‘INTIMACY: Part 1’
CAERS SUBSTACK ARTICLE #36
In a previous article I noted that humans are not only the most social creatures on the planet, they also possess the greatest communication skills, which explain in part our strong tendency to tribalism (Article #32). In addition, these traits provide opportunities for relationships that are more profound than any other species because they involve the idea of intimacy.
We are not only capable of sharing our innermost thoughts with other human beings, we long to do so. In fact, we crave the closeness, the near-oneness, that intimacy provides. But it comes with one major risk: rejection. When we share our deepest selves with another, we can feel intensely hurt if the other recoils from us, or worse still, betrays our intimacy with others who may turn on us as well. That rollercoaster from what we felt was complete acceptance to outright rejection can wound us to our very core.
It is akin to the feelings we might experience on a cloudless night staring up at the heavens. On the one hand, we may feel a deep sense of awe, of oneness with the universe, a sense that we are part of a very big picture. But on the flipside, we can also feel very insignificant and alone in a universe that can seem very harsh, even brutal. At some level we all desire a sense of meaning for our lives, that we matter, but at the same time we must reconcile that with a humility that accepts what a small role we play in the cosmic dance. That requires a delicate balancing so that we view ourselves from a position of reverence and not irrelevance.
In a similar way, the intimacy of relationships requires a balance as well. We allow ourselves to share our innermost thoughts and feelings as we enter into relationships gradually, and we enjoy becoming more connected with someone outside of ourselves. It involves humbling ourselves by manifesting our frail humanness to another person, revealing potentially embarrassing thoughts that may seem silly or cruel. The degree to which we are willing to be intimate is guided by our sense of how much we trust that the other person will continue to respect us and maintain our confidence. We do not want to risk humiliation; we want to be reassured by them that despite our shortcomings we have as valid a place in the universe as everyone else.
This business of intimacy is at the heart of the concepts of privacy and confidentiality. As autonomous individuals, we have the right to choose our own levels of intimacy, which means we are allowed to decide what we want to keep private and confidential. However, when we live in a collective, can that be absolute? How do we balance the rights and obligations of the individual with those of the collective? How do we balance intimacy, privacy and confidentiality with the need for some transparency?
Flying a commercial airplane is a privilege granted to those who have proven competency to do so. However, if a pilot develops an uncontrolled seizure disorder, they have an obligation to report that, even though it is highly intimate medical information. This is because prospective passengers have a right to know that their pilot is safe to fly. But passengers do not have the right to know specific and intimate medical details of the pilot. To manage this balance of rights and obligations of pilot and passengers we have physicians swear an oath whereby they are granted the privilege to have a pilot reveal their very personal medical symptoms within strict boundaries of confidentiality. Such a mechanism provides a controlled degree of transparency about the pilot’s ability to fly a plane that still respects the intimacy of the pilot’s medical health within the context of a confidential patient-physician relationship.
In a similar vein, we have a right to know if another person could be exposing us to a serious communicable disease from which they are actively suffering, without them necessarily having to reveal the intimate details of their medical health to us. If I am suffering from active tuberculosis (TB), I will have to restrict my contact with others until I am no longer contagious. But I need not sacrifice all of my privacy and confidentiality in that regard; I may choose to do so, but perhaps only to those individuals with whom I have a sufficiently intimate relationship of trust. The same could be said of hepatitis C, a disease spread by intimate sexual contact.
Our need to be concerned with the health of those around us with respect to communicable diseases is even more important with respect to individuals with conditions that compromise their own ability to resist disease. That might include immune deficiencies from many causes (natural or acquired), but also might incorporate conditions such as serious lung disease, for example. Of course, such unfortunate individuals need to accept some responsibility as well by taking the necessary precaution of limiting the kind of social contact that may put them at greater risk than most of the population. They may not want to risk going to a crowded cinema to watch a movie and choose instead to wait until it is available to be streamed at home. But that does not mean that they have the right to prevent everyone else from going to the theatre.
We can never avoid all potentially infectious and transmissible organisms; in fact, attempting to do so might itself be harmful. For example, our gastrointestinal system has more bacteria than we have cells in our body; we need this ‘microbiome’ to digest our food and stay healthy, but we can limit transmissibility with proper hygiene. When we are healthy, a small exposure to most infectious organisms usually allows our immune systems to become familiar enough with the organism to mount an immune response that will provide us with long-lasting immunity with little risk of serious disease.
Each of us is allowed to decide the risk to which we are prepared to expose ourselves, but we should not be making that decision for other people. This balancing has been a fundamental issue during the pandemic. What factors must be considered when making decisions about quarantine or other restrictions on intimacy and individual liberty? What are the limits of transparency? I’ll explore this in my next article, ‘Intimacy: Part 2’.
J. Barry Engelhardt MD (retired) MHSc (bioethics)
CAERS Health Intake Facilitator