The value of emotionally expressive visual art in medical education

This paper approaches the topic of visual art in medical education from a philosophical perspective, drawing on arguments from epistemology, philosophy of science, aesthetics, and contemporary ethical theory. Several medical ethicists have noted that the traditional clinical paradigm may increase the epistemic and emotional distance between patient and physician in part by focusing on the physical body and medical technology. Some of these same writers recommend a new approach to patients based on empathy and increased attention to suffering. After reviewing these arguments, supporting examples, and recommendations, I explain how visual art that expresses or symbolizes the emotional response to illness could be used to introduce an additional paradigm into medical education. This would be a paradigm based on empathetic attention to patients' emotional experiences in illness. My own argument is that this additional way of perceiving and relating to patients may reduce the distance between patient and physician and may allow physicians to better meet the ideal of treating the patient as a person.     

Walking a mile in their patients' shoes: empathy and othering in medical students' education

One of the major tasks of medical educators is to help maintain and increase trainee empathy for patients. Yet research suggests that during the course of medical training, empathy in medical students and residents decreases. Various exercises and more comprehensive paradigms have been introduced to promote empathy and other humanistic values, but with inadequate success. This paper argues that the potential for medical education to promote empathy is not easy for two reasons: a) Medical students and residents have complex and mostly unresolved emotional responses to the universal human vulnerability to illness, disability, decay, and ultimately death that they must confront in the process of rendering patient care b) Modernist assumptions about the capacity to protect, control, and restore run deep in institutional cultures of mainstream biomedicine and can create barriers to empathic relationships. In the absence of appropriate discourses about how to emotionally manage distressing aspects of the human condition, it is likely that trainees will resort to coping mechanisms that result in distance and detachment. This paper suggests the need for an epistemological paradigm that helps trainees develop a tolerance for imperfection in self and others; and acceptance of shared emotional vulnerability and suffering while simultaneously honoring the existence of difference. Reducing the sense of anxiety and threat that are now reinforced by the dominant medical discourse in the presence of illness will enable trainees to learn to emotionally contain the suffering of their patients and themselves, thus providing a psychologically sound foundation for the development of true empathy.     

Who's Responsible? Our Mutual Implication in Each Other's Suffering

In this paper, I examine the social and psychological roots of what I call neoliberal subjectivity, a version of contemporary subjectivity marked by a repudiation of vulnerability that has arisen from the social, economic, and political milieu of the past 30 years. The defense mechanisms involved in such a repudiation cause a decline in empathic capacities and in the capacity to experience ourselves as responsible and accountable for the suffering of others. I look at the way conflicts in the area of accountability and responsibility are lived both within our patients and within the interaction between patient and analyst. I argue that contemporary definitions of empathy normalize the repudiation of vulnerability and thereby foster an experience of empathy in which one can sustain a safe distance from the suffering other and not hold oneself accountable. A two-way version of empathy that counters neoliberal trends requires that we examine the ways we seek refuge in identifications that distance us from vulnerability, and it requires us to recognize the harm we inflict when we do so.     

The empathetic mind: the essence of human spirituality

The discovery of mirror neurons has led to some exciting research into the role of the brain and human empathy. Empathy is a significant element in human relationality and, therefore, human spirituality. This article will focus on the links between mirror neurons and human empathy and education. It will then examine how technology may be a factor in causing the erosion of empathy in today’s world, leading to school violence and bullying. It will conclude by offering some guidelines for educational programmes which may lead to the nurturing of children’s empathy.     

青少年责任感缺失的认知维度分析——学校责任感教育合理性追问

目前对青少年社会责任感缺失原因的分析多从社会、家庭、时代等方面着手,对学校范围内进行责任感教育并无多大帮助。本文从认知维度分析了青少年责任感缺失的三种情形及其原因,并以此为基础阐明了学校范围内责任感教育的合理性,提出在学校范围内开展的应是以责任知识、责任思维和责任实践为主要内容的责任感教育。     

In Defense of the Moral Significance of Empathy

It is commonly suggested that empathy is a morally important quality to possess and that a failure to properly empathize with others is a kind of moral failure. This suggestion assumes that empathy involves caring for others’ well-being. Skeptics challenge the moral importance of empathy by arguing that empathy is neither necessary nor sufficient to care for others’ well-being. This challenge is misguided. Although some forms of empathy may not be morally important, empathy with another’s basic well-being concerns is both necessary and sufficient to care for another’s well-being, provided that one’s empathy is both cognitive and affective. I further defend the idea that empathy of this form is a moral virtue. In doing so, I address three challenges to empathy’s status as a virtue: (1) that empathy is unnecessary for being ethical, (2) that it is not useful for promoting ethical behavior, and (3) that an empathetic person can lack other traits central to being virtuous, such as being motivated by the moral good and being disposed to do virtuous things whenever appropriate opportunities arise. I argue that these challenges are mistaken.     

