Hostname: page-component-8448b6f56d-gtxcr Total loading time: 0 Render date: 2024-04-24T03:06:49.768Z Has data issue: false hasContentIssue false

Should Empathic Development Be a Priority in Biomedical Ethics Teaching? A Critical Perspective

Published online by Cambridge University Press:  18 August 2010

Extract

Biomedical ethics is an essential part of the medical curriculum because it is thought to enrich moral reflection and conduce to ethical decisionmaking and ethical behavior. In recent years, however, the received idea that competency in moral reasoning leads to moral responsibility “in the field” has been the subject of sustained attention. Today, moral education and development research widely recognize moral reasoning as being but one among at least four distinguishable dimensions of psychological moral functioning alongside moral motivation, moral character, and moral sensitivity. In a reflection of this framework, medical educators and curriculum planners repeatedly advance the idea that educators should be concerned with supporting empathy, and this, very often, as a means of improving on and broadening medical ethics education’s traditional focus on moral reasoning.

Type
Special Section: Bioethics Education
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Rest, J. An overview of the psychology of morality. In: Rest, J, ed. Moral Development: Advances in Research and Theory. New York: Praeger; 1986:1–27.Google Scholar

2. Self, DJ, Gopalakrishna, G, Kiser, WM, Olivarez, M. The relationship of empathy to moral reasoning in first-year medical students. Cambridge Quarterly of Healthcare Ethics 1995;2:448–53.CrossRefGoogle Scholar

3. Hilfiker, D.From the victim’s point of view. Journal of Medical Humanities 2001;22(4):255–63.CrossRefGoogle Scholar

4. Tong, R.Feminist perspectives on empathy as an epistemic skill and caring as a moral virtue. Journal of Medical Humanities 1997;18(1):153–68.CrossRefGoogle ScholarPubMed

5. Callahan, D. Goals in the teaching of ethics. In: Callan, D, Bok, S, eds. Hastings Center Report on Ethics Teaching in Higher Education. New York: Plenum Press; 1980:61–80.CrossRefGoogle Scholar

6. Annis, DB.Teaching ethics in higher education. Metaphilosophy 1992;234(1&2):187–202.CrossRefGoogle Scholar

7. Scholz, S, Groarke, L.Seven principles for better practical ethics. Teaching Philosophy 1996;19(4):337–55.Google Scholar

8. See note 5, Callahan 1980:65.

9. Royal College of Physicians and Surgeons of Canada. The CanMEDS 2005 Physician Competency Framework. Ottawa: Royal College of Physicians and Surgeons of Canada; 2005Google Scholar; Accreditation Council for Graduate Medical Education. ACGME Outcome Project: Enhancing Residency Education through Outcomes Assessment. Chicago: Accreditation Council for Graduate Medical Education; 2009Google Scholar; Working group on behalf of the Association of Teachers of Ethics and Law in Australian and New Zealand Medical Schools. An ethics core curriculum for Australasian medical schools. Medical Journal of Australia 2001;175:205–10; ACP-ASIM Foundation, ABIM Foundation, European Federation of Internal Medicine. Medical professionalism in the new millenium: A physician’s charter. Lancet 2002;359:520–2.

10. Buyx, AM, Maxwell, B, Schöne-Seifert, B.Challenges of educating for medical professionalism: Who should step up to the line? Medical Education 2008;42:758–64.CrossRefGoogle Scholar

11. Doukas, DJ.Where is the virtue in professionalism? Cambridge Quarterly of Healthcare Ethics 2003;12(1):147–54CrossRefGoogle ScholarPubMed; Surdyk, PM. Educating for professionalism: What counts? Who’s counting? Cambridge Quarterly of Healthcare Ethics 2003;12(1):155–60CrossRefGoogle ScholarPubMed; Kuczewski, MG. Responding to the call of professionalism. Cambridge Quarterly of Healthcare Ethics 2003;12(1):144–54.CrossRefGoogle Scholar

12. See note 1, Rest 1986.

13. You D, Bebeau M. Moral sensitivity: A review. Paper presented at the 30th Annual Meeting of the Association for Moral Education, Boston; 2005.

14. Hoffman, M.Empathy and Moral Development: Implications for Caring and Justice. Cambridge, UK: Cambridge University Press; 2000.CrossRefGoogle Scholar

15. See note 1, Rest 1986.

16. Maxwell, B, LeSage, L.Are psychopaths morally sensitive? Journal of Moral Education 2009;38(1):75–91.CrossRefGoogle Scholar

17. See note 5, Callahan 1980; see note 6, Annis 1992; see note 7, Scholz, Groarke 1996; Morton, KR, Worthley, JS, Testerman, JK, Mohoney, ML. Defining features of moral sensitivity: Pathways to moral reasoning in medical students. Journal of Moral Education 2006;35(3):387–406.CrossRefGoogle Scholar

18. Akabayashi, A, Slingsby, BT, Kai, I, Nishimura, T, Yamagishi, A.The development of a brief and objective method for evaluating moral sensitivity and reasoning in medical students. BMC Medical Ethics 2004;5(1):1–7CrossRefGoogle ScholarPubMed; Hébert, PC, Meslin, EM, Dunn, EV. Evaluating ethical sensitivity in medical students: A study at the University of Toronto. Journal of Medical Ethics 1992;18(3):142–7CrossRefGoogle Scholar; see note 13, You, Bebeau 2005.

