From Bedside to Biosphere — Bichara Sahely

A physician and a life-grounded thinker: Tell us about yourself and the questions guiding your work.

I am a physician from St. Kitts and Nevis, trained in biology at Dalhousie University, and in medicine and internal medicine at the University of the West Indies. After more than two decades of clinical practice in the Caribbean, I am now beginning a new chapter in Canada.

Medicine taught me that illness may appear within the body, but its causes and consequences rarely remain there. Patients live within relationships, families, communities, economies, institutions, and ecosystems. Food, housing, clean water, meaningful work, social recognition, ecological stability, and access to care are not optional additions to health. They are among the conditions that make health possible.

My correspondence with the Canadian philosopher John McMurtry helped me recognize that what I encountered clinically reflected a deeper philosophical and civilizational problem: societies can become remarkably efficient at pursuing money, institutional performance, and technical control while neglecting the living conditions upon which their own existence depends.

My work therefore brings together McMurtry’s life-value philosophy, Humberto Maturana’s biology of cognition and love, and Johan Galtung’s understanding of structural violence. Across these traditions runs a deceptively simple question: Does a practice, institution, or way of living protect, restore, and expand the capacities of life — or does it disable them?

I explore that question through medicine, public health, peace-building, ecological responsibility, and my evolving online Life-Knowledge Commons.

What place does humour occupy in your work and everyday life?

Humour and clinical diagnosis have something important in common: both can reveal a pattern that everyone has been living inside without quite seeing.

In medicine, shared laughter can interrupt fear, soften professional hierarchies, and remind people that the patient is not merely a diagnosis and the physician is not merely a functionary. It can restore a little breathing space precisely when circumstances threaten to close it.

But humour is never automatically innocent. We can laugh with another person in ways that affirm our shared vulnerability, or we can laugh at someone in ways that convert vulnerability into entertainment. The difference matters.

I am particularly drawn to humour that exposes institutional absurdity. Modern healthcare, for example, sometimes appears capable of achieving excellent performance indicators while leaving the patient’s underlying circumstances untouched. One could imagine the reassuring clinical update: “The patient remains unwell, but the dashboard has made an excellent recovery.”

Such humour matters because it makes visible the gap between what institutions measure and what living beings actually need. At its best, laughter loosens the grip of false necessity and helps us imagine that things could be otherwise.

How does cruelty enter your understanding of medicine, social institutions, and culture?

As a physician, I encounter cruelty not only in deliberate acts of harm but also in forms of suffering that become normalized because they are distributed across systems.

A distinction is necessary: not every tragedy is caused intentionally, and not every institutional failure should be called cruelty. Nevertheless, when social arrangements repeatedly produce foreseeable and preventable suffering, when evidence of that suffering is available, and when workable alternatives are persistently ignored, indifference becomes organized.

Galtung helps us recognize how violence can be direct, structural, or culturally justified. McMurtry shows how systems can become life-blind when financial or institutional success displaces the protection of life itself. Maturana reminds us that ethical failure begins when another person ceases to appear as a legitimate other whose existence matters.

Consider a child repeatedly treated for asthma and then returned to damp, mould-infested housing. The medical treatment may be exemplary. Yet if no institution accepts responsibility for the conditions producing the illness, the child remains trapped inside a perfectly administered cycle of preventable harm.

No individual clinician can solve that problem alone. Responsibility must extend across healthcare, housing, environmental policy, and the institutions that determine which needs are recognized and which are ignored.

The unsettling feature of modern cruelty is that it can wear respectable clothing: efficiency, compliance, budget discipline, professional competence, or economic necessity. The antidote is not compassion alone, although compassion is indispensable. It is compassion joined to truthful diagnosis, shared accountability, and the practical redesign of the conditions that make suffering needlessly predictable.

Which foundational and recent works would you recommend to readers interested in these questions?

Three works are especially important to me.

John McMurtry’s The Cancer Stage of Capitalism: From Crisis to Cure exposes the destructive consequences of treating money accumulation as an end in itself and identifies the life-supporting arrangements required for a healthier society.

Humberto Maturana and Francisco Varela’s The Tree of Knowledge: The Biological Roots of Human Understanding invites us to reconsider knowing, living, and coexistence as deeply relational processes.

Johan Galtung’s landmark essay Violence, Peace, and Peace Research makes visible forms of injury that conventional thinking overlooks because they arise through social arrangements rather than identifiable acts of aggression.

Among more recent contributions, I would recommend Riane Eisler and Douglas Fry’s Nurturing Our Humanity, which explores how cultures organized around domination or partnership shape human development and social possibility.

I would also recommend Ten Essays in Honour of John McMurtry, edited by Giorgio Baruchello and Jeff Noonan, to which I contributed an essay. The collection demonstrates how a life-grounded philosophy can inform questions of health, education, science, political economy, and the commons.

If these works share a single lesson, it is this: the deepest measure of any civilization is not what it accumulates, controls, or claims to represent, but whether it enables the living beings within and around it to flourish.

Readers can explore Bichara Sahely’s work at Toward Life-Knowledge.