. The sentences have to be heard first to have an effect on the group and on the thinking. There were sentences like:

• “The belt does not touch the dignity of the boy”—that is, the violence cannot violate dignity or the sense of dignity (which was further discussed and challenged later with other examples, like human trafficking, torture).

• Dignity is a matter of choice, in the sense that the child who sticks to the truth does not accept injustice. The boy feels that there is something in him that gives him the power to keep to his dignity.

• Dependence on others is not the crucial trait about dignity.

• Those who have a sense of dignity can endure many things.

• The victim was stronger—the lack of dignity is in the perpetrator.

At the same time, the guest, telling the story, is dignified with his story and has found an audience. The group shared the thinking effort about the boy’s story.

3.2 The analytical style

3.2.1 Description

Philosophical Practice does not only mean to proceed hermeneutically and phenomenologically, as in the dialogical approach. There are also methods of Philosophical Practice that place clear emphasis on a very rational analysis. Oscar Brenifier’s style of conducting a philosophical consultation shows an example of this.

The immediate opinions, questions, ideas that a guest brings to the philosophical consultation are subjected to a thoroughly rigorous, critical analysis. Whilst in the dialogical approach, the Philosophical Practitioner takes on a role as a friendly, philosophically educated good listener, in the analytical approach, the philosopher takes on the role of the troublesome Socrates or that of a “detective” ([32], p. 31). Often humorous and playful, nevertheless rigorously and sometimes at first unpleasantly, they undertake a probing interrogation of the guest’s ideas and opinions. At the core of interaction lies the guest’s question, not their story, which they bring with them, and which in itself already implies a lot of (unconscious) presuppositions. The guest is asked to bring only one philosophical question per session.

The conversation is characterised by short sentences, for example ([33], p. 301), Oscar Brenifier would ask: “What is your question?”, and the guest might respond with another question: “How to find the right distance with my parents?” Then the elements of the question are explored, like: “What does ‘right distance’ mean?” As the conversation progresses, the guest’s attempts at definition and statements are comprehensively questioned and examined. The unclear initial question is transformed into a clear one, key terms are defined and distinguished, and contradictions are identified or sought through counterstatements.

Whilst in the dialogical approach, the atmosphere of a participating, empathic understanding in the interpersonal encounter prevails, the atmosphere in the analytical approach is rather that of a clear questioning, which can also be hurtful and frustrating if necessary. The guest—for the sake of coherence and rigour of thought—can be contradicted, interrupted and overall, the guest has to endure that their immediately taken-for-granted opinions and questions are very quickly shaken. Since these opinions are not some purely intellectual theoretical building blocks, but rather the lived conceptions and ideas that are “stored” in one’s mind, imprinting patterns, spontaneous ways of acting, one’s own life is also put to the test with the examination of one’s thinking. Philosophical Practice has the task of transforming a person’s unconscious and “indisputable postulates” ([32], p. 25) into “simple hypotheses” about a matter and subjecting them to examination. Those who endure the questioning may well experience a liberating effect, an expansion of thought in the Enlightenment sense. The painfulness of the examination is often softened by humour and playful lightness.

3.2.2 An example

In one of our philosophical cafés, on the topic of “How do we want to die?”, a participant tells in a very personal way how she experienced death of a relative. From this experience, she goes on to describe her wish to die peacefully, in the circle of the closest relatives, without pain, with a clear consciousness, and at peace. The atmosphere in the group is now decidedly quiet and a certain emotion is palpable. But, since the group agreed at the beginning that they want to look at the stories with philosophical interest and also question the statements behind them, the moderator asks: “What is the thesis behind this? I would say it is the thesis of peaceful, reconciled dying. Isn’t that the ideal and cliché death of the hospice movement? Let’s try to question this thesis of dying well. Who can refute it?” In the following sequence—after a short thinking silence—first thoughts come up, like: It is a very quiet, a well-behaved, perhaps all too disciplined death; dying, which is originally supposed to be brought out of the taboo, is after all silenced again; there is no resistance, no revolt in dying, no outcry against the imposition that is death; Suffering must be kept a secret in society, it must not disturb everyday life. The pointed articulation and questioning (even refutation) of a thesis that implies the unspoken, lived, embodied theory of a reconciled, peaceful death “stored” in feelings, spontaneous reactions, and also external structures allows the excluded, repressed to become conscious, expands thinking, and perhaps even leads to—at that moment, in any case, strongly perceptible—“conversion”.

