Compassion in Medicine and Healthcare

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Introduction

With scientific and technological progress, the mechanistic approach began to dominate the human touch in modern health care. Following the principles of mind-body dualism, most physicians are inclined to focus on the diseased body and its physiological mechanisms, disregarding the patients’ suffering and psychological conditions. Compassion needs to be reintroduced into modern health care practice for humanizing biomedicine and improving the quality of the provided health care services.

The moral of Christ’s parable about the Good Samaritan

Christ’s lessons about the Good Samaritan can be regarded as an example of human compassion which should be followed by everyone and especially healthcare providers who need to serve the best interests of their patients.

The discussed parable about the Good Samaritan who took care of the victim’s wounds was Jesus’ answer to a question concerning our neighbors. Through Christ’s parable does not answer the question directly, it teaches people how they should behave like neighbors. This lesson is especially valuable for healthcare providers who have the moral obligation to act by the patients’ best interests.

However, in contrast to the man lying on the side of the street whose needs were obvious to the passing Good Samaritan, modern physicians may have difficulties with understanding the needs of their clients. With the pluralism of modern society, morality is the matter of personal preference and most individuals have become moral strangers and black boxes to each other (Welie 1995, 476). Thus, analyzing the application of black-box anthropology for establishing the relationship between healthcare providers and their patients, it can be stated that the principle of distancing to show respect for the patient’s privacy as the primary principle of modern healthcare contradicts the moral of the discussed parable.

Disregarding the present decline in people’s ability to feel compassion, sharing the patients’ feelings and establishing the interpersonal rapport with them is necessary for modern healthcare providers for acting beneficently.

Various definitions of the concept of compassion

Though the concept of compassion has various definitions that make its meaning rather controversial, healthcare practitioners should nurture their ability to feel compassion as one of the greatest virtues.

Analyzing the etymology of the word “compassion”, it can be stated that it originates from the Latin “co-pati” which means “suffer with” (Thomasma and Kushner 1995, 416). The element of suffering which is bad adds shades of a negative meaning to the concept of compassion. However, taking into account its antonyms, including cruelty, indifference, hard-heartedness, it can be logically assumed that compassion is attractive at least by contrast (Comte-Sponville 2009).

By the way, the word sympathy as the synonymic doublet for compassion in modern Romance languages means “fellow feeling” which can be regarded as the more appropriate translation for compassion as well. In general, the definitions of compassion can be divided into two basic subgroups, including those which present compassion as an individual’s ability and willingness to understand person’s suffering by entering deep into his/her situation and those which define compassion as a virtue of willing to alleviate another person’s suffering if it is possible (Dougherty and Purtillo 1995, 427).

Most theoreticians treat the word compassion either as a feeling or as the moral principle and the greatest virtue of humanity. In that regard, the individual cannot be forced to feel compassion, but he/she can nurture their ability to enter the world of another person which would be especially beneficial for medical workers who need to gain knowledge on the best interests of their patients before serving them.

Compassion and medicine

The concept of compassion plays an important role in modern healthcare and has been incorporated even into the official AMA principles of Medical Ethics, saying that a physician has to provide healthcare services with compassion.

Humanizing biomedicine has become the central issue of the modern healthcare industry aimed at overcoming the current quality-of-care crisis. The shift from a mechanistic approach to healthcare in the form of logos (rationality) towards medicine based on pathos (passion) is suggested as a solution for improving the quality of modern Western medicine (Marcum 2008, 399).

Then, instead of using a solely mechanistic approach and viewing the patient’s diseased body as an object, a humane practitioner not only focuses on the inner bodily structure but also empathizes with the patient and takes into account his/her experience of suffering. In that regard, the traditional goals of modern medicine have been updated and complemented with the professional objectives to relieve patients’ suffering from maladies and care for those who cannot be cured for preventing premature death and ensuring peaceful death (“An International Project of the Hastings Center: The Goals of Medicine: Setting New Priorities”).

