(2013). Sickle Cell Disease and the “Difficult Patient” Conundrum. The American Journal of Bioethics: Vol. 13, No. 4, pp. 3-10. doi: 10.1080/15265161.2013.767954.

This is a semifinal draft of a forthcoming paper. Kant’s account of the pain of remorse involves a hybrid justification based on self-retribution, but constrained by forward-looking principles which say that we must channel remorse into improvement, and moderate its pain to avoid damaging our rational agency. Kant’s corpus also offers material for a revisionist but textually-grounded alternative account based on wrongdoers’ sympathy for the pain they cause. This account is based on the value of care, and has forward-looking constraints (...) much like Kant’s own account. Drawing on both Kant’s texts and recent work in empirical psychology, I argue that experiences of remorse which conform to the sympathetic account may fulfill Kant’s forward-looking goals better than those conforming to his own account. (shrink)

Socially extended knowledge has recently received much attention in mainstream epistemology. Knowledge here is not to be understood as wholly realised within a single individual who manipulates artefacts or tools but as collaboratively realised across plural agents. Because of its focus on the interpersonal dimension, socially extended epistemology appears to be a promising approach for investigating the deeply social nature of epistemic practices. I believe, however, that this line of inquiry could be made more fruitful if it is connected with (...) the critical notion of epistemic responsibility, as developed in feminist responsibilism. According to feminist responsibilists, at the core of epistemic responsibility is a critical disposition toward correcting epistemic injustice. This epistemic idea is highly relevant to the epistemological context of illness, where patient testimony is often disregarded. Hence, though restricted to the epistemological context of the experience of illness, this chapter delves into epistemic injustice and its robust mechanisms. I thus explore what responsible epistemic practices should involve in order to redress that injustice and how epistemic responsibility should be socially extended. The discussion proceeds as follows. First, by relying on Arthur Frank’s innovative work on illness narratives, I focus on chaotic bodily messages from patients overwhelmed by suffering and then explain why these messages should count as genuine narratives or testimonies despite their inarticulateness. Second, I elaborate on how epistemic injustice concerning such narratives (i.e., chaos narratives) is produced and reproduced, in particular how both a dominant sociocultural norm and our inherent vulnerability can contribute to its production and reproduction. Finally, I propose an extended form of epistemic responsibility that ameliorates this aspect. Laying particular emphasis on the epistemic role of mature empathy, I characterise the extended epistemic responsibility in terms of extended empathic knowledge. (shrink)

In one sense of the term, empathy refers to the act of sharing in another person’s experience of and perspective on the world. According to simulation accounts of empathy, we achieve this by replicating the other’s mind in our imagination. We explore a form of empathy, empathic perspective-taking, that is not adequately captured by existing simulationist approaches. We begin by pointing out that we often achieve empathy (or share in another’s perspective) by listening to the other person. This form of (...) empathy, which we call “empathy through listening”, involves four distinctive features: (i) the actual sharing of a perspective; (ii) dynamical unfolding; (iii) collaboration; and (iv) mutual transformation. Next, we consider the individual basis of empathy through listening. We argue that it requires an attitude of “receptivity” and elaborate on this elusive concept in terms of “epistemic respect”. Finally, we consider whether this form of empathy can be adequately explained within the simulationist framework. We argue that simulationist approaches must be complemented by a receptivity-based conception of empathy—that is, a conception that envisions empathy not so much as an individual imaginative enterprise, but rather as a collaborative practice of engaging with the other while paying her due epistemic respect. (shrink)

As empathy gains importance within academia, we propose this review as an attempt to bring clarity upon the diverse and widely debated definitions and conceptions of empathy within the medical field. In this paper, we first evaluate the limits of the Western mainstream medical culture and discuss the origins of phenomena such asdehumanizationanddetached concernas well as their impacts on patient care. We then pass on to a structured overview of the debate surrounding the notion of clinical empathy and its taxonomy (...) in the medical setting. In particular, we present the dichotomous conception of clinical empathy that is articulated in the debate aroundcognitive empathyandaffective empathy. We thus consider the negative impacts that this categorization brings about. Finally, we advocate for a more encompassing, holistic conception of clinical empathy; one that gives value to a genuine interest in welcoming, acknowledging and responding to the emotions of those suffering. Following this line of reasoning, we advance the notion of ‘empathic concern’, a re-conceptualization of clinical empathy that finds its source in Halpern in Med Health Care Philos (2014) 17:301–311engaged curiosity. We ultimately advance Narrative Medicine as an approach to introduce, teach and promote such an attitude among medical trainees and practitioners. (shrink)

The development of empathy is central to positive social adjustment. However, issues remain with integrating empathy research conducted with children, adolescents, and adults. The current article (...