3.3 The contemplative style

3.3.1 Description

A contemplative style can be found in the work of the Israeli-American philosophical practitioner Ran Lahav. His style is called Deep Philosophy and is motivated by “love, yearning, wonder” [34]. In common with all other styles of Philosophical Practice, Lahav also states that Philosophical Practice dives into deeper meaning: “In Deep Philosophy we contemplate on basic life issues from our inner depth, in togetherness with our companions and with historical philosophical texts” ([34], p. 14).

By this inner depth, he and the members of the Deep Philosophy Group form a source of understanding that is accessible to any interested person even without prior philosophical knowledge. In order to enter this state of inner understanding, members of the Deep Philosophy Group invite you to join sessions, which can take place preferably in presence, but also online. The 1–2 hour Deep Philosophy unit follows certain moderated rituals based on the joint reading of short text excerpts from a philosophical work. In this way, the participants elicit thoughts prompted by the text, but not necessarily truths.

The session usually begins with a meditative exercise to get into the right mood for the philosophy lesson. The joint reading of the text follows; it can be the exercise of “interpretive reading”. Each participant reads a certain passage and adds their own interpretation in the form of individual words or short sentences to the text. The next person then interprets the same passage again. The exercise is repeated in several rounds and, if necessary, only interrupted by reading without adding one’s own thoughts. The Deep Philosophy Group is applying the principle of Ruminatio, which might be already known from religious contexts. Another method of the Deep Philosophy Group is “precious speaking”, meaning all participants say only those terms that came to them as ideas after reading the text. It is important to say just enough to let the others participate in one’s own thoughts and to choose the words carefully.

At the end-of the session, the facilitator usually invites the participants to reflect on the whole text. In his book What is Deep Philosophy?, Lahav describes the emergence of a “philosophical polyphony” through this particular way of doing Philosophical Practice. Deep Philosophy does not aim to develop something new, but to come back to one’s own thoughts.

3.3.2 An example

In the “Philosophicum” titled “Experiencing Mortality”, the participants begin by introducing themselves and their initial associations with the topic. There is still a certain hustle and bustle in the room—the waitress is still taking orders for drinks, the pace of everyday life has not been completely discarded. Gradually, with time and a calm manner, the philosophical practitioner facilitates a break from everyday life urgencies. The atmosphere becomes calmer, concentrated, listening, all participants are very present—it becomes “meditative” to a certain degree. For a while, the associations are strung together, and over time the spoken contributions begin to (implicitly) revolve around a leitmotif. A leitmotif or reference point in this specific conversation is that of “commonality in the face of death”, posing a question: What makes us feel connected in the shared fate of mortality? The experience of mortality turns into an exploration of the riddle of life with its bonds and divisions. Another leitmotif has an almost philosophical, epistemological character: What does it actually mean to “experience” death or one’s own mortality? A nurse says he was often present with dying people, but did not really experience death because he had to function (go on). One mode is “being there without experiencing” or feeling the death. A woman tells how, when her husband died, she had to organise many things and simply “function”, which is why she did not consciously experience mortality, grief, and the feeling of her own finiteness at the first moment. But “functioning” kept her alive. Narratives of the perceived sacredness at the time of a dying person’s death, where sadness and beauty would touch, are answered by narratives of subsequent family conflicts around the funeral. The experience of the greatest depth and the banality of everyday life meet. Without it being said quite explicitly—in an intellectual way—the notion of experience (and therefore different ways of being and acting as a human being in the world) was differentiated along a crystallising distinction of superficial-deep or everyday-“sacred”. The participants struggle for suitable words, for language, for verbalisation of the experiences, which are often relapses. They “understand” without naming the “perfect terms”. Instead, philosophical insights are wrapped up in stories. Access to philosophical understanding is created not through the intellect, but from one’s own affected existence, from a space of inner and shared depth. It feels as if fundamental meanings, which are precisely not objectified for the intellect, float, as it were, in the common thinking space or settle amongst people.

4. Some conclusions and practical recommendations

Generally speaking, there is a need for further research, practical experience, and experimentation on Philosophical Practice in the field of palliative care. We are pursuing this in our research project Philosophical Practice in Palliative Care and Hospice Work. The aim of this chapter is to provide an initial overview and first attempts at giving points of orientation. Limitations are that we make no claim to completeness, and that conclusions have a hypothetical character at this early stage of our research.

