Day 2 FASPE-Sponsored Session : The Role of Empathy in Clinical Practice

Okay. Uh good morning everyone. Uh welcome back to uh day two of uh the MLAN conference and um I uh hope uh you all had a a nice evening yesterday and uh uh if you uh as you're looking at if you feel like this beautiful view is too bright uh we can negotiate whether to close the curtains, but I think squinting a little bit is probably worth it so we're not feeling like we're in a cave all day. Um so anyway, um it's a real pleasure for me to uh introduce the first panel for today. Um and this is something that we've never done before and it's a a new um uh idea to try to uh collaborate with another organization which is FASPY. Um FASPY is the fellowships at Achvitz for the study of professional ethics. Um, and for those of you who are not familiar with this program, FASBY's mission is to promote ethical leadership and responsibility among professionals, those with the authority to impact all segments of society. Fastby's distinctive approach is to examine the roles and behavior of individual professionals in Germany and elsewhere between 1933 and 1945 as an initial framework for approaching ethical responsibility in the professions today. Um there are several MLAN faculty and a number of Pritsker medical students have been FASPY fellows in the past and you know I have to say I thought that this would be a wonderful opportunity to collaborate with another program in the hopes of really mutual educational benefit. Um and so uh I am going to very briefly uh based on his uh request uh father Michael Rosier is the moderator for this session and I'm going to introduce him very briefly and then it is uh he will take over. Um father uh Rosier is vice provost for strategic initiatives and associate professor of healthc care administration. um and uh he is a uh former FASBY fellow from 2012. So I'm going to turn things over to you. Thank you. >> Thank you very much, Peter, and thank you to the MLAN Center for the invitation um to uh have this panel this morning. I'm looking forward to both what our panelists have to say and um questions and comments that you all might have. Um, so we're just going to jump right in and I'm going to ask each one of you, um, what is your current role and what is your interest or connection to empathy in clinical practice? And maybe we can start with you Torston and if you also maybe want to say a little bit more about FASBY if that would be helpful. >> Thank you. Uh, good morning. Thank you so much for the invitation. We're really grateful for this cooperation. It's very exciting. Um so my name is Torstston Vagner. Um I'm the principal scholar these days of FASBY. Fazby has been around for I think we're going on our 17th year now. Um, FASBY uh is active in a broader spectrum of activities, but our core mission in many ways is to offer uh two-week fellowships where we explore um the history of Nazi Germany in a failure of the professions uh in Nazi Germany as a window as a context to think about contemporary ethics and that's very much what we're doing. My role with a very variety of different titles has been to provide the kind of historical setting for that over the years. uh and so my uh interest in uh empathy in that context is mainly also from trying to get a sense of how does ethics unfold in a practical historical setting. How can we look at very specific historical examples of moral choice choices that individuals took in that kind of a setting and what can we glean from that as an exploration of ethical questions including of course also how a European nation uh in the early mid 20th century is able to redefine their ethical commitments and their commitments to empathy so radically. >> Thank you Ana. Hi everyone, my name is Ana Levenson. I am uh the sort of medical representative here. I'm a pediatric oncologist. I work at UCSF in San Francisco and I specialize in childhood leukemia. I think like probably many people here, empathy is what drew me to medicine in the first place. Uh as a as a young child, I was always really drawn to uh and interested in people who were suffering. starting actually as in elementary school with a real interest in the Holocaust. Uh I was the granddaughter of a Holocaust survivor and got really interested and and read many many books uh in in kind of early to middle childhood about that. And then um in 8th or ninth grade uh I had sort of a singular event that led me to really my career today um was we my youth orchestra was performing at the Ronald McDonald House at Stanford University. This is a housing facility for children undergoing uh long-term treatments at Stamford. Um and I was really really struck by what I was saw around me. Kids my own age, younger babies um pale in wheelchairs, bald, you know, toing IV poles. And it was really transformative this this one experience. And it was actually at that moment that I um sort of realized that this is what I wanted to do with my life. I wanted to learn how to take care of these children. So I think now uh empathy is really a core and foundational component of my job as it is for many people here. Um it is what uh allows me to align with patients and gain their trust and um anyways I'm excited to be on the panel. Thank you. >> Michael um great uh my name is Michael Lioali. I'm the senior associate director of the Lumen Christi Institute. And if we could just lower two buildings back there you'd see where my office is just next to the Roby House. Um and like FASBY it is an academic adjacent institution. Uh we work with students with graduate uh students, undergraduate students and faculty both here at the University of Chicago and across the nation. Um I have my MD and my PhD in religious ethics here from the University of Chicago. Um and have spent the past eight years organizing programming on the intersection of biotechnology uh ethics and religion. um and also served for one year with Dr. John Yun here as the co-director of the program in religion and medicine at the University of Chicago. Um while I had my moment uh as a chaplain in training at the hospital and later as a minister of care, my work is primarily in the world of education public and public engagement um albeit outside of the traditional classroom. uh which means that uh students come not for the grade um but because they're interested in learning more uh I have that advantage of not having those obstacles uh