19. See note 16, Maxwell, Lesage 2009.

20. See note 16, Maxwell, Lesage 2009.

21. See note 3, Hilfiker 2001; see note 5, Callahan 1980; see note 6, Annis 1992; see note 7, Scholz, Groarke 1996.

22. See note 1, Rest 1986.

23. See note 6, Annis 1992; see note 7, Scholz, Groarke 1996.

24. See note 13, You, Bebeau 2005.

25. Maxwell, B.Professional Ethics Education: Studies in Compassionate Empathy. Dordrecht: Springer; 2008.CrossRefGoogle Scholar

26. See note 14, Hoffman 2000.

27. Batson, CD.The Altruism Question: Toward a Social-Psychological Answer. Hillsdale, NJ: Erlbaum; 1991.Google Scholar

28. Eisenberg, N, Miller, P. Empathy, sympathy and altruism: Empirical and conceptual links. In: Eisenberg, N, Strayer, J, eds. Empathy and Its Development. Cambridge, UK: Cambridge University Press; 1987:292–316.Google ScholarPubMed

29. Blasi, A.Emotions and moral motivation. Journal for the Theory of Social Behaviour 1999;29(1):1–19.CrossRefGoogle Scholar

30. Landau, RL. …And the least of these is empathy. In: Spiro, HM, Curnen, MGM, Peschel, E, James, DS, eds. Empathy and the Practice of Medicine: Beyond Pills and the Scalpel. New Haven, CT: Yale University Press; 1993:108.Google Scholar

31. See note 14, Hoffman 2000.

32. McKie, J, Richardson, J.The rule of rescue. Social Science and Medicine 2003;56:2407–19.CrossRefGoogle ScholarPubMed

33. Sherman, N. The place of emotions in Kantian morality. In: Flanagan, O, Rorty, AO, eds. Identity, Character and Morality. Cambridge, MA: MIT Press; 1990.Google Scholar

34. Nussbaum, M.Upheavals of Thought: The Intelligence of the Emotions. Cambridge, UK: Cambridge University Press; 2001.CrossRefGoogle Scholar

35. Fox, R, Lief, H. Training for "detached concern." In: Lief, H, ed. The Psychological Basis of Medical Practice. New York: Harper & Row; 1963.Google Scholar

36. Oser, W.Aequanimitas. New York: Harper; 1963.Google Scholar

37. Blumgart, H.Caring for the patient. The New England Journal of Medicine 1964;270(9):449–56.CrossRefGoogle ScholarPubMed

38. Airing, C.Sympathy and empathy. Journal of the American Medical Association 1958;167(4):448–52.CrossRefGoogle Scholar

39. Halpern, J. Empathy: Using resonance emotions in the service of curiosity. In: Spiro, HM, Curnen, MGM, Peschel, E, James, DS, eds. Empathy and the Practice of Medicine: Beyond Pills and the Scalpel. New Haven, CT: Yale University Press; 1993:160–73.Google Scholar

40. Maxwell, B.Naturalized compassion: A critique of Nussbaum on literature as education for compassionate citizenry. Journal of Moral Education 2006;35(3):335–52.CrossRefGoogle Scholar

41. Eisenberg, N, Fabes, RA. Prosocial development. In: Damon, W, ed. Handbook of Child Psychology: Social, Emotional and Personality Development. New York: Wiley; 1998:701–78; see note 14, Hoffman 2000.Google Scholar

42. See note 25, Maxwell 2008.

43. Blum, L.Moral perception and particularity. Ethics 1991;101(3):701–25.CrossRefGoogle Scholar

44. Feudtner, C, Christakis, DA, Christakis, NA.Do clinical clerks suffer ethical erosion? Students’ perception of their ethical environment and personal development. Academic Medicine 1994;69:670–9CrossRefGoogle ScholarPubMed; Coulehan, J, Williams, P. Conflicting professional values in medicine. Cambridge Quarterly of Healthcare Ethics 2003;12(1):7–20.CrossRefGoogle Scholar

45. Self, DJ, Baldwin, DC. Moral reasoning in medicine. In: Rest, J, Narvaez, D, eds. Moral Development in the Professions: Psychology and Applied Ethics. Hillsdale, NJ: Erlbaum; 1994:147–62.Google Scholar

46. Hafferty, FW, Franks, R.The hidden curriculum, ethics teaching and the structure of medical education. Academic Medicine 1994;69(11):861–71CrossRefGoogle ScholarPubMed; Mizrahi, T. Getting Rid of Patients: Contradictions in the Socialization of Physicians. New Brunswick, NJ: Rutgers University Press; 1986Google Scholar; Liederman, DB, Grisso, J. The gomer phenomenon. Journal of Health and Social Behaviour 1985;26:222–32CrossRefGoogle Scholar; see note 44, Coulehan, Williams 2003; Boon, K, Turner, J. Ethical and professional conduct of medical students: Review of current assessment measures and controversies. Journal of Medical Ethics 2004;30:221–6CrossRefGoogle ScholarPubMed; Kelly, B, Verghese, F. The emotional hazards of medical practice. In: Sanders, MR, Kelly, B, Byrne, GJA, eds. Medical Consultation Skills. Sidney: Addison-Wesley; 1997:472–88.Google Scholar

47. Barnbaum, DR.Teaching empathy in medical ethics. Teaching Philosophy 2001;24(1):63–75.CrossRefGoogle Scholar