The paper presents an account of suffering as a multi-level phenomenon based on concepts such as mood, being-in-the-world and core life value. This phenomenological account will better allow us to evaluate the hardships associated with dying and thereby assist health care professionals in helping persons to die in the best possible manner. Suffering consists not only in physical pain but in being unable to do basic things that are considered to bestow meaning on one’s life. The suffering can also be (...) related to no longer being able to be the person one wants to be in the eyes of others, to losing one’s dignity and identity. These three types of suffering become articulated by a narrative that holds together and bestows meaning on the whole life and identity of the dying person. In the encounter with the patient, the health-care professional attempts to understand the suffering-experience of the patient in an empathic and dialogic manner, in addition to exploring what has gone wrong in the patient’s body. Matters of physician assisted suicide and/or euthanasia—if it should be legalized and if so under which conditions—need to be addressed by understanding the different levels of human suffering and its positive counterpart, human flourishing, rather than stressing the respect for patient autonomy and no-harm principles, only. In this phenomenological analysis the notions of vulnerability and togetherness, ultimately connecting to the political-philosophical issues of how we live together and take care of each other in a community, need to be scrutinized. (shrink)

According to recent approaches in the philosophy of medicine, biomedicine should be replaced or complemented by a humanistic medical model. Two humanistic approaches, narrative medicine and the phenomenology of medicine, have grown particularly popular in recent decades. This paper first suggests that these humanistic criticisms of biomedicine are insufficient. A central problem is that both approaches seem to offer a straw man definition of biomedicine. It then argues that the subsequent definition of humanism found in these approaches is problematically reduced (...) to a compassionate or psychological understanding. My main claims are that humanism cannot be sought in the patient–physician relationship alone and that a broad definition of medicine should help to revisit humanism. With this end in view, I defend what I call an outcomes-oriented approach to humanistic medicine, where humanism is set upon the capacity for a health system to produce good health outcomes. (shrink)

A recent version of the view that aesthetic experience is based in empathy as inner imitation explains aesthetic experience as the automatic simulation of actions, emotions, and bodily sensations depicted in an artwork by motor neurons in the brain. Criticizing the simulation theory for committing to an erroneous concept of empathy and failing to distinguish regular from aesthetic experiences of art, I advance an alternative, dynamic approach and claim that aesthetic experience is enacted and skillful, based in the recognition of (...) others’ experiences as distinct from one’s own. In combining insights from mainly psychology, phenomenology, and cognitive science, the dynamic approach aims to explain the emergence of aesthetic experience in terms of the reciprocal interaction between viewer and artwork. I argue that aesthetic experience emerges by participatory sense-making and revolves around movement as a means for creating meaning. While entrainment merely plays a preparatory part in this, aesthetic engagement constitutes the phenomenological side of coupling to an artwork and provides the context for exploration, and eventually for moving, seeing, and feeling with art. I submit that aesthetic experience emerges from bodily and emotional engagement with works of art via the complementary processes of the perception–action and motion–emotion loops. The former involves the embodied visual exploration of an artwork in physical space, and progressively structures and organizes visual experience by way of perceptual feedback from body movements made in response to the artwork. The latter concerns the movement qualities and shapes of implicit and explicit bodily responses to an artwork that cue emotion and thereby modulate over-all affect and attitude. The two processes cause the viewer to bodily and emotionally move with and be moved by individual works of art, and consequently to recognize another psychological orientation than her own, which explains how art can cause feelings of insight or awe and disclose aspects of life that are unfamiliar or novel to the viewer. (shrink)

