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Ethics and empathy

  1. Apr 13, 2008 #1
    This thread is regarding the need for ethics and empathy within the field of medicine. I would of course appreciate if some actual MDs would reply to this since they have the practical experience of medicine whereas my opinions are merely based on cold logic. Others are of course welcome to critize me aswell, as long as they take the thread seriously and don't label me as some "mad-scientis mengele-type mad-man" :wink:

    My opinion is that empathy is not needed within medicine, on the contrary, "difficult ethical dilemmas" is best solved with cold logic, a way of thinking that is inhibited gravely by empathy. Empathy reduces your chances of making the best possible decision in every situation, whereas the positive results of empathy, (telling someone "the right things", making them feel better etc. ) can be learned, trained in etc. This argument is strongly supported by the facts that some high-functional autist (Aspergers syndrom) have learned what to say in certain situations, and it is even suggested by some statements that certain MDs have said. The types of statements I think about is for instance "...I find these decisions the tuffest to make. Afterwards I have to rationalize it for myself, and my collegues. Its the worst part of the job." The MD knows what has to be done, but has difficulties doing it.

    Right and wrong are just words and their definition differs between cultures. The only relevant thing is whats necessary.
  2. jcsd
  3. Apr 13, 2008 #2


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    Do you really mean empathy, or sympathy? Empathy comes from having been in a similar situation and sharing feelings regarding that. This would be next to impossible for physicians to have unless they've spent a lot of time being a patient for a lot of reasons. For example, one cannot express empathy for someone who they are about to inform about a diagnosis of a terminal illness if they have never gone through that experience themselves. And, reacting based on your own feelings would certainly not help you give your patient the best care based on their feelings.

    If, instead, you mean sympathy, then yes, it's needed. Physicians cannot be robots, they need to respond to their patients' needs, give them reassurances they need, notice if they are afraid and deal with it. Otherwise, you cannot effectively treat your patient if you don't pick up on their emotional state...stress can adversely affect outcome. Fear or distrust of the doctor can lead to non-compliance with treatments, or even an unwillingness to return for a follow-up visit.
  4. Apr 13, 2008 #3
    No it doesn't. You don't have to have been in someones position to show empathy for them. Proof for this you have in the autists, whom never themselves have been tortured, and appear completely unaffected by watching someone being tortured, whereas other "normal" empathic people (whom haven't benn tortured) get affected by it. Autist are known to have "problems" with empathy, i.e. don't have that function.

    As goes for sympathy, of course it is needed. Basically that was what I wrote, albeit I might have done it between the lines :rofl:
  5. Apr 13, 2008 #4


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    I too think empathy is the wrong word, though it doesn't mean literally being in someone's shoes, but just imagining yourself in their shoes. Regardless, if you haven't been in someone's shoes, it is tough to empathize with them. And even if you could place yourself in their shoes, a physician should not. It could lead to poor decision making to too closely identify with the fear and pain of the patients.

    Sympathy, on the other hand, is essential for dealing with scared patients effectively. That makes being a doctor a tough balance. Parts of the job require cold, hard logic, while other parts require emotional connection with the patients.
  6. Apr 13, 2008 #5
    Can you give me an example of the emotional connection part? As far as logic goes, you shouldn't care what your doctor thinks about you, or whether he cares if you live or die anymore than that it's his job to make you not to. In my opinion, the ideal doctor doesn't care whether someone dies as long as a medical mistake has not been made.

    Once again, sympathy might help the patient in its recovery due to optimistical approaches, therefor it is necessary.
  7. Apr 13, 2008 #6


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    I already gave an example. Yes, patients DO care if their doctor cares about them. Would YOU want to go to a doctor who doesn't care if you live or die? And you seem to be creating a new definition of empathy. Empathy is emotionally putting oneself in another person's shoes. That's separate from caring if one lives or dies, which is sympathy, or just generally caring. Doctors are dealing with human patients with the full range of human emotions and expectations.

    We teach our med students here the acronym KMART: Keep My Attitude Right Today. This is a key part of patient care.
  8. Apr 13, 2008 #7
    So fake it. As far as I go, I only want my physician to care about giving me the right diagnosis and treatment.

    If you care about someone, you are not emotionally detached. Therefore you do not operate with the objectivity needed for the purely medical stuff. I bet most doctors wouldn't like to operate on their own mothers. Why? They loose their objectivity. Many situations requires from the doctor only to make decisions which gives, purely probably speaking, the patient the biggest chance statistically to... let's say survive.

    Why should you form an emotional connection with someone if you can get by simply by saying the right words and SYMPATHIZE? Hollow words, said with the rigth tone, are just as meaning-full as "true words" in the ear of the patient.
    Last edited: Apr 13, 2008
  9. Apr 14, 2008 #8
    Can you give an example?

    I think you at least need some "first principles" and these have to be based on something. If not "empathy", then presumably some kind of utilitarianism: "the greatest health for the greatest number of citizens".

