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Kindness, Not Compassion, in Healthcare

Published online by Cambridge University Press:  01 July 2009

HALLEY S. FAUST
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Abstract

“Dissecting Bioethics,” edited by Tuija Takala and Matti Häyry, welcomes contributions on the conceptual and theoretical dimensions of bioethics.

The section is dedicated to the idea that words defined by bioethicists and others should not be allowed to imprison people's actual concerns, emotions, and thoughts. Papers that expose the many meanings of a concept, describe the different readings of a moral doctrine, or provide an alternative angle to seemingly self-evident issues are therefore particularly appreciated.

The themes covered in the section so far include dignity, naturalness, public interest, community, disability, autonomy, parity of reasoning, symbolic appeals, and toleration.

All submitted papers are peer reviewed. To submit a paper or to discuss a suitable topic, contact Tuija Takala at tuija.takala@helsinki.fi.

Type
Dissecting Bioethics
Information
Cambridge Quarterly of Healthcare Ethics , Volume 18 , Issue 3 , July 2009 , pp. 287 - 299
Copyright
Copyright © Cambridge University Press 2009

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References

1. Advertisement for Allina Hospitals and Clinics, JAMA 2006;296(1):125.

2. See, for example, Methodist Hospital in Houston, Texas (“Statement of Values”): “Compassion—We embrace the whole person and respond to emotional, ethical and spiritual concerns as well as physical needs.”; available at http://www.methodisthealth.com/cgi-bin/hmdim/home/basic.do?channelId=-1073829781&contentId=536884147&contentType=GENERIC_CONTENT_TYPE (last accessed 19 Jul 2006); The Hospital for Sick Children in Toronto Values statement: “Excellence … in compassionate family-centred care and service”; available at http://www.sickkids.ca/abouthsc/section.asp?s=Who+We+Are&sID=11873&ss=Vision%2C+Mission+%26+Values&ssID=231 (last accessed 24 Jul 2006); Beth Israel Deaconess Medical Center in Massachusetts: “Our expert staff provides care that is compassionate, personal, and respectful of patients and their families.”; available at http://www.bidmc.harvard.edu/sites/bidmc/search.asp (last accessed 19 Jul 2006).

3. Beauchamp T, Childress J. Principles of Biomedical Ethics, 5th ed. New York: Oxford University Press; 2001:166–9.

4. Pellegrino ED. Toward a virtue-based normative ethic for the health professional. Kennedy Institute of Ethics Journal 1995;5(3):253–77.

5. Such terminology is often used in other aspects of our lives; for example, we might enter a stark, unadorned office lacking pictures on its white walls and state it has a “clinical” feeling, meaning it is devoid of warmth or friendliness.

6. Kahn MW. “Etiquette-based medicine.” New England Journal of Medicine 2008;358(19):1988–9.

7. We certainly can be beneficent to people not in need—we can send them an unsolicited and unexpected birthday present or generously give them unsolicited tickets to a concert—just because we know they would like that, even though they are unneeding and sometimes even undeserving. Although this type of considerate or generous act is benevolent, it is not usually an act expected or encouraged within the realm of the healthcare setting.

8. Nussbaum M. Upheavals of Thought, The Intelligence of Emotions. New York: Cambridge University Press; 2001:301.

9. Aristotle, Rhetoric, Book 2 1385b12–1386a3. Chicago: Encyclopedia Brittanica; 1990.

10. See note 8, Nussbaum 2001:309.

11. Later in her book, Nussbaum implies that a sustained commitment to action, even if not possible, is an important component of compassion. She takes up the objections to compassion, one of which is the momentary desire to help without the prolonged effort needed to effect change. She concedes to this concern: “People can all-too-easily feel that they have done something morally good because they have had an experience of compassion—without having to take any of the steps to change the world that might involve them in real difficulty and sacrifice” (see note 8, Nussbaum 2001:399).

12. Solomon RC. In Defense of Sentimentality. New York: Oxford University Press; 2001:55 (italics added).

13. I am avoiding the often disdainfully stated controversy of whether we can or should “blame the victim” for significantly contributing toward his own illness. The politically correct view is not to do so, though I believe there certainly can be justification for blaming someone where they have persisted in habits that they know substantially contribute to the cause of their disease.

14. Gillon R. Toleration and healthcare ethics. Cambridge Quarterly of Healthcare Ethics 2005;14:100–6.

15. Thanks to Kelly Sorenson for this observation.

16. Or, as Kelly Sorenson suggested in a review of a draft of this paper, suppose I'm a male gynecologist.

17. See, for example, Chen SM, McMurray A. “Burnout” in intensive care nurses. Journal of Nursing Research 2001;9(5):152–64.

18. See note 9, Aristotle, Book 2 1385b12–1386a3.

19. Clark CC. In harm's way: AMA physicians and the duty to treat. Journal of Medicine and Philosophy 2005;30:65–87.

20. See note 8, Nussbaum 2001:374.

21. In some cases “charitable” care might be used to mean “providing care with love” or “from the heart” (caritas). Including the term “charitable” in mission statements would, most likely, produce the same objectionable issues as I posit for using “compassion.”

22. See, for example, Brady P. Center blasts hospitals' debt collection policies. Yale Daily News, 17 Nov 2003; available at http://www.yaledailynews.com/Article.aspx?ArticleID=24152 (last accessed 27 Sep 2006).

23. See note 8, Nussbaum 2001:302.

24. Hurka T. Virtue, Vice, and Value. New York: Oxford University Press; 2001:106.

25. Walker ADM. Virtue and character. Philosophy 1989;64(249):349–62.

26. See note 6, Kahn 2008:1988–9, wherein he claims that, “I may or may not be able to teach students or residents to be curious about the world, to see things through the patient's eyes, or to tolerate suffering. I think I can, however, train them to shake a patient's hand, sit down during a conversation, and pay attention. Such behavior provides the necessary—if not always sufficient—foundation for the patient to have a satisfying experience.”