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Fall 2006
Volume 06, Number 1

Newsletter on Philosophy and Medicine

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Comments on Empathy

Howard Spiro
Yale University

In the 1960s, “telling the truth” and “autonomy” replaced “paternalism” and “equanimity” as the canonical virtues of the medical profession. As respect for authority dissolved in that decade, the notion arose that patients, renamed “clients” or “customers,” given some information, should select what they needed or wanted from the cafeteria choices that physicians, renamed “providers,” could tell them about. Forgotten was the observation that people in the hospital, patients long-suffering in pain, become child-like in many respects and are very often incapable of making the rational choice that philosopher/ethicists recommend.

Physicians never have caught up with their emotions. One book, When Doctors Get Sick, published in the 1987 by H. N. Mandell and myself, made clear how little emotion physicians allow themselves to feel. This was true even when I was sick. It is true of other doctors even when they are dying. Detachment, so praised by Osler, led to distance and numbness so that doctors would not suffer when their patients died.

That compassion has been left out of medicine, to be supplied, one hopes, by the clergy, may not be all bad. For compassion carries an implication of superiority, pity, and an urge to relieve suffering through praying. I prefer the term empathy, for it implies the notion that “I could be you.” Empathy, as opposed to compassion, has a ring of equality.

Empathy implies recognizing the patient’s humanity or “dignity.” Dignity is sometimes ascribed to humans because they are created in the image of God, and sometimes ascribed because of humans’ sentience or their ability to communicate and think. But patients and their families are mainly concerned about deference and decorum. That means paying attention to the kinds of issues that physicians have been attending to for a long time, keeping the private parts covered to preserve the illusion of privacy, treating patients as equals regardless of how uneducated, or old, or disagreeable they may be.

Physicians also recognize how different patients are from one another, just as physicians themselves differ from each other. They try to respond to the individual needs of their patients, to relieve suffering and pain as expeditiously as possible. They always try to address each patient as an equal, and choose a topic for conversation that invites the individual patient to talk and be heard.

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