This paper aims to clarify the nature of understanding in medicine. The first part describes in more detail what it means to understand something and links a type of understanding (i.e., objectual understanding) to explanations. The second part proceeds to investigate what objectual understanding of a disease (i.e., biomedical understanding) requires by considering the case of scurvy from the history of medi- cine. The main hypothesis is that grasping a mechanistic explanation of a condi- tion is necessary for a biomedical (...) understanding of that condition. The third part of the paper argues that biomedical understanding is necessary, but not sufficient for understanding in a clinical context (i.e., clinical understanding). The hypothe- sis is that clinical understanding combines biomedical understanding of a disease or pathological condition with understanding illness, which involves some degree of personal understanding of the patient. It is argued that, in many cases, clinical understanding necessitates adopting a particular second-personal stance and using cognitive resources in addition to those involved in biomedical understanding. (shrink)

The ethics of bearing bad news has not yet been discussed by philosophers. How should the messenger feel? Is she, as Toni Morrison claimed in one of her novels, ‘corrupted’ by the message? And shou...

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)

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)

What are the limits of the use of artificial intelligence (AI) in the relational aspects of medical and nursing care? There has been a lot of recent work and applications showing the promise and efficiency of AI in clinical medicine, both at the research and treatment levels. Many of the obstacles discussed in the literature are technical in character, regarding how to improve and optimize current practices in clinical medicine and also how to develop better data bases for optimal parameter (...) adjustments and predictive algorithms. This paper argues that there are also in principle obstacles to the application of AI in clinical medicine and care where empathy is important, and that these problems cannot be solved with any of the technical and theoretical approaches that shape the current application of AI in specific areas of clinical medicine in which care for patients is fundamental. This is important, because it generates specific risks that may be overlooked otherwise, and it justifies the necessity of human monitoring and emotional intervention in clinical medicine. Consequently, difficult issues concerning moral and legal responsibility may ensue if these in principle problems are ignored. (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)

Burnout is a multidimensional work-related syndrome that is characterized by emotional exhaustion, depersonalization – or cynicism – and diminution of personal accomplishment. Burnout particularly affects physicians. In medicine as well as other professions, burnout occurrence depends on personal, developmental-psychodynamic, professional and environmental factors. Recently, it has been proposed to specifically define burnout in physicians as “pathology of care relationship”. That is, burnout would arise, among the above-mentioned factors, from the specificity of the care relationship as it develops between the physician (...) and the patient. Accordingly, experimental studies and theoretical approaches have suggested that burnout and empathy, which is one of the most important skills in physicians, are closely linked. However, the nature of the relation between burnout and empathy remains not yet understood, as reflected in the variety of theoretical and contradictory hypotheses attempting to causally relate these two phenomena. Firstly, we here question the epistemological problem concerning the modality of the burnout-empathy link. Secondly, we hypothesize that considering the multidimensional features of both burnout and empathy, on one hand, and on the other hand, the distinction between empathy and sympathy enables to overcome these contradictions and, consequently, gives a better understanding of the relationship between burnout and empathy in physicians. Thirdly, we propose that clarifying the link between burnout, empathy and sympathy would enable developing specific training in medical students and continuous professional formation in senior physicians and would potentially contribute to the prevention of burnout in medical care. (shrink)

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)

Bioethics has begun to see the revaluation of affects in medical practice, but not all of them, and not necessarily in the sense of affects as we know them. Empathy has been accepted as important for good medical practice, but only in a way that strips it of its affectivity and thus prevents other affects, like sympathy, from being accepted. As part of a larger project that aims at revaluing the importance of affectivity in medical practice, the purpose of this (...) paper is to develop a clinical sympathy that can serve as a trainable skill for medical professionals. While everyday sympathy may be problematic as a professional skill for physicians, this does not imply that sympathy should be entirely rejected. As a natural part of our moral psychology, sympathy is an intersubjective affect that aids in our interactions with others and our decision-making abilities. I present here a theory of clinical sympathy as an affective response to patients, in which physicians are both attuned to their affective response and understand how their affects are influencing their beliefs and judgments. In this way, clinical sympathy serves as a trainable skill that can aid physicians in their interactions with their patients. (shrink)

