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IMPLICATIONS OF , AND IN MEDICO-LEGAL PRACTICE

Ariyarathne D1 Hulathduwa S R2 1, 2 Dept. of Forensic Medicine, Faculty of Medical Sciences, University of Sri Jayawardenepure, Nugegoda, Sri Lanka

ABSTRACT

The terms sympathy and empathy have how much to react in a given setting. It subtly different meanings. Sympathy is the should be judged by the practicing doctor caring, concern and understanding for the using common wisdom and past . of others while empathy refers to Therefore it is important to address the being-putting oneself in the place of an matter from the very first stages of post- aggrieved party. Apathy means lack of graduate training in Forensic Medicine. , , or concern which leads the individual to a state of indifference. Key Words: sympathy, empathy, medico- This article is aimed at creating a dialogue legal practice, emotional labiality among medico-legal practitioners as to what extent should empathy or sympathy be shown to their clients. INTRODUCTION

Expression of sympathy or empathy by The terms sympathy and empathy are often medico-legal professionals in Sri Lanka may used similarly and interchangeably though be limited because of several reasons. As the their emotional meaning is subtly different. prime concern of a medico-legal professional In simple terms, sympathy is the caring, is to gather information for a court of law, concern and understanding for the suffering this may require him to be more factually of others-the concern for the well-being of oriented without taking into another. Empathy refers to the understanding account. Emotional involvement in a case and sharing of a specific emotional state with may cloud the professional’s judgement. a fellow human being-putting oneself in the Furthermore, as medico-legal professionals place of the aggrieved party. A person see many emotionally agonising cases on a expresses sympathy while he shares daily basis, one might find it traumatising to empathy. When sympathising, one become emotionally involved in each case. recognizes that another person is suffering Unless the practicing doctors are while when empathising, the person’s or appropriately trained in such as the suffering is felt. As such, empathy is a deeper desired method of reacting in front of the feeling compared to sympathy1,2. The origin patients, bereaved relatives and of the word sympathy comes from the old concerned parties, the overwhelming Greek terms syn (meaning together) and reactions to emotions would make the (meaning to feel). The term empathy practitioner trespass the professional was coined by the British psychologist boundaries. However if one reacts with Edward Titchener in 1909 to translate the apathy and indifference, the investigation meaning of a German word which meant process may be deficient and incomplete. It “shared feeling”. is important to strike a balance between ‘caring too much’ and ‘caring too little’. Sympathy and empathy are both complex However it is not easy to lay guidelines as to , which, though, are neither the same

Sri Lanka Journal of Forensic Medicine, Science & Law-May 2015-Vol.6 No.1

21 nor are mutually exclusive. One may feel interested parties who may be the both together as the bases for both are the representatives of the clinical client blended with understanding and (examinee), the senior next of kin of the of others enhanced by knowledge deceased or certain other parties legally, and wisdom. Thus, the capacity to socially and culturally interested about the sympathize and empathize is considered as case or the situation. Trends are positively features of humanity. changing. Yet, the “holistic” and “therapeutic” nature of the approach which is On the other hand apathy means lack of currently available in the developed feeling, emotion, interest or concern which countries is not yet fully established in Sri leads the individual to a state of indifference. Lanka. Thus the medico-legal specialist may Such an individual may show lack of interest lack an opportunity to express sympathy or in emotional, social, cultural, spiritual and empathy and take further steps based on philosophical aspects of life as well as these emotions for the good will of his client physical life and worldly events. Apathy may (or other interested parties). Forensic arise when the individual feels that he does Medical Specialists are in a way “forced” to not possess the level of required to be apathetic and show indifference in certain confront and overcome a challenge. This situations. type of transient feelings will be experienced by almost all individuals at some point in life On the other hand the prime expectation from and as such it is considered a natural response the medico-legal specialist is that he gives to , stress and dejection as it scientifically solid, unbiased, impartial, helps to forget these negative feelings. Long accurate and truthful evidence and opinion standing apathy may be a sign of more within his capacity. Certain emotions that specific mental disorders such as they invariably encounter during clinical or dementia. Extremely medico-legal work as well as death apathetic individuals (together with other investigations might adversely this behavioural abnormalities) will be classified expectation. In other words, the as narcissistic, sociopathic or psychopathic3. medico-legal specialist should not be emotionally biased. This article is aimed at creating a dialogue among medico-legal practitioners as to what Impact on personal and professional life extent should empathy or sympathy be shown to their clients. Clinical Forensic Medicine and Forensic Pathology are the two topmost medical disciplines where the practitioners very DISCUSSION commonly and frequently receive extremely emotionally agonizing and psychologically Sri Lankan practice traumatizing first-hand information in the form of history, examination and The existent practice in the country is that the investigative results. This, they receive not in same medico-legal specialist deals with both an ad-hoc manner (like emergency autopsies and clinical cases. The prime department surgeons) but in a continuous concern of the medico-legal specialist is daily basis as long as they are involved in gathering information so as to provide active practice. The short-term and long-term evidence to courts of law in the form of impacts of this on the doctor’s psychological documents and verbal evidence. There are well-being as well as the defence legal as well as customary restrictions mechanisms in operation in the -set of towards a wide array of other forms of the doctor (such as dissociation) and the communication and contacts with the long-term personality and behavioural

