Compassion is defined as the act of empathizing with someone to the point of suffering with him or her (Comte-Sponville 2001, 103; Thomasma and Kushner 1995, 415). Suffering on the other hand is defined as “the most profound and disturbing of human experiences…” (Hooft 1998, 13). More profoundly, Cassel (2004, 32) defines it as “the state of severe distress associated with events that threaten the intactness of a person.”
As such, most human beings detest suffering and any action that may lead to it. Considering the link between compassion and suffering, it is understandable that some healthcare providers deliberately chose to remain aloof, distant, hard-hearted, and even indifferent patients. To such healthcare providers, treating patients with indifference shields them from sharing in their patients’ suffering.
Suffering poses a threat to human hope and happiness especially when the affected person feels degraded or alienated. Specifically, the suffering that comes with terminal illnesses has a potential to make people feel abandoned and uncared–for (Cassel 1982, 639). Luckily, the palliative care movement introduced the notion of compassion in healthcare, and as a result, health workers now understand that painless living is just as important to the terminally ill as it is to those who have treatable illnesses (Callahan 2009, 105). The challenge in integrating compassion in healthcare comes with the medics’ knowledge that they too must share in the patients’ suffering if at all they will succeed in providing compassionate care for the ailing (Comte-Sponville 2001, 105; Connelly 2009, 383).
Having established that human beings naturally detest suffering, how then are healthcare providers expected to be compassionate seeing that such an action would require them to share (at least emotionally) with their patients’ suffering? Well, Cassel (1991, 3) suggests that attending to patients’ emotional and physical needs would be a good starting point for compassionate healthcare provision.
In fact, Cassel (1991, 3) argues that in an attempt to offer healing solutions to the sick, medicine and healthcare has repeatedly erred by separating the ailing physical being from the emotional aspect of the patient. Cassel (1991, 3) argues that the reliance of science and technology in medicine and healthcare has rendered medics indifferent towards the emotional needs of the sick, often concentrating on medical solutions targeting the body.
In their pursuit to save more lives and extend the lives of the terminally ill through scientific and technological means, medics often ignore the feelings, needs, and opinions of the ill. Failing to acknowledge or even share in the patients’ sentiments only drive away compassion from healthcare provision. When dealing with the terminally ill, such lack of compassion by the medics can threaten the “intactness of the person as a complex social and psychological entity” (Cassel 1982, 640).
Callahan (2009, 106) observes that people who face death, but are unable to accept the fact that their demise is nigh, suffer from physical pain as well as psychological distress. The quality of their remaining life can however be enhanced by compassionate healthcare workers since they identify with the physical and psychosomatic pressure that patients undergo, and are therefore more willing to adjust healthcare provision to suit the patients’ emotional and physical needs.
Accomplishing goals of medicine and healthcare when handling the terminally ill patients requires dedication, patience, and counseling for the health workers. The latter is necessary because it has been proven that health workers who experience too much suffering in the course of their job tend to develop resistance towards the same. The mind has a way of protecting a person against too much suffering (Hooft 1998, 16).
As such, the hardhearted, indifferent, or even ignorant attitude that some healthcare workers put up, is an unconscious self-defense mechanism instituted by the mind to shield the person from the effects of everyday suffering witnessed in healthcare facilities (Hooft 1998, 16). While it would shield the healthcare workers from emotional suffering, the uncaring attitude would no doubt make the terminally ill feel alienated or unappreciated.
If Comte-Sponville’s (2001, 105) definition of compassion is anything to go by, healthcare workers cannot avoid participating in their patients suffering, if at all they (healthcare workers) chose to be compassionate. Notably, even an ounce of mercy is enough to make a healthcare worker regard patients with consideration thus viewing them as living beings, rather than ‘things’ or ‘items’. According to Crisp (2008, 244) compassionate people refuse to regard suffering with indifference or human beings as items; instead, they consider being merciful, compassionate and considerable towards the suffering a moral obligation that they must uphold (Chwang 2009, 494).
