Journal of Religion and Health

, Volume 34, Issue 4, pp 287–300

Physicians' values and physician-value neutrality

  • John F. Peppin

Abstract

For years articles have decried the lack of empathy in physicians' relationships with patients. In addition to being empathetic, physicians are called upon to assume the posture of “value neutrality,” i.e., not imposing one's values when dealing with patients. Empathy is clearly an expression of deeply held values; even the language used to define it is value-laden. Physicians are consistently called upon to exhibit traits which are expressions of their underlying values. However, if proponents of value-neutrality are to be taken literally one must not impose any of one's values on one's patients. But then one wonders how empathy could ever be expressed; further, it is hard to imagine what a truly “value neutral” physician would be like. It is time we recognize that any relationship between two persons requires the expression of values from both parties. These values help shape that relationship and define its further history. Physicians are not excluded from this process just because they consider themselves “professionals.” Divulging personal values to patients is both more honest and more in keeping with the concepts of justice, beneficence, non maleficence, and autonomy than to feign value-neutrality. A presentation of some type statement of values is timely and would give patients an idea of where a physician stands on a myriad of issues. Rather than being value-neutral, value “non-neutrality” seems a more right and reasonable posture for physicians to assume.

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References

  1. 1.
    American Medical Association, “Public Opinion on Health Care Issues.” May, 1992.Google Scholar
  2. 2.
    Osler, William, “Address.”Albany Medical Annals, 20(6), 1899, p. 308.Google Scholar
  3. 3.
    Rosenberg, James E. and Towers, Bernard “The Practice of Empathy as a Prerequisite for Informed Consent.”Theoretical Medicine 7(2), 1986.Google Scholar
  4. 4.
    Ceccin, Gianfranco, “Hypothesizing, Circularity, and Neutrality Revisited.”Family Process 26(4), 1987, p. 405.Google Scholar
  5. 5.
    Spiro, Howard. “What is Empathy and can it be Taught?”Annals of Internal Medicine, 116(10), 1992, p. 845.Google Scholar
  6. 6.
    Petersdorf, Robert G. “Are we Educating a Medical Professional who Cares?”American Journal of Diseases of Children, 146, 1992, p. 1339.Google Scholar
  7. 7.
    Squier, Roger W. “A Model of Empathic Understanding and Adherence to Treatment Regimens in Practitioner-Patient Relationships.”Social Science and Medicine 30(3), 1990, p. 326.Google Scholar
  8. 8.
    Glick, Shimon M. “The Empathic Physician: Nature and Nurture,” in Howard Spiro, Mary G. McCrea Curnen, Enid Peschel, and Deborah St. James eds.Empathy and the Practice of Medicine. New Haven: Yale University Press, 1993, pp. 85–102.Google Scholar
  9. 9.
    Levasseur, James and Vance, David R. “Doctors, Nurses, and Empathy,” inEmpathy and the Practice of Medicine, pp. 76–84.Google Scholar
  10. 10.
    Muslin, Homan L. and Schlessinger, Nathan. “Toward the Teaching and Learning of Empathy.”Bulletin of the Menninger Clinic, 35(4), 1971.Google Scholar
  11. 11.
    Glick, Shimon M.Op. cit.Google Scholar
  12. 12.
    Ibid. pp. pp. 85–102.Google Scholar
  13. 13.
    Petersdorf, Robert G. “Are we Educating a Medical Professional who Cares?”American Journal of Diseases of Children, 146, 1992, p. 1338.Google Scholar
  14. 14.
    Subcommittee on Evaluation of Humanistic Qualities in the Internist, American Board of Internal Medicine. “Evaluation of Humanistic Qualities in the Internist.”Annals of Internal Medicine, 99, 1983.Google Scholar
  15. 15.
    Bird, Lewis P. and Barlow, James,Codes of Medical Ethics, Oaths, and Prayers. Richardson, Texas: Christian Medical Dental Society, 1989.Google Scholar
  16. 16.
    Gribble, James and Oliver, Graham. “Empathy and Education.”Studies in Philosophy and Education, 8, 1973, p. 5.Google Scholar
  17. 17.
