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What are the limits of the use of artificial intelligence (AI) in the relational aspects of medical and nursing care? There has been a lot of recent work and applications showing the promise and efficiency of AI in clinical medicine, both at the research and treatment levels. Many of the obstacles discussed in the literature are technical in character, regarding how to improve and optimize current practices in clinical medicine and also how to develop better data bases for optimal parameter adjustments and predictive algorithms. This paper argues that there are also in principle obstacles to the application of AI in clinical medicine and care where empathy is important, and that these problems cannot be solved with any of the technical and theoretical approaches that shape the current application of AI in specific areas of clinical medicine in which care for patients is fundamental. This is important, because it generates specific risks that may be overlooked otherwise, and it justifies the necessity of human monitoring and emotional intervention in clinical medicine. Consequently, difficult issues concerning moral and legal responsibility may ensue if these in principle problems are ignored.

Physicians recognize the importance of patients' emotions in healing yet believe their own emotional responses represent lapses in objectivity. Patients complain that physicians are too detached. The book argues that by empathizing with patients, rather than detaching, physicians can best help them. Yet there is no consistent view of what, precisely, clinical empathy involves. This book challenges the traditional assumption that empathy is either purely intellectual or an expression of sympathy. Sympathy, according to many physicians, involves over-identifying with patients, threatening objectivity and respect for patient autonomy. How can doctors use empathy in diagnosing and treating patients without jeopardizing objectivity or projecting their values onto patients? The book develops an account of emotional reasoning as the core of clinical empathy. It argues that empathy cannot be based on detached reasoning because it involves emotional skills, including associating with another person's images and spontaneously following another's mood shifts. Yet it argues that these emotional links need not lead to over-identifying with patients or other lapses in rationality but rather can inform medical judgement in ways that detached reasoning cannot. For reflective physicians and discerning patients, this book provides a road map for cultivating empathy in medical practice. For a more general audience, it addresses a basic human question: how can one person's emotions lead to an understanding of how another person is feeling?

An empathic approach to patient‐centred care is a core of nursing practice. One of the methods to develop empathy, which is gaining currency is the use of virtual reality simulations in education. This paper posits some questions, does it simply reinforce a ‘type’ of patient, neglecting caring for the patient as unique, is empathy what results or is it pity, does it result in a greater distance being created between the patient and the health care provider? Can we ever really know what it is like to walk in a patient's shoes when what we experience through virtual reality provides a small snapshot of the vicissitudes of living with an illness or disability. We suggest that what matters most in simulations using virtual reality is how the student exits the experience and if they leave knowing just what patients ‘like that’ feel, or whether they leave with humility and curiosity.

Patients facing medical decisions that will impact quality of life make assumptions about how they will adjust emotionally to living with health declines and disability. Despite abundant research on decision-making, we have no direct research on how accurately patients envision their future well-being and how this influences their decisions. Outside medicine, psychological research on “affective forecasting” consistently shows that people poorly predict their future ability to adapt to adversity. This finding is important for medicine, since many serious health decisions hinge on quality-of-life judgments. We describe three specific mechanisms for affective forecasting errors that may influence health decisions: focalism, in which people focus more on what will change than on what will stay the same; immune neglect, in which they fail to envision how their own coping skills will lessen their unhappiness; and failure to predict adaptation, in which people fail to envision shifts in what they value. We discuss emotional and social factors that interact with these cognitive biases. We describe how caregivers can recognize these biases in the clinical setting and suggest interventions to help patients recognize and address affective forecasting errors.

A timely collection of essays on the pressing possibilities and risks of gene-editing technology. Scientists and genetic engineers are becoming increasingly adept at editing the human genome. How far can—and should—they go in editing future generations? In The Promise and Peril of CRISPR, editor Neal Baer brings together a timely collection of essays by influential bioethicists, philosophers, and geneticists to explore the moral, ethical, and policy challenges posed by CRISPR technology. We are at a technological and ethical crossroads in grappling with the impacts of genetic editing. Gene-editing technology holds the promise of curing more than 7, 000 known genetic diseases. Yet with that promise comes the peril of using CRISPR to edit the human genome, which could not only lead to manipulating human evolution, but also to creating and releasing pathogens capable of wreaking havoc on human, animal, and plant life. Although CRISPR has already cured several genetic diseases, it could also be used to design biological weapons or to edit the embryos of people who can afford to purchase genetic \"enhancements\" for their children. What role can and should the public play in discussing the far-reaching implications of gene editing? What oversights should be put in place to prevent a rogue scientist from engineering another baby – as was recently done with twins in China? Essay contributors offer informed predictions and guidelines for how the uses of CRISPR today will affect life in the future. Decisions we make now may have unpredictable consequences for future generations. For anyone concerned about the uses and potential abuses of gene editing, these essays provide a critical and comprehensive discussion of the central issues surrounding CRISPR technology. Contributors: Florence Ashley, R. Alta Charo, Marcy Darnovsky, Kevin Doxzen, Rosemarie Garland-Thomson, Gigi Kwik Gronvall, Jodi Halpern, Katie Hasson, Andrew C. Heinrich, Jacqueline Humphries, J. Benjamin Hurlbut, Ellen D. Jorgensen, Peter F. R. Mills, Carol Padden, Marcus Schultz-Bergin, Robert Sparrow, Sandra Sufian, Krystal Tsosie, Ethan Weiss, Rachel M. West