to education there um and inspired by uh FASPY the fellowship at Ashwitz for the professional ethics um study professional ethics I've organized two formation programs engaging students preparing for medicine careers uh a course here at the University of Chicago continuing now in its second year on religion, medicine, and human flourishing on the south side of Chicago. Um, and a summer seminar that I am now launching this year from ancient wisdom to person- centered care, historical, philosophical, and theological foundations of healthcare. Um, both of which are broadly engaged uh with empathy. >> Thank you. Thank you all. Um so since the title of our panel is the role of empathy in clinical practice, we're going to give primacy of place to our clinician. So the first question um is to you Anya. Um as a clinician, how would you define empathy and um what other professional values do you see it um as being related to? I think empathy is a little bit tough to define and and probably does um depend on context. But in in the context of medical empathy, I I would say that I would define it as the both the cognitive and emotional ability to understand your patient, their experience, their perspective, their concerns, but also your capacity to communicate that understanding to them. because if they don't know that that's if they don't if they don't feel that or experience that um it it sort of doesn't doesn't work. And then and lastly, you know, the the obviously but the desire to help alleviate whatever suffering or problem is is at play. Um and I think as far as other related values, I would say trust or trustworthiness. I think you know you you need empathy to gain trust. Uh I think if a patient doesn't feel that you have empathy towards them, they will have a hard time trusting you. And also compassion um and autonomy as well. Um if you you have to appreciate your patients autonomy in order to feel empathetic towards them. So >> thank you. I'm going to follow up on that um to Michael as a as a theological uh ethicist. I'm I'm wondering what your definition of empathy is and maybe pulling on what Anna said about compassion. How is it different than compassion or care or other values that we might be familiar with? >> Um, well, thank you. I'm a bit of a contrarian in the empathy world. Um, too often empathy is presented as a panacea uh for moral ills, claiming that the world would just be a better place with just a little more empathy. Whether it be more empathic doctors, judges, politicians, police officers. Um, I see empathy as an overburdened term um because it's often folding into it moral values that are not present in that basic definition. Um, you Chicago philosopher Martha Nusban def defines empathy very similar to what Ana said as an imaginative reconstruction of another person's experience without particular evaluation of that experience. That is to say, it doesn't presume, for example, that another person's distress is bad. Empathy is limited. It is fallible and it is valuable. Um, on its own, empathy is not a virtue. It is a good habit. It is a habit, but not necessarily a virtue. A good doctor can lack empathy, and a good torturer can excel at it. uh knowing how to twist the knife whether physical or emotional just so uh to bring great effect. It is a capacity but on its own it is not necessarily directed at the good. Yet in our pluralistic context it is attractive to find an ethical foundation in something that is neutral and seemingly universal. But I don't want to mislead here in my uh preliminary comments. There is something of value here. Um because you seeing another more clearly is necessary and as Nisbum captures it does presume a basic personhood um of the other and Thorston could speak more to the efforts for example in concentration camps to quash empathy within the overse the German overseers of that camp. Um, if we are in a world that solely prioritizes the health of the body, empathy can help us see the person and help better appreciate the health of the person in a broader, more comprehensive um, sphere. But it is insufficient. What compassion begins to presume are evaluative judgments. And for Nusbam, this is three judgments. Uh, first that the suffering is serious and not trivial. And so when my son this morning was saying, "It's too hard to put on my soccer socks. There there bumps in there." You know, I can I can sympathize with my child, but I don't really have deep compassion because it's pretty trivial. Um uh it is unmmerited. Uh we typically have compassion for those who are overtaken with COVID or with the flu, not necessarily for those who have a hangover. Um and it is udon there is a udonistic judgment there. uh for for Nusbomb she says that we have compassion for those um for for when a person is a part of our projects our plans and our schemes right they're part of our broader circle of we they're part of how we are envisioning a good life uh udon udon and I would contend here with udonism the the the the claim that Nusbomb is bringing of this third essential judgment um living well or human flourishing that that's actually the province of thicker comprehensive world views be they cultural, philosophical or religious and they are not neutral but they can be more or less developed reasoned and considered. So to take just one case for the Catholic visiting the sick feeding the poor clothing the naked visiting those in prison is an encounter with Christ. This doesn't occlude the person but pushes us to see and hear more clearly and they become a part for that medical practitioner for that police officer for that judge for that average lay person. They become a part of their larger circummental sacramental circle of wei. Um so compassion which I think is vital within the medical sphere and within um sites of care is partly fueled by these deeply held personal views. So you um you mentioned Torston and and this is the panel on Faspie. So um Torson the next one is is to you that um you know as a historian what does the case of Nazi Germany what insight does it give us into the um the social or historical dimensions of empathy >> both in the context of this panel and also I guess for many others uh who confront uh fast for the first time and probably also for fellows that seems a little bit like an extreme step to go all the way to the Nazis to try to think about these things But I will try to within a few minutes to argue our