After I discussed, concerning interprofessionality, the confrontation between connections (what the idea of interprofessionality sets in concatenation) and boundaries (what this idea sets in accommodation), and after I discussed the confrontation between form (solution of a problem, presentation of a response) and formation (activation of a construction, active apprehension of a “perturbation” in relation to oneself and the world) in order to defy the self stasis comfort, a technically adjusted finish line, and a permanent discomfort, the inexorable problematization of any kind of finish line (interprofessionality as the new ideal standard or as an ethical summoning, an openness to signs-in-motion on working), I received the debate of three brave readers: Márcio Florentino Pereira, Emerson Elias Merhy and Hugo Mercer. The text that was the object of the debate, “Connections and boundaries of interprofessionality: form and formation”, aimed to present the terminology of interprofessionality, removing the connotation of a simple neologism. After all, to some extent, it is a notion that still faces efforts of objection and refutation, serving undefined, unpredicted or intangible reconfigurations (connections), but also consensual configurations in innovation agreements, contained in protocols and programs (like providing boundaries).
I wanted to show interprofessionality as the form of the obvious (the multiprofessionality and interdisciplinarity that are inescapable issues in work due to integrality and humanization in healthcare), but also as the torment of form in professions (their mystical/mythical desire of private attributes). The obvious would be submitted to “ethical competence”, not to the moral constraint from which it is impossible to escape in work-related rules and norms, recommendations given by international agencies, science standards and scholars’ arguments. While I made my path, I brought authors who use this terminology in a conceptual way, as an epistemological construct. I barely addressed the categorical international recommendations supported by study standards and special formulation committees based on evidences from practical and theoretical knowledge. I reviewed the literature and enunciated the Brazilian experience related to that exact and precise question, without flooding towards a general overview of work in its living micropolitics. However, as a conclusion, I wanted to indicate the power of the affective or emotional experience in the course of a learning experience, when the most important thing is not the success of a teaching goal or the embracement of a notion to implement, but the openness to a free and creative learning, capable of transforming itself, the surroundings and the constituted forms.
The assumed element of interprofessionality can be apprehended or sensed simply by intuition, but its presence is not undoubtedly guaranteed in the formal education of professionals, in the normative regulation of work, or in the audit of healthcare practices. That professionals work or must work in teams is obvious, which does not mean introducing objective resources of education and work management based on interprofessionality. Merhy’s analysis about Brazil is correct: the intellectual production of the Brazilian Collective Health presents paths and conceptual strategies, and the practices have not dismissed this terminology to challenge the permanent creation of work, which, in his production, as he highlighted, he has called Live Work in Act, performed through the cartographic device of the health action. Perhaps Mercer’s argument related to boldness, which, according to him, my text proposes, lies precisely there, when he focuses, particularly, on the notion of praxis, highlighting it as a pragmatics of teaching, learning, doing and acting in health. He concludes that it is a form of doing politics, as it leads to an integration of different levels of knowledge and practices, going beyond the current tasks recognized by the professions’ regulation councils and the protocols established by accreditation processes. Florentino Pereira argued that, in professional and curricular settings strongly dominated by the disciplinary monoculture and by the biotechnicist specialization, the presence of interprofessionality underlines the presence of conflicts, reprimands, disruptions, discomforts and blurs, aiming at a creative and constructive reunion of health work and education, and delimiting the claim for an ecology of knowledge, instead of the monoculture of scientific or corporative disciplines. He also mentions cultural diversity, which requires domains in a plural epistemological field.
From the contact with the debaters, some aspects stand out: the marks of the live work in act, of a political pragmatics related to the construction of oneself and the world, and the need to join interdisciplinarity, interprofessionality and interculturality, bearing in mind that the step of verifying whether it is correct or not is no longer necessary. Interprofessionality is an ethical requirement: the recognition of the large limits of the notion of field and nucleus of professions in view of the transversalization of the affective experience and subjectivities, and the need to overcome the stage of claiming for more doctors and move to the stage of claiming for more interprofessionality. All this without interprofessionality being the new fashionable concept or the new term imported from “international science”, the “new wave”. My effort, to some extent, was exactly this: the term was not here, many concrete practices were, as Merhy argued. Mercer lists these practices in his debate. Florentino suggests a university project with this orientation, instead of programs of teaching, work or interprofessional collaborative practices. Therefore, it occurs to me to enunciate adaptation, resistance and ethical competence in interprofessionality, leaving, as Merhy asks, these issues as an open debate.