    Free, Noel K, Green, Bonnie L., Grace, Mary C., Chernus, Linda A., and Witman, Roy M. “Empathy and Outcome in Brief Focal Dynamic Therapy.”American Journal of Psychiatry, 142(8), 1985.Google Scholar
  18. 18.
    Shapiro, D.A. “Empathy, Warmth and Genuineness in Psychotherapy.”British Journal of Social Clinical Psychology, 8, 1969, p. 350.Google Scholar
  19. 19.
    Clearly statements that suggest we can experienceexactly what a patient feels, or understandcompletely another's experiences are problematic from a metaphysical perspective. There is, as I see it, no way to know whether another's perspective is the same as one's own (admittedly this statement is contentious)! Wiseman, Mary B. “Empathetic Identification.”American Philosophical Quarterly, 15(2), 1978. Nagel, Thomas, “What is it like to be a Bat?” inMortal Questions. Cambridge: Cambridge University Press, 1979.Google Scholar
  20. 20.
    Squier, Roger W.Op. cit., “ p. 328.Google Scholar
  21. 21.
  22. 22.
    Goldman, Alvin. “Empathy, Mind, and Morals.”Proceedings of the American Philosophical Association, 66(3), 1993.Google Scholar
  23. 23.
    Nightingale, Stephen D., Yarnold, Paul R., and Greenbers, Michael S. “Sympathy, Empathy, and Physician Resource Utilization.”Journal of General Internal Medicine, 6, 1991.Google Scholar
  24. 24.
    Zabarenko, Ralph N. and Zabarenko, Lucy M. “Empathy.”Current Psychiatric Therapies, 19, 1980, p. 35.Google Scholar
  25. 25.
    It is interesting to note that a number of studies have shown an inverse correlation with the amount of medical education, the MCAT score, and empathy. Spiro, Howard M. “Experts in Empathy.”Drug Therapy, July, 1992. Lief, Harold I. and Fow, Renee C. “Training for ‘Detached Concern’ in Medical Students.” InThe Psychological Basis of Medical Practice. Life, Harold I., ed) New York: Harper and Row, 1963, pp. 12–35.Google Scholar
  26. 26.
    Spiro, Howard. “What is Empathy: Can it be Taught?” inEmpathy and the Practice of Medicine.Google Scholar
  27. 27.
    Ci, Jiwie. “Conscience, Sympathy, and the Foundation of Morality.”American Philosophical Quarterly, 28(1), 1991, p. 49.Google Scholar
  28. 28.
    Scheman, Naomi. “On Sympathy.”The Monist, 62, 1979, p. 322.Google Scholar
  29. 29.
    Clyne, Max B. “How Personal is Personal Care in General Practice?”Journal of the Royal College of General Practitioners, 24(141), 1974, p. 263.Google Scholar
  30. 30.
    King, Valeria J. “Passion and Compassion.”North Carolina Journal of Medicine, 53(4), 1992.Google Scholar
  31. 31.
    Pellegrino, Edmund D. “Profession, Patient, Compassion, Consent: Meditations on Medical Philology.”Connecticut Medicine, 42(3), 1978.Google Scholar
  32. 32.
    Linenthal, Arthur J. “Past and Present.”The Pharos, 50(4), 1987.Google Scholar
  33. 33.
    Goldman, Alvin I. “Ethics and Cognitive Science.”Ethics, 103, 1993.Google Scholar
  34. 34.
    Sherlock, Richard. “Reasonable Men and Sick Human Beings.”American Journal of Medicine, 80, 1986, p. 4.Google Scholar
  35. 35.
    Curzer, Howard J. “Is Care a Virtue for Health Care Professionals?”The Journal of Medicine and Philosophy, 18, 1993, p. 53.Google Scholar
  36. 36.
    Rosenberg, James E. and Towers, Bernard. “The Practice of Empathy as a Prerequisite for Informed Consent.”Theoretical Medicine, 7(2), 1986, p. 182.Google Scholar
  37. 37.
    Dorpat, Theodore L. “On Neutrality.”International Journal of Psychoanalytic Psychotherapy, 6, 1977, p. 50.Google Scholar
  38. 38.
    Van Fraassen, Bas C.The Scientific Image. Oxford: Clarendon Press, 1980, p. 80.Google Scholar
  39. 39.
    Ibid., pp. 87–88.Google Scholar
  40. 40.
    Cassell, Eric J.The Nature of Suffering and the Goals of Medicine, New York: Oxford University Press, 1991, p. 227.Google Scholar
  41. 41.
    Ibid., p. 226.Google Scholar
  42. 42.
    Dorpat, Theodore L. “On Neutrality.”International Journal of Psychoanalytic Psychotherapy, 6:39–64, 1977.Google Scholar
  43. 43.
  44. 44.
    Freud, Sigmund.Recommendations to Physicians Practicing Psycho-Analysis. Standard Edition 12, 1912.Google Scholar
  45. 45.
    Kevorkian, Jack. “The Last Fearsome Taboo:Medical Aspects of Planned Death.”Medicien and Law, 7, 1988, p. 12.Google Scholar
  46. 47.
    Rosenberg, James E. and Bernard Towers,op. cit.Google Scholar