case and say that one of the reasons, one of the potentials that we have in looking at what happens in Germany in the 30s and 40s is that we see and we can study how a society more or less with a cultural cultural religious background within a very short amount period of time transforms into a society of radical exclusion. while the members of that society barely noticed that normative shift and still continued to see themselves as morally intact. And that massive transformation of norms that probably in the world of 2026 is a little bit less shocking than 10 years ago um is very mind-blowing and important also to think about uh for the role of empathy. And I'm completely with you that we need to think twice about uh how to uh bring the sufficient complexity to that term and to these questions. I think that's also what uh Germany in the 30s and 40s teaches us because in the context of that normative transformation that we can see in Germany which obviously and I cannot go into details here very much starts with radically defining one group of Germans as radically different from everybody else. German Jews and then the dynamics that grows out of this that in practice in social everyday practice with that shift of course we see and sometimes that's easy to overlook a that morality doesn't disappear Germany is very much still driven by moral standards they're just slightly different that they were a few years before and increasingly different so this is not about collapse or absence of morality and not of empathy either and secondly um We see that within the group of we within the group of those who belong many of certain norms continue to be relevant. So there's can be attenderness there can be charity there can be a sense of mutual moral commitment to each other within the Aryan German community. And please hear all the quotation marks that I'm using here. Um and it's those who are outside who then are seen different. So it's Germany is a um impressive and shocking but also very instructive case to look at selective empathy as a phenomena that works. Point two of course also the nature and the values that surround this change. So what we see in the 30s and 40s as so often is not the Nazis inventing things. They shape existing concepts. And one that comes out of World War I and the early decades of the 20th century is a cultivation of um a persona of hardness, masculine militant hardness that is celebrated and that then becomes more and more extreme in the course of the 30s and 40s as a value and which obviously then will qualify and define the limits for that empathy that I talked about uh earlier in that context. And we again and again see for those who become complicit in crimes who witness them who perhaps even perpetrate them that it's not they are not robots right we sometimes in the sources see that there's a moral reflection there's a moral readjustment but then they realize this is the right thing to do because otherwise if we are not hard enough to do this job future generations of Germans will suffer from this because the Jews or the enemies of Germany will come back with the revenge you for those of you who studed the Holocaust. I think I'm sure that many of us share this this ex additional bafflement by looking at how to rationalize the murder of children and women in many of these cases. But that's the logic. If we don't kill them, they will grow up and take revenge and take that freedom that we have been struggling so hard for to achieve away from us. And finally, I'll say what I find fascinating is that historians even over the last few years and the name Mary Fullbrook is probably is the one who deserves most of the credit in that context has helped us understand that we even have some not the majority but we have cases where people have some degree and now I'm mixing all the terms I know that compassion, pity, empathy, sympathy. It's always hard to in that historical setting to exactly figure out what's going on with the victims of persecution, perhaps even with their victims, but they continue to function and practice their roles. So, we have cases where people say, "I'm really sorry that you're losing your job. I'm really sorry that you have to leave Germany now. I'm really sorry that that you are being deported. You have my empathy. >> Let's get on the train now. H um wow. Okay. Uh there's [clears throat] there's quite a bit there. Um and and I'd like to pick up on this idea of um shaping and missshaping. So you talked about kind of misshaping this notion of of empathy or any value can be misshapen. And so um all of you work in some way with students who are preparing for their professions. Uh, Michael, you work with those preparing in medical education um in in some respects. And so I'm I'm wondering where have you seen this notion being shaped well and where has it maybe been some misshaping or things need to be reshaped in terms of empathy for people preparing for clinical practice? >> Right. Um so working with premed students who um have not yet uh been sort of put through the the funnel of medical education um I've seen a deep openness um to seeing the more complex larger lives of people who they might see in their practice in the future. Um, granted there's self- selection, but uh the students who signed up for our religion, medicine, and human flourishing course on the south side of Chicago um came in curious, you know, willing to sort of try and pick apart their own understandings of human flourishing, willing to confront it and brush it against, you know, the the both familiar um elements that they might find within other religious practices um and the strange elements. Um so for example going down with us to um Harvey Illinois to Engles to talking to an Islamic uh doctor there uh sharing uh that in Islamic practice health is a blessing but illness is a blessing too um which totally turned their head um and tried to understand well how does this fit in um and I saw them willing to to try and expand their view to see a southside that honestly by being at the University of Chicago they're inculturated to fear. um anything beyond you know three blocks past the the neighborhood of Hyde Park. Uh so going to uh Back of the Yards uh Precious Blood Ministry of Reconciliation and sitting effectively at the feet of Fred Weatherspoon, a man incarcerated for 25 years uh who directs their mentoring program there. um and and to have him as