Integration of compassion as the basic principle of healthcare not only into official manifestations but also into educational programs and professional practice is required for humanizing modern biomedicine and improving the quality of healthcare services.

Compassion and the patient with chronic illness or the dying patient

Disregarding all the benefits of compassion for providing high-quality healthcare services, the issue concerning empathizing patients in all cases as a great challenge and a source of pressure is rather controversial.

In most cases, suffering is subjective and cannot be identified with bodily pain only (Van Hooft 1998). On the one hand, the bodily disease cannot be separated from the overall patient’s condition and modern medicine obtains a more extended view of its mission than mere treatment of physical diseases (Cassell 2004). On the other hand, in particular, situations, when the patients’ claims do not belong to the domain of medicine and cannot be solved through the implementation of healthcare intervention strategies, the doctor should draw the line. For example, the problems of managing the meaning of life and death cannot be handled through medical interventions (Callahan 2004, 101).

There are two levels of human suffering, including those of uncertainty of an ill person if he/she will be able to cope with the disease and the second level which touches upon the links between suffering and the meaning of life itself. Though the struggle against aging and death is a utopian idea, patients’ thoughts about the meaning of life and death can make patients suffer (Callahan 2009). This second level of suffering involves the solution of philosophical and religious issues which are more fundamental than psychological problems, and the physician’s interference into this level would be inappropriate.

Though relieving the suffering of dying patients is one of the central objectives of modern healthcare services, the medical workers cannot handle the issues which are outside the medical domain. It can be stated that compassion can be irrelevant in certain cases with dying patients or patients who have chronic diseases when the problems go beyond the physician’s competence.

Compassion and the physician: a virtue or a duty?

Disregarding the ethical aspect of compassion and taking into account its importance for improving the quality of modern health care services, it should become a duty of every physician.

The main argument which can support the claim that compassion should become every physician’s duty instead of a preferred virtue or an elective element of the physician-patient relationship is the strong link between compassion and physicians’ professional responsibilities (Dougherty and Purtillo 1995, 429). The changes in healthcare educational programs and medicine paradigms need to foster compassion as a part of physicians’ professional duty.

Compassion and ethics

Despite all its benefits and the fact that compassion should be made a part of physicians’ professional duties, it can conflict with other professional responsibilities of an individual physician. For example, compassion to one patient can become a hurdle for identifying and satisfying the needs of other clients. The same goes for the ethical issue of preserving the confidentiality of the patient’s information. In their professional practice, physicians make decisions concerning the appropriateness and usefulness of certain intervention strategies. However, in hard cases, when physicians regard the further treatment as useless, the decision to stop treatment is a real ethical dilemma (Chwang 2009). In general, compassion may require different conduct in various situations and cannot be identified with the rest of the physicians’ professional duties.

Characteristics of a compassionate physician

The main characteristics of a compassionate physician include the ability to obtain a humane gaze upon their patients and take into account the experience of suffering for providing high-quality health care services. A compassionate physician can establish interpersonal rapport with patients, obtain knowledge on their experience of suffering including not only physical but also psychological pain and find the most appropriate strategies for alleviating the patients’ suffering.

Another significant side is the prevention of futile treatment, taking into account the following patients’ disillusionment. Thus, in case if the treatment is not likely to work, a compassionate doctor will never prescribe it (Ten Have and Janssens, 2002, 213). Recognizing compassion as a significant element of their professional duties, compassionate physicians manage to reach a compromise between their empathy with an individual patient and the rest of their professional duties and use rational consideration for making the most appropriate professional decisions.

Benefits of compassion

Integration of compassion as one of the significant physician’s duties into the modern health care paradigm would be beneficial for humanizing biomedicine and improving the quality of the provided services. Compassion can provide a source of motivation for alleviating the patients’ suffering (Crisp, 2008, 245). Recognizing the fact that psychological conditions can have a significant impact on the patient’s overall well-being, physicians cannot separate mental suffering from the patients’ bodily pain. The main advantage of compassion for modern medicine is an opportunity to extend the mechanistic biomedical approach by taking into account the aspects of the patients’ feelings and implementing a complex approach to treatment.