Recent studies have revealed a drop in the ability of physicians to empathize with their patients. It is argued that empathy training needs to be provided to both medical students and physicians in order to improve patient care. While it may be true that empathy would lead to better patient care, it is important that the right theory of empathy is being encouraged. This paper examines and critiques the prominent explanation of empathy being used in medicine. Focusing on the component (...) of empathy that allows us to understand others, it is argued that this understanding is accomplished through a simulation. However, simulation theory is not the best explanation of empathy for medicine, since it involves a limited perspective in which to understand the patient. In response to the limitations and objections to simulation theory, interaction theory is presented as a promising alternative. This theory explains the physicians understanding of patients from diverse backgrounds as an ability to learn and apply narratives. By explaining how we understand others, without limiting our ability to understand various others, interaction theory is more likely than simulation theory to provide better patient care, and therefore is a better theory of empathy for the medical field. (shrink)

This article proposes a three-step model of empathy. It assumes that people have various empathy-related mechanisms available and thus can be described as hyper-empathic (Step 1). Under these conditions, the question of blocking and controlling empathy becomes a central issue to channel empathic attention and to avoid self-loss (Step 2). It is assumed that empathy can be sustained only when these mechanisms of controlling empathy are bypassed (Step 3). In particular, the article proposes a three-person scenario with one observing a (...) conflict of two others. By taking the side of one of the combatants, the observer is led into empathizing, perhaps to justify her/his earlier side-taking. (shrink)

In this article I propose to reframe debates about ideals of emotion in medicine, abandoning the current binary setup of this debate as one between ‘clinical detachment’ and empathy. Inspired by observations from my own field work and drawing on Sky Gross’ anthropological work on rituals of practice as well as Henri Lefebvre’s notion of rhythm, I propose that the normative drive of clinical practice can be better understood through the notion of attunement. In this framework individual types of emotions (...) are not, as such, appropriate or inappropriate, but are evaluated depending on their synchronicity with the specific rhythms of the practice. To set up this proposal, I show how typical arguments about emotions in medicine—what I call emotion-entity focused frameworks—are insufficient. I then draw on ethnographic observations from two orthopaedic departments and interviews with medical practitioners to show (1) how clinical practice is driven by rhythmicity, shaped in the case of orthopaedic surgery by a clinical aim of efficient, controlled intervention, and (2) how clinicians continuously refer to this drive and the flow of rhythms when evaluating inappropriate or problematic emotion. I argue that the use of a rhythm framework rather than ideals of detachment or empathy allows for a sensitivity to the complexity and situation-dependent elements of emotional ideals in clinical practice; and I end by proposing the term ‘attuned concern’—which stresses the importance of regulation and adjustment to circumstances rather than of maintaining a constant distance/involvement—as a more fitting alternative to ‘clinical detachment’. (shrink)

This article takes Heidegger's design distinctions for human being [Dasein] including affectivity, understanding, and speech, and, using these distinctions, generates a Heideggerian definition of empathy [Einfuehlung]. This article distinguishes empathic receptivity, empathic understanding, empathic interpretation, and empathic speech (or responsiveness). It also looks at characteristic breakdowns.

This paper presents a phenomenological account of empathy inspired by the proposal put forward by Edith Stein in her book On the Problem of Empathy, published originally 1917. By way of explicating Stein’s views, the paper aims to present a characterization of empathy that is in some aspects similar to, but yet essentially different from contemporary simulationist theories of empathy. An attempt is made to show that Stein’s proposal articulates the essential ingredients and steps involved in empathy and that her (...) proposal can be made even more comprehensive and elucidating by stressing the emotional aspect of the empathy process. Empathy, according to such a phenomenological proposal, is to be understood as a perceptual-imaginative feeling towards and with the other person’s experiences made possible by affective bodily schemas and being enhanced by a personal concern for her. To experience empathy does not necessarily or only mean to experience the same type of feeling as the target does; it means feeling alongside the feeling of the target in imagining and explicating a rich understanding of the experiences of the very person one is facing. (shrink)

Julie Childers and Bob Arnold’s (2019) article, “The Inner Lives of Doctors: Physician Emotion in the Care of the Seriously Ill,” uses Kübler-Ross’s influential work on death and dying to remind us...

