While we are working on the next blog commentary, check out a Lancet article by Jane Macnaughton, “The Dangerous Practice of Empathy,” a perspective on the art of medicine. Macnaughton argues that “true empathy derives from an experience of intersubjectivity and this cannot be achieved in the doctor-patient relationship.” “It is potentially dangerous and certainly unrealistic to suggest that we can really feel what someone else is feeling. It is dangerous because outside the literary context, where we are allowed direct experience of what a fictional patient is feeling, we cannot gain direct access to what is going on in our patient’s head.”
My take is that literature (and art and film), by giving access to fictional lives, prepares the mind for analogous situations and lives, so that one can imagine, however imperfectly, experiences to which one has no direct access and contemplate their significance.
Another online commentary of interest is posted at The University of Connecticut’s Advance Archive: “Prenatal testing for Down Syndrome raises ethical concerns“, by Chris DeFrancesco. The commentary refers to a paper published by Peter Benn and Audrey Chapman in JAMA, May 27. They raise concerns about the potential consequences of noninvasive prenatal diagnosis, with regard to termination of pregnancy. Of course, it’s always important to read the original article, “Practical and Ethical Considerations of Noninvasive Prenatal Diagnosis”, which I quote from here: ” . . . noninvasive diagnosis might result in a substantially reduced prevalence [of Down Syndrome] and in the process subtly alter attitudes about the acceptability of continuing an affected pregnancy. Doing so could diminish understanding and support for affected individuals and their families and increase the stigma associated with having a genetic disorder. Moreover, noninvasive prenatal diagnostic testing for Down syndrome would be a first step toward screening for other genetic disorders and birth defects and potentially for physical and mental traits.”
I call your attention also to our Regional Events section of this blog — there are many events of interest relevant to medical humanities that are posted here.
Felice Aull
Rebecca Garden, PhD
While I think that the title of the article is a little sensational, I generally agree with Macnaughton’s concerns and cautions (& have published on this). It’s natural to make assumptions based on one’s own experience, whether that’s one’s own experience of illness or knowing someone who is ill or disabled or whether it’s one’s experience of having read first‑hand accounts and other sorts of literature (medical and literary). It’s also easy, I think, to project and to become distracted by one’s own experience of empathy. We need to incorporate these concerns into our educational practices.
Literature scholars like Saidiya Hartman (writing on slavery) and Stephen Greenblatt (on colonialism) and disability studies scholars like Martha Stoddard‑Holmes and Rosemarie Garland‑Thomson have looked at the history of cultural and textual uses of sympathy and empathy to underwrite oppression. I think that these are important concerns and cautions to incorporate into our theories and practices of what Halpern calls “clinical empathy,” not reasons to reject it. And I do think that Macnaughton’s article is moving in that direction (despite the scary title).
I really like her use of Buber and Edith Stein. And her concerns about the power differential in the patient‑physician relationship bring us back to the cautions of Wear (Colonization of Med Hum, JMH 1992) and Taussig (Reification and the Consciousness of the Patient. Nervous System, 1992). But I also agree with Felice’s counter‑argument regarding literature/arts/film.
Edu
Empathy is an emotion important to medical care. In saying that, I have long differed from the belief expressed in these papers and elsewhere by Hojat that empathy comprises a cognitive skill. For me, empathy arises out of our own feelings and reactions; it happens when you and I becomes I am you or I could be you. For clinicians, empathy is the spontaneous feeling of identity with someone who suffers-fellowship, if you will. It is a comfortable emotion generated by interactions with our patients. We are familiar with it, but we struggle to define it. For example, as the authors of these papers recognize, the borders between empathy and sympathy are fuzzy. In contrast to empathy, I believe sympathy requires compassion but not passion.
Emma
Please let me know where I can find article, The Dangerous Practice of Empathy,
admin
The Lancet, Volume 373, Issue 9679, Pages 1940 – 1941, 6 June 2009