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你的痛苦与我无关:对临床同理心的批判。

Your pain is not mine: A critique of clinical empathy.

机构信息

Department of Philosophy, Sociology, Education and Applied Psychology (FISPPA), University of Padova, Padova, Italy.

出版信息

Bioethics. 2022 Jun;36(5):486-493. doi: 10.1111/bioe.12980. Epub 2021 Dec 12.

Abstract

Both in mainstream culture and in bioethical literature, there is a general agreement on the absolute positive value assigned to empathy in healthcare settings. Thanks to its two components-affective and cognitive-clinical empathy should allow physicians to be emotionally affected by the experiences of their patients, and at the same time, to imagine their situations in order to gain a deeper understanding and implement a 'tailored' approach to care. So, it seems that good physician has become synonymous with empathetic physician. However, while acknowledging its numerous benefits, I will argue that clinical empathy seems to harbour some dark sides. First, the affective component of clinical empathy (i.e. emotional resonance) is responsible for its partial nature and can lead to cognitive and moral distortions. Moreover, it can lead healthcare providers to negative psychological states, such as burnout and personal distress. Second, the cognitive component of empathy can be problematic as well: perspective-taking is a far more difficult task than it is ordinarily thought to be. I will also try to demonstrate that accessing the inner world of others is neither possible nor desirable since this operation can result in undermining the patient's agency. Third, clinical empathy can become a tool that disguises the power imbalance between patients and doctors, and this can reinforce an elitist and paternalistic conception of the clinical encounter. Furthermore, the disregard for the influence that the sociocultural context has on the clinical relationship can amplify and promote instances of epistemic injustice perpetuating discriminatory and unfair dynamics.

摘要

在主流文化和生命伦理文学中,人们普遍认为同理心在医疗保健环境中具有绝对的积极价值。由于同理心包含情感和认知两个组成部分,它应该使医生能够对患者的经历产生情感共鸣,同时设身处地地理解他们的处境,从而获得更深入的了解,并实施“量身定制”的护理方法。因此,好医生似乎已经成为富有同理心的医生的代名词。然而,尽管承认同理心有许多好处,但我认为临床同理心似乎存在一些阴暗面。首先,临床同理心的情感成分(即情感共鸣)导致其具有片面性,并可能导致认知和道德扭曲。此外,它还会导致医疗保健提供者产生负面的心理状态,如倦怠和个人困扰。其次,同理心的认知成分也可能存在问题:换位思考远非人们通常认为的那样简单。我还将试图证明,进入他人的内心世界既不可能也不可取,因为这种操作可能会破坏患者的自主权。第三,临床同理心可能成为一种掩盖医患之间权力失衡的工具,从而强化临床接触中精英主义和家长式的观念。此外,忽视社会文化背景对临床关系的影响会放大并助长知识不公正的现象,从而延续歧视性和不公平的动态。

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