  47. 48.
    Osler, William.Aequanimitas. 3rd ed. Philadelphia: Blakiston, 1932. pp. 3–11. and, Osler, William.Aphorisms. New York: Henry Schuman, 1950, p. 105.Google Scholar
  48. 49.
    Dougherty, Charles J. “Ethical Values at Stake in Health Care Reform.” JAMA 268(17), 1992.Google Scholar
  49. 50.
    Ibid., 2 40(9).Google Scholar
  50. 52.
    Edell, Dean S. “Acting for Patients.” JAMA 269(9), 1993.Google Scholar
  51. 53.
    Orentlicher, David. “The Illusion of Patient Choice in End-of-Life Decisions.” JAMA 267(15), 1992. p: 2101.Google Scholar
  52. 54.
    Miller, Bruce L. “Autonomy and the Refusal of Lifesaving Treatment,” in Gorovitz, Samuel, Macklin, Ruth et al., eds.,Moral Problems in Medicine. 2nd Ed. Englewood Cliffs, NJ: Prentice-Hall, 1993, p. 63.Google Scholar
  53. 55.
    Beauchamp, Tom L., and Childress, James F.Principles of Biomedical Ethics. 3rd ed. New York: Oxford University Press, 1989, p. 88.Google Scholar
  54. 56.
    Squier, Roger W.Op cit., “ p. 326. p. 326.Google Scholar
  55. 58.
    The concept of coercion is not so clearly defined, see; Nozick, Robert, “Coercion.” InPhilosophy, Science, and Method. S. Morgenbesser, ed. New York: St. Martin's Press, 1969. pp. 440–472. However, I take the sense of coercion as described by Joel Rudinow, “Coercion always involves irrestible incentives.” Rudinow, Joel. “Manipulation.”Ethics 88, 1978, p. 341.Google Scholar
  56. 59.
    Shimon Glick describes an interesting study, at Ben Gurion University in Israel, consisting of 231 questionnaires. They found that: “Among ideologies influencing their behavior the ‘empathic compassionate’ physician had a higher proportion with religion as a dominant influence than did other groups” (page 94). He states further, “it is true that the kind of saintly behavior typified by Mother teresa or Dr. Schweitzer is found almost exclusively among those with a deeply religious commitment.” S. Glick,op. cit., p. 92.Google Scholar
  57. 60.
    Wright, Virginia Baxter. “Will Quitting Smoking Help Medicine Solve its Financial Problems?”Inquiry 23, 1986.Google Scholar
  58. 61.
    Cassell, Eric J.Op. cit., p. 227.Google Scholar
  59. 62.
    Ibid., p. 226.Google Scholar
  60. 64.
    This is a distinction drawn by; Shelly, Judith Allen and Miller, Arlene B. InValues in Conflict. Downers Grove, IL: InterVarsity Press, 1991.Google Scholar
  61. 66.
    McKee, Denise D. and Chappel John N. “Spirituality and Medical Practice.”The Journal of Family Practice, 35(2), 1992.Google Scholar
  62. 67.
    American Psychiatric Association Committee on Religion and Psychiatry. “Guidelines Regarding Possible Conflict between Psychiatrists, Religious Commitments and Psychiatric Practice.”American Journal of Psychiatry, 147, 1990.Google Scholar
  63. 68.
    McKee, Denise D. and Chappel John N. “Spirituality and Medical Practice.”The Journal of Family Practice 35(2), 1992. p. 208.Google Scholar
  64. 69.
    Clouser, Roy A.The Myth of Religious Neutrality. University of Notre Dame Press, Notre Dame, IN: 1991, p. 1.Google Scholar
  65. 70.
    I take a broad definition of religion here such as that of Edward Caird, “A Man's religion is the expression of his ultimate attitude to the universe, the summed-up meaning and purport of his whole consciousness of things.” In Paul Edwards, ed.,The Encyclopedia of Philosophy. Volume 7. New York: Macmillan, 1967.Google Scholar
  66. 72.
    Although beyond the realm of this article, it is interesting to speculate on studies correlating the lack of empathy with aggressive or antisocial behavior. Miller, Paul A., and Eisenberg, Nancy. “The Relation of Empathy to Aggressive and Externalizing/Antisocial Behavior.”Psychological Bulletin, 103(3), 1988.Google Scholar
  67. 76.
    Dorpat, Theodore L. “On Neutrality.”International Journal of Psychoanalytic Psychotherapy, 6, 1977. p. 58.Google Scholar

Copyright information

© Institutes of Religion and Health 1995

Authors and Affiliations

  • John F. Peppin
    • 1
  1. 1.The Marshfield Clinic of St. Joseph's HospitalDepartment of Internal MedicineMarshfield

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