Care and Compassion

By Steve Fouch

read : Care and Compassion (Part 2)

Care/Cure Split
Before the 20th Century in the West, the notion of care and cure went hand in hand, principally because medicine was limited in the illness and injuries where effective cures and treatments were available. As a consequence, often the best and only treatment in many instances remained compassionate care that enabled the body to heal itself, or allowed for the minimisation of suffering in instances where no cure was possible. Edward Trudeau, the pioneer of TB treatment in the 19th century said that the aim of medicine was ‘to cure sometimes, to relieve often, to comfort always’.

At the same time, for most of Western history, religion, science and medicine were not separate disciplines, but were all seen as part of accessing divine knowledge. As Francis Bacon put it: ‘God has, in fact, written two books, not just one. Of course, we are all familiar with the first book he wrote, namely Scripture. But he has written a second book called creation.’16 However, natural philosopher in the 17th and 18th centuries and early scientist in the 19th and 20th centuries began to use principle of observation and experimentation, so a lot of earlier learning about the natural world moved from ancient texts to what we now call the scientist method of observation, hypotheses, experimentation and theory. The shift in thinking during the 18th century Enlightenment towards more scientific models of medicine was part of a revolutionary change in Western thought that divorces the arts and humanities from the sciences.17

At the same time the caring component of medicine began to be seen as secondary to the curative. Whereas in medieval and Renaissance Europe, both male and female were involved in caring and curing, medicine now became almost exclusively male and nursing almost exclusively female – the former seen as objective and scientific and increasingly high status, the latter as of lower status and the provenance of women of ‘poor repute’. Nightingale and the Lutheran Deaconess movement did much to raise the status of nursing, but it was still seen as subordinate rather than complementary to medicine.

The ironic consequence is that as medicine has become more able to treat a widening range of illness and traumas successfully, so there has been a shift in emphasis away from care and compassion towards technical care, Our health system has subsequently become very good at ‘Transactional Care’ – the technical provision of treatment for illness and injury – often employing complex technology, surgical techniques and pharmacology with great precision and efficacy. ‘Relational Care’ – the interpersonal, human interactions that expresses care and compassionate concern for the individual in their suffering and treatment has become less and less prioritised in practice. Both are essential to effective medicine, but as technology and technical skill are more measurable and more highly valued, the focus tends to be on the transactional rather than the relational.18

At the same time, the increasing business orientation and market driven approach to health service delivery in much of the West has been seen by many as the source of a drive towards the measurable (and therefore, costed and chargeable) over the unquantifiable (and thus of no monetary or market value)19.

There is also evidence that the very process of training doctors seems to militate against compassion and empathy, especially once trainee doctors begin their clinical placement.20 So medical training and the structure of the health service and its underlying value system seem to be set against compassion being developed or practised in the modern health service.

More and more research and commentary suggests that this loss has been to the detriment of patient care. As an earlier CMF File21 has pointed out, meeting the emotional and spiritual needs of patients has a significant impact on recovery and prognosis, and a failure to address them can lead to poorer clinical outcomes. Compassion should be an integral component of cure, not an optional add-on.

Compassion as a Christian Virtue
Anne Bradshaw, senior lecturer in nursing at Oxford Brookes Faculty of Health and Life Sciences, states that:

Throughout nursing history, compassion has been viewed as a quality associated with an individual’s character. Compassion stems from virtue. It is about the intent and practised disposition of the nurse. It is nurtured in, and by, the culture and ethos of clinical practice22 [emphasis added].

Compassion as a virtue is a familiar concept. Our Western understanding of virtue stems (at least in part) from the Greek notion of the virtues as principle human strengths that generate and are generated by the character of the individual. However, in Greek thinking the main virtues were mostly masculine (courage, strength, restraint, wisdom, etc.) and compassion was not regarded as one of them. Indeed if anything it was seen as a weakness in a man, and of only passing value as displayed by a woman to her family (and even positively harmful if expressed to strangers or foreigners). A virtue was not innate but was a habit of heart and mind that was developed studiously by effort over time until it became ‘second nature’. Therefore a person of virtue was very much self-made, andd one who lacked virtue had only oneself to blame.

Virtues in New Testament understanding are something quite different. Firstly, the authors of the New Testament recognised humanity’s inability to be truly virtuous. This is because the true virtue is to live sinlessly according to God’s will and purposes, something that fallen humanity is unable to achieve alone.23 To become truly virtuous is only possible as a result of inner transformation by the indwelling power of God the Holy Spirit.24 It is about a transformation of character and will, in which we play a part, but which is ultimately God’s work in us.25

As NT Wright puts it:

Christian virtue…. is both the gift of God and the result of the person of faith making conscious decisions to cultivate this way of life and these habits of heart and mind.26

Compassion (or kindness and gentleness) is seen as one of these virtues, or as the Apostle Paul puts it, part of the ‘fruit of the spirit’.27 These include qualities of character and virtue that God brings to life in us and that we then express in our lives, individually and as a community, through the power of the Holy Spirit.28

In Greco-Roman thought, compassion was an emotional response, and not a product of mind, from whence came virtue. Therefore to show compassion and kindness was merely affection – not a virtue. At best, it was a natural response to the needs of friends and family, and certainly went no further than one’s fellow countrymen.