    Is this what you have in mind?
  10. Apr 16, 2008 #9
    Example of "difficult ethical dilemma": We have a patient with... let's say three genetic, fatal and incurable diseases. The patient also suffers in agony. Suddenly someone comes with the idea of changing medicine so as to extend the patients life say... a few hours, maybe a day. What would you do?

    An other example is the isolation of a smaller group of people infected with a yet unknown deadly disease. Is it "ethically right" to isolate them to protect the others? By isolate I also mean revoke their human rights, and similar. The cold logic says that the larger groups health is more important than the smaller group.

    What more specifically do you mean by "first principles"? I guess "the greatest health for the greatest number of citizens" would not be far off, but that's not the point here. The point is wether empaty is needed at all, or even should be allowed to exist within medicine.
    Last edited: Apr 16, 2008
  11. Apr 16, 2008 #10
    I don't know if it's the right example, but I'm observing one right one now. So here is that 84 year old man with a artifical heart valve, showing some discrepancies during a routine checkout. he had no idea that something was wrong and to his idea could live on for a long time.

    But the valve might/will fail eventually Must be it be dealt with? If not, he may soon have major problems, but how soon?

    So the surgery was complex (a whole day) and the recovery is not going that well, several complications emerged. What can you expect at that age?

    I can imagine that the decision for surgery or not in cases like this, are tough and may be complicated by empathy/sympathy issues.
    Last edited: Apr 16, 2008
  12. Apr 16, 2008 #11


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    You are being unrealistic. Sick people get scared, but they are still the primary decision-maker in their treatment and therefore need someone to help them deal with the emotions that may affect the decision.
  13. May 2, 2008 #12
    Youre absolutely right. In fact, lets just strip them of their choice all together. The notion that they're going to fully understand what the doctor just told them, (information which he has years of theoretical, and practical training to back up) is completely ridicoulus.

    That's as far as my general opinion is, but could you give me a more concrete example of a situation where the patient is given alternate treatment-options?
  14. May 3, 2008 #13
    Is it really so difficult to be a little empathetic? Most patients don't want a whole lot of sympathy. But a little understanding goes a long way.

    Is your judgement drastically jeopardised by concern for a patient? It would seem you are far to close.

    A person should find it difficult to perform a procedure on their mother, though it would get easier over time. Imagine helping your mother learn to change her colostomy bag.

    If you think it is hard to remove your emotion from a problem then you will find it very difficult working in medicine.

    At times you must be calculating and if that is perceived as being cold so be it.

    But if your only concern is with the mechanics of something, stick to mechanics.

    As for alternate treatment options the first thing you should do, assuming one has been given, is to seek another (due to misdiagnosis if nothing else).

    If you find yourself isolating or secluding another there is no need not to empathise, your feelings should not change the job but may well affect the patients experience.

    And at the end of the day, even saving lives will become boring, a little empathy makes a repetitive task relevant. So have some for your own sake.
  15. May 3, 2008 #14
    I've seen the term empathy used in this fashion many times. Sort of broadly defining it as the ability to perceive another human being as like yourself and in need of the same emotional considerations as yourself. Generally I've seen it used when describing the lack of "empathy" in nuerologically or psychologically handicapped people.

    As for the actual topic it seems that greghouse is a fan of the television show House MD with a character of the same name and that is likely a major part of the inspiration for this thread. House is a doctor who has no bedside manner and who is famously quoted "We don't treat people, we treat diseases." Of course he treats special cases and rare diseases where he needs a diagnosis and treatment asap before the patient dies rendering the whole getting-to-know-you and sympathy phase of the relationship rather superfluous. And he is generally rather successful at treatment.
    But the show does illustrate the problems with his detachement. Often patients don't trust him and are difficult to persuade to take his treatments.
    You can't treat a patient against their will. That is not ethical. Even the character in the show would not do it. And it's always best for a patient to be comfortable with all facets of their environment, including their relationship with their doctor. I'm sure there are plenty of medical issues and treatments that can go awry due to unneccessary stress on the patient.
  16. May 3, 2008 #15


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    That's impossible except in the case of emergency care. This is the United States.
    Sure. I got my wisdom teeth removed. My treatment options were:

    -Get my wisdom teeth removed.
    -Don't get my wisdom teeth removed.
  17. May 3, 2008 #16
    Just as "take the medicine or die" is an option.

    And besides, I bet your choice was really eased by your doctors great load of empathy...
    Last edited: May 3, 2008
  18. May 3, 2008 #17


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    There's no need to be like that, greg. The choice I made to get my wisdom teeth removed was my choice. It wasn't an essential procedure. I wasn't in pain (ehh, slight ache every now and then), I got them removed more to avoid future problems (something like a 70% chance of infection). It isn't a clear-cut choice. And it wasn't a dire circumstance and I wasn't emotional about it, so empathy doesn't play much of a role there.