In clinical ethics consultations, clinical ethicists bring moral reasoning to bear on concrete and complex clinical ethical problems by undertaking ethical deliberation in collaboration with others. The reasoning process involves identifying and clarifying ethical values which are at stake or contested, and guiding clinicians, and sometimes patients and families, to think through ethically justifiable and available courses of action in clinical situations. There is, however, ongoing discussion about the various methods ethicists use to do this ethical deliberation work. In this (...) paper, we make visible and accessible seven steps of facilitation used in the critical dialogue method of ethics consultation.We describe how the facilitation techniques serve two overall purposes. First, to identify ethically justified responses to ethical questions. Second, to assist participants to gain greater moral clarity, understanding and confidence to respond to ethical challenges as independent moral agents.By describing in detail facilitation steps for clinical ethics consultation, we aim to advance the scholarship of ‘clinical ethics facilitation methods’ and to demystify the ethical deliberation work undertaken by clinical ethicists. (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)

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.

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)

Background Clinical empathy is an essential part of healthcare, and patient-centered care models require clinical empathy to be established. Despite this, little is known about its measurement in the neonatal scenario. Research Aim To measure clinical empathy in health professionals who work with medium and high-risk neonates and build a construct of this empathy. Research Design Single-center survey study. Participants and Research Context The Jefferson Scale of Empathy for Health Professionals questionnaire was applied to health professionals who work in an (...) intensive care unit and a medium-risk unit, in Brazil. Analysis was done using descriptive statistics and a factor analysis model, to build the construct of empathy. Overall empathy was calculated, and the domains’ punctuations were analyzed and compared to the maximum punctuation possible. The study followed the STROBE checklist. Ethical Considerations This study was approved by the Research Ethics Committee of the institution. All participants signed the informed consent form. Participants’ confidentiality and anonymity were protected. Findings Median empathy was 117 (IQR 113–124). The domain of Walking in the Patient’s Shoes had lower scores and represented 77.6% of the maximum punctuation possible. The factor analysis included three factors named Understanding, Experiences, and Treatment, and Emotional Relationships, explaining 64.3% of the overall variance. The domain Walking in the Patient’s Shoes was not included in the model. Conclusions In this scenario, clinical empathy should improve. There is a need to improve the domain of Walking in the Patient’s Shoes, in this case, the neonate, and provide more empathic care to them. (shrink)

Emotion Review, Volume 14, Issue 3, Page 167-181, July 2022. A growing cadre of influential scholars has converged on a circumscribed definition of empathy as restricted only to feeling the same emotion that one perceives another is feeling. We argue that this restrictive isomorphic matching definition is deeply problematic because it deviates dramatically from traditional conceptualizations of empathy and unmoors the construct from generations of scientific research and clinical practice; insistence on an isomorphic form undercuts much of the functional value (...) of empathy from multiple perspectives of analysis; and combining the opposing concepts of isomorphic matching and self-other awareness implicitly requires motivational content, causing the RIM definition to implicitly require the kind of non-matching emotional content that it explicitly seeks to exclude. (shrink)