This paper argues that enthusiasm for empathy has grown to the point at which empathy has taken on the status of an “ideal” in modern medicine. We need to pause and scrutinize this ideal before moving forward with empathy training programs for medical students. Taking empathy as an ideal obscures the distinction between the multiple aims that calls for empathy seek to achieve. While these aims may work together, they also come apart and yield different recommendations about the sort of (...) behavior physicians should cultivate in a given situation. I begin by demonstrating how enthusiasm for empathy has increased dramatically. I then specify precisely what I mean in calling empathy an “ideal.” I then describe some dangers associated with taking empathy to be an ideal unreflectively. I discuss the merits of works that provide conceptualizations of empathy that are specifically tailored for the medical domain and conclude that although these works move discussions about empathy in medical care forward, they could do more to foreground the goals and aims underlying calls for increased empathy. I provide specific suggestions as to how exactly we might foreground these goals and aims to further avoid conceptual confusion about empathy in medical education. (shrink)

Empathy is an extensively studied construct, but operationalization of effective empathy is routinely debated in popular culture, theory, and empirical research. This article offers a process-focused approach emphasizing the relational functions of empathy in interpersonal contexts. We argue that this perspective offers advantages over more traditional conceptualizations that focus on primarily intrapsychic features. Our aim is to enrich current conceptualizations and empirical approaches to the study of empathy by drawing on psychological, philosophical, medical, linguistic, and anthropological perspectives. In doing so, (...) we highlight the various functions of empathy in social interaction, underscore some underemphasized components in empirical studies of empathy, and make recommendations for future research on this important area in the study of emotion. (shrink)

This article is an introduction to a thematic section on the phenomenology of empathy in medicine, attempting to provide an expose of the field. It also provides introductions to the individual articles of the thematic section.

In this paper I look at various ways that interpersonal and social relations can be seen as required for autonomy. I then consider cases where those dynamics might play out or not in potentially paternalistic situations. In particular, I consider cases of especially vulnerable persons who are attempting to reconstruct a sense of practical identity required for their autonomy and need the potential paternalist’s aid in doing so. I then draw out the implications for standard liberal principles of paternalism, specifically (...) in clinical or therapeutic situations. The picture of potential paternalism that emerges here is much more of a dynamic, interpersonal scenario rather than a case of two separate individuals making decisions independent of each other. (shrink)

Volume 19, Issue 12, December 2019, Page 66-68.

This article offers a critique and reformulation of the concept of empathy as it is currently used in the context of medicine and medical care. My argument is three pronged. First, that the instrumentalised notion of empathy that has been common within medicine erases the term’s rich epistemological history as a special form of understanding, even a vehicle of social inquiry, and has instead substituted an account unsustainably structured according to the polarisations of modernity. I suggest that understanding empathy by (...) examining its origins within the phenomenological tradition, as a mode of intersubjective understanding, offers a different and profitable approach. Secondly, I argue that the appropriation of empathy in medicine means that, ironically, empathy can function as a technique of pastoral power, in which virtue, knowledge and authority remain with the doctor. And thirdly, empathy is in danger of being resourced as a substitute for equity and funding within health systems. I conclude however with hope for the productive possibilities for empathy. (shrink)

Whereas empathy is most often looked upon as a virtue and essential skill in contemporary health care, the relationship to sympathy is more complicated. Empathic approaches that lead to emotional arousal on the part of the health care professional and strong feelings for the individual patient run the risk of becoming unprofessional in nature and having the effect of so-called compassion fatigue or burnout. In this paper I want to show that approaches to empathy in health care that attempt to (...) solve these problems by cutting empathy loose from sympathy—from empathic concern—are mistaken. Instead, I argue, a certain kind of sympathy, which I call professional concern, is a necessary ingredient in good health care. Feeling oneself into the experiences and situation of the patient cannot be pursued without caring for the patient in question if the empathy is going to be successful. Sympathy is not only a thing that empathy makes possible and more or less spontaneously provides a way for but is something that we find at work in connection to empathy itself. In the paper I try to show how empathy is a particular form of emotion in which I feel with, about, and for the other person in developing an interpretation of his predicament. The with and for aspects of the empathy process are typically infused by a sympathy for the person one is empathizing with. Sympathy can be modulated into other ways of feeling with and for the person in the empathy process, but these sympathy-replacement feelings nevertheless always display some form of motivating concern for the target. Such an understanding of empathy is of particular importance for health care and other professions dealing with suffering clients. (shrink)

