65 The future of empathy and care

Many people have suggested that one of the reasons healthcare has resisted the kinds of reforms that have swept through other industries in recent decades, is that it is deeply rooted in inter-subjective human experiences. But even if it were true that healthcare was more relational than other disciplines, there are still few who have ‘concluded that the professions will carry on indefinitely as they have for the past fifty years’ ^[1]. The professions, ‘are approaching the end of an era’ (ibid), that is no more secure simply because health professionals believe healthcare to be fundamentally empathic and relational.

The main reason for this is, once again, tied in with the logic of late capitalism. If, as Daniel and Richard Susskind suggest, healthcare will now be increasingly subject to the logic of ‘more for less’, alongside growing automation and innovation; new modes of personal interaction and forms of knowledge and data management; new relationships with technology, and diversified roles; routinisation (tasks becoming increasingly regular and repeatable), disintermediation (professionals losing their role as arbiters, brokers and experts), and decomposition (breaking complex work into divisible tasks and distributing these among lower-skilled workers) of work tasks; digitally-enabled labour arbitrage (the global ‘offshoring’ of work), and para-professionalisation (task encroachment by lower cost workers into work that was once held by professionals); robotics, AI and natural language processing; personalisation and mass consumerisation (personalised medicine and the consumer culture invading healthcare); new business models and forms of specialisation, then there will be few areas of healthcare practice left untouched in the coming years ^[2].

Work decomposition alone may radically reshape the nature of professional expertise. In the near future, anything that a professional currently does that can be described as a series of tasks, standardised, or explained, will, in all likelihood, be taken from the profession and given to someone, or something, that is easier to train and employ, more readily updatable (in the case of networked technologies), more reliable, and accurate. We are seeing this already with robotic surgery, radiography, and pharmacy dispensing ^[3]. But the effects of decomposition may extend beyond the loss of mundane or laborious work. To become an elite neonatal cardiac surgeon, for example, currently takes many years of training and thousands of routine operations. How will people become neonatal cardiac surgeons in the future if robots take over all of the basic components of surgery that were once an intrinsic path on the road to becoming a specialist? Decomposition, then, is as much about the ‘hollowing out’ of traditional professional pathways to expertise as it is about workplace skill mix.

Decomposition may have a particularly telling effect on professions that have traditionally depended on their technical competence, with physiotherapy being a prime example. But even if all of the technical tasks of healthcare were given to healthcare assistants and robots, many still believe healthcare will still require personal care (what the Susskinds call ‘empathy workers’) ^{[4][5][6][7][8]}.

But even here, traditional healthcare assumptions are not safe, in part because although ‘health professionals often claim exclusive license to empathy’, they ‘provide it only during the infrequent, short encounters made possible in our harried, underfunded institutions’ ^[9][10][11]. Aged care and community mental health support are telling examples of this. In localities where we encounter some of the most vulnerable people in society, it might be reasonable to expect the highest standards of personal care. But inquiry after inquiry has found that here abuse is rife, care practices are often inhumane, and even the most basic forms of caring support can be absent ^[12]

Not surprisingly, then, some have argued that even basic empathic caring might be delivered more consistently by non-human systems, like robots and online apps, that are available around the clock, never get irritable or tired, are never judgemental or stigmatising, are consistent and up-to-date. It is not difficult to imagine these replacing the poorly paid, untrained, and unskilled shift-workers currently delivering most of the personal care. As Amelia DeFalco suggests, ‘we must also move beyond the assumption that human care is the gold standard’ ^[13].

Of course, what is missing from this argument is consideration of the fundamental conditions of late capitalism that justify the shift to technological replacements in the first place. In the case of care homes, few advocates for change suggest that the problem lies with a system that encourages employers to pay wages below the poverty line for work that is often abject, emotionally and physically draining ^{[14][15][16][17]}. Care facilities are often staffed by women, and especially women of colour because it is assumed that their labour will be cheap (this kind of caring work being seen in the West as ‘natural’ labour for women). Perpetuating such gender stereotypes allows employers to offer little investment in lengthy training, and because the work is less likely to command the same prestige as the more elite professional work dominated by men, there is little perceived need to create a meaningful career structure.

By reducing costs and maximising profits for the organisation, late capitalism perpetuates the belief that disruption is inevitable, effectively masking capitalism’s atomistic and socially divisive tendencies. And advocates for human-centred healthcare are increasingly pitched against the very system that was once the safe harbour for true empathic care: a system which is increasingly turning to digital disruption to alleviate its shortcomings.