Beyond "Detached Concern" : the cognitive and ethical function of emotions in medical practice

Jodi Lauren Halpern, Yale University.


This dissertation analyzes the ideal of "detached concern" in medical practice. This ideal arises as an attempt to bridge the gap in medicine between managing diseases and recognizing patients "as persons." First, physicians take their emotions to interfere with making objective diagnoses and making every aspect of their practice "scientific." Second, physicians idealize detachment as the stance of the impartial moral agent who is able to care for all types of patients out of a sense of duty. Third, physicians also recognize the need to be empathic; however they conceive empathy as a purely cognitive capacity that is compatible with detachment.Chapter one analyzes the features of emotions that contribute to and also threaten rational agency. Chapter two analyzes Descartes' theory of the emotions, which is the outcome of his "scientific" method for understanding reality. Descartes' legacy to physicians is not only the capacity to build powerful mechanistic models of diseases, but the failure to account for human experience via such models.Chapter three considers the turn to Kantian ethics to restore respect for patients "as persons" to the practice of medicine. Kantian impartiality is shown not to require detachment. Further, the practice of Kantian ethics in medicine is impoverished when physicians are not affectively engaged.Whereas chapters two and three show the limitations of the arguments for emotional detachment, chapters four and five give positive arguments for the role of emotions in medical practice. Chapter four examines the cognitive and affective aspects of clinical empathy, and argues that emotions are essential for directing the empathizer to imagine what the patient is experiencing. The final chapter argues that given the importance of emotional engagement and the fact that emotions can obstruct rational and moral agency, physicians need to regulate their emotions without detaching themselves from patients. Physicians can best meet the goals of medicine by cultivating overarching emotional attitudes like curiosity and courage to effectively move themselves towards a more realistic and respectful appreciation of patients.