In my thesis I argue for a philosophical-anthropological approach which enables investigations in empathy and care by opening up a window on the motivation of recognition. I show how biographies as narratives can help to understand the other within her or his own life-world, even if the life-world is the very part of our personality as a dividually conceived relational self. Therewith, personhood can be conceived in a new concept of personhood that is understood as a category of the human (...) being endowed with a stronger focus on culturally and historically founded dividuality and relationality, instead of relying exclusively on individuality and subjectivity. To show this relational movement in our life-world, I introduce ‘the Melanesian’ worldview on personhood. This worldview assumes that we are holistically relational. Thus, it lets the perception of an objective world shift into a world of animated entities which become parts of the human. Other people are also part of our life, and, in this way, take part in the life-world − and thus in life. In consequence, the life-world as the place where humans get in touch with each other builds up the social community: others have a particular role just as we take part in their lives. Our relationship with others is related to certain tasks in the social community and to definitions of personality and character. In academia, it is common ground that increasing individuality causes an increasing claim to recognition, especially since Honneth’s revival and actualization of Hegel’s concept of recognition. It is also Honneth who is inseparably linked with the recent philosophical discussion about recognition. We are recognized and we recognize others both on a personal as well as on a social level. The leading question, still unsolved and at the same time unsolvably linked with the relationship of individual and society, is: why are we relying on recognition? In other words: how do we recognize me, my self, and the other? My approach of a self-based model of mutual recognition follows two methodological paradigms: hermeneutics and phenomenology. Unsurprisingly, the hermeneutical investigation of our self in relation to mutual recognition has to start at the current state of the recognition debate, and takes its way to the anthropological state of personhood- and self-debate. The phenomenological approach constitutes the second main basis for an approach to a self-based concept of mutual recognition. Also the connection of philosophical and anthropological approaches to identity, personhood, and self-recognition is very fruitful in the way of developing a holistic approach of mutual recognition. To support this, I connect Western approaches in the phenomenological and hermeneutical traditions as well as theories of narrativity and human biography with non-Western approaches to elaborate and emphasize the intersection of both approaches. In consequence, the Cartesian Ego is rejected in favour of a decentral, cosmomorphic, and sociocentric approach to personhood. This anthropological approach is merged with a narrative concept of identity to emphasize the self-reflexive way of personal identity. Building on this set of philosophical and anthropological arguments, my purpose is to draw up a self-based model of mutual recognition which includes all stages of mutual recognition: recognition of one’s own identity, recognition of one’s own acting, recognition of others, and evaluative recognition. I begin this journey with preliminary remarks on recognition, person, and self by elaborating the state of the art in approaches to mutual recognition, the Anthropological notion of personhood, individual, and self, and their Philosophical notion. In the second part of my work, I show how these approaches compose a self-based model of mutual recognition. Here we receive the idea how we are recognized: through empathic understanding an act of knowledge is performed, in which the other is perceived and acknowledged as another human similar to ourselves. Therefore, empathic understanding, feelings of sympathy, care and solicitude, personal ethos, and theories of mind are related to mutual recognition. The definition of our being through empathy highlights our social wellbeing. By implication we refer to the recognition of others as constitutive of the community, since we recognize others and take care of them. (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)

In Italy in recent years, an exponential increase in the frequency of medical malpractice claims relating to the issue of informed consent has substantially altered not only medical ethics, but medical practice as well. Total or partial lack of consent has become the cornerstone of many malpractice lawsuits, and continues to be one of the primary cudgels against defendant physicians in Italian courtrooms. Physicians have responded to the rising number of claims with an increase in ‘defensive medicine’ and a prevailing (...) preoccupation with the purely formal aspects of consent. The result is a plethora of consent forms, believed to be a guarantee of ‘informed consent’, as well as a growing reliance on informed consent as a shield against judicial action brought by the patient. Physicians ‘inform’ patients without really sharing information, often delegating the task of communication to other professionals who are not doctors. Italian judges always condemn the physician when information to the patient has been inadequate, thus leading insurance companies to consider the lack of valid informed consent as the total responsibility of the physician and/or the hospital. It is necessary to change tack, to remove this idea of consent which permeates the defensive culture of medical practice. Italian physicians need to be trained, first of all, to become aware that information and consent are two distinct processes, albeit closely connected. Valid communication demands a higher level of professionalism from physicians. (shrink)

This article examines responses to the controversial picketing and media‐savvy provocations of the Westboro Baptist Church (WBC). Since WBC’s conduct is widely perceived as cruel, people often respond with anger and animosity, which reinforce WBC’s self‐representation as a persecuted church. Conversely, I have engaged Westboro Baptists in interviews that function as “bridging conversations.” This methodology centers on critical‐empathic listening, comparative religious ethics, and a disciplined restraint from expressing moral judgment. I argue that this response is supported by the data and (...) understandings obtained, metapragmatic commentary, my rapport with churchgoers, and evidence of their empathy. In conclusion, I gauge the methodology’s risks and consider its expansion, for example, with undergraduates who have joined our conversations. In an era of polarized discourse, nonjudgmental listening is a counter‐intuitive response that troubles entrenched binaries, including the public fashioning of WBC as a dehumanized enemy. (shrink)

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)