Care and Compassion
By Steve Fouch
While it is generally assumed that care and compassion are fundamental parts of medicine and nursing, in recent years it has become apparent that this is not always the case. A series of news stories and reports from statutory bodies over the last few years have questioned how caring our healthcare institutions and professions actually are, and showed that institutions and structures within the NHS can actually allow poor care to go unrecognised.1,2
These reports have highlighted examples of poor basic care, communication and neglect of patients,3 and in extreme cases, appalling abuse of vulnerable adults and children.4
The overwhelming professional, political and popular consensus is that compassion is an essential part of nursing and medical care5,6 and the general public and media are understandably outraged at perceived failures to care compassionately. But it is harder to define what we really mean by compassion, why it is important and how we can ensure that it is an integral part of healthcare.
The questions that this CMF File will seek to address include: What exactly is compassion? Is it innate or learnt? Why has there been a perceived increase in an uncaring attitude in care in the NHS? Why is it important And what is the Christian understanding of compassion?
What is compassion?
Compassion is not as easy to define as one might expect. One approach is to focus on the Latin roots of the word – com [from cum – with] passus [past participle of the verb pati, to suffer] – literally to ‘suffer alongside’. However, this could suggest entering into suffering of another in a manner that so overwhelms the second party that they are effectively paralysed by it. Most definitions tend to focus on this emotional understanding, but in the context of nursing and medicine it is better understood as a spur to action and an entering into the suffering and needs of another in order to understand how best to meet those needs actively. Florence Nightingale warned her nurses to let compassion be a spur to action, but not to let emotional responses to the suffering of their patients overwhelm them.7
All this suggests a strongly relational component; in other words that compassion comes out of a relationship that is built up over time. This does not preclude a compassionate response to a person in a first encounter however, so this also suggest that compassion is an attitude we take into each encounter with another person that then shapes our relationship and interactions with them.8
Therefore, a working definition could be that compassion is an attitude of active attentiveness to the needs and suffering of the other that seeks to take effective action to address that need. However, as we shall see, this is still only a partial definition, especially in light of a Christian understanding of compassion.
The roots of compassion
Recent neurological research suggest that compassionate responses to another’s physical or psychological pain involve a change in activity in the anterior insula, anterior cingulate, hypothalamus, and midbrain – all brain structures involved in emotional responses. However, there is also evidence of cortical activity on the posterior medial surface of each brain hemisphere, regions implicated in self-related processes.9 This suggests that there is more than just an emotional response, but also a cognitive effort of self-identification in the suffering of the other.
The basis for compassion (and any altruistic behaviour – putting the needs of others above one’s own needs) has long been argued in the field of evolutionary biology from the concept of ‘kin selection’. That is, we seek to put the needs of those who share the same genes as us (close family and in particular, offspring) above our own needs as this ensures our genetic line continues. This could well explain the idea of compassion when dealing with those in our immediate circles, even those not related to us (mutual care ensures the safety of both gene lines).10 However, as with most models, this is necessarily reductionist and does not adequately address altruism to those outside the immediate group, where there can be little or no chance of benefit to one’s own gene line, nor the fact that compassion towards animals is closely linked to compassion towards fellow humans.11, 12 The instinct to care is more complex in its origins than just neurobiology or preservation of genetic lines. As we shall see though, the notion of caring outside of one’s immediate group (technically, religious or otherwise) is not universal.
Is compassion innate or learnt?
There is considerable debate on this subject, particularly around whether we should select medical and nursing students on the basis of innate empathic ability and compassion (if it were even possible), or whether those qualities can be inculcated during training. Some evidence suggests that those students with a high innate empathy are more likely to be more caring and compassionate in practice.13 More recently, there has been debate about teaching compassion as part of the core curriculum in nursing training.14 This seems counterintuitive if we understand empathy and compassion to be innate personality traits, but if we understand compassion as being an attentive, practical skill rather than a purely reflexive response then it makes sense to train those already exhibiting strong empathy in the skills of practical compassion. Indeed historically, nursing in particular as a profession has always seen compassion as a quality or virtue to be developed in training, alongside the acquisition of technical skills.15
Read more: Care and Compassion (Part 2)….
- eg Healthcare Commission’s Investigation into Mid Staffordshire NHS Foundation Trust (2009) accessed at http://bit.ly/1334Gql
- Francis R. The final report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, 6 February 2018, accessed at http://www.midstaffspublicinquiry.com/report
- Triggle N. Why can’t the NHS get basic care right? BBC Online, 22 November 2012 accessed at http://bbc.in/ULONPa
- Four arrests after patient abuse caught on film. BBC News, 1 June 2011 accessed at http://bbc.in/19pxWV
- Prime Minister’s Commission on the Future of Nursing and Midwifery. Front Line Care, 2010, accessed in National Archive at http://bit.ly/hVKEsc
- Cumming J, Bennett V. Developing the culture of compassionate care; Creating a new vision for nurses, midwives and care-givers, Department of Health & NHS Commissioning Board, September 2012, accessed at http://bit.ly/QQkG6A
- Nightingale F. Notes on Nursing: What It Is, and What It Is Not. Dover Publications Inc. 1898. New impression edition, 4 May 1970.
- Davison N, Williams K. Compassion in nursing 1: defining, identifying and measuring this essential quality. Nursing Times, 14 September 2009.
- Immordino-Yang MH et al. Proc Natl Acad Sci USA 2009;106(19): 8021-8026 (12 May). Published online 20 April 2009, accessed at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2670880/
- Dawkins R. Twelve Misunderstandings of Kin Selection; Z Tierpsychol 1979; 51:184-200 Verlag Paul Parey, Berlin und Hamburg TSSN 0044-3573/ASTM-Coden: ZETIAC
- Meng, Jenia. Origins of attitudes towards animals. Brisbane: Ultravisum, 2009.
- Ascione FR, Arkow P. Child abuse, domestic violence, and animal abuse: linking the circles of compassion for prevention and intervention. Lafayette, IN: Purdue University Press.
- Magalhaes E, Costa M. Empathy of medical students and personality: evidence from the Five-Factor Model. J.Med Teach 2012;34(10):807-12.
- Davidson and Williams. Op cit
- Bradshaw A. Compassion: What history teaches us. Nursing Times 2011; 107(19,20): 12-14
Christian Medical Fellowship (CMF) Files No. 50, 2013