4.1 Philosophical Practice as a cultural technique for end-of-life care

The various elements of the different styles taken together give an idea of the potential of Philosophical Practice and characterise it as a cultural technique. Philosophical Practice is based in dialogue; it is an encounter and mutual participation of people who share their experiences not merely for the point of narration, but for understanding a life problem from different sides. Thereby, philosophising essentially emerges between people. The dialogical style points to the community-building potential and empowering potential of Philosophical Practice, especially in the face of questions and in the face of experiencing borderline situations. Philosophical Practice further critically examines the implicit theories that determine our personal and collective lives (analytical approach), which unfolds political-critical potential for the development of a caring society. Finally, Philosophical Practice connects one’s own thinking with the thoughts that had already appeared in history in a resonance from the depths (contemplative approach) and elevates and connects the human being with the many voices of life and reality. The focus here is on the spiritual potential of Philosophical Practice.

4.2 The philosophical care: to philosophise is to learn to die

Philosophising can mean learning to die, which is an old topos in the history of philosophy and can also be identified in the basic styles of Philosophical Practice. The typical philosophical path of abstraction here lies in distancing oneself from the immediacy of one’s own feelings, one’s own experience, and one’s own unquestioned opinions. This moment of distancing thus characterises the starting point of philosophising and can be regarded as a way of consolation and learning to die. By moving onto the general level, the individual may enjoy a break from the problems of “earthly” life, whilst being very actively engaged in shared thinking and placing one’s own questions and experience in a universal context that connects us with life in general. The soul does not find comfort by solving its problems too quickly (which are often unsolvable anyway), but, paradoxically, by deepening these problems. One’s thinking opens up to the plethora of many different voices of reality.

Thus, when asked whether philosophy “helps”, two paradoxes must be reckoned with. The first paradox is that Philosophical Practice does not aim at helping, but at investigating a matter—but the help is usually a result. The second paradox is that philosophy helps by moving away from the individuality of the participants and aiming at the general level. Instead of detaching, moving towards the general “raises” the individual beyond themselves and connects them with whole life and reality. Philosophising is called learning how to die not so much because one talks about death, but because the movement of philosophical thinking is itself a kind of exercise through which the finiteness of the individual person is transcended.

4.3 Everyday philosophising in care practice

From a philosophical perspective, professionals in everyday care could be empowered and encouraged to develop a sense of wonder [16, 30], to consider existential experiences, to share them with one another, and to deepen understanding. We can ask ourselves: What moves me more deeply? Why? What does this mean for care and selfcare? In some ethical approaches, wonder is considered the appropriate moral feeling towards the other person [35]. It would be useful to create spaces for discussing existential experiences by Philosophical Practice.

4.4 Last Aid and last questions

Philosophical Practice could be combined with Last Aid courses. Last Aid courses [25] teach basic knowledge and practical skills in a short time, touching on existential questions and providing space for conversation. Participants who are interested in deepening existential questions could attend a philosophical format afterwards (e.g., “Speed-Philo”, “Philosophicum”). The combination of Last Aid and Last Questions would be a holistic and still manageable and effective concept to further develop death literacy of communities.

4.5 Caring communities and death literacy

The public health approach in end-of-life care contains a philosophical core and mission. It is ultimately immoral when experts influence “behaviour and conditions” (according to their ideas and ultimately key figures of health and good dying, etc.) without enabling people themselves to come to and articulate insights on what good life and good dying actually mean to them [36]. These questions go beyond the competence of individual sciences and specialists and require people involved to think for themselves and to think together. The first or at least an essential task of end-of-life-care developments in the population would therefore have to be:

1. To initiate and organise an open process of reflection, conversation, and networking that allows and empowers citizens to think about what matters in life, what are concerns and hopes, what constitutes good living and dying, and

2. To organise that citizens—across different roles, life, and work worlds—can share experiences and insights with each other in a deeper sense so that compassion, care, and empathy are to be real structural elements of social life.

Caring Communities would accordingly begin in a thoroughly philosophical sense as a social and existential, maieutic learning process in the social system of the “community”. This is where philosophy comes into play in its original (ancient) meaning as: “midwifery in everyday life” ([37], p. 26). Philosophical Practice has potentials for exploring further: from the programmatic reflection of the Lancet Commission on the Value of Death [3] to concrete practices in the midst of society.

Acknowledgments

This research was funded by the Austrian Science Fund (FWF) P 35627-G. For the purpose of Open Access, the authors have applied a CC BY public copyright licence to any Author Accepted Manuscript (AAM) version arising from this submission.

Conflict of interest

The authors declare no conflict of interest.

Thanks

We thank our colleague Urša Marinšek for her support with proofreading and feedback.