Jewish Sources and Empathic Patient Care
Alan Astrow, MD, Maimonides Cancer Center
Among front-line physicians who treat seriously ill patients, depersonalization and emotional exhaustion, or ‘burn-out' are commonly reported phenomenon. Empathy curricula, communications skills workshops, narrative medicine workshops, and mindfulness training are approaches that have been proposed to address this problem, but a deeper level of spiritual grounding may provide needed support to these useful techniques. Empathetics: The Neuroscience of Emotions, an on-line curriculum developed by the Massachusetts General Hospital Program on Empathy and Relational Science is a case in point. The curriculum cites the work of philosopher Martin Buber as a primary source to justify empathy training, neglecting to mention that Buber is a religious thinker, one of the greatest Jewish thinkers of the 20th century. His seminal work, I and Thou, argues for reciprocal and authentic relationships with others but presumes a transcendent God who demands ethical action and gives meaning to human relationships. The curriculum elides this spiritual underpinning, perhaps to broaden its appeal, at the price of curtailing a rich secular/religious dialogue. This paper seeks to make explicit the potential contribution of engagement with religious sources to empathy training. The paper will focus specifically on Jewish sources. Jewish medical ethics as a discipline has centered on halachic (legal) analysis of bioethical quandaries—the ethics of withdrawal of ventilator support, cloning, assisted suicide, or abortion rights for instance. In daily practice, however, the character of the physician and the quality of the physician’s relationships with her patients rather than expert legal decision-making constitute the domain of the ethical. Judaism can be seen not simply as a religion focused on faithful observance, but more broadly as a system designed to refine the human personality and perfect human character. This conceptual approach would be most directly applicable to the task of the physician. I will examine the problem of empathy in patient care and argue that Jewish narrative and philosophic writings are a crucial complement to secular ones. I will present several cases from my clinical practice as a medical oncologist in which my capacity to provide empathic care was challenged. I will then examine Jewish texts from a range of sources including Exodus 23:9, the Book of Jonah, rabbinic writings including Pirke Avot, Babylonian Talmud Ketubot 104a, and contemporary Jewish philosophers such as Heschel, Buber, and Levinas that directly or indirectly bear on the problem of empathic concern for the suffering other. Many Jewish physicians, often unfamiliar with Jewish source material and unaware of its profoundly humanistic character, have been reluctant to acknowledge the contribution of specific Jewish content to their understanding of their ethical aspirations. While this was understandable at a time when there was widespread discrimination against Jews and Judaism, this makes less sense today in the United States, where overt anti-Semitism is uncommon and the range of possibilities for Jewish practice and belief has greatly expanded. Jewish text study has the potential to enrich the discourse concerning empathic patient care and humanize medical practice.
Among front-line physicians who treat seriously ill patients, depersonalization and emotional exhaustion, or ‘burn-out' are commonly reported phenomenon. Empathy curricula, communications skills workshops, narrative medicine workshops, and mindfulness training are approaches that have been proposed to address this problem, but a deeper level of spiritual grounding may provide needed support to these useful techniques. Empathetics: The Neuroscience of Emotions, an on-line curriculum developed by the Massachusetts General Hospital Program on Empathy and Relational Science is a case in point. The curriculum cites the work of philosopher Martin Buber as a primary source to justify empathy training, neglecting to mention that Buber is a religious thinker, one of the greatest Jewish thinkers of the 20th century. His seminal work, I and Thou, argues for reciprocal and authentic relationships with others but presumes a transcendent God who demands ethical action and gives meaning to human relationships. The curriculum elides this spiritual underpinning, perhaps to broaden its appeal, at the price of curtailing a rich secular/religious dialogue. This paper seeks to make explicit the potential contribution of engagement with religious sources to empathy training. The paper will focus specifically on Jewish sources. Jewish medical ethics as a discipline has centered on halachic (legal) analysis of bioethical quandaries—the ethics of withdrawal of ventilator support, cloning, assisted suicide, or abortion rights for instance. In daily practice, however, the character of the physician and the quality of the physician’s relationships with her patients rather than expert legal decision-making constitute the domain of the ethical. Judaism can be seen not simply as a religion focused on faithful observance, but more broadly as a system designed to refine the human personality and perfect human character. This conceptual approach would be most directly applicable to the task of the physician. I will examine the problem of empathy in patient care and argue that Jewish narrative and philosophic writings are a crucial complement to secular ones. I will present several cases from my clinical practice as a medical oncologist in which my capacity to provide empathic care was challenged. I will then examine Jewish texts from a range of sources including Exodus 23:9, the Book of Jonah, rabbinic writings including Pirke Avot, Babylonian Talmud Ketubot 104a, and contemporary Jewish philosophers such as Heschel, Buber, and Levinas that directly or indirectly bear on the problem of empathic concern for the suffering other. Many Jewish physicians, often unfamiliar with Jewish source material and unaware of its profoundly humanistic character, have been reluctant to acknowledge the contribution of specific Jewish content to their understanding of their ethical aspirations. While this was understandable at a time when there was widespread discrimination against Jews and Judaism, this makes less sense today in the United States, where overt anti-Semitism is uncommon and the range of possibilities for Jewish practice and belief has greatly expanded. Jewish text study has the potential to enrich the discourse concerning empathic patient care and humanize medical practice.