Other-Consciousness and the Use of Animals as Illustrated in Medical Experiments

abstract  Ethicists such as Peter Singer argue that consciousness and self-consciousness are the principal considerations in discussing the use of animals by humans, such as in medical experiments. This paper raises an additional consideration to factor into this ethical discussion. Ethics deal with the intentional impact of subjects on each other. This assumes a meta-representational ability of subjects to represent states of mind of others, which may be termed other-consciousness. The moral weight of other-consciousness is manifest in the notion of responsibility, where humans lacking in other-consciousness (such as individuals with autism) may not be held responsible for their harmful actions towards others. As responsibility implies not only duties but also rights and more generally high moral status, it follows that other-consciousness grants high moral status, other things being equal — recognizing that other factors grant moral status too. Other-consciousness also increases the capacity for suffering, both due to increased freedom (and consequently increased possibility of restriction of freedom) and to increased empathy (with suffering of others). Hence, the more an animal is other-conscious, the more it deserves high moral status and the more it can suffer, other things being equal, and consequently, the less it should be used for human purposes. Further study is required to elucidate to what extent animals used by humans, such as in medical experiments, particularly primates and other highly evolved mammals, are other-conscious.     

Primordial Moral Awareness: Levinas,Conscience, and the Unavoidable Call to Responsibility

The phenomenon of conscience as articulated in Roman Catholic moral theology has at least three dimensions: a fundamental and universal call to moral goodness; the search for moral truth; and a commitment to act in a particular way. Recent moral theology has tended to focus on the latter two dimensions, but there has been a strong call from Thomas Ryan for attention to the first dimension of conscience, especially its constitution in ‘horizontal relationality’. In this article I respond to Ryan's call, and demonstrate that the philosophy of Emmanuel Levinas can show how the experience of conscience is constituted in horizontal relationality, as well as that it supports an understanding of conscience as a universal call to responsibility. Correlatively, and perhaps more significantly, the introduction of Levinas’ philosophy into the discussion of conscience sheds light on a significant aspect of this call to moral responsibility. This highlights that the Roman Catholic understanding of conscience has ethical consequences for theology more broadly considered (as well as the other academic disciplines) in terms of understanding why it is impossible to set aside considerations of responsibility in the search for truth.     

Relationality in Kohut's psychology of the self

In this essay, I will posit that Kohut's psychology of the self portrays relationality and that its relationality can be categorized into the explicit aspects. I will also put forth the six aspects of relationality contained in Kohut's psychology of the self as relational, dynamic, wholistic, unilateral, mutual, and doxological and they can be summarized as following: (1) Relational: Narcissism is not self-love but is a particular kind of object relationship; (2) Dynamic: The most central self is dynamic or agentic and not defined in substantival attributes; (3) Wholistic: The whole of the self is important; (4) Unilateral: In order for one's self to develop, one is in need of and at the receptive end of another's empathy; (5) Mutual: Others’ empathy is needed in maintaining the health of the developed selves; and (6) Doxological: Joy and thanksgiving are natural expression of developed selves.     

Anthropocene in Context: A Response to Rasmussen

In response to Larry Rasmussen's article about religious ethics in the Anthropocene, I offer an analysis that both contextualizes and elaborates upon his ideas. I introduce other humanities disciplines that have already wrestled with this question, and scholars of color whose voices offer needed correctives to the colonial heritage of most academic disciplines. I explore topics including human agency, non-human agency, exploitation, and refuge. I encourage scholars in our field to move beyond questions of responsibility and lamentations of moral incompetence and into concepts of right relationality and analysis of grassroots climate action already taking place in religious, ethical contexts.     