Empathy is a thing constantly asked for and stressed as a central skill and character trait of the good physician and nurse. To be a good doctor or a good nurse one needs to be empathic—one needs to be able to feel and understand the needs and wishes of patients in order to help them in the best possible way, in a medical, as well as in an ethical sense. The problem with most studies of empathy in medicine is that (...) empathy is poorly defined and tends to overlap with other related things, such as emotional contagion, sympathy, or a caring personality in general. It is far from clear how empathy fits into the general picture of medical ethics and the framework of norms that are most often stressed there, such as respect for autonomy and beneficience. How are we to look upon the role and importance of empathy in medical ethics? Is empathy an affective and/or cognitive phenomenon only, or does it carry moral significance in itself as a skill and/or virtue? How does empathy attain moral importance for medicine? In this paper I will attempt to show that a comparison with the Aristotelian concept of phronesis makes it easier to see what empathy is and how it fits into the general picture of medical ethics. I will argue that empathy is a basic condition and source of moral knowledge by being the feeling component of phronesis, and, by the same power, it is also a motivation for acting in a good way. (shrink)

Tax administrators are empowered by the state to secure compliance with tax obligations. Enforcing compliance on the ground is complex, and street-level administrators often engage in the “art of the possible,” leading to dilemmas in the field. This paper examines tax administrators’ practices with regard to Jamaican property tax defaulters with outstanding tax liabilities in excess of 3 years. Drawing on interviews with tax administrators and other key agents, we find that tax administrators reposition themselves from objective enforcers to empathizing (...) officials engaging in schemes of action, doing what they can do rather than what they should do. This is a practical-sense approach to securing compliance. We identify two forms of empathy, assimilated and cynical, and conclude that administrators’ empathetic identification with defaulters does not necessarily arise solely from concern for social cohesion, or inter-subjective compassion, but also sometimes from self-interest. (shrink)

Especially since the discovery of mirror neurons, scholars in a variety of disciplines have made empathy a central focus of research. Yet despite this recent flurry of interest and activity, the cross-cultural study of empathy in context, as part of ongoing, naturally occurring behavior, remains in its infancy. In the present article, I review some of this recent work on the ethnography of empathy. I focus especially on the new issues and questions about empathy that the ethnographic approach raises and (...) the implication of these for the study of empathy more generally. (shrink)

Empathic concern is essential to our social lives because it motivates helping behavior. It has, however, well-known shortcomings such as its limitation in scope. Here, we highlight a further shortcoming of empathic concern: it contributes little to understanding the relevant features of complex social situations (e.g. the causes of somebody’s distress), and unaided by further cognitive inputs, likely fails to produce effective helping. We then elaborate on the conditions needed for an accurate assessment of others’ situations: the ability to pay (...) attention and try to understand others for their own sake. We explain that when combining these abilities with the valuing aspect of empathic concern, we obtain “availability”, an understudied mental state which plays a crucial role in helping motivation. We provide a detailed definition of that notion and show how availability can be trained and exercised by health professionals in order to improve their care and relationships with patients. (shrink)