a teacher and if you think about it being a student at R1 University coming from the elite echelons and suddenly for a day to allow this man who who probably can't even vote you know who's a secondass citizen within our society um to have him serve as the instructor for the day and to actually have a student who um whose father I know uh had come out of the prison system um because of uh corruption and white collar crime um unbeknownst to the other students in room asking him about anger, asking about what it what it's like to leave the prison system and how one deals with that and to have unexpectedly this man um serve as a healing agent for her. And we don't allow prisoners or the formerly incarcerated really to serve as healing agents, agents of reconciliation. I do however also see so there's a great hunger, a great willingness. you can't have uh 12 quarters of field trips. Uh so this can only serve as 11 um for to help better inform the the training that they're doing um or that they'll be going into into the future. Um nonetheless, I have found um students to be religiously illiterate. And I don't mean they can't read religious and philosophical texts. They're doing that from day one here. But as we all know, literacy both involves reading and writing or articulating. And the ability for people today to better articulate their own religious foundations or their own philosophical foundations is wanting um in part because we don't have spaces that allow for people to actually do that. Um and so if as I contend compassion includes this udimonistic judgment includes a better tilling of our own resources for understanding how people fit within our schema of human flourishing um within our um circle of concern. then people can only benefit from better tilling that, better considering that. And some people I can hear people in the room imagining, well, doesn't that just invite religious ideology into medical practice? Um, and I would say that religious ideology typically comes from a very thin formation. But to engage difference within your own tradition, whether it be Jewish, Hindu, Catholic, or even secular humanism, actually, I think better prepares you to engage difference beyond your tradition. And the next time you have an argument with someone coming from a religious perspective, um, you'll recognize that that is a person better able to hold their own grounds because it's not a formation that stopped at 13 that but potentially pre proceeded long past their formation. And so that's why I tried to organize inspired by FASBY and the the amazing sharp medical students I met um through our trip there as a religious leader on the religious leader cohort um organized this seminar. >> Thank you. Thank you. Um, I want to pick up on another uh element of of what Dorston mentioned and that's these kind of kind of competing logics that can be going on that somebody can um communicate some sympathy or something and also say still I need you to do this. Um, I think there are a lot of kind of competing logics in in our lives. um probably not as um um clear as as the example that you gave, but but Ana, as as a as a practitioner and encountering people in the most challenging moments they've maybe ever faced, you have you have your logic as a as a practitioner, they might have their own value systems that you're bringing to it. How how do you bring empathy into those moments where sometimes there might be alignment with what's being done and trying to be achieved and there might be some conflicts between you as a medical practitioner and and what they desire. How how do you navigate that? How do you communicate it? Um, I think I'll start with just kind of a straightforward perhaps oversimplified toolkit of of really like simple but practical strategies that I generally employ as do many of you I'm sure um regularly but that I do see um often trainees sort of you know it takes time to learn how to do this um and I I think um body language um active listening eye contact. The these things sound so obvious but actually are easy to not are easy to not do with the pressures that you know medical providers are under and the you know the time pressures and all the other things that you have on your mind. Um, phones. Got to get rid of the phone. I see, you know, on I do a lot of inpatient and outpatient medicine, but on rounds, you know, we we're all so attached to our phones. Uh, it's, you know, for the from the patient perspective, you you I think they lose trust and faith in you that you have their best interest in mind when you pull out your phone the first second it rings. I mean, for most doctors, the vast majority of things can wait a few minutes, right? It's it there are there are exceptions to that, but they're relatively rare. Um, another another one is, and I will get to the, you know, the the crux of your question, but um, some of you may be familiar with this, but there's some interesting literature on sitting down versus standing. Has anyone heard this? I see like a couple nod, so few enough that I'll tell you about it. Um, so in inpatient medicine, you know, the team rounds every day and goes and sees every patient. And um, a mentor told me this a long long time ago, and I I've since dug up the the literature on it. It's really interesting. So um, a a study was done that looked at 120 post-operative adult patients. Um, and it was actually prospective randomized. These patients were uh randomized into having a provider who sat down in the room versus stood up in the room. And um what it turned out was that the patients whose pro provider or physician sat down in the room perceived the provider to have been in the room way longer than they were and much longer than the the standing group. Uh and furthermore, when they um asked them qualitatively to describe their experience and sort of patient satisfaction, um 95% of the patients in the sitting group, in the provider sitting group, um reported a satisfying experience with their doctor versus only 61% in the other group. So, you know, these studies have limitations for sure. Uh, and there's other studies I could talk about, but the point is I think that um things like body language and uh are are really important and and these nonverbal communication strategies can be really key. And when I am not that infrequently faced with these types of scenarios, you know, our our patients are undergoing really really