A Pedagogy of Unknowing: Witnessing Unknowability in Teaching and Learning

Using insights from the tradition of via negativa and the work of Emmanuel Levinas, this paper proposes that unknowability can occupy an important place in teaching and learning, a place that embraces the unknowable in general, as well as the unknowable Other, in particular. It is argued that turning toward both via negativa and Levinas offers us an alternative to conceptualizing the roles of the ethical and the unknowable in educational praxis. This analysis can open possibilities to transform how educators think about the goals of education in two important ways. First, creating spaces for embracing unknowing in educational settings is an act of ethical responsibility that recovers a sense of the Other and his/her uniqueness. Second, rethinking the value of unknowing in the classroom may inspire in students and teachers a sense of vigilance, responsibility and witnessing. Unknowing is an act of embracing otherness and presents a curious element of redemption; in the lack of knowledge, the meaning of its absence is found.     

A Student’s Perspective on Medical Ethics Education

Despite many efforts to increase ethics education in US medical schools, barriers continue to arise that impede the production of morally driven physicians who practice medicine with ideal empathy. Research has shown that, particularly during the clinical years, medical students lose the ability both to recognize ethical dilemmas and to approach such situations with compassionate reasoning. This article summarizes the current status of ethics education in US medical schools, described through the eyes of and alongside the story of a graduating medical student.     

Placement of responsibility and moral reasoning in couple therapy

Within the past two decades there has been a growing awareness of the importance of moral and ethical judgements in family and couple therapy. In this article we provide a detailed analysis of placements of responsibility related to blame in one couple therapy session. We suggest that it is important to study therapeutic interaction in situ , when searching for an understanding of moral reasoning in couple therapy and an ethical evaluation of the practice. A detailed analysis of discursive tools used by clients and therapists makes it possible to look at moral reasoning in action as it unfolds within the flow of therapeutic conversation. The findings are discussed in relation to two discourses of moral justification: autonomy and relationality. The principle guiding the therapists' actions in the studied conversation could be called 'relational autonomy'.     

Responsibility,Complexity Science and Education: Dilemmas and Uncertain Responses

While complexity science is gaining interest among educational theorists, its constructs do not speak to educational responsibility or related core issues in education of power and ethics. Yet certain themes of complexity, as taken up in educational theory, can help unsettle the more controlling and problematic discourses of educational responsibility such as the potential to limit learning and subjectivity or to prescribe social justice. The purpose of this article is to critically examine complexity science against notions of responsibility in terms of implications for education. First, themes of complexity science prominent in contemporary educational writing are explained. Then dilemmas of responsibility in complexity are explored, such as what forms and meanings responsibility can have in a ‘complexified’ perspective of education, how care for others is mobilised, and how desire can be understood. Analyses of ethical action grounded in complexity science are then examined, as well as theories of the ethical subject and participatory responsibility that are congruent with certain tenets of a complexity ontology. Finally, the possibility of an educational vision of responsibility animated by complexity theories is considered, drawing from related writings of Bai, Biesta, Derrida, Levinas and Varela.     

Intergroup reconciliation: effects of adversary's expressions of empathy, responsibility, and recipients' trust

The present study explores the effects of expressions of empathy for the ingroup's conflict-related suffering and assumed responsibility for causing it by a representative of the rival outgroup on recipient's willingness for reconciliation. It is suggested that such positive expressions by an adversary will have positive effects on reconciliation only in the presence of a basic level of trust in the outgroup. In two studies, Israeli-Jewish participants were exposed to a Palestinian leader who either expressed or did not express empathy and/or Palestinian responsibility for Israelis' suffering. After reading the speech, participants completed a questionnaire that measured their attitudes toward reconciliation with Palestinians. Results of both studies show that whereas expression of empathy led to more positive attitudes when trust was high, it tended to have adverse effects when trust was low. Similar effects were not found for assumed responsibility. Implications for research on intergroup conflict and reconciliation are discussed.     