This dissertation contributes to the philosophy of empathy and biomedical ethics by drawing on phenomenological approaches to empathy, intersubjectivity, and affectivity in order to contest the primacy of the intersubjective aspect of empathy at the cost of its affective aspect. Both aspects need to be explained in order for empathy to be accurately understood in philosophical works, as well as practically useful for patient care in biomedical ethics. In the first chapter, I examine the current state of clinical empathy in (...) medicine including professional opinions about empathy, the dominant definition being employed, and the problems that arise from this definition. By trying to define empathy in a way that is useful to the current presuppositions in medicine, clinical empathy aligns with simulation theory, which has three problems: the discrepancy between the way empathy is defined and the way it is explained, the lack of diversity that this theory of empathy allows in our understanding of others, and the lack of affective understanding and affective engagement involved in the patient-physician interaction. These three problems are used to derive three questions that are important for any theory of empathy: (1) What is the phenomenon being explained? (2) What is the intersubjective context of empathy? (3) What is the affective dimension of empathy? The best theory of clinical empathy can be formulated by answering these three questions as they relate to phenomenological theories, which are more attuned to overcoming presuppositions. Chapters two and three each examine a different phenomenological approach to empathy from opposite extremes in their theories of intersubjectivity. Husserl and Stein begin from an isolated, transcendental subject that needs empathy to bridge the gap between itself and others, while Scheler begins from a primary intersubjectivity in which self and other are undifferentiated, making empathy a largely unnecessary skill. Despite their strongly opposed positions, and the acknowledgement that their theories of intersubjectivity necessitate their theories of empathy, I argue that both fail to understand the affective dimension of empathy. Husserl and Stein leave no room in empathy for it to be an affect, while Scheler prioritizes affects that reunite subjects, but leaves empathy itself as a non-affective skill. Chapter four explains Gallagher’s interaction theory as a more moderate approach to the relation between empathy and intersubjectivity. He draws on the insights of the other two theories, but conceives of empathy as a multi-leveled phenomenon that allows for an understanding of others. While this theory does aid in addressing the intersubjective context of empathy in a way that best solves the first two problems with clinical empathy, interaction theory still fails to fully address the affectivity of empathy, maintaining empathy as a largely cognitive ability. Gallagher does acknowledge the affective core of empathy, but he does not explain the way in which it is affective. In response to this problem, I explain Anya Daly’s application of Merleau-Ponty’s theory of reversibility to affectivity as a possible solution to the problematic gap in Gallagher’s theory. Chapter five focuses on theories of clinical empathy in order to address the neglected affective aspects of empathy, and respond to the problem of detached concern. The problems caused by detached concern are explained, as well as why the theories discussed in the middle chapters are still unable to solve them. This is done in two parts. In the first part, I explain the basis of this issue in the cognitive/feeling divide, as explained in the philosophy of emotion. Then, I give a brief overview of the phenomenology of affectivity to be used as a guide to the affectivity of empathy. In the second part, I examine three theories of clinical empathy that attempt to solve the problem of detached concern, noting their strengths and weaknesses based on their similarities to phenomenological approaches to empathy and affectivity. (shrink)

BackgroundThe academic and medical literature highlights the positive effects of empathy for patient care. Yet, very little attention has been given to the impact of the requirement for empathy on the physicians themselves and on their emotional wellbeing.DiscussionThe medical profession requires doctors to be both clinically competent and empathetic towards the patients. In practice, accommodating both requirements can be difficult for physicians. The image of the technically skilful, rational, and emotionally detached doctor dominates the profession, and inhibits physicians from engaging (...) emotionally with their patients and their own feelings, which forms the basis for empathy. This inhibition has a negative impact not only on the patients but also on the physicians. The expression of emotions in medical practice is perceived as unprofessional and many doctors learn to supress and ignore their feelings. When facing stressful situations, these physicians are more likely to suffer from depression and burnout than those who engage with and reflect on their feelings. Physicians should be supported in their emotional work, which will help them develop empathy. Methods could include questionnaires that aid self-reflection, and discussion groups with peers and supervisors on emotional experiences. Yet, in order for these methods to work, the negative image associated with the expression of emotions should be questioned. Also, the work conditions of physicians should improve to allow them to make use of these tools.SummaryEmpathy should not only be expected from doctors but should be actively promoted, assisted and cultivated in the medical profession. (shrink)

It is clear a relational approach to the study of empathy is gaining traction across multiple disciplines. Both commentaries on “A Relational Framework for Integrating the Study of Empathy in Child...

This article examines the cultural practices through which a group of professionals infuse their work and community with charisma. Although previous research has theorized the “charisma of office” (Weber 1978), we know little about how the occupants of such offices sustain it. I focus on a group of psychoanalytically-inclined psychotherapists, whose field, despite its early charismatic beginnings, has been especially embattled in recent decades. Drawing on ethnographic and interview data, I reveal how they share stories emphasizing their “idealization” by others, (...) draw boundaries between their professional and private lives to manage their work identities, and perform interpersonal affective work that shores up their claims to extraordinary abilities. Together, these cultural practices constitute charisma within the professional group. This article thus makes a case that, as expertise becomes increasingly contested, we must look beyond social organization and the evidentiary bases of knowledge to understand professional authority. (shrink)

