CENTER FOR EMPATHY IN HEALTHCARE IN BRAZIL

Affiliated with the International Network for Empathy in Healthcare

International Network for Empathy in Healthcare

The International Network for Empathy in Healthcare, with Centers in more than seven countries around the globe and in various continents, was designed by Professor Jeremy Howick, Director of The Stoneygate Centre for Empathic Healthcare. The Center for Empathy in Healthcare in Brazil aims to develop good practices and research, offer training and promote initiatives to disseminate empathy in healthcare, and to contribute to the recognition of empathy as a fundamental component of Patient-Centered Care, the provision of quality care and the improvement of clinical outcomes in health services and in the training of professionals.

The Center for Empathy in Healthcare in Brazil brings together researchers and professionals from various fields of knowledge, thus constituting an interdisciplinary group.

In particular, the Center for Empathy in Healthcare in Brazil focuses on the correlations between Empathy, Bioethics and Patient Law, seeking to deepen the moral role of empathy and its importance for the implementation of patients’ rights, as well as the role of such rights in the dimension of clinical empathy action, that is, its importance for the adoption of pro-patient behaviors.

The Center for Empathy in Healthcare in Brazil aims to be a catalyst for empathy in the country and for the promotion of a new culture in healthcare, based on the professional-patient partnership and on the endorsement of patient centrality in their care.

The basic assumption of this theme is demonstrating that issues around the morality of empathy matter in the day-to-day of healthcare, notably for the implementation of a culture of respect for the centrality and participation of the patient, and of patients’ rights. On the other hand, it is important to recognize that the moral role of clinical empathy in judgment and motivation has significant controversies, which reflect those present in the literature on empathy and morality in general. Thus, an intermediate position is supported, in other words, that clinical empathy has a relevant moral role in healthcare; however, this is insufficient to guide the ethical behavior of health professionals, given that empathy is not always the best guide for moral behaviors, since it generates social preferences and favoritism. Thus, despite empathy being associated with pro-social behaviors, a comprehensive ethical theory requires the adoption of principles or other prescriptive constructs. In fact, clinical empathy is not enough for professionals to respect the patients as agents of their health and their lives, and to act with a view to empowering them in this regard.

To prevent clinical empathy from being associated with paternalistic behaviors, patients’ rights must be combined with the therapeutic responses that health professionals give when checking their understanding of the patient’s mental states and perspective. Therefore, the language of patients’ rights must modulate the behavior of the professional, by assigning this professional with moral and legal obligations, and conferring power of agency to the patient. Clinical empathy, in its active component, cannot be disconnected from the empowerment of the patients and their rights, in order to prevent it from becoming a tool to conceal the power of the professional, since clinical empathy is premised on the understanding of the professional, who can modify the contributions brought by the patient or disregard these contributions in the decision-making process.

In addition to the aforementioned benefits and its role in specific approaches in healthcare, clinical empathy’s role is to contribute to the realization of Patients’ Rights in the daily life of clinical practice, and is articulated with its theoretical foundations. Studies on the correlations between clinical empathy and patients’ rights are scarce. Such scarcity can be attributed to the fact that the theoretical construction around Patients’ Rights is still incipient and that clinical empathy is a topic unknown to researchers in the area of Law.

The child patient, especially the newborn, is more vulnerable. It is essential that the evolutionary capacities of childhood are known to all health professionals and that the rights of the child during healthcare are respected. In this sense, quality and safe care is a patient’s right and their participation in their care should be supported and encouraged. This does not happen in practice, and the child, regardless of age and level of care, has their perceptions, values and feelings undervalued or not even taken into account, being left on the sidelines with regard to care, and not its protagonist. This practice invalidates the individual as a person and as a patient. A structural, intrinsic, and sustained change is necessary for these practices to be modified, in favor of the most humane and fair care offered to the pediatric patient. Thus, a patient-centered care that values and understands the perspective and reality of the newborn in a compassionate way, that is, empathic care should be the goal, and professionals should make every effort to achieve this goal. I started my studies on empathy with a focus on neonatology, given the particularities of the newborn, who is totally dependent on their caregiver.

Despite extensive and expanding research on empathy, including contributions in this journal1, there is still a significant gap in advocating for the promotion of a more empathetic health workforce globally. The demonstrated benefits of empathy training for the well-being of healthcare professionals and patients underscore the urgent need to establish curricula and programs that support healthcare teams in developing proficient empathic practices. We are in the construction process to meet this need.

A growing body of research underscores the positive impact of empathic interactions on health and on people’s physical and psychological well-being. In many high-income countries, a deficit in empathy has been linked to preventable patient harm, increased post-operative pain, poor medication adherence, and preventable mortality. In low-resource settings, although there is a great need for more resources to provide basic access to healthcare, the emphasis on empathy must be maintained.

The Network has outlined goals and five-year goals to ensure consultations consistently incorporate high levels of empathy. These goals can be achieved in partnership with patients, educators, practitioners, healthcare staff, leaders, and policymakers. Key initiatives include: creating frameworks for generating empathic systems; evidence-based empathy training for healthcare professionals; empathic leadership training; strengthening communication.