Physicians associate empathy with benevolent emotions and with developing a shared understanding with patients. While there have been many articles on managing \"difficult\" patients, little attention has been paid to the challenges physicians face during conflicts with patients, especially when both parties are angry and yet empathy is still needed. This topic is especially important in light of recent studies showing that practicing medicine increasingly requires physicians to manage their own feelings of anger and frustration. This article seeks to describe how physicians can learn to empathize with patients even when they are both subject to emotions that lead to interpersonal distancing. Empathy is defined as engaged curiosity about another's particular emotional perspective. Five specific ways for physicians to foster empathy during conflict are described: recognizing one's own emotions, attending to negative emotions over time, attuning to patients' verbal and nonverbal emotional messages, and becoming receptive to negative feedback. Importantly, physicians who learn to empathize with patients during emotionally charged interactions can reduce anger and frustration and also increase their therapeutic impact.

The Covid-19 crisis has accelerated a trend toward burnout in health care workers, making starkly clear that burnout is especially likely when providing health care is not only stressful and sad but emotionally alienating; in such situations, there is no mental space for clinicians to experience authentic clinical empathy. Engaged curiosity toward each patient is a source of meaning and connection for health care providers, and it protects against sympathetic distress and burnout. In a prolonged crisis like Covid-19, clinicians provide care out of a sense of duty, especially the duty of nonabandonment. We argue that when duty alone is relied on too heavily, with fear and frustration continually suppressed, the risk of burnout is dramatically increased. Even before Covid-19, clinicians often worked under dehumanizing and unjust conditions, and rates of burnout were 50 percent for physicians and 33 percent for nurses. The Covid-19 intensification of burnout can serve as a wake-up call that the structure of health care needs to be improved if we are to prevent the loss of a whole generation of empathic clinicians.

Conscientious objection to abortion, clinicians' refusal to perform legal abortions because of their religious or moral beliefs, has been the subject of increasing debate among bioethicists, policymakers, and public health advocates in recent years. Conscientious objection policies are intended to balance reproductive rights and clinicians' beliefs. However, in practice, clinician objection can act as a barrier to abortion access-impinging on reproductive rights, and increasing unsafe abortion and related morbidity and mortality. There is little information about conscientious objection from a medical or public health perspective. A quantitative instrument is needed to assess prevalence of conscientious objection and to provide insight on its practice. This paper describes the development of a survey instrument to measure conscientious objection to abortion provision. A literature review, and in-depth formative interviews with stakeholders in Colombia were used to develop a conceptual model of conscientious objection. This model led to the development of a survey, which was piloted, and then administered, in Ghana. The model posits three domains of conscientious objection that form the basis for the survey instrument: 1) beliefs about abortion and conscientious objection; 2) actions related to conscientious objection and abortion; and 3) self-identification as a conscientious objector. The instrument is intended to be used to assess prevalence among clinicians trained to provide abortions, and to gain insight on how conscientious objection is practiced in a variety of settings. Its results can inform more effective and appropriate strategies to regulate conscientious objection.

The health effects of intra-ethnic conflict include hatred and fear among neighbors and friends who have become enemies. The dehumanization of specific groups through concomitant stereotyping does not stop when conflicts end. The inability to see former enemies as real people impedes reconciliation. While much attention has been paid to the reconstruction of infrastructure and the establishment of rule of law, little thought has been given to what is required at the day to day level in order to restore a sense of interpersonal security. To reverse the destruction of social and familial networks that normally sustain health and well-being, a process of rehumanization must occur. We suggest that the promotion of empathy is a critical component of reconciliation.