    I had (have?) another issue, a bone spur under my Achilles tendon. When I was in 9th grade, it caused a lot of pain due to the amount of running I was doing. The doctor said it could be removed, but there was a risk of damage to the tendon. I kinda wanted to get it removed, but I got cut from the soccer team (mainly due to the injury), didn't run much for a while, and it stopped hurting.

    Situations like these happen all the time in medicine and it is essential for doctors to be able to connect with their patients on an emotional level when necessary to help them make these decisions
  19. May 3, 2008 #18


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    I was thinking the same thing. Also, the character "House" often has to have one of his more compassionate subordinates be the interface with the patient, House mostly interacts with his staff, not the patient. And it never goes well when House does interact with the patient. So, even imaginary doctors that show no compassion don't do well with patients.
  20. May 3, 2008 #19


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    Yes. My grandfather passed away earlier this year of bladder cancer. This was his third recurrence of cancer (the first incidence being about 25 years ago). He also already had a pacemaker installed, was taking insulin since having his pancreas removed from an earlier bout of cancer, and was in his 90s. His choices were have his bladder removed with a high chance of dying from surgical complications at his age and condition, start chemotherapy with a high chance of it killing him at his age and condition, or do nothing with a high chance of dying from the bleeding resulting from the tumor progression. Basically, he was going to die sometime within a few weeks to a year later, regardless of his treatment choices, although there remained a very very slim chance he could live a few more years if he received treatment, although the quality of those years was highly questionable. He had to consider the pressure from my mother, aunt and grandmother who all thought he should keep fighting, as I tried to explain to them that he needed to make the decision for himself and that the best decision might be to do nothing and allow the cancer to take him sooner with dignity than to spend another few years nauseous from chemotherapy and attached to a catheter and bag for urine collection while unable to continue doing any of the activities he had previously enjoyed in life. He chose no treatment and passed away within a month of making that decision. This is a situation where a doctor needs to suspend all of their knowledge of ways to treat a patient and realize that compassionate, palliative care is all that the patient desires and needs.

    In contrast, I was speaking with someone earlier today whose wife is a cancer survivor. She was diagnosed with ovarian cancer and given a 75% likelihood she would not survive past 5 years even with treatment. Based on cold, hard facts, there was no point wasting time treating her..the odds were she was going to die anyway. She and her husband are going out tonight to celebrate her results of being cancer free...10 years after her initial diagnosis. Patients need to be involved in decisions regarding their own care.

    And, that caring extends beyond one's patients. It extends to the family of the patients as well. The caring and compassion help the family cope with the death or disability of a loved one. It is not uncommon, at least here in the US, for one's family doctor to attend the funeral of a long time patient. This provides comfort to the family...it also ensures the family continues to receive the care they need. Going to the doctor needn't be a cold, scary experience, and the more comfortable patients are with doctors, the more likely they are to get the treatment they need, remain compliant with treatment, and return for follow-up care.
  21. May 4, 2008 #20


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    That's rough. I had a similar situation last year with my grandfather. He's in his early 90s and got sick - a lung infection, I think. He seemed near death and signed a DNR order that extended to the point of cutting off most medical treatment (I saw it briefly, it said things like no antibiotics, no dialysis, etc.). There was a fight between my ants/uncles and mom about this, and I think my mom was the only one of the 4 who agreed with the order (besides, of course, my grandfather).

    The infection cleared, but he didn't get stronger and the medical staff was tough to read on what the prognosis and course of action was -- but it seemed he was still near death. He couldn't feed himself or roll over, etc. After a few weeks of basically being in limbo, my mother convinced him and the other relatives to accept home hospice care instead of just waiting to die in the hospital. Perhaps that's just what he needed, though - he's recovered fully now (at least as much as a 92 year old can).

    These are very difficult and emotional decisions. In this case, it didn't seem like the doctors were doing a good job of communicating the issues. A couple of the nurses gave more help than they probably were supposed to. One issue is that my grandparents seem to be overmedicated - my grandfather was delirious sometimes when I went to visit him and I'm still not sure if it was because of the illness or medication. A nurse showed us the medication orders in black and white, and I guess I believe him, but it is tough to be sure. His regular doctor flat-out refuses to talk to my mother - she asks too many questions (mostly about why they are taking sleeping pills...).

    [edit] Actually, that reminds me of another relevant situation. My grandfather had an anyeurism of his aorta about 20 years ago. When it was discovered, the doctor in the small, rural hospital outside of Allentown wanted to do the surgery and my grandfather agreed. My mother asked how many he'd done and what his success rate was. IIRC, he was something like 1 for 3. My mother, of course, threw a fit and demanded that they seek a better hospital and more experienced surgeon. She accompany'd him to Dallas where a surgeon who had performed dozens (hundreds?) did the procedure and he eventually recovered fully.
    Last edited: May 4, 2008
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