Declaration

Recognizing that empathy-informed healthcare is essential to the well-being of health professionals and patients, we declare that all medical and nursing courses and all health systems must adopt policies and procedures to address and implement training in empathy and compassion for self and others.

Goals

For patients: Consistent high levels of empathic care.

For professionals: Formal inspiring and evidence-based empathy training and support, including revalidation when feasible.

For systems: Workplace conditions that include empathic leadership, as well as psychological and physical spaces that facilitate empathic relationships.

Proposed five-year goals

The Network aims to achieve the ten goals below in five years:

1. Advocate for the establishment of Empathy Centers in all nations, especially in developing countries and others where they do not currently exist.
2. Support existing empathic healthcare centers.
3. Organize training and teaching with efficient, evidence-based methods, so that practitioners offer consistently high levels of empathy.
4. Refine, test, and evaluate frameworks to create health systems that promote empathy.
5. Raise awareness among HCPs, managers and leaders on the benefits of empathy for patients, professionals, and teams.
6. Reduce the damage caused by a lack of empathy.
7. Improve patient health outcomes by enhancing empathy.
8. Improve the well-being of the professional by improving empathy.
9. Promote international collaboration of programs for empathy research through national, regional and international agencies and in partnership with patient advocacy groups and practitioners.
10. Establish contact and develop the World Health Organization’s “Humanity, empathy and autonomy” initiative.

Most importantly, the Network is committed to organizing an international symposium that includes additional members and Centers, ensuring representation that reflects the global population.

Valete, Cristina; Albuquerque, Aline; Ferreira, Esther. Empathic Care of Neonates: A Critical Literature Review. Perm J. 2024; 28(1): 46-51.
Link: https://pubmed.ncbi.nlm.nih.gov/38332703/.

Valete, Cristina et al. Clinical empathy in a medium and high-risk Brazilian unit. Nursing Ethics 2024.
Link: https://journals.sagepub.com/doi/abs/10.1177/09697330241238334.

Albuquerque, Aline; Melgaço, Nelma.; Cunha, Isis. Clinical empathy and patients’ rights in geriatric care: analysis of the perception of physicians and elderly patients. International Journal of Family & Community Medicine, v. 7, n/ 6, 2023.
Link: https://www.researchgate.net/profile/Aline-Albuquerque-3/publication/375861642_IJFCM-07-00339/links/655f7dbbce88b8703107e654/IJFCM-07-00339.pdf.

Albuquerque, Aline. Empathic care as a command of a new clinical bioethics Nursing and Care Open Access Journal v. 9, n.2, 2023.
Link: https://www.researchgate.net/profile/Aline-Albuquerque-3/publication/371783139_Empathic_care_as_a_command_of_a_new_clinical_bioethics/links/6494a5d0c41fb852dd270f9b/Empathic-care-as-a-command-of-a-new-clinical-bioethics.pdf.

Albuquerque, Aline; Howick, Jeremy. The moral role of clinical empathy in patient healthcare. International Journal of Family & Community Medicine, v. 7, n. 1, 2023.
Link: https://www.researchgate.net/profile/Aline-Albuquerque-3/publication/367774051_The_moral_role_of_clinical_empathy_in_patient_healthcare/links/63fe0ebc0cf1030a565c331f/The-moral-role-of-clinical-empathy-in-patient-healthcare.pdf.

Empatia nos cuidados em saúde – 1ª Edição – Comunicação e ética na prática clínica – Ebook

O primeiro livro sobre empatia no cuidem saúde do Brasil foi fruto da pesquisa desenvolvida por Aline Albuquerque no Programa de Empatia da Universidade de Oxford, coordenado pelo Prof. Jeremy Howick.
Link: https://www.manole.com.br/empatia-nos-cuidados-em-saude-1-edicao-comunicacao-e-etica-na-pratica-clinica-1-edicao/p

Construção e validação de cartilha sobre cuidado empático no contexto dos cuidados paliativos – Mariana Menezes, Doutoranda do Programa de Pós-Graduação em Bioética da UnB.

A empatia clínica como eixo estrutura da Bioética do Cuidado em Saúde – Felipe Rocha – Mestrando do Programa de Pós-Graduação em Bioética da UnB.

Clinical Empathy Workshop

The workshop aims to:

General objective: to train health professionals in order to increase their empathic capacity in the interaction with patients and to improve the reflection on ethical issues emerging from healthcare.

Specific objectives:

(1) To explain the definition of empathy and its cognitive and emotional dimensions, as well as create a safe space for participants to experience empathic interactions with each other.

(2) To explain the concept of clinical empathy, its components and benefits for patients, professionals and hospitals.

(3) To develop the health professionals’ capacity to have other perspectives in relation to patients in ethically complex decision-making contexts.

(4) To reflect on the moral function of clinical empathy and its importance for the resolution of conflicts and bioethical issues.

(5) To develop empathic skills to understand ethical issues in the clinical practice environment.