Mandating compassion

How are we to achieve a compassionate healthcare system? This question has been posed in various papers and books over the years, and most recently in a feature article in the Journal of Medical Ethics.

In his brief paper ‘Smiling through clenched teeth: why compassion cannot be written into the rules’, Dr. Yinchu Wang of Barts and the London Medical School argues that we cannot mandate compassion through healthcare rules and guidelines. Wang suggests that ‘emotional rules’ stifle real emotional engagement with patients and in many cases are totally impracticable.

“…The authorities are now proposing to officialise [compassion]. Perhaps not realising that even in the private sector, such moves had faced difficulties and accrued significant human costs…


“The first drawback is the damage it can do to the service worker…” Wang suggests that a worker will either not want to conform to the requirements, or will feel frustrated because they are unable to achieve them.

He continues:

“…The demand for compassion may also have a negative impact on the service users. We have all become adept at recognising and discounting enforced emotions…”


“…[this sort of policy] ignores that such measures are limited by practical constraints…”

Wang doubts that a formalization of emotion could ever avoid the usual obstacles:

“…As long as contractualism remains the mainstay of doctor–patient relationships, we can expect compassion to always take a backseat. Any rule concocted to demand compassion from the healthcare professional is unlikely to yield results…”

Some agree with Wang, but argue that it is not a question of structural change; we need to get rid of ‘emotional expectations’ altogether. In a 2013 post on the blog Practical Ethics, Hannah Maslen suggested that emotions may not be as important as many think:

“that lack of emotional compassion does not necessarily result in cruelty or incompetence. Whilst many doctors and nurses and surgeons will care about their patients, they should not be expected to experience strong emotions towards them or their situations.”

In the recently released medical ethics book Health Humanities, Paul Crawford and Brian Adams et al call for a more nuanced approach to educing compassion in healthcare practitioners:

“…The development of more compassionate health services will need to go deeper than mandating angelic nurses or setting up initiatives for compassion to be poured in as a ‘skill’ through linear or values-based criteria…


“…Compassionate care will be achieved in and by governments and their healthcare organizations designing low-threat, compassion-generating spaces and processes, rather than through spurious ‘compassion training’ of the workforce.”

MORE ON THESE TOPICS | clinical practice, healthcare policy, professional virtue

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