title: The place for emotions in professional carers' thinking: reflections on two cases.
abstract: How do carers know what is right for their patient? What can they do further to relying on the two pillars of knowledge and ethics? Knowledge foregrounds rational decision-making based on scientific evidence. It allows cost-benefit rationalization and the choice of the best feasible objective. The steady advance of medical science drives responsible carers to keep their knowledge and skills up-to-date. Bioethics grants primary attention to the prevention of causing harm in general, to pursuant of patients' subjective wellbeing and to allow the latter enjoy their autonomy and to guarantee them the sense of justice. There are, however, cases where these values collide and any care decision violates one principle or another. How are carers expected to act then? This article concerns the choices made by carers, as presented and discussed in two cases. These cases deal with a clash between two principles: parenthood vs. fertility, religious rite vs. social affiliation. This class has generated an ethical dilemma. In each case carers try to justify their choices by expert knowledge and other ethical values, but later reflection reveals that the predominant element in 'solving' these dilemmas was "emotions." Professional training submits that: 'Set aside feelings in order to keep your thinking 'straight.' However, reality proves this simply infeasible. The more complex the medical-ethical situation, it is more likely that "emotions" take over. We have no choice as responsible carers but to allow our emotions the status of a factor of influence in their own right. Nowadays, a basic medical training for doctors and nurses offers an integrated body of knowledge and therapeutic skills. In addition, trainees are introduced to bioethics, supposedly sufficient to guide their future steps in their chosen profession. But how does this training in fact shape their future ethical conduct, if at all? How does it affect their ability to maintain ethical responsibility throughout therapeutic interactions? Perhaps there are other factors which govern the individual's conduct and his/her ethical responsibility? Simulation exercises were conducted, designed to induce healthcare professionals to reflect on the ethics of their own decision-making. The results demonstrated that therapeutic skills and familiarity with bioethical principles are not the sole factors governing the individual's ethical conduct. It turns out that emotions and feelings play a key part; this at once raises the question as to whether a medical training for doctors and nurses, in its current format, concerns itself with emotions and with how emotions shape a therapeutic personality. If not, then our training designers have food for thought. How can such training make trainees more aware of the power of their emotions? And, what are the ramifications on daily practice concerning ethical responsibility? Another question concerns the possible proper methods for mastering the theoretical materials and the practical techniques that promote emotional self-development?
authors.affiliation: Nursing Division, The Israeli Ministry of Health, Jerusalem. ellakoren@gmail.com
authors.forename: E
authors.initials: E
authors.lastname: Koren
mesh_terms: D026688:Bioethical Issues; D004644:Emotions; D004645:Empathy; D006801:Humans; D007600:Judgment; D011369:Professional-Patient Relations; D012945:Social Values