Compassion in healthcare can also be understood for what it does not represent. Comte-Sponville (2001, 106) for example argues that , “compassion is the opposite of cruelty…and of egoism…” As such, a compassionate healthcare provider will treat patients without resorting to cruelty, and will cut all egoistic tendencies by being gentle and caring to the suffering.
In order to understand compassion in relation to goals of medicine and healthcare however, one would need to identify just what the goals of medicine and healthcare are. Payne(2003, 18) identifies the goals of healthcare as diagnosing the disease that a patient has, and managing the medical condition in order to either treat it, or relieve the pain where treatment cannot be attained. As such, medics have a professional, ethical, and social responsibility to save lives, and/or help patients attain quality living even where treatment is not possible. The diagnostic stage does not require much compassion since all the medics have to do is understand the cause of a health problem.
The disease management stage however, calls for more compassion from the medics since it is their responsibility to do everything in their power to save or extend the life of a patient through medicine. Where treatment is not possible, the medics do everything in their capacity to relieve the patient’s suffering in order to help them attain a pain-free extended life (Dougherty and Purtilo 1995, 427). Payne (2003,19) specifically points that if a medic cannot provide treatment to a patient under his/her care, he or she has a responsibility to “1) relieve suffering, 2) prognosticate (including reassure), 3)rehabilitate, 4) prevent further illnesses, injury or further deterioration, and 5) do research”.
Swick (2000, 614) holds the opinion that compassion in medicine and healthcare is only possible to those healthcare practitioners who perceive the medical professional not only as an occupation, but a calling too. Specifically, Swick (2000, 614) states that compassion is among the humanistic values that physicians need to uphold in order to be truly effective in meeting their professional goals. While technical expertise enables the medics to offer the right diagnosis about health conditions, it is the ethical sensitivity and the awareness about the suffering affecting the emotional being, that invoke compassionate deeds in a medic (Welie1995, 485).
Managing patients successfully either through giving them the right treatment or managing pain in terminal cases requires medics to set professional behaviors that strive to give patients the best possible care. Interestingly though, Chin (2001, 585) observes that in some cases, and in the quest to give patients the best care, medics have to give up some legitimate self-interests. For the compassionate medics, such sacrifices fit into an ethical system that transcends what the law and duty requirements demand. To the uncompassionate medics however, any calling to be enjoined in the patients suffering is easily dismissed as “naïve and idealistic” (Chin 2001, 585).
For patients who know that death will beckon them sooner than later, Callahan (2000, 11-23) outlines steps that they should take in order to prepare for a peaceful death. Throughout Callahan’s book, it is evident that the role of compassionate healthcare providers is essential. The medic’s roles range from the scientific-technical ones like regulating euthanasia, to the ethical-moral roles like helping patients master the medical choices available to them. Regrettably, Callahan (2000, 188) notes that medicine tries too hard to lengthen life and improve its quality, to the point of ignoring that death is the “end point of medical care.”
A major disadvantage posed by such ignorance is the fact that in the process, the dying person is denied a chance to have a peaceful death through what Callahan (2000, 192) terms as “deforming the process of dying.” Callahan (2000, 192) argues that when the dying process is interfered with through scientific and technological interventions, the dying self is deformed. This happens because the interventions sometimes fail to provide a cure, hence prolonging the patients’ physical and emotional suffering. Callahan (2000, 192) also argues that family and friends of the dying share in his or her pains through watching the prolonged suffering. When such is the case, dying peacefully is almost unattainable.
Conclusion
Though the concept of peaceful death may vary, most people would rather die sooner than prolong their suffering even where no hope exists for their recovery. Describing his own take on peaceful death, Callahan (2000, 195) identifies several things that would make the ultimate peaceful death experience to him. Standing out in his pointers is his desire to be treated with sympathy and respect, and to uphold his spiritual and physical dignity to the very end.
It is notable that Callahan’s or any other person’s desire for a peaceful death can only be granted by compassionate medics, who are willing to understand the reasoning behind a patient’s wishes. An indifferent clinician would instead pursue scientific and technological interventions in medicine, only allowing death to take over when all the interventions have been exhausted. Such ambition by the medics not only deny the patient’s wishes for an honorable, dignified, and peaceful death, but could also expose the patient to prolonged physical and emotional suffering.
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