Shame as a moral mood in medicine

Abstract

Background & Aims: The emotional underpinnings that facilitate and complicate the practice of ethical principles like respect warrant sustained interdisciplinary attention. In this article, I suggest that shame is a requisite component of the emotional repertoire than makes respect for persons possible. Materials & Methods: I use person‐centered interview data from a sample of 54 physicians (including 35 surgeons), 60% of whom are women, to examine the emergence and endurance of shame as a mood with moral significance. Drawing on anthropologist Throop's concept of a moral mood, I explore physicians’ first‐person narratives of the endurance of shame experiences. Results: Narratives demonstrate that shame inheres in biomedical contexts that reinforce the physician's responsibilization and culpability for events beyond their control. As a persistent cognitive and affective state, mooded shame is a recursive and compulsory motive force for a physician's dynamic evolution as a moral actor. Discussion: Variably distressing, looming and commonplace, mooded shame becomes an atmospheric and imaginative mode through which physicians contemplate their responsibilities and connections to patients. Sometimes in a hypercognized manner that conceals its emotional roots, physicians link the mood of shame to their incessant efforts to fulfill responsibilities to each unique patient. Conclusion: I suggest that through reflection made possible within mooded shame, physicians develop a sense of being both accountable to and alongside patients, and I explore the ties between this position and philosophical concepts of respect.

Philosophy and the clinic: Stigma, respect and shame

“…The contributions which make up this subsection Respect and Shame in Healthcare and Bioethics come from contributors to this workshop series, including Katharine Cheston 21 and Vania Smith-Oka, 22 and the section includes the contribution from Elizabeth Bromley. 20 The contributions published here ground their analyses from diverse disciplinary frameworks with a focus on the experiential aspects, particularly from shaming, shame and humiliating experiences. The articles illustrate how these experiences complicate the practice of ethical principles such as 'respect for persons' within healthcare settings.…”

“…The “Respect and Shame in Healthcare and Bioethics” Workshop Series ran in late 2021 and included scholars from various disciplinary backgrounds, who critically engaged with conceptual and phenomenological understandings of respect, disrespect and shame, and their significance to healthcare and bioethics debates. The contributions which make up this subsection Respect and Shame in Healthcare and Bioethics come from contributors to this workshop series, including Katharine Cheston 21 and Vania Smith‐Oka, 22 and the section includes the contribution from Elizabeth Bromley 20 …”

“…These important themes are developed further in this edition, which includes a special section on stigma, shame and respect. This section includes papers aimed at identifying, understanding and addressing discrimination in clinical settings 12–19 and on respect and shame in healthcare and bioethics 20–22 …”

“…This section includes papers aimed at identifying, understanding and addressing discrimination in clinical settings 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 and on respect and shame in healthcare and bioethics. 20 , 21 , 22 …”

“…This section includes papers aimed at identifying, understanding and addressing discrimination in clinical settings [12][13][14][15][16][17][18][19] and on respect and shame in healthcare and bioethics. [20][21][22] The edition opens with a number of papers that address core issues in health philosophy, which have been the preoccupation of the philosophy thematic editions of this journal for over a decade. Authors raise pertinent and challenging questions concerning our understanding of the nature of health and disease, 23,24 diagnosis and the processes of clinical decision making.…”