If ethics is a manner of being and conducting oneself, as Foucault11. Foucault M. A hermenêutica do sujeito. São Paulo: Martins Fontes; 2010. argued, it also involves objecting to the explanation of knowledge as the representation of a given world and refusing to accept that the learning action is an adaptation to this world. The notion of ethical competence demands the capacity for affecting and being affected, being sensitive to the world’s signs. This indicates that the ethical conduct requires a learning process. To resist adaptation necessarily means to learn, to be capable of composing. This is a simultaneous process of composing oneself and the world. I specially recommend the intellectual production of Kastrup22. Kastrup V. A invenção de si e do mundo. Belo Horizonte: Autêntica; 2007.,33. Kastrup V. A propos de l'apprentissage de la compétence ethique. Intellectica. 2002; 2(35):299-322. (psychology of cognition) and Varela44. Varela F. Sobre a competência ética. Lisboa: Edições 70; 1992. (biology of cognition). Kastrup addresses “inventive learning”, as it should not be confused with a problem-solution process nor with adaptation to a pre-existing world22. Kastrup V. A invenção de si e do mundo. Belo Horizonte: Autêntica; 2007.. Rather, it is an impetuous formulation of a question to thought (the author calls it “invention of problems”), a problematization experience (which includes the notion of disruption, in a Foucaultian approach) and, at the same time, the invention of oneself and the world (subject and object co-engender one another; thus, a common and a heterogeneous are produced in cognition). Varela has insisted in not limiting cognition to a problem-solution process and introduced the concept of perturbation or breakdown as a kind of weakening of the cognitive system, a rupture that ensures the continuity of its autopoiesis44. Varela F. Sobre a competência ética. Lisboa: Edições 70; 1992.. It is as if it were a cleavage, a deviation, a lag, a maladjustment, which is precisely an openness, the act of unlocking live cognition. We can also call it openness to difference or re-singularization.
It is because of this condition of openness to difference or re-singularization that free and creative learning is “resistance” and not “adaptation”. Resistance and “rexistence”, resistance as refusal of given forms and rexistence as invention of existence. To resist and to exist, because the refusal derives from a problematization of the previous knowledge (uneasiness affection) and an invention of other forms of existing (chronoGenesis, invention of a world). Ethical competence is neither previous nor given; it emerges in the midst of learning. “The mediation of a learning process is necessary to achieve the immediate action that is characteristic of ethical competence”22. Kastrup V. A invenção de si e do mundo. Belo Horizonte: Autêntica; 2007..
The discussion about resistance/rexistence brings to light an ethics of openness to difference or re-singularization. The concept of ethical competence constitutes, precisely, a concept of resistance. We have here, with Latour55. Latour B. Cogitamus: seis cartas sobre as humanidades científicas. São Paulo: Editora 34; 2016., the researcher’s logic and task: to outline or map movements, passages, transformations and intensive changes. This includes monitoring statements still permeated with doubts and hesitations, passing by intermediate stages like “rumor”, “opinion”, “considerations”, “proposition”, until they reach the possible final stage, in which they become “finding” and “fact”, and are subsequently translated into academic papers. Science proposes to follow “all proofs”, assemblies, subtleties and findings, thus allowing interlocutors to change their opinions about the case they are discussing. Nothing, not even evidence itself, is evident a priori. Therefore, we are left with the entire work of compiling the constitution modalities of its emergence. If there is evidence, two conditions should be respected in the analysis: first, it should depart directly from the actors; second, it must result from a joint activity. In other words, instead of originating from personal cogito (“I cogitate”), evidence must stem, always, from cogitamus (“we cogitate”).
1Foucault M. A hermenêutica do sujeito. São Paulo: Martins Fontes; 2010.
2Kastrup V. A invenção de si e do mundo. Belo Horizonte: Autêntica; 2007.
3Kastrup V. A propos de l'apprentissage de la compétence ethique. Intellectica. 2002; 2(35):299-322.
4Varela F. Sobre a competência ética. Lisboa: Edições 70; 1992.
5Latour B. Cogitamus: seis cartas sobre as humanidades científicas. São Paulo: Editora 34; 2016.
Translator: Carolina Siqueira Muniz Ventura
Publication in this collection
12 Sept 2018
12 Sept 2018