Empathological: Understanding the Bounds of Empathy in Paediatric Care

Empathy abounds in paediatrics and is deemed a valuable trait that enhances child and family care. Concurrently, research indicates there has been a decline in paediatric training applications, both medical and nursing, and there are challenges to workforce retention related to empathy exhaustion. While the cause is unclear and likely multifactorial, there may be a correlation with empathy levels, requiring analysis by policy makers and governing bodies. Empathy is a disposition, generally understood as cognitive or affective, and I propose here that clinician empathy exists on a continuum. At the affective extreme, there may be an intense emotional transference or pathological empathy response-I use the portmanteau 'empathological' to describe this. Further, that this response may be associated with negative sequelae, and compromise child and family care when complexity, uncertainty, and tragedy co-occur. Identifying the appropriate empathy dose and duration is therefore key to mitigate harm to all parties. Developing strategies to harness empathy by judiciously employing reason and moral theory could be protective. To help understand empathy bounds and balance, I outline the moral foundations of clinical empathy and weigh its benefits and burdens in clinical settings. I conclude that reasoned empathy, which draws on specific elements of Paul Bloom's analysis of rational compassion, allows for engaging empathetically with children and families without paralysing moral action by overly deeply relating to tragic circumstances. Attending to a form of reasoned empathy could ultimately inform healthcare staff selection and training to sustain a healthier paediatric workforce, and lead to better care for sick children.