Six Challenges for Ethical Conduct in Science

The realities of human agency and decision making pose serious challenges for research ethics. This article explores six major challenges that require more attention in the ethics education of students and scientists and in the research on ethical conduct in science. The first of them is the routinization of action, which makes the detection of ethical issues difficult. The social governance of action creates ethical problems related to power. The heuristic nature of human decision making implies the risk of ethical bias. The moral disengagement mechanisms represent a human tendency to evade personal responsibility. The greatest challenge of all might be the situational variation in people’s ethical behaviour. Even minor situational factors have a surprisingly strong influence on our actions. Furthermore, finally, the nature of ethics itself also causes problems: instead of clear answers, we receive a multitude of theories and intuitions that may sometimes be contradictory. All these features of action and ethics represent significant risks for ethical conduct in science. I claim that they have to be managed within the everyday practices of science and addressed explicitly in research ethics education. I analyse them and suggest some ways in which their risks can be alleviated.     

Engagement and suffering in responsible caregiving: On overcoming maleficience in health care

The thesis of this article is that engagement and suffering are essential aspects of responsible caregiving. The sense of medical responsibility engendered by engaged caregiving is referred to herein as ‘clinical phronesis,’ i.e. practical wisdom in health care, or, simply, practical health care wisdom. The idea of clinical phronesis calls to mind a relational or communicative sense of medical responsibility which can best be understood as a kind of ‘virtue ethics,’ yet one that is informed by the exigencies of moral discourse and dialogue, as well as by the technical rigors of formal reasoning. The ideal of clinical phronesis is not (necessarily) contrary to the more common understandings of medical responsibility as either beneficence or patient autonomy — except, of course, when these notions are taken in their “disengaged” form (reflecting the malaise of “modern medicine”). Clinical phronesis, which gives rise to a deeper, broader, and richer, yet also to a more complex, sense than these other notions connote, holds the promise both of expanding, correcting, and perhaps completing what it currently means to be a fully responsible health care provider. In engaged caregiving, providers appropriately suffer with the patient, that is, they suffer the exigencies of the patient's affliction (though not his or her actual loss) by consenting to its inescapability. In disengaged caregiving — that ruse Katz has described as the ‘silent world of doctor and patient’ — provides may deny or refuse any ‘given’ connection with the patient, especially the inevitability of the patient's affliction and suffering (and, by parody of reasoning, the inevitability of their own. When, however, responsibility is construed qualitatively as an evaluative feature of medical rationality, rather than quantitatively as a form of ‘calculative reasoning’ only, responsibility can be viewed more broadly as not only a matter of science and will, but of language and communication as well — in particular, as the task of responsibly narrating and interpreting the patient's story of illness. In summary, the question is not whether phronesis can ‘save the life of medical ethics’ — only responsible humans can do that! Instead, the question should be whether phronesis, as an ethical requirement of health care delivery, can ‘prevent the death of medical ethics.’     

Beyond Role-Playing

Abstract

Approaches utilized in preparing actors are similar to developing empathy. This article defines empathy as a state and a trait and examines the use of theater exercises in the development of empathy. Theoretical, practical, and research bases for utilizing theater exercises are presented. A small study using theater exercises designed to develop empathy is described. While quantitative analysis did not reveal significant results, qualitative results indicated high salience for a participating counselor education class and need for further research.     

Contextualizing Nanotechnology Education: Fostering a Hybrid Imagination in Aalborg,Denmark

In the context of worldwide economic and environmental crisis it is increasingly important that nanotechnology, genomics, media engineering and other fields of ‘technoscience’ with immense societal relevance are taught in ways that promote social responsibility and that educational activities are organized so that science and engineering students will be able to integrate the ‘contextual knowledge’ they learn into their professional, technical–scientific identities and forms of competence. Since the 1970s, teaching programmes in science, technology and society for science and engineering have faded away at many universities and have been replaced by courses in economic and commercial aspects, or entrepreneurship and/or ethical and philosophical issues. By recounting our recent efforts in contextualizing nanotechnology education at Aalborg University in Denmark, we consider a socio-cultural approach to contextual learning, one that is meant to contribute to a greater sense of social responsibility on the part of scientists and engineers. It is our contention that the social, political and environmental challenges facing science and engineering in the world today require the fostering of what we have come to call a ‘hybrid imagination’, mixing scientific–technical skills with a sense of social responsibility or global citizenship, if science and engineering are to help solve social problems rather than create new ones. Three exemplary cases of student project work are discussed: one on raspberry solar cells, which connected nanotechnology to the global warming debate, and two in which surveys on the public understanding of nanotechnology were combined with a scientific–technical project.