Parallel Concepts

SYMPATHY. The history of the ethics of sympathy provides useful insights for the developing notion and ethics of care. A number of philosophers writing between the end of the seventeenth century and the beginning of the twentieth— principally Joseph Butler (1692-1752), David Hume (1711-1776), Adam Smith (1723-1790), Arthur Schopenhauer (1788-1860), and Max Scheler (1874-1928)— developed an ethic of sympathy. Taken from the Greek word sympatheia, meaning "feeling with," sympathy referred to a "felt concern for other people's welfare" (Solomon, p. 552).

There are several reasons for considering some highlights of an ethic of sympathy in the context of this entry. First, there are some links between care and sympathy: Some of the authors who have developed the notion of care include sympathy, empathy, or compassion as elements of care, for example, Rollo May and Milton Mayeroff; yet sympathy differs from care, for care has a deeper role in human life, is broader than sympathy in its tasks, and entails a more committed role with other people and projects. Second, the ethics of sympathy offers sustained philosophical examination of issues that are of interest to the ethics of care, which has been subjected to relatively little systematic philosophical inquiry. In particular, an ethics of care has much to learn from an ethics of sympathy regarding its most distinctive formal feature: It is based on a fundamental human emotion that is viewed as the central feature of the moral life and the basis of an ethic—a fundamental characteristic that it shares with the ethics of sympathy.

Accordingly, there are questions significant for an ethic of care that could be examined in the context of the ethics of sympathy. For example, there is the question regarding justification for the use of a passion or emotion such as care as the starting point or central point in ethics. Joseph Butler, writing in the sympathy tradition, argued against the view of psychological egoism, which asserted that we cannot be motivated simply by a concern for others, for human psychology is such that we cannot help but act in our own interests when we act on emotion. Against this, Butler argued that passions and affections, which are "instances of our Maker's care and love," contribute to public as well as private good and naturally lead us to regulate our behavior. Benevolence for others and the self-love that prompts care of the self are distinct; they are not in conflict; and they are both governed by moral reflection or conscience. David Hume went much further: Passions, or moral emotions, are primary, for they alone move humans to action; reason must serve the passions by providing the means for achieving the ends that sentiment selects. Consequently, moral judgments, which are the motives moving us to action, must be based primarily on moral sentiments or feelings, not on reason (Hume, 1983; Raphael).

Another question is whether an altruistic virtue traditionally regarded as soft could have much effect on the ethics of the practice of medicine, which emphasizes principles and objectivity. A comparable issue arose particularly in the writings of John Gregory (1724-1773), a prominent Scottish physician-philosopher, who applied the ethics of "sympathy" and "humanity" (the paired terms were taken from David Hume) to the medical care of the sick. Gregory held that the chief moral quality "peculiarly required in the character of a physician" is humanity, namely "that sensibility of heart which makes us feel for the distresses of our fellow creatures, and which, of consequence, incites us in the most powerful manner to relieve them" (1817, p. 22). The moral quality paired with humanity is sympathy, which

"produces an anxious attention to a thousand little circumstances that may tend to relieve the patient" and "naturally engages the affection and confidence of a patient, which, in many cases, is of the utmost consequence to his recovery" (1817, p. 22).

Gregory speaks of the development of a balanced skill of medical compassion in the clinician: Physicians who are truly compassionate, "by being daily conversant with scenes of distress, acquire in process of time that composure and firmness of mind so necessary in the practice of physic. They can feel whatever is amiable in pity, without suffering it to enervate or unman them" (1817, p. 23). In this way, Gregory closely tied the virtue of sympathy to the art of medicine and to medical benefit, while answering the objection that sympathy causes an emotional imbalance in the practitioner.

Not only does Gregory defend the role of the "soft" altruistic virtue in medicine; he pointedly identifies the core of the objection against them. Rejecting as "malignant and false" the view that compassion is associated with weakness, Gregory argues that rough manners are "frequently affected by men void of magnanimity and personal courage" in order to conceal their defects (1817, pp. 22-24). Men can gain from women both "humanity" and "sentiment," qualities that are at the very core of the moral life (1765).

ATTENTION. Attention (or heed or regard) has, for centuries, been one of the meanings of care; it remains an element of care today. To care for someone is to pay solicitous attention to him or her and to have a disposition of attentiveness. To take good (conscientious) care of a patient means to be attentive both to the needs of the patient and to the duties of proper care. The "attending physician" is one who has primary responsibility for the care of, and is ready for service to, the patient. Thus, the notion of attention is not only a concept parallel to care; it is an ingredient in care. The philosopher Gilbert Ryle says, "To care is to pay attention to something ..." (p. 135).

The most significant and stimulating thinker on the topic of attention was Simone Weil (1909-1943), a French philosopher and mystic who makes attention the central image for ethics. Attention, she explains, is a negative effort consisting of suspending one's thought, leaving it detached, empty, and ready to receive the being one is looking at, "just as he is, in all his truth" (1977, p. 51).

Weil says that solving a philosophical problem (including one dealing with morality) requires a kind of caring contemplation: "clearly conceiving the insoluble problems in all their insolubility, . simply contemplating them, fixedly and tirelessly, . patiently waiting" (1970, p. 335). Being attentive is being open to illumination (Weil, 1978, p. 92); we should look at these problems "until the light suddenly dawns" (1952, p. 174). What we sometimes fail to see is what Weil perceives: that solving moral problems sometimes entails facing mystery. Thus, to discover what is causing a person's suffering and how to respond to it, the caring nurse may need to employ Weil's contemplative attention to all details; and even that exercise of attention is itself a caring act.

Attention offers a powerful approach to ethics. For example, Simone Weil thinks of equality and justice not as abstract concepts or principles that serve the well-ordered society; she conceives of them as virtues that can only be illuminated and developed through attentive knowledge. Thus, for Weil, equality is a certain kind of attention, "a way of looking at ourselves and others" (Teuber, p. 223). Respect for another person is not respect insofar as the other has a rational nature or is a person: Weil states bluntly that she could put out a man's eyes without touching his person or personality. Rather, we show respect for individuals in their concrete specificity: "There is something sacred in every man, but it is not his person [nor] the human personality. It is this man____ The whole of him. The arms, the eyes, the thoughts, everything ..." (1981, p. 13). Respect for others is based more in compassion than in awe for personhood, and compassion does not depend on familiarity: We can and should foster compassion for individuals who are very different from ourselves (Teuber, p. 225).

Attention is also a key part of the practice of compassion. Weil explained that those who are suffering "have no need for anything in this world but people capable of giving them their attention." She contended that the capacity to give one's attention to a sufferer is a very rare and difficult thing; "it is almost a miracle; it is a miracle ..." (Weil,

Attention and the equality it discovers do not suffice for all problems in ethics: They do not in themselves define any principles for adjudicating conflicts; but they can and do convey certain attitudes and forms of conduct without which we would lose sight of the meaning and substance of our obligations and rights (Teuber, p. 228). In addition, Weil's sort of attention can show us duties we did not see before (Nelson, p. 13) and can instruct us in the skills required for caring.

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