1. The ideas and arguments presented in this article have been worked out in greater detail in the author's doctoral dissertation In the Face of Suffering. Prolegomena to a Philosophical Foundation of Clinical Ethics (1994, 350 pp., paperback, Dfl. 40,00 or US$ 25.00 + postage) can be ordered by contacting Drs. Marian Poulissen, Dept. of Ethics, Philosophy & History of Medicine, Catholic University of Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, Netherlands, fax: +31 80 540254; or by contacting the author in the United States: Dr. Jos V.M. Welie, tel.: 305–424–9304.
2. Engelhardt, HT. Bioethics and Secular Humanism: The Search for a Common Morality. London/Philadelphia: SCM Press/Trinity Press International, 1991:xiv.
3. I will use the Greek term sympathy (which literally means the same as the Latin word compassion) to indicate this anthropological as opposed to moral quality. I use it in the literal sense of feeling together, feeling along with another human being, sharing a particular awareness or expe rience, etc. This philosophical understanding of sympathy, then, has less of an emotional connotation than would be common in English (as in saying to the widow of a recently deceased person “Please, accept my sympathy”) as well as in other languages (e.g., in Dutch sympathie means positive affection while a sympathiek persoon is a nice person).
4. Toombs, SK. The Meaning of Illness. A Phenomenological Account of the Different Perspectives of Physician and Patient. Dordrecht/Boston: Kluwer. 1992:7–9; emphasis altered.
5. See note 4. Toombs, . 1992:xi.
6. See note 4. Toombs, . 1992:xv.
7. See note 4. Toombs, . 1992:xvi.
8. Toombs limits her account to somatic illness.
9. See note 4. Toombs, . 1992:33–7, 58–62.
10. See note 4. Toombs, . 1992:87.
11. See note 4. Toombs, . 1992:103; emphasis added.
12. See note 4. Toombs, . 1992:106.
13. See note 4. Toombs, . 1992:109.
15. Plotinus, . The Enneads [Trans MacKenna, S]. London: Faber and Faber, 1962.
16. See note 15. Plotinus, . 1962;IV:5,8.
17. See note 15. Plotinus, . 1962;IV-9–1:365.
18. Butler, J. Fifteen Sermons, V: Upon Compassion. In: Raphael, DD, Ed. British Moralists 1650–1800. Oxford: Clarendon Press. 1969:361–4; Hume, D. An Enquiry Concerning the Principles of Morals. Indianapolis, Indiana: Hackett Publishing Company, 1983; Smith, A. The Theory of Moral Sentiments. Oxford: Clarendon Press, 1976.
19. See note 18. Smith, . 1976:9.
20. Hobbes, T. Leviathan. London/New York/Canada: Penguin Books, 1987:126.
21. See note 18. Smith, . 1976:10.
22. See note 18. Smith, . 1976:11–2.
23. Smith presumes that it is possible on the basis of what seems to be an analogical inference from the external behavior of my fellow, via what I know about my own external behavior and its relationship to my own internal processes, to a conclusion about my fellow's internal processes. But this analogy is flawed because it already presumes that I know that my fellow will feel simi larly in similar situations (which presumption has yet to be proven).
24. Scheler, M. Wesen and Formen der Sympathie, 6th ed.Bern/München: Francke Verlag, 1973.
25. The term semi-fellow-feeling (which is not employed by Scheler himself) I have introduced because these two forms of fellow-feeling do not invoke in us a feeling like our fellow man's feeling, yet they do inform us about his feelings. In fact, such being informed about the nature of our fellow man's feelings according to Scheler is a necessary precondition to develop genuine fellow-feeling.
26. See note 25. Scheler, . 1973:19.
27. See note 25. Scheler, . 1973:20.
28. Again, Scheler does not use the term pseudo-fellow-feeling, but he leaves no doubt about these two forms of fellow-feeling failing to provide insight in the otherness of my fellow.
29. It should be emphasized that the use of the Aristotelian distinction between various causes is not Scheler's but my own.
30. See note 25. Scheler, . 1973:48, 50, 56.
31. See note 25. Scheler, . 1973:42.
32. See note 25. Scheler, . 1973:93–4. Scheler does not mention Plotinus explicitly, but he does discuss the commonly adhered to Greek theorem of the impossibility of dissimilar beings to relate to another without an encompassing “world soul.” According to Scheler, the surplus value of this Greek theory (over Indian philosophy as well as Schopenhauer's) is its nontotalitarian character, thus allowing for genuine sympathy. Scheler takes the emotional identification (German Einsfühlung) of the Orphean mysteries to be a romantic countermovement against the more moderate original theorem.
33. See note 25. Scheler, . 1973:76–7.
34. See note 25. Scheler, . 1973:25; note 1. Scheler blames his German contemporary Lipps (in the latter's theory of empathy, German Einfühlungstheorie) for overlooking this difference. Lipps, T. Leitfaden der Psychologie. 3rd ed.Leipzig: Verlag Wilhelm Engelmann, 1909.
35. See note 25. Scheler, . 1973:61–6. Scheler explicitly rejects a third explanation of pleasure from pain, that is, to grant suffering itself positive value.
36. See note 25. Scheler, , 1973:244; emphasis altered. A similar conclusion is reached by the French existentialist Gabriel Marcel: “[C]ontrary to those who would want to invoke analogical reasoning to account for belief in the existence of others, it must be said that I only constitute myself as interiority inasmuch as I take cognizance of the reality of those others.” Marcel, G. Présence et Immortalité. Paris: Flammarion. 1959:169; as translated by O'Malley, JB. The Fellowship of Being: An Essay on the Concert of Person in the Philosophy of Gabriel Marcel. The Hague: Martinus Nijhoff. 1966:84.
37. See note 25. Scheler, . 1973:233.
38. This I take to also be an argument in favor of the term sympathy over empathy. Different authors such as Wyschogrod (1981), Wispé (1986), Chismar (1988), and Natsoulas (1988) suggest keeping both terms. However, their various definitions of the terms, which anyway do not coincide, leave standing the suggestive nature of their literal meaning. Scheler does not use the term empathy, but he rejects all models that are based on Einfühlung (such as Lipps' theory from 1909, see note 35) for being guilty of a faulty analogy, as well as the explanation of fellow-feeling in terms of Sympathy as the Basis of Compassion Einsfühlung. Wyschogrod, E. Empathy and sympathy as tactile encounter. The Journal of Medicine and Philosophy 1981;6:25–43.Wispé, L. The distinction between sympathy and empathy: to call forth a concept, a word is needed. Journal of Personality and Social Psychology 1986;50(2):314–21.Chismar, D. Empathy and sympathy: The important difference. The Journal of Value Inquiry 1988;22:257–66.Natsoulas, T. Sympathy, empathy, and the stream of consciousness. Journal for the Theory of Social Behavior 1988;18(2):169–95.
39. See note 25. Scheler, . 1973:251.
40. See note 25. Scheler, . 1973:220.
41. Cassell, EJ. Recognizing suffering. Hastings Center Report 1991;21(3):24–31, at p. 27.
42. Cherry, C. Knowing, imagining and sympathizing. Ratio 1980;22:133–144, at p. 137.
43. Luijpen, W. Existentiële Fenomenologie. Utrecht/Antwerpen: Het Spectrum. 1964:201; emphasis added.
44. See note 39. Natsoulas, . 1988:171.
45. Contrary to Scheler, I would maintain that a good novel can only be written by a sympathic novelist rather than by one who is merely feeling along.