The Bible gives us a different image, showing that compassion was part of the very character of God himself. God created a world to be good and fruitful,29 which as a consequence of the disobedience and sinfulness of humans (and angels) is now fallen. Pain and suffering are an intrinsic consequence.30 But while the nature of existence is now mixed with sorrow and pain,31 God himself shows kindness and compassion on his fallen creation and on humanity itself, supremely in sending Jesus to die and take punishment for sin so that we can be fully forgiven and become reconciled with God.32 So the healing and reconciliation to God of a hurting world can be achieved, with the final hope and expectation that there will be a new creation where suffering and pain will cease.33 The Bible speaks throughout of a God who passionately care for His creation and acts constantly out of compassion towards his people.34 Christian are called to walk in his footsteps and to display his character.35

Jesus exemplified God’s compassion in his life and teaching. He made it clear that compassion was an essential virtue, but that is was to be expressed to those outside the normal parameters of kin and close friends. Compassion was all the more a virtue when shown to the stranger, the prisoner and the outcast, and even more to those who ill-treated you, hate or even persecuted you.36 Compassion was for any and all who were in need, because in caring for them we care for Jesus himself.37

Jesus lived this out in practice. Regularly, when confronted with people in need (spiritual or physical) he has moved to compassion.38 In each case, his compassion led to action that transformed the situation.

Jesus showed compassion in its most selfless sense by choosing to lay down his life for others on the cross,39 firstly as an act that paid the price for sin and thus brought reconciliation with God, but also as an example of self-sacrifice for others, even those who hated him or did not know him.40

Christian understanding of compassion is also shaped by our understanding of the Incarnation. God himself entered into our suffering by becoming human, a servant and ultimately a condemned man who died for us.41 As John Wyatt says:

Because Jesus was a baby, all babies are special. Because Jesus was a dying man, all dying people are special.42

Jesus, by identifying with us so completely endowed our humanity with a profound dignity and worth. So it is that Christian understanding of compassion comes with a strong sense of respect for the dignity of the person in need. It is not ‘pity-love’ but ‘respect-love’, recognising the image of God in the other person. As Mother Teresa put it, ‘It is more than pity that motivates us, it is respect mingled with compassion.’

Thus in Christian thought compassion becomes one of the highest virtues. It expresses the very heart and actions of God himself, being a God-given quality that sees value and dignity in every human being made in the image of God. It also seeks ti imitate Jesus by meeting the need of the other person as an expression of both service and worship of God. It was this that spurred the early church into action caring for the poor, the dying, the disabled and abandoned infants, to the scandal of respectable Roman and Greek society.43

Read more: Care and Compassion (Part 3-End)

References

      16. Bacon. F, Pitcher J. The Essays. London: Penguin Classics, 1986 (first published 1597)
      17. MacCulloch D. A History of Christianity, The First Three Thousand Years, Part IV God in the Dock – Natural and Unnatural Philosophy (1492-1700). London: Allen Lane, 2009.
      18. Iles V, Sweeney K, Vaughan Smith J. What makes good doctors practise bad medicine? ReallyLearning.com 2009, accessed at http://bit.ly/117Dg33
      19. Gerada C. NHS doctors are under pressure to replace caring with market values, Comment is Free, guardian.co.uk, 20 October 2011 accessed at http://gu.com/p/32mqm/tw
      20. Hojat M, et al. The Devil is in the Third Year: A Longitudinal Study of Erosion of Empathy in Medical School. Academic Medicine 2009; September: 84;1182-1191. accessed at http://bit.ly/3kcY5h
      21, Bunn A, Randall D. Health benefits of Christians Faith. CMF File 44 2011, accessed at http://cmf.li/TGjxDf
      22. Bradshaw. Op cit
      23. Romans 3:21-25
      24. 2 Corinthians 3:18
      25. Philippians 2:12-13
      26. Wright NT. Virtue Reborn. London: SPCK Publishing, 2011
      27. Galatians 5:22-23
      28. Colossians 3:12-14
      29. Genesis 1
      30. Genesis 3
      31. Proverbs 14:13
      32. Ephesians 2:1-10
      33. Revelation 21:1-6
      34. eg Psalm 116 (esp. v4-9); Isaiah 30:7-9
      35. Ephesians 5:1,2; 1 John 2:6
      36. Luke 6:27-36
      37. Matthew 25:31-46
      38. eg Mark 8:1-8; Luke 7:11-15
      39. John 10:14-18
      40. Romans 5:6-8
      41. Philippians 2:1-11
      42. Wyatt J. Matters of Life and Death. London: Inter-Varsity Press. 2009:78
      43. Davey F. Introduction to Heralds of Health, Browne, Davey & Thompson Eds. London: Christian Medical Fellowship, 1985:1-16

Christian Medical Fellowship (CMF) Files No. 50, 2013