Sri Lanka Journal of Forensic Medicine, Science & Law-May 2015-Vol.6 No.1

22 implications upon the doctor are much under- Moulding of characters and developing researched. life-skills

Unless the practitioner employs his common All doctors deal with human life in different human wisdom as well as the experience he aspects, stages and forms. Forensic has gained over the years to measure the right practitioners deal with legal aspects of amount of human response that should be human life mostly merged with the quality, ideal for the occupational demands in freedom and dignity of life. Unless the relation to the challenging situation before practicing doctors are appropriately trained him, he may be emotionally overwhelmed by in such as the desired method of sympathy and over react to the situation to reacting in front of the patients, bereaved the extent that his evidence and opinion will relatives and other concerned parties, the be biased and un impartial1,4. On the other overwhelming reactions to emotions (not hand, if he under-reacts in apathy and only sympathy and empathy but also , indifference, not only that his client -dead or , and repulsion at times) alive- will not receive the bare minimum of would make the practitioner trespass the his due but also the investigative process may professional boundaries7. This experience become deficient and incomplete. should be gained during formal post- Being less sensitive to an incident may be graduate training and it is the responsibility due to varied reasons. Lacking in awareness, of the supervisors to assess the degree of knowledge, experience or skills to overcome acquisition of skills in this aspect. the situation would make one lethargic towards an incident. This does not imply an abnormal behaviour. However it is CONCLUSION AND important to care for the people in front of RECOMMENDATIONS you and do the needful without getting personally and emotionally attached or Novice practitioners in the field of forensic detached. medicine may encounter many cases where they are psychologically entangled with the Boundaries in between empathy and emotions of the examinees and the kiths and sympathy at times may be blurred. Yet, the kins of the deceased. Such encounters may doctor must maintain the objectives of his tarnish professional image as well as lead to professional duty consciously, rather than complexities in personal life. In the long run, merging with the emotions under the “wrong over-reacting as well as under-reacting to impression” that he perceives the situation patient’s emotions will have a negative accurately. This emotional labiality may impact upon the field. It is not easy to lay drive a doctor into troublesome and guidelines as to how much to react in a given unprofessional pathways. In extreme cases it setting. How much is too much and how might lead to personal sympathetic much is too little has to be clearly judged by relationships with the patients or relatives, the practicing doctor using common wisdom which is considered highly unethical. Co- and past experience. Only then will the client dependency and professional burn-outs are either alive or dead will be able to experience other undesired consequences of being the broadest sense of real natural justice. emotionally labile5,6.

Sri Lanka Journal of Forensic Medicine, Science & Law-May 2015-Vol.6 No.1

23 REFERENCES

1. Elliot M. Hirsch MD, Illuminating the art of 5. Decety, J; Michalska, KJ (2010). medicine, Virtual Mentor. June 2007, "Neurodevelopment changes in the circuits Volume 9, Number 6: 423-427 underlying empathy and sympathy from childhood to adulthood". Developmental 2. Lishner D A. Baston C D. Huss E. Science 13 (6): 886–899. Tenderness and Sympathy-Personality and Social Psychology Bulletin 2011, 37 (5),614- 6. Melody Beattie, Beyond Co-dependency: 625 And Getting Better All the Time., Hazelden, 2013 3. Narcissistic – Diagnostic and Statistical Manual of Mental 7. MaibomHL, Empathy: Philosophical and Disorders Fourth edition Text Revision Psychological Perspectives, edited by Amy (DSM-IV-TR) American Psychiatric Coplan and Peter Goldie. Mind (2014) 123 Association (2000) (491)

4. Bellet, Paul S., and Michael J. Maloney (1991). "The importance of empathy as an interviewing skill in medicine". JAMA 226 (13): 1831–1832.

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