challenging um experiences and and the families are under extreme stress. So the in many cases it's the parents uh that I'm that I'm interacting with most. um they're not always under control, right? They're they're they in the worst cases are punching the wall, they're swearing, they're they're so distraught and scared um that their behaviors and their outward, you know, outwardly it can feel more difficult to empathize w with a person who is behaving that way. But what I found is that, you know, if you peel back the layers of of their behaviors and even of their desires and their the requests that they're voicing, um you can you can almost always find something to empathize with. So what is driving that behavior, right? Is it is it fear of losing their child? Um is it is it anger at not having been listened to? Uh whatever it is, I I try to find that and and start there and and and find my own ability to empathize with that component as as sort of an opening with those families. So >> that's my my strategy. >> Thank you. Thank you. Um, I'm going to ask one more question of Dorston, then we're going to open up the floor for any questions that you might have. Um, but so we've put this in the context of of Nazi Germany and the Third Reich and and you've already mentioned a little bit about medical professionals. How from your um understanding, how did medical professionals think of empathy um during that moment in history? how how did they conceptualize it and yeah any any insight you can provide. >> I assume that quite a few of you in this room already are aware of that the most important paradigmatic shift is that increasing number of doctors into the 30s see themselves as having a duty to the body politic of the German people instead of the individual patient. So the idea of the folk, the idea of the folk's kera, the body of the of this kind of uh ethnosentrically defined, racially defined nation is central. uh so the imagery that we need to use is of course to say well I can put out my kind of operative knife and do some cuts but it's for the benefit of the whole right and with that kind of approach and with of course a radical breaking of the dignity and the rights of the individual patient um something radical shifts so that's the context of course the second part that I think is important is that we see a very conscious reflected articulated shift away from what is called already pre33 but then put into practice after the Nazis come to power um moving away from what is called a morality of sympathy I'm trying to translate the midlight category here um that was seen as something where we cultivate the weak where we cultivate the sick and the inferior towards a um celebration of power strength health um so it's a focus on strengthening the national body at any cost. Uh and that of course means that the whole notions of racial hygiene of eugenics is geared towards that as a broader framework. I find it perhaps as a last thought uh also worth reflecting on that what we know as the murder of disabled and patients to begin with 70 80,000 within Germany eventually probably around 300,000 all over German controlled Europe. the systematic murder in gas chambers. That's of course very much the the precedent, right, for uh what we then later on think of as the broader case of the Holocaust. Um grows step by step out of discussions around a liberal approach to the right to die, right? That's of course a discussion in the late 19th early 20th century. And that notion of a liberalization uh then gradually um can pick up on terminology of mercy killing and then you move from having the right to die towards having the duty to die. Right? And that's of course this gradual process and there's no automatism and I'm not trying to make a sophisticated point about medically assisted uh uh dying or suicide. uh but I think that's important just to keep in mind that we can see these decades of the early 20th century as that dynamics of changing what leads to also the role of doctors in that context uh and the ethical implications of that. >> Thank you. If people have questions you can feel free to come down to the microphone. I'm going to keep asking questions. Okay, never mind. Um [laughter] great. Please >> be sure that mic is on. Sorry. >> Well, the people online will probably need it to be on on >> right where your thumb is. Do you flip that up? >> Testing. >> Great. >> Thank you. Um, my understanding of empathy and compassion is that empathy is limitless. It's the ability to understand what the emotions are and without being necessarily involved in them, without being involved in them. Compassion is when you feel what's going on with this person as if it were going on with you. Um, and there are different parts of the brain that are activated in compassion just like you were going through that same thing where as an empathy there isn't. So my question is, so I'm a young surgeon. My question is, how should an ethical practitioner view their own resources from the standpoint of empathy, which should be universal, and compassion in decision-m? >> I'm going to invite one or maybe two panelists to respond. >> Tough question, huh? Yeah, >> I you're the medical practitioner. >> Yeah, let me try to take that's a good question. Um I think it's tough. I think the risk that I feel on a regular basis is of getting is if you when you start to feel the emotions of the patient, right? there's obvious harm, you know, potential harms and and and and factors that could go be at play that could be problematic. Um that what you want to avoid at all costs is the patient having to console you as the provider. And sometimes that happens. It's not that infrequent that that actually, you know, if you when the provider becomes overcome with emotion um that so that that's a problematic dynamic. Um so I think over time not that I'm you know that many decades into my career but I do think over time this is something that uh this does come with time to to to an extent. Um as far as the distinction between empathy and compassion you know I thought a lot about that actually preparing for this and um I I do think it's subtle. I I think there is a lot of overlap um and I think compassion is a little bit more actionable. I think it slants a little bit more towards like I'm I'm experiencing or or understanding your experience and and here's what I'm going to do about it. Whereas empathy to me is more I'm