Cultivating the dispositions to connect: an exploration of therapeutic empathy

Empathy is a broad concept that involves the various ways in which we come to know and make connections with one another. As medical practice becomes progressively orientated towards a model of engaged partnership, empathy is increasingly important in healthcare. This is often conceived more specifically through the concept of therapeutic empathy, which has two aspects: interpersonal understanding and caring action. The question of how we make connections with one another was also central to the work of the novelist E.M. Forster. In this article we analyse Forster’s interpretation of connection—particularly in the novel Howards End—in order to explore and advance current debates on therapeutic empathy. We argue that Forster conceived of connection as a socially embedded act, reminding us that we need to consider how social structures, cultural norms and institutional constraints serve to affect interpersonal connections. From this, we develop a dispositional account of therapeutic empathy in which connection is conceived as neither an instinctive occurrence nor a process of representational inference, but a dynamic process of embodied, embedded and actively engaged enquiry. Our account also suggests that therapeutic empathy is not merely an untrainable reflex but something that can be cultivated. We thus promote two key ideas. First, that empathy should be considered as much a social as an individual phenomenon, and second that empathy training can and should be given to clinicians

On having control over our actions

In this essay, I investigate the longstanding philosophical problem of whether we have control over our actions in a deterministic world. In working through a range of everyday situations in which this problem could arise, I come to the realisation that determinism has no bearing on whether we have control over our actions, because having control over our actions and determinism only make sense under different aspects

A fictionalist account of open label placebo

The placebo effect is now generally defined widely as an individual’s response to the psychosocial context of a clinical treatment, as distinct from the treatment’s characteristic physiological effects. Some researchers, however, argue that such a wide definition leads to confusion and misleading implications. In response, they propose a narrow definition restricted to the therapeutic effects of deliberate placebo treatments. Within the framework of modern medicine, such a scope currently leaves one viable placebo treatment paradigm: the non-deceptive and non-concealed administration of ‘placebo pills’, or open label placebo (OLP) treatment. In this paper I consider how the placebo effect occurs in OLP. I argue that a traditional belief-based account of OLP is paradoxical. Instead, I propose an account based on the non-doxastic attitude of pretence, understood within a fictionalist framework

Manufacturing the placebo effect

In the context of modern medicine, the placebo effect is a troublesome and controversial phrase. In this paper, I use investigative ordinary language philosophy to try to get clear on what it means. In so doing, I uncover three points. (i) The placebo effect makes sense in research but not clinical practice. (ii) To make the phrase make sense in clinical practice, we must manufacture a situation in which we can change linguistic habits. (iii) Such action is not necessary because in clinical practice we do better with other, more settled words and phrases

Return of the evil genius

In this essay, I consider whether it makes sense to say that our cognitive capacities—remembering, imagining, intending, hoping, expecting and so on—manifest as inner, subpersonal processes. Given whether something makes sense is a grammatical rather than theoretical or empirical issue, it cannot be explained but can only be better understood by describing and reflecting on situations in which it arises. As such, I approach this issue using the descriptive method of O.K. Bouwsma, which is a development of Wittgenstein's latter methodological approach of conceptually clarifying our bounds of sense. In the course of my investigation, I come to the realisation that cognitive capacities do not, as much psychology and cognitive science imply, make sense as inner, subpersonal processes. Instead, they make sense as personal capacities, which manifest in many ways of acting

Unintentional deception still deceives

In my recent article, Pretending to care, I argue that a better understanding of non-doxastic attitudes could improve our understanding of deception in clinical practice. In an insightful and well-argued response, Colgrove highlights three problems with my account. For the sake of brevity, in this reply I focus on the first: that my definition of deception is implausible because it does not involve intention. Although I concede that my initial broad definition needs modification, I argue that it should not be modified by involving intention but by involving responsibility

Pretending to care

On one hand, it is commonly accepted that clinicians should not deceive their patients, yet on the other there are many instances in which deception could be in a patient’s best interest. In this paper, I propose that this conflict is in part driven by a narrow conception of deception as contingent on belief. I argue that we cannot equate non-deceptive care solely with introducing or sustaining a patient’s true belief about their condition or treatment, because there are many instances of clinical care which are non-doxastic and non-deceptive. Inasmuch as this is true, better understanding of non-doxastic attitudes, such as hope and pretence, could improve our understanding of deception in clinical practice

Bioethics to the rescue! A response to Emmerich.

In our article, Where the ethical action is, we argue that that medical and ethical modes of thought are not different in kind but merely different aspects of a clinical situation. In response, Emmerich argues that in so doing we neglect several important features of healthcare and medical education. Although we applaud the spirit of Emmerich’s response, we argue that his critique is an attempt at a general defence of the value of bioethical expertise in clinical practice, rather than a specific critique of our account

Rules, Practices and Principles

Bioethics seems preoccupied with establishing, debating, promoting and sometimes debunking principles. While these tasks trade on the status of the word ‘principle’ in our ordinary language, scant attention is paid to the way principles operate in language. In this paper, we explore how principles relate to rules and practices so as to better understand their logic. We argue that principles gain their sense and power from the practices which give them sense. While general principles can be, and are, establishable in abstraction from specific practices, as they are in principlist bioethics, such principles are impotent as moral guides to action. We show that the purchase any principle has as a moral guide to action emerges from its indexical properties as a principle which has sense in a specific practice. The meaning of any principle is internal to the practice and context in which it is invoked and, therefore, principles are not kinds of master rule which dictate moral judgement in new contexts but rather chameleon-like rules which change with the contexture in which they are invoked