Physicians, nurses, and other clinicians readily acknowledge being troubled by encounters with patients who trigger moral judgments. For decades social scientists have noted that moral judgment of patients is pervasive, occurring not only in egregious and criminal cases but also in everyday situations in which appraisals of patients' social worth and culpability are routine. There is scant literature, however, on the actual prevalence and dynamics of moral judgment in healthcare. The indirect evidence available suggests that moral appraisals function via a (...) complex calculus that reflects variation in patient characteristics, clinician characteristics, task, and organizational factors. The full impact of moral judgment on healthcare relationships, patient outcomes, and clinicians' own well-being is yet unknown. The paucity of attention to moral judgment, despite its significance for patient-centered care, communication, empathy, professionalism, healthcare education, stereotyping, and outcome disparities, represents a blind spot that merits explanation and repair. New methodologies in social psychology and neuroscience have yielded models for how moral judgment operates in healthcare and how research in this area should proceed. Clinicians, educators, and researchers would do well to recognize both the legitimate and illegitimate moral appraisals that are apt to occur in healthcare settings. (shrink)

One of the major tasks of medical educators is to help maintain and increase trainee empathy for patients. Yet research suggests that during the course of medical training, empathy in medical students and residents decreases. Various exercises and more comprehensive paradigms have been introduced to promote empathy and other humanistic values, but with inadequate success. This paper argues that the potential for medical education to promote empathy is not easy for two reasons: a) Medical students and residents have complex and (...) mostly unresolved emotional responses to the universal human vulnerability to illness, disability, decay, and ultimately death that they must confront in the process of rendering patient care b) Modernist assumptions about the capacity to protect, control, and restore run deep in institutional cultures of mainstream biomedicine and can create barriers to empathic relationships. In the absence of appropriate discourses about how to emotionally manage distressing aspects of the human condition, it is likely that trainees will resort to coping mechanisms that result in distance and detachment. This paper suggests the need for an epistemological paradigm that helps trainees develop a tolerance for imperfection in self and others; and acceptance of shared emotional vulnerability and suffering while simultaneously honoring the existence of difference. Reducing the sense of anxiety and threat that are now reinforced by the dominant medical discourse in the presence of illness will enable trainees to learn to emotionally contain the suffering of their patients and themselves, thus providing a psychologically sound foundation for the development of true empathy. (shrink)

This paper introduces an innovative curricular approach—the Health Humanities Portrait Approach —and its pedagogical tool—the Health Humanities Portrait. Both enable health professions learners to examine pressing social issues that shape, and are shaped by, experiences of health and illness. The Portrait Approach is grounded in a set of “critical portraiture” principles that foster humanities-driven analytical skills. The HHP’s architecture is distinctively framed around a pressing social theme and utilizes a first-person narrative and scholarship to explore how the dimensions of the (...) personal and the structural are mutually constituted. We argue that when creator-educators adopt the Portrait Approach and its critical portraiture principles to design and teach the HHP, they enable learners to become proficient in synthesizing and analyzing—with both depth and breadth—the human and social dimensions of patients’ lives. This inventive curricular intervention provides a needed contribution to health professions education in that it utilizes health humanities methodologies to elucidate the multiple aspects of health, illness, disability, and healthcare. (shrink)

This qualitative social scientific study explores professional texts of healthcare ethics to understand the ways in which ethical professionalism in medicine and nursing are culturally constructed in Finland. Two books in ethics, published by Finnish national professional organizations—one for nurses and one for physicians—were analyzed with the method of critical discourse analysis. Codes of ethics for each profession were also scrutinized. Analysis of the texts sought to reveal what is taken for granted in the texts as well as to speculate (...) what appeared to be relegated to the margins of the texts or left entirely invisible. Physicians’ ethics was discovered to emphasize objectivity and strong group membership as a basis for ethical professionalism. The discourses identified in the physicians’ ethics guidebook were universal ethics, reductionism, non-subjectivity, and threat. Nursing ethics was discovered to highlight reflectivity as its central focus. This idea of reflectivity was echoed in the identified discourses: local ethics, enlightenment, and moral agency. The analysis exposes a cultural gap between the ethics discourses of medicine and nursing. More work is needed to bridge ethics discourses in Finland in a way that can support healthcare professionals to find common ground and to foster inclusivity in ethical dialogue. Further development of bioethical practices is suggested as a potential way forward. (shrink)