experiencing or or I'm understanding and appreciating your experience and I want you to and I'm and I'm communicating that to you. So th those are that's sort of my interpretation. I don't know if that's you know universal but that's how I feel about it. I don't know that I really answered your question, but hopefully I touched on it a little bit. >> Hi. Um um thank you all so much for this. um as a background um um uh um um I'm a philosopher so I've been deeply influenced by the work of Adam Smith who who who thought that empathy was a really sort of central core of like our ability to project in cognitively and emotionally into the perspective of others is like a really central thing of like how we relate to people like in a in in a society um but I've really been interested in the sort of the criticism of empathy from people like Paul Bloom the moral psychologist ologist um Paul Bloom has argued that uh empathy can has a is can be can be a very sort of parochial moral attitude. It's much easier for me to identify and understand the perspective of people who are like me who share some identifi features with me that than people who are different. Um and this very much shows up in the con certainly since we're thinking about this in the context of the Holocaust. Um, one of the ways in which empathy can be um, exploited is by, you know, they pick out like somebody, some victim of a crime who is very much like me and they want to say, you know, this innocent victim, you know, is was murdered by this other group and like much much it's much easier for me to to to feel empathy for the victim and that that is going to therefore be sort of exploit like that's why I should treat those other others as well others. Um, and so I'm curious what you all make of that critique and like how do we and you know how do we how do we avoid that? Um, yeah, thank you. >> I'm going to open up it. It seems to be related to to empathy can be warped in a lot of different ways. We've just been given one of them. Any any thoughts on this? >> That's a very very important horizon you're opening there. And I'll just briefly start with historical perspective on this. What you make me think of is of course the significance um of um the constitution of a racialized identity that happens in Germany, right? How you partially enforced partially also kind of making it seem attractive to adapt concept of concepts of self and concepts of others along racialized lines. That takes time by the way, right? we can see and of course it's not fully comprehensive. The other point that I want to make is uh and it might be stating the obvious but I think significant nevertheless is of course that that was one of the big challenges for the Nazi regime because in 1933 45 or 38 with a pogram that we know as Christ um we are in a very different situation from [snorts] um the other uh that German soldiers or as killers or others will find in Eastern Europe where sometimes we will have the phenomenon that the Jew seems to uh look similar to the anti-semitic stereotypes. Uh not always but partially but that's not the situation in the beginning. In the beginning it's your neighbor. They do look like you. Right? So we also can look at Germany as a case of perhaps qualifying some of that perspective and seeing that there are certain social and social psychological dynamics that can happen in a society where even what looks similar to me can be defined as the other. It just takes some more other factors in >> um rats, cockroaches, aliens, the disabled, right? There's a playbook for how our public language others people. And you find this in Germany with how the Jews are first described. You find this in Rwanda uh in the language of describing the totsis as cockroaches. Uh you find this in our own society and I think that this is where uh forever we have to not we have to be vigilant. We have to be vigilant about the language that is going on around us. And that is calling to us not just as uh educators or medical practitioners but also as citizens. Uh, as an old surgeon, I'm interested in history and for Thirstston, I have a question. We physicians have had the hypocratic oath for millennia, some iteration of it, but mostly it's patient centered. Do no uh do not harm your patient, do good for your patient. In the Soviet Union, they purposely changed that to say that the physician serves the state. And with that, of course, I think empathy was lost. And I saw that in the post-siet era in Ukraine when I speak with and I see the interaction of physicians there is a loss of empathy. They're very cold and brusk with patients uh what we see as ethical patient doctor relationship uh is skewed. So my question is in Nazi Germany was there a prelude to how the physicians and doctors uh changed their attitude towards patients in such a way that for instance was the oath changed specifically to to underline that it's a state that we serve and not your fellow man. >> Thank you. Very very interesting question. Um I will get at it with a detour of 20 seconds. Um and that is to say if we wouldn't sit here and have this kind of situation of communication um you probably would not have been able [snorts] to guess the answer to the following question where for the first time medical students have obligatory courses in medical ethics and medical history. You probably would not have guessed Nazi Germany. Right? So again uh medical ethics is central and even historical approach. Now briefly about the oath, the hypocratic oath. It's a very complex checkered picture. There are some ways of where medical scholars in the in the 20s and 30s in Germany redefine it. And there are also probably more predominant scholars who say it's not relevant for us for now. So we have different uh operations. What we definitely see and I'll just confirm that is that there is a um training both in the literal sense of medical training and then also overall in terms of incentives and thinking and what is written in medical journals and in the press and so on to redirect your obligations and your sense of duty perhaps slightly less to the state and more to the people in the sense of folk right in in the sense of that kind of ethnic um group of Germans. But definitely that is the commitment that you are uh obliged to in that uh setting where you then sometimes uh have to overcome your hesitation and overcome your qualms. And we can see that for the killer in the