A controversial topic

Some time ago, I presented a paper on empathy at a review seminar. A colleague and fellow care ethicist asked me: ‘Why would one assume that empathy is of interest to the field of care ethics at all?

I wasn’t too surprised by my colleagues’ question. Four years into my PhD, I had learned that a somewhat reserved, critical or outright dismissive stance towards empathy is quite common in the field of care ethics and that such a critical stance is of value.
Admittedly, empathy was not the first topic on my mind when I wrote my PhD-research proposal. Initially, I was interested in the practice of perspective-shifting: shifting between a caregiver’s outer perspective and a client’s inner perspective as a means to help provide good care. I soon learned that the idea of perspective-shifting is actually an aspect of cognitive empathy. I was not too thrilled about the connection. I had always thought empathy was a rather vague and ‘soft’ concept and I was not keen on diving into the topic. Once I started reading, however, I became intrigued by the richness and complexity of empathy, it’s many contradictions, strengths and flaws. I was also intrigued by the way care ethicists perceive empathy.

When I started working on my first review article, I was surprised to discover that empathy is not a core concept in the field of care ethics and that it was rather difficult to find extensive literature on the subject. Apart from Slote’s (2007) work on care ethics and empathy, the topic has been undertheorized in this field. Care ethicists themselves mostly draw on literature from related disciplines such as moral psychology when discussing empathy.
Care ethics is a form of relational ethics that values both cognitive and affective knowledge sources and that stresses the importance of including the inner perspective of clients or patients in providing care. Hence, empathy appears to ‘tick all the boxes’ of care ethics interests and concerns. Or so I thought. I soon found out that empathy is actually a controversial topic in care ethics for reasons I will later explain.

Why care about empathy?

Care ethicists’ ambivalence towards empathy stands in stark contrast to their acceptance of other, empathy-related caring concepts such as attention, concern or responsivity. These constructs hold a far more prominent place in care ethics. Moreover, it stands in contrast to the acceptance of empathy as a core concept in both health care and nursing ethics and theory.
Over the past few years, care ethicists have started to realize that empathy deserves our attention and needs further inquiry. One of the reasons for this reconsideration, is that research in other fields indicates that our innate ability to empathize with other people is what makes us relational beings (Waal, 2012). As a form of relational ethics, care ethicists have recently referred to empathy research in primatology, evolutionary anthropology and moral psychology to stress this point (Gilligan, 2013). Moreover, empathy is a crucial ingredient of care practices. Since care ethics investigates actual caring practices, empathy deserves our attention, especially since it has a variety of important advantages and disadvantages that need to be considered.
Nowadays we see an upsurge of interest in empathy. The many books and articles that have recently been published are oftentimes either a naive celebration of the concept or a hostile pledge for a less empathic society. Care ethicists both praise and challenge empathy. They don’t take its significance for granted and therefore offer an interesting perspective on the concept. Understanding empathy from a care ethics perspective urges one to choose a more nuanced view on the topic. Such a critical perspective may contribute to a deeper understanding of both the significance and limitations of empathy to good care.

Conceptual confusion

Before proceeding, we have to shortly answer the question: what is empathy? One of the first and main problems of empathy is that it is an exceptionally vague concept. There is little to no consensus on its definition in academic literature. The word ‘empathy’ refers to a wide variety of different phenomena. This conceptual confusion leads to desperate article titles such as Will the real empathy please stand up? (Coplan, 2011).
Empathy is a relatively new term, that first appeared in the English language around 1900. Since then, it’s meaning has gradually evolved. There are a few distinctions that may be helpful. First of all, empathy is predominantly defined as an individual capacity, ability, act or process. We can broadly distinguish between three empathic abilities or capacities:

1. Affective empathy refers to the capacity to feel oneself into the other’s experiential world or situation.
2. Cognitive empathy or perspective-taking refers to the capacity to imagine what it is like to be in the other’s experiential world or situation.
3. Perceptive empathy refers to the capacity to directly perceive the other’s experiential world. We witness the other in his or her situation and immediately get a broad understanding of what the other is going through based on seeing the other’s gestures, facial expression and on simply being present in the other’s lifeworld. This third, lesser known conception of empathy is a more direct way of understanding what the other is experiencing and is found mainly in phenomenological literature.

The strengths of empathy

In my first paper, me and my co-authors reviewed the functions and limitations of empathy from a care ethics perspective (van Dijke, van Nistelrooij, Bos, & Duyndam, 2018). We distinguished four of these functions:

First, empathy has relational functions. When we empathize, we transcend our own position and take the other person’s inner perspective. As such, empathy is a unique way to connect with the other’s experiential world and see or experience the situation from an inner instead of an outer perspective. Connecting to people in such a way, may contribute to building and maintaining a trusting relationship.

Second, empathy has epistemic or knowledge functions. By empathizing we gain insight into the other’s inner world, into what is at stake for him/her or into what the other is going through. This insight may help determine what care or help is truly needed and how we can attune our care to a client or patient in such a way that it is indeed experienced as good care.

