Prof. Paul Komesaroff1
1Monash University, Armadale, Victoria 3143, Australia
Biography:
Physician, Alfred Hospital, Melbourne.
Professor of Medicine, Monash University
Abstract:
It is commonly assumed that empathy is not only an essential feature of any effective and ethically appropriate clinical consultation but that the ability to experience it is a necessary quality of any competent clinician. This assumption, however, is profoundly mistaken. It is based on a lack of critical analysis of the purported philosophical basis of empathy as well erroneous conceptions of the nature of ethical dialogue and clinical practice.
In reality, empathy is an ideological construct linked to a set of narrow assumptions that serve the interests of social control and subvert and obstruct ethical discourse. From a philosophical point of view it is a relatively recent concept that is strongly tied to, and representative of, the conceptual formations of individualistic, modern western societies. It assumes that all humans think and feel in a uniform manner; it allows for only one standard of personhood, modelled inevitably on the dominant culture; and it is deployed to limit non-conformity both in knowledge and affective life.
In reality, human communication is not uniform but arises out of dynamic encounters with other persons founded on irreducible differences that themselves provide the generative source of new meaning. The clinical dialogue is not a solipsistic recapitulation of a single general structure but a fecund process of innovation and discovery that draws on limitless cultural, linguistic and other resources.
The preservation of the integrity of ethical discourse – and of clinical communication – requires not only the deconstruction and decolonisation of empathy but its active and vigorous rejection.