field who has a gun in his hand. And we sometimes can see that with the professionals including the doctors where the sense of success, the sense of pride comes from being able to overcome that hesitation. That's the heroic act. The ethical thing to do is to overcome that hesitation and be of duty to the people perhaps more than the state. >> Yeah. Marshall Chin from MLAN center. So there's a large part of the panel discussion which has us focus on like the diad and the individual like clinician and the patient and and empathy. And I think probably a lot of this as we think about the clinical examples or examples of education the southside can put ourselves in like well we've been in some type of similar situation and visualize that if there's a part of the panel discussion maybe most vividly Thorson's comments that that shows that what happens in the now regarding an individual diad really can't be viewed that way but there's sort of a history how we got there uh as well as like a set of like maybe systems and structures that might impact that diad Right. And I guess the other thing that then you sort of alluded to this that like this there's a lot of semi parallels between some of the things you mentioned and some of the trends worldwide or in this country. And so um the question is like um what do we know from the lessons from from history or from systems and structures that impact then how we train students or ourselves to do better with that diad. So in other words, even if you compare like the advice we may have given in the US 10 years ago to now in terms of how we get better uh because again it's more this this conflictuals othering the partisan dynamic that makes it I would argue harder now than even like 10 years ago regarding having those effective um empathic interactions and conversation communication. So what's your advice? What have we learned? what do we know about how we can do better now that goes beyond in some ways universal um points. >> Thank you very much. I'm I'm going to um open up for question but I'm going to actually add a layer to it as well. So in addition to what can we learn historically it makes me think is it possible to have an um empathetic system not just empathetic individuals can we can the system itself be empathetic and kind of inculcate that value in those people. So history and then that system level question sorry >> yeah um I think especially your point about the last 5 10 years I will leave to my colleagues who are a little bit closer to that and I'll take the long perspectives um and I will shamelessly um lift from the work of one of Fazby's faculty Jay Malone and one of Fazby's uh alumni Ben Frush who wrote an article five six years ago on the basis of the fast experience. Um that for me is partially a response a reaction to what you said because they argue that it when we are trying to think the experience of the 20th century with in this case Nazism as its center in terms of the failure of professionals uh that perhaps it might be more fruitful not to look at specific um outrageous atrocities and then think well I don't have anything in common with that I'm not going to do this so then to create a distance but instead to do the painful work of thinking where do I have something in common with these doctors and what they offer and what convinced me and I also saw how their scholarship and I think what uh historical perspective as we can bring in is to think about moral orientations and perhaps that's a little bit of a segue to thinking more about systems also in a moment what they argue and what they do and again many of you will be familiar with this is the work of Stanley howas who very appropriately of course is a theologian with a lot of philosophical interest where He argues um couldn't you define couldn't you describe what happens in Nazi Germany as a moral orientation of what they call I mean again leaning building on how I was as a moral orientation of elimination. Um my pity my reaction to suffering and to the patient is to um remove suffering by eliminating the sufferer. To what degree and in what forms do we see a moral orientation of elimination today without having this kind of genocidal context but also in my interaction as a doctor in terms of seeing pain as as the fifth vital sign and wanting to remove pain and then ending up having doctors being involved with narcotic uh uh medication to a degree that is let's say call it problematic right uh or many other examples that we could give for that kind of uh process. And what based on how was again what their recommendation is to develop and to push and to teach and to introduce into systems a moral orientation of presence of doctors um reflecting about their own tendency to want to fix to solve to get rid of uh illness and sometimes realize that that way of understanding empathy can bring new problems with it and that instead some things sometimes it's about being present with the patient in her suffering in his suffering in that context for me that's very was very convincing compelling and also unpleasant and challenging way of thinking uh about the implications the ethical implications of the Nazi context for today >> um I risk saying something obvious uh which is that there are no systems without people um and uh all systems are formed by persons interacting not individuals We're not it's not just a collection. Yes, we have policies and procedures and laws and everything else, but it's full of people including a whole lot of people who are not caregivers. Um, and I've been inspire I I I'm in one of the other hats I wear. I get all the passion jobs at my work. So, I'm also in charge of the Catholic Criminal Justice Reform Network. Um, in which we have been creating these dialogues that bring together all those who are agents who are responsible for our criminal justice system. uh judges, prosecutors, public defenders, um uh PE incarceration officers, uh and probation officers. And we bring them together and we have a roundt discussion where we ensure at the table there are those who are most directly impacted by the criminal justice system. Um returning citizens and survivors of crime. Um, in part because like doctors, a judge only sees a uh a person in front of them who's who's um on trial and get maybe a 15minute snapshot of their life, right? And often the worst moment of their life. And in this broader conversation, they're able