Survivorship and medical ethics

When psychological analyses of the encounter with death ignore consequences for moral agency, psychological coping can appear as an end in itself, rather than as a means for enhancing the morally conscientious care of patients. Functioning as a moral agent in medicine entails more than knowledge of ethical principles and appropriate use of moral reasoning. It also involves two more personal dimensions of professional life: The capacity for identification with others’ plights, and a measure of self-concern. Yet medical professionals are “survivors,” in Robert Jay Lifton’s sense of that term. Survivorship makes both identification with others and selfconcern problematic in medicine. Survivorship compromises the capacity for identification through promoting avoidance of identification, overidentification, and pseudoidentification. Self-concern is thus not only a psychological matter-an effort to cope with the emotional impact of death-but a moral obligation: the effort to heal the wounds of survivorship helps restore the capacity for identification with others that is central to moral agency.