Empathy: Good for Doctors and Bad for Judges?

The word "empathy" is getting interesting play these days. At times it even sounds like a pejorative. President Obama used the word frequently while campaigning and since being in office. In the context of choosing a Supreme Court nominee, he said that ideally such a person should understand Americans' problems and have empathy for their fellow beings.  But he's also talked about empathy (in Atlanta in Jan 09) in the context of its absence: "We have an empathy deficit when we're still sending our children down corridors of shame--schools in forgotten corners of America where the color of your skin still affects the content of your education . . . when there is Scooter Libby justice for some and Jena justice for others . . . when homeless veterans sleep on the streets . . ."

Most dictionaries will define empathy as "the intellectual identification with or the vicarious experiencing of the feelings, thoughts, or attitudes of another."  Yet, for some, like Senator Orrin Hatch, President Obama's saying "empathy" when talking about judicial appointments is seen as a "code" for appointing a left leaning liberal. Instead of being seen as an admirable quality that describes someone with a visceral understanding of the human condition and especially of human suffering, it is seen as a bias.

To be fair, it could be that Republicans reflexively and correctly see the President's use of "empathy" as being empathy not for all people, but for some people, or even (in their view) the wrong people: for mothers instead of the unborn, for unions instead of big business, for the homeless and unemployed rather than for the well-off or even for the middle-class tax payer.

It did not help that Judge Sotomayor once said in a speech, "I would hope that a wise Latina woman with the richness of her experiences would more often than not reach a better conclusion than the white male who hasn't lived that life."  This would seem reasonable, but only if the issue at hand involved Latina women. What if the issue had to do with white men with un-rich experiences? One sees the slippery slope she is on.

As someone not in the legal field, it seems to me that if the law were absolutely cut and dry, and if the process of being a judge meant simply following algorithms, being impartial, ensuring that justice was done and procedure followed, then empathy would be irrelevant.  But since judges always seem to be writing 'opinions' and disagreeing with each other, clearly, there is a human factor at work.  In that case, broad empathy, a Shakespearean breadth of interest in all people, in the wise and the foolish, in the misanthrope and the saint, in politicians and the public who suffer them would surely be a good thing.

Fortunately, in medicine the word empathy is less ambiguous. Indeed it is considered desirable. I have always felt that new medical students come to medical school with tremendous empathy, with a wonderful ability to imagine the suffering of the patient. What we need in medical schools is not to teach empathy, as much as to preserve it-- the process of learning huge volumes of information about disease, of learning a specialized language, can ironically make one lose sight of the patient one came to serve; empathy can be replaced by cynicism.

We can actually measure empathy by something called the Jefferson Scale of Physician Empathy (with 20 items on a Likert scale). In at least one study, female physicians scored higher than their male counterparts (though it did not reach statistical significance), and psychiatrists did better than physicians in surgical fields, while there was no difference among internists, psychiatrists and emergency medicine physicians. An intriguing question is whether each specialty creates a change in degree of empathy, or does one select a specialty based on one's inherent empathy or lack thereof.

We may debate the role of empathy in a judge, but patients have little doubt about what they want in a physician: Anatole Broyard, in a poignant account (Intoxicated By My Illness) of his cancer writes: "To the typical physician, my illness is a routine incident in his rounds, while for me it's the crisis . . . "  Broyard wants a physician who will "give me his whole mind just once, be bonded with me for a brief space, survey my soul as well as my flesh, to get at my illness, for each man is ill in his own way."

I can't think of a better definition of empathy.