Physicians associate empathy with benevolent emotions and with developing a shared understanding with patients. While there have been many articles on managing "difficult" patients, little attention has been paid to the challenges physicians face during conflicts with patients, especially when both parties are angry and yet empathy is still needed. This topic is especially important in light of recent studies showing that practicing medicine increasingly requires physicians to manage their own feelings of anger and frustration. This article seeks to describe how physicians can learn to empathize with patients even when they are both subject to emotions that lead to interpersonal distancing. Empathy is defined as engaged curiosity about another's particular emotional perspective. Five specific ways for physicians to foster empathy during conflict are described: recognizing one's own emotions, attending to negative emotions over time, attuning to patients' verbal and nonverbal emotional messages, and becoming receptive to negative feedback. Importantly, physicians who learn to empathize with patients during emotionally charged interactions can reduce anger and frustration and also increase their therapeutic impact.

Empathy is an extensively studied construct, but operationalization of effective empathy is routinely debated in popular culture, theory, and empirical research. This article offers a process-focused approach emphasizing the relational functions of empathy in interpersonal contexts. We argue that this perspective offers advantages over more traditional conceptualizations that focus on primarily intrapsychic features (i.e., within the individual). Our aim is to enrich current conceptualizations and empirical approaches to the study of empathy by drawing on psychological, philosophical, medical, linguistic, and anthropological perspectives. In doing so, we highlight the various functions of empathy in social interaction, underscore some underemphasized components in empirical studies of empathy, and make recommendations for future research on this important area in the study of emotion.

We sought to understand the expectations and concerns of older adults with cognitive impairment with regard to their relationship with medical providers. In particular, we observed whether study participants were involved in therapeutic alliances. Medical providers and patients create therapeutic alliances when they agree on the goals of the treatment and share a personal bond. Whereas such alliances have been studied in cancer research, little is known about therapeutic alliances in dementia research. Data were gathered in a qualitative study of 27 older adults with cognitive impairment and analyzed with narrative analysis. We introduce four case studies that illustrate the effects of having or missing a therapeutic alliance. Whereas the participant in the first case benefited from a therapeutic alliance, the other cases are marked by different experiences of abandonment. Findings suggest that interventions should concentrate on ways to enhance the relationship between medical providers and patients with cognitive impairment.

This article draws on investigations by its authors, and from American and Italian interventions to provide recommendations for decreasing social isolation in older adults for policy makers, researchers, and other professionals committed to supporting the improved social integration of older adults. The article argues that to mitigate social isolation it is critical to foster a sense of belonging (personal involvement in a system or environment so people feel they are an integral part of that system or environment). Suggestions are provided on how to leverage systematic interventions to foster isolated older adults' sense of belonging to their communities.

Background

Recent research shows that by age 5, children form rigid social hierarchies, with some children consistently subordinated, and then later, bullied. Further, several studies suggest that enduring mental and physical harm follow. It is time to analyze the health burdens posed by early social dominance and to consider the ethical implications of ongoing socially caused harms.

Methods

First, we reviewed research demonstrating the health impact of early childhood subordination. Second, we used philosophical conceptions of children's rights and social justice to consider whether children have a right to protection and who has an obligation to protect them from social harms.

Results

Collectively, recent studies show that early subordination is instantiated biologically, increasing lifetime physical and mental health problems. The pervasive, and enduring nature of these harms leads us to argue that children have a right to be protected. Further, society has a role responsibility to protect children because society conscripts children into schools. Society's promise to parents that schools will be fiduciaries entails an obligation to safeguard each child's right to a reasonably open future. Importantly, this role responsibility holds independently of bearing any causal responsibility for the harm. This new argument based on protecting from harm is much stronger than previous equality of opportunity arguments, and applies broadly to other social determinants of health.

Conclusions

Social institutions have a role responsibility to protect children that is not dependent on playing a causal role in the harm. Children's rights to protection from social harms can be as strong as their rights to protection from direct bodily harms.

Abstract Because of the high costs of providing long-term care, artificial companions are increasingly considered an opportunity to provide support to older adults with cognitive impairment while saving costs. Artificial companion can comfort and inform, thus inducing a sense of being in a relationship. Sensors and algorithms usually allow these applications to exude a life-like feel. The explosion of these technologies has created a “cultural lag” between their rapid commercial introduction and the slower evolution of regulations. An outcome of this cultural lag is a tension between the potential of artificial companions to support users and a series of unresolved ethical issues related to the fact that users might lack the capacity to fully understand the implications of using these technologies. Specific challenges of deception, surveillance, consent and social isolation are raised by the introduction of these technologies in users with cognitive impairment. The case study of a sophisticated artificial companion commercially available in the United States lends the opportunity to examine the tension between the potential of this technologies vs. unresolved ethical issues. This companion is an avatar on an electronic tablet that is displayed as a dog or a cat. Whereas artificial intelligence guides most artificial companions, this application is a hybrid of robots and human beings because it also relies on technicians “behind” the on-screen avatar, who via surveillance, interact with users. We conclude with a call to develop regulations promoting artificial companions as “human-driven technologies,” i.e. technologies focused on truly empowering users according to their cognitive abilities.