Compassion is widely recognized as a critical and fundamental element of ethical medical practice. Although this trait is not included among the four traditional pillars of medical ethics, which are autonomy, beneficence, non-malfeasance and justice, it is perhaps the most important value in the field of medical ethics and in medical clinical practice. Indeed, compassion is the first articulated principle in the American Medical Association’s standards of conduct for physicians’ honorable behavior: “A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.” Beyond ethics codes, the importance of compassion in health care is clear from its prominence within articulated principles of patients’ rights, best practice guidelines, heath care reform, and standards of quality care. Although most discussed in the context of palliative end-of-life medicine, an ethical approach in medicine requires that compassionate care standards be extended to every patient undergoing a health challenge. While prioritizing what is now known as Universal Compassionate Care in all circumstances has its complexities, it must be prioritized as a critical endeavor requiring genuine commitment from both individuals and organizations in the health care.
An ongoing debate surrounding the element of compassion in the medical ethics field includes not only what is the most meaningful and appropriate definition of the term, but also the question of whether it is the physician’s or the patient’s perspective which best informs all aspects of the concept. There is also a trend to see whether, and to what extent, standards of palliative compassionate care are applicable to all patient care scenarios. Most recently, the definition of Universal Compassionate Care in medicine has been best articulated as the suffering along with the patient, or a profound understanding of the patient’s suffering, coupled with a deep desire to alleviate that suffering. Compassion in the medical context is marked by unique deep feelings that are stirred by personal contact with a patient, an empathic understanding of the patient’s condition, and an acknowledgement that those feelings will govern care decisions. Moreover, compassion goes beyond the mere recognition or understanding of other’s suffering as an intellectual appreciation. Compassion is a profound, deeply-felt empathy towards the patient, fostering care and interconnectedness. The desire to relieve the suffering is not just an objective, it is an active wanting and striving to help the patient.
Defining compassion for the purposes of medical ethics and practice has also moved beyond the theoretical understanding of its attributes as mirroring deep empathy, to highlighting that action is a critical and paramount component. It is only recently that action has been deemed to be of crucial importance. The necessity of action as a requirement imbedded within the concept of compassion is drawn from and reflective of palliative care practices. Palliative care patients’ and care providers define compassion for the purposes of end-of-life care as “a virtuous response that seeks to address the suffering and needs of a person through relational understanding and action.” Many ethicists agree that compassion exercised for all patients must include actively working to prevent or alleviate suffering through an early identification, correct assessment, and treatment of trauma, disease or pain and other problems from all aspects, whether physical, psychosocial, sociocultural, or spiritual.
The benefits of delivering Universal Compassionate Care to all patients are proven to improve patient outcomes because compassionate care can lead to more focused treatment by physicians and an increased feeling of hope and control for patients. Patients feel heard and supported in compassionate care models, so their experiences improve, and their anxiety reduces, allowing for greater healing focus. A stronger patient-physician relationship develops with compassionate care, growing trust and bolstering a therapeutic connection which increases treatment effectiveness. Furthermore, and perhaps most significantly, compassionate care reduces health disparities and promotes health equity.
As new models and definitions of compassion continue to develop, medical ethicists have begun to focus on how to cultivate compassion in health providers and nurture those qualities in individuals who already possess these traits. Recent studies show that while traits of compassion are often inherent, they can also be influenced by experiences and can change and fluctuate over time. Healthcare leaders have started evaluating whether it is possible to increase compassionate care mindsets by employing actual training and curricula to develop compassion. Recent studies show that teaching compassion has resulted in clinicians increasing their levels of compassion and empathy towards patients, which results were measured through a variety of tools and the perspectives of both physicians and patients. Medical ethicists believe that medical schools must also take responsibility of instilling the goal of compassion in its students by having virtuous faculty serve as positive role models actually teaching what it means to be compassionate in clinical settings. Educators should be modeling what compassionate empathy looks like for students in the same way a master virtuoso instructs a novice musician. Leadership plays a crucial role in promoting a culture of compassion in medicine where compassionate care is valued and prioritized. While at times it is challenging to formulate a standardized-curricula, it is important to continue to nationally develop compassion training that is empirically based and clinically relevant to improve patient-centered healthcare delivery.
In sum, extending compassionate care standards usually reserved for palliative care circumstances to all patients is a very complex but important objective in medicine. This endeavor mandates a strong commitment from physicians and healthcare systems alike to both prioritize compassion and to train those in the health care industry to employ and promote this patient-centered value. In elevating the priority of compassion in all clinical contexts, medical care will become more patient-focused, equitable and more effective in healing and promoting wellness.
References
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