Barriers to compassion

Though the benefits of making compassion one of physicians’ professional duties may seem obvious, there are certain barriers to implementing this approach in healthcare practice. First of them is the perception of compassion as a source of suffering for physicians and their natural willingness to avoid it. However, rejecting compassion, physicians deprive themselves of opportunities to develop their professional skills and see the gratitude of their clients because the interpersonal rapport is responsible for not only negative but also positive implications. “They will miss the experience of human openness and vulnerability and the chance to experience unconditional love and the power of human connection” (Connelly, 2009, 386). Physicians need to overcome the barriers to compassion for implementing a complex approach to treatment and improving the quality of healthcare services.

Teaching of compassion

Taking into account the fact that the inability to feel compassion and share emotions can harm not only physicians’ competence but also their well-being. Not responding to suffering and not acknowledging their emotions, physicians put at risk not only the quality of healthcare but even their wellbeing (Connelly, 2009, 386). It explains the importance of teaching compassion. The doctor-patient interpersonal relationship presupposes a high level of confidentiality and vulnerability. For this reason, the teaching of compassion and developing skills of finding rational consideration for selecting the most appropriate strategies are recognized as lifetime learning. Learning to recognize their emotions and respond to suffering is significant for improving the quality of healthcare services and physicians’ well-being.

Conclusion

In general, taking into account the drawbacks of the mechanistic approach to treatment and the integrity of physiological and psychological processes, it can be concluded that compassion should be reintroduced into healthcare educational programs and practice. As one of the physician’s professional responsibilities, compassion requires different conduct in various situations and rational consideration for selecting the most appropriate intervention strategies for improving the quality of the provided services as well as physicians’ wellbeing.

Reference List

“An International Project of the Hastings Center: The Goals of Medicine: Setting New Priorities”. Hastings Center Report 26(1996): S 1-27.

Callahan, Daniel. “Death, mourning, and medical progress”. Perspectives in Biology and Medicine 52(2009): 103-115.

Callahan, Daniel. The Troubled Dream of Life: In Search of a Peaceful Death. Georgetown University Press, 2004.

Cassell, Eric. The Nature of Suffering and the Goals of Medicine. New York: Oxford University Press, 2004.

Chwang, Eric. “Futility Clarified”. Journal of Law, Medicine & Ethics 2009: 487-495.

Comte-Sponville, André. “Compassion”, in Comte-Sponville, André. A Small Treatise on the Great Virtues. New York: Henry Holt & Company, 2001: 103-117.

Connelly, Julia. “The Avoidance of Human Suffering”. Perspectives in Biology and Medicine 52(2009): 381-391.

Crisp, Roger. “Compassion and Beyond”. Ethical Theory and Moral Practice 11 (2008): 233-246.

Dougherty, Charles and Ruth Purtilo: “Physicians’ Duty of Compassion”. Cambridge Quarterly of Healthcare Ethics 4 (1995): 426-433.

Marcum, James. “Reflections on Humanizing Biomedicine”. Perspectives in Biology and Medicine 51 (2008): 392-405.

Ten Have, Henk and Rien Janssens. “Futility, Limits and Palliative Care” in Ten Have, Henk and David Clark (eds.): The Ethics of Palliative Care. Buckingham: Open University Press, 2002.

Thomasma, David and Tomasine Kushner. “A dialogue on Compassion and Supererogation in Medicine”. Cambridge Quarterly of Healthcare Ethics 1995: 415-425.

Van Hooft, Stan. “The Meanings of Suffering”. Hastings Center Report 28(1998): 13-19.

Welie, Jos. “Sympathy as the Basis of Compassion”. Cambridge Quarterly of Healthcare Ethics 4 (1995): 476-487.

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