can Maria be sure she has plumbed the depths of her client ’ s depression , unless he has experienced it herself ?
The third concern is with the link between empathy and action , with empathy as a motivator to act for the other ’ s well-being . This is an old story . Motivation to do good does not necessarily lead to good ; indeed , a wrongful understanding of the recipient ’ s feelings may lead to more harm than good if acted upon , again especially given the power imbalance . Maria may be motivated to suggest treatment options for helping her client deal wither depression that are not in fact what the client needs or desires .
But let ’ s assume for the moment that we do get it right , that we really can feel what the other is feeling . Our next concern is that we may be so emotionally involved in the other that the story becomes about us rather than them . We find it hard to stop thinking about what we are feeling and ensure that the relationship is based on what they are feeling . Maria has found herself talking about her own experiences with depression , turning the consultation into a conversation with herself as the main focus . 13
Research also suggests that we tend to empathise more easily with those close to us ( which is termed ‘ familiarity bias ’); 5 with those physically present , and with those whose feelings and thoughts are intelligible and appropriate .
While it may be innate , there is some concern that empathy is highly sensitive to societal influences and can be manipulated by media or politics . Whom we empathise with , what perspectives we choose to follow , and whether we act on our empathetic insights are not solely matters of individual capacity or choice . Recall what was said above about the belief in nursing ethics that empathy can be trained . If it is that malleable then it can be distorted or politicised or institutionalised . While that may be the case with Maria and her client , there is the lack of familiarity with the client ’ s culture and language that may lead to a real misunderstanding of the client ’ s actual emotional situation . 14
Perhaps because of its origins , care ethics is , as we have seen , very alert to the political power imbalances in health care . It therefore expresses concern over the possibility that the carer , in a well-meaning expression of empathetic feeling , comes over too strongly , that the recipient of that empathic feeling might feel overwhelmed by it and end up resenting it . How dare you presume to know what I am feeling , even better than I do , simply because of your being a registered practitioner ?
Finally , as a related concern , the carer , if dealing repetitively with clients who need expert levels of care and associated empathy , might , if not supported , experience what has been termed empathy fatigue . The term suggests that empathy is not easy , that it demands substantial amounts of emotional and cognitive energy , prolonged attentiveness , cultural sensitivity , and associated concerns with power differentials , all of which means it can be exhausting and eventually counterproductive . 15
Conclusion
There would be little disagreement with the idea that empathy has an important place in CM practice . It does however face some challenging questions that require careful consideration . First , it needs to be clearly defined and placed in a network of associated ethical concerns in health care such as sympathy , compassion and care itself . Second , it needs to be seen in its relational aspect , as active and not abstract . Third , it needs to be seen in light of the limitations identified above , and those limitations need to be subjected to personal and educated scrutiny . And fourth , it needs to be recognised for its place in the power relationships that are embedded in all health care practice : political , social , and institutional .
The author would be pleased to receive any comments or questions concerning this article . Paul . Strube @ endeavour . edu . au
REFERENCES
1 . Hamington , M . Empathy and care ethics . In : Maiborn H , editor . The Routledge Handbook of Philosophy of Empathy . New York : Routledge ; 2017 . p . 2674 -272 .
2 . Held V . The ethics of care as normative guidance : Comment on Gilligan . J Soc Philos . 2014 : ( 45 ): 107 – 115 .
3 . Stein E . On the Problem of Empathy . Third revised ed . Stein W , translator . Washington , DC : ICS Publications ; 1989 .
4 . Slote MA . The ethics of care and empathy . New York : Routledge ; 2007 .
5 . Hoffman ML . Empathy and moral development : Implications for caring and justice . Cambridge : Cambridge University Press ; 2001 .
6 . Coplan A , Goldie P , editors . Empathy ; philosophical and psychological perspectives . Oxford : Oxford University Press ; 2014 .
7 . Klaver K , Elst E and Baart AJ . Demarcation of the ethics of care as a discipline : discussion article . Nurse Ethics , 2014 ; ( 21 ): 755 – 765 .
8 . Vetlesen AJ . Perception , empathy and judgement : An enquiry into the preconditions of moral performance . University Park , PA : Pennsylvania State University Press ; 1994 .
9 . Hamington M . Embodied care : Jane Addams , Maurice Merleau-Ponty , and feminist ethics . Urbana , Il .: University of Illinois Press ; 2004 .
10 . Koehn D . Rethinking feminist ethics care , trust and empathy . New York : Routledge ; 1998 .
11 . Waal FBM . The age of empathy : Nature ’ s lessons for a kinder society . London : Souvenir Press Ltd ; 2012 .
12 . Douglas DH . Empathy . In : Fitzpatrick JJ and Kazer MW , editors . Encyclopedia of Nursing Research . 3rd ed . New York : Springer : 2012 ; 146 – 148 .
13 . Bateson DH . Altruism in humans . Oxford : Oxford University Press ; 2011 .
14 . Oxley JC . The moral dimensions of empathy : Limits and applications in ethical theory and practice . Basingstoke : Palgrave Macmillan ; 2011 .
15 . Reynolds W , Scott PA , Austin W . Nursing , empathy and perception of the moral . J Adv Nursing . 2000 ; 32 ( 1 ): 235 – 242 .
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