requiring that institutions have a process in place to disclose unanticipated outcomes to patients and families, has been in effect since July 2001. The initial reaction of the medical community ranged from a full embrace of the standard to circumvention. In 2002, JCAHO issued a new interpretation of the intent of standard RI.1.2.2. At a minimum, the patient and, when appropriate, the patient’s family are informed about outcomes of care that the patient (or family) must be knowledgeable about in order to participate in current and future decisions affecting the patient’s care, and unanticipated outcomes of care that relate to sentinel events considered reviewable by the Joint Commission. The responsible licensed independent practitioner (LIP) or his or her designee

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which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. One of the major tasks of medical educators is to help maintain and increase trainee empathy for patients. Yet research suggests that during the course of medical training, empathy in medical students and residents decreases. Various exercises and more comprehensive paradigms have been introduced to promote empathy and other humanistic values, but with inadequate success. This paper argues that the potential for medical education to promote empathy is not easy for two reasons: a) Medical students and residents have complex and mostly unresolved emotional responses to the universal human vulnerability to illness, disability, decay, and ultimately death that they must confront in the process of rendering patient care b) Modernist assumptions about the capacity to protect, control, and restore run deep in institutional cultures of mainstream biomedicine and can create barriers to empathic relationships. In the absence of appropriate discourses about how to emotionally manage distressing aspects of the human condition, it is likely that trainees will resort to coping mechanisms that result in distance and detachment. This paper suggests the need for an epistemological paradigm that helps trainees develop a tolerance for