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Editor's Choice

Empathy or imperturbability?

BMJ 2012; 344 doi: (Published 13 June 2012) Cite this as: BMJ 2012;344:e4118
  1. Jane Smith, deputy editor, BMJ
  1. jsmith{at}

In this week’s BMJ Daniel Sokol, following Osler, commends imperturbability as an essential quality for a doctor (doi:10.1136/bmj.e3980). He advocates the “outward calm, a reassuring coolness” that inspires confidence in patients. And he contrasts it with empathy—“doctors crying in front of patients, praying with them, or displaying outward effusions of emotion.”

Both empathy and imperturbability are reflected in articles we publish this week on assisted dying, suggesting that both qualities have their place. Tess McPherson’s Personal View (doi:10.1136/bmj.e4007) about her mother’s death appeals for an empathic response: would you want to die like that? But Raymond Tallis argues that doctors’ organisations should stand back from the debate about assisted dying and adopt a neutral stance (doi:10.1136/bmj.e4115).

Tess McPherson’s mother was the general practitioner Ann McPherson, perhaps best known for her books on health for teenagers and for her research into patients’ experiences—which led to the website Healthtalkonline, a resource that helps doctors and patients to learn from those experiences. But she was also a lifelong advocate for assisted dying, because she had seen too many patients die undignified and uncomfortable deaths. As her daughter describes, Ann too died such a death. “She used her illness with incredible bravery to become a voice for terminally ill people that is rarely heard because they are ill, weak, and tired.”

Raymond Tallis is now chair of the organisation that Ann McPherson helped to set up, Healthcare Professionals for Assisted Dying. He does not argue against individual doctors expressing views about assisted dying for terminally ill people, but says that their representative bodies should stay neutral. He points out that the public strongly supports assisted dying. “Our professional organisations, committed to shaking off the paternalism of the past, should not use their influence to impose the beliefs of some of their members on patients: it is inconsistent with the idea of patient centred care.” Instead they should limit themselves to speaking on subjects where they have “an expertise that goes beyond that of the general public—for example, advising on the necessary safeguards should any law be passed.”

The BMJ’s editor, Fiona Godlee, supports this call for neutrality in her editorial (doi:10.1136/bmj.e4075), but adds that the BMJ will continue to provide a platform for the debate—exemplified this week by the letters (p 29) reacting to a previous article opposing assisted dying (doi:10.1136/bmj.e4016).

Another personal story in this issue is Darren Egdell’s account of becoming ill with herpes simplex virus encephalitis (doi:10.1136/bmj.e3630). The story he tells, with his father, is of a severe illness, despite prompt treatment, and a long and unfinished recovery dogged by behavioural changes and cognitive problems. It fits the description of the illness given by Mazen Sabah and colleagues in their Easily Missed article (doi:10.1136/bmj.e3166). They explain that the condition is often missed because of its varied presentation, but Guy Thwaites provides another reason—that encephalitis (of whatever cause) is rare and most doctors will see few cases (doi:10.1136/bmj.e3489). His editorial welcomes new management guidelines, which should help ensure that the right dose of aciclovir is given promptly to patients with Daniel’s condition. But he laments the fact that in nearly half of all cases of encephalitis the cause is unknown, and the evidence base for the guidelines is weak.


Cite this as: BMJ 2012;244:e4118


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