Third, empathy has normative functions. According to the care ethicist Slote (2007), empathy may help us to decide what is the right action to take. Those actions that are based on mature or genuine empathy, are claimed to be better actions than those that show a lack of empathy. Thus, empathy can function as a moral compass. Moreover, research indicates that when empathy is grounded in concern, it may promote helping or caring behavior and motivate one to act altruistically (Batson, 2011).
Fourth, empathy has political functions. It may help to dislodge prejudices, overcome stereotypes, connect to people who differ from us and bridge the gap between ourselves and people who are distant (Hamington, 2004). Especially cognitive perspective-taking, in which we imagine ourselves in the other person’s situation, is claimed to have a powerful function in this respect, since it does not require the other to be immediately present.

The downsides of empathy

Despite the above mentioned strengths of empathy, care ethicists have also been critical towards the concept for at least four reasons:
One of the main problems with empathy, is that it was initially defined as a form of projection or identification. Although such a conceptualization is not generally accepted today, the association with projection is still alive and may cause confusion.

A second, related problem is that empathy could lead to inaccurate insights. We may think we understand the other really well, but as mentioned above we may actually be projecting. Inaccurate understandings could in turn lead to care or help that is not attuned to what the other truly values or needs.

Third, although empathy may help guide moral behavior, it is basically a morally neutral concept that in itself does not guarantee good care. For instance, our empathic abilities may be used to manipulate people. Psychopaths are known to be particularly talented in cognitive perspective-taking and may use these talents to control or even torture people. For empathy to function in a moral way, it needs to be grounded in concern and it needs corrective mechanisms such as professional reflection, moral deliberation or the guidance of moral principles.

Fourth, although empathy may help to initiate or deepen relationships, the relational qualities of empathy are prone to biases and prejudices. Research indicates that we empathize more naturally with people we feel close to or with whom we can identify (Hoffman, 2001). This means that we may be more willing to care for patients or clients that we find sympathetic and abandon or neglect clients that are difficult to relate to.
Further analysis is needed to address these downsides, create awareness of the limits of empathy and understand how we can address them. This is one of the reasons why it is important to analyze empathy: if the concept remains undertheorized, we miss understanding the strengths of empathy and lose ways to address or overcome its flaws.

An ethics of empathy?

In a recent paper, we concluded that care ethics is not, or not yet, an ethics of empathy (van Dijke et al., 2018). The concept needs to be further explored and it needs to be reconceptualized from a care ethics perspective. What does this mean? For starters, empathy is oftentimes conceived of as a personal quality or virtue. We believe such an individual conceptualization is too narrow. From a care ethics perspective, empathy must be understood as a relational practice as well. We are currently writing a second paper in which we discuss these relational aspects and aim to reconceptualize empathy as a relational concept. We believe such a conceptualization is more realistic and helps address some of the downsides of empathy. In a third paper, care ethical alternatives for empathy will be explored such as Noddings’ (Noddings, 1984/2013) concept of engrossment or receptive attention.

The second part of this PhD-project consists of qualitative research into the meaning of empathy in care practices. Twenty humanist chaplains have been interviewed for 1.5-2 hours about the significance and limitations of empathy in existential caregiving. In addition, we interviewed them about experiences with ‘challenged’ or difficult empathy: situations in which the natural flow of empathy is broken. What happens when empathy is not self-evident, for instance when the client does not open up, uses emotions to manipulate others or has experiences that are ‘alien’ and difficult to relate to? How does challenged empathy affect existential care and in what ways do chaplains react to challenged empathy? All interviews have been transcribed verbatim and have been coded in Atlas.ti. We are currently working on further (axial) coding and analysis and expect to present the results of our empirical research in 2019.

References
Batson, D. C. (2011). Altruism in humans. Oxford, New York: Oxford University Press.
Coplan, A. (2011). Will the real empathy please stand up? A case for a narrow conceptualization. The Southern Journal of Philosophy, 49, 40-65.
Gilligan, C. (2013). Joining the resistance. Oxford: Polity Press.
Hamington, M. (2004). Embodied care: Jane Addams, Maurice Merleau-Ponty, and feminist ethics. Urbana, Chicago: University of Illinois Press.
Hoffman, M. L. (2001). Empathy and moral development: implications for caring and justice. Cambridge Cambridge University Press.
Noddings, N. (1984/2013). Caring: a relational approach to ethics and moral education (2nd ed.). Berkeley: University of California Press.
Slote, M. A. (2007). The ethics of care and empathy. London, New York: Routledge.
van Dijke, J., van Nistelrooij, I., Bos, P., & Duyndam, J. (2018). Care ethics: An ethics of empathy? Nursing ethics, 0(0), 1-10. doi: 10.1177/0969733018761172
Waal, F. B. M. (2012). The age of empathy: nature’s lessons for a kinder society. London: Souvenir.