judges, prosecutors, everyone else to see a fuller vision of that person and to see the ways in which, you know, a judge may have condemned this person to guilt, but they did not jud you know, condemn them to the harms that actually occur to them in our prison system. And I think the the more we can find opportunities to get the full range of people involved in the medical system and not just those who are on the front line to see and experience those who are most directly impacted by our medical system, the families of patients and patients themselves in the broader context, the easier it will be for them to levven the institutions that they're a part of and bring about transformational change. We have do you like to respond? Okay, we have time for one more brief question. >> Yeah, I just wanted to follow on to all the things you just said. I really loved what you said, but in my own research, I work with the military, so a lot of these overlays and I've done a different type of program. I have not done yours. I don't know if you know the math program. Um, but one of the things I see globally in our society that doesn't allow us to move toward shared presence through suffering is a social disenfranchisement with grieving. And so I wonder if you have any historical examples especially more at the social level because medicine systemically doesn't have the time for this. the military doesn't and I've seen the outcome of that which is a rigid angry robotic sort of interaction. I just wonder if you can speak to this phenomenon of grieving either historically or how you've I liked your example of the justice system. It's another system that has this problem I think. So that's my question. Thank you. Um, I've been amazed in terms of the I think it's important to see beyond the actors of those in this room and uh, for example, just with the criminal justice system to see men who um are looking to be agents of healing while they're in prison. Um, not finding an avenue for that. Uh, and then upon leaving are now going back into the prison and starting healing circles and peace circles and and circles in which it's it's possible for men to and women um to to be vulnerable and to share what's going on. And I think that this means, you know, enabling a broader engagement beyond just agents who are the ones who are in positions of power. um take moderator's privilege uh with one final question for each one of you and um about yeah up to 80 seconds um each for you. Um, so if if you take a step back, um, how do you think empathy can most concretely appear in our healthcare delivery or any of the systems that support that healthcare delivery? Whether um, yeah, and if if you can give us a tangible example or two to help us stir our imagination, that would be great. >> I'll I'll try. Um I would say for physicians trying to really see the whole person um it can be so easy in clinical encounters to focus on the medical problem. Sometimes we even refer to a patient as their disease, right? You know, the diabetic, the you what. And um I think that does a lot, not the labeling them really, but just in the the general approach of not just caring about the medical, you know, the the diagnosis that you're trying to work to to help um treat, but really the the entire person. So I I think for me just a as far as like a a simple example would be if we're rounding on on um on [snorts] the inatient wards. Um you know if a family wants to spend the time that they have venting about the fact that they're not allowed to bring a coffee machine into the ICU that they've been in for four months. Like we can empathize with that, right? Even though in our mind we're saying, "Well, wait a minute. We haven't talked about the the potassium level. We haven't talked about the methadone wean. We haven't like that's okay. Like we can do that later. So I think that that would be I think the whole person often is so much more than the medical problem that we're there we think we're there to address. So that's that's my response. I'm going to comp compleiment that uh just by saying inviting medical practitioners to also be whole persons um within their medical practice and to also create an atmosphere in which they're inviting their colleagues to also be wholeer fuller persons. We shouldn't be afraid of Jonathan R's uh you know calls them comprehensive worldviews. They are messy but it's not like we're building a political system here. We're we're engaging in practices of care. to that sort of earlier question. I think that helps people to draw upon the much broader resources than those just available within our medical system to help them deal with things like burnout. You know, I think it helps for a more fully integrated holistic person who has a deeper sense of their vocation because of the resources that they're able to draw upon uh that run much deeper than the required medical ethics course that they may take in their second year of med school. I will just harp on the concept of messiness and say what this question makes me think of is how there seems to be a balance that needs to be struck a balance between on the one hand and this is very much a fastpie uh sermon to encourage professionals to take the stability and to say it's not always about delegating it's not about informed consent it's not always about pushing everything back to the patient sometimes you need to decide what is the right thing in a situation that can be hard but that's why you're a professional. Shoulder it. Take that responsibility on the one hand and on the other hand to at the same time be able to cultivate a certain element of epistemic humility and to say but also even as a professional I will not know everything. I can't fix everything. And there is an existential difference between me as the doctor, me as the professional and the human being that in that moment is a patient. He or she might experience the situation very differently, might define suffering very differently from me. We are not the same. I can I'm here for that person, but there will always be that distance. And uh for me, it's about that balance. >> Thank you all very much. And and Torston, you're speaking my language. My very favorite word in Catholic theology is and. And so you ended us perfectly there. Um thank you to the MLAN Center for the invitation for FASBY to join you today. and I wish you all the best with the remainder of the conference. Thank you.