Compassion in Medicine
(senior project components)

I. Prologue
II. Compassion
III. Good Medicine
IV. Purpose of Medicine
V. Healing
VI. Spirituality
VII. Compassoin in Medicine
VIII. Works Cited

Prologue (Top)

Compassion is the act and emotion of taking up one's place with the sufferer and suffering with the person. Many of today's health care professionals consider compassion to be a frill that does not impact a patient's physical responses. However, emerging data suggests that compassion has a positive effect on patient's physical, mental, emotional, and spiritual well-being.(1) Compassion in medicine focuses on the spiritual and ethical realities of health care in addition to the scientific practices of medicine. To understand the essential role of compassion in medicine, one must consider medicine as a relational practice that is rooted in the physician-patient relationship. To understand the inherent need for compassion in the practice of medicine, I will explore the intrinsic moral good of medicine, examine the overall purpose of medicine; critique the healing process in terms of the science and art of medicine; investigate the spiritual component of the healing process; and consider compassion as the facilitator of the spiritual component of healing in the practice of medicine. Compassion is an essential element of a healing relationship, and therefore an essential element of the practice of medicine.

Compassion (Top)

The meaning of compassion is conveyed by the by the original Latin root, compati , which means to suffer with.(2) One may use it to describe something only saints are capable of, not attainable by ordinary people. Or one may give acknowledgment merely to the idea. More often than not, compassion is defined simply as a feeling. Such definitions, however, neglect its deeper meaning.

The vocabulary of compassion entails a hierarchy of terms: beneficence , meaning active kindness; empathy, which implies the understanding of another's feelings; sympathy , which goes a step further, meaning like-feeling or fellow-feeling; and compassion , which literally means "to suffer with." Thus, compassion means having a sympathetic consciousness of another's distress together with a desire to alleviate it.(3)

According to Oliver O'Donovan, moral theologian at Oxford University:

Compassion is the virtue of being moved to action by the sight of suffering. It is a virtue that circumvents thought, since it prompts us immediately to action. It is a virtue that presupposes that an answer has already been found to the question, 'What needs to be done?'" (4)

Throughout history, healers of every culture have recognized compassion to be an element of the healing process. Traditionally, it focuses on a feeling response to another and an active practice. The Dalai Lama defined compassion to be "(that which) inspires others to be free of suffering." Compassion is an emotion that can be activated and practiced. "We are not paying enough attention to the development of the heart, compared to the amount of attention we pay to the development of the brain," he said.

Compassion or "suffering with" is fundamentally different from the science of palliation. Instead of covering up symptoms, compassion seeks connection with the sufferer, without seeking to negate the suffering that comes from grieving and mourning. Palliation is a caring, appropriate response to the suffering of the sick. According to author Rita Charon, compassion is a caring, appropriate response to the emotional and spiritual suffering of persons that accompanies human experiences.

Once we (physicians) allow ourselves to listen with compassion and to let the full implications of their suffering register on us, we are in a position to change the state of affairs. We who witness can give control and hope through our compassion. It will not always lead to cure, and it will not always lead to a change in the medical treatment, but it can lead to a radical change for the patient. It can confer recognition and communion, ending the isolation and strangerliness of sickness. (5)

Good Medicine (Top)

The term "good medicine" suggests that medicine is a profession that pursues an intrinsic human good. Since ancient times, the aim of medicine has revolved around health and healing. The traditional goals of medicine are to restore sick patients to health and alleviate patients distressing symptoms.

The overall purpose of medicine is realized in the core of medical practice, the physician-patient relationship. The true nature of this healing relationship is what makes the purpose of medicine intrinsically moral. Therefore, the moral standards that are followed to attain it, such as the quality of character required of healthcare professionals as well as the right actions that accomplish that good, are constituents of medicine itself.

The idea of medicine as an intrinsically moral pursuit is Greek in origin and character, as handed down by the Hippocratic Oath. The Oath articulates the importance of healing relationships in the practice of medicine and constitutes a recognition of and fellow feeling for the patient as a human being. It is upon this basis that medicine as a healing and caring activity is founded and has developed as a profession regulated by its own professional ethical code.

Purpose of Medicine (Top)

To understand the purpose of medicine one must consider its tradition and history, as well as its scientific and technological aspects. In examining the origins of medicine one acquires a better understanding and clearer insight into this purpose. The Hippocratic Oath, originally a prayer to the Greek gods of healing and medicine, articulates the physician-patient connection to be the true nature of the healing relationship and the essence of medicine. Its principles are maintained today in the physicians' code of ethics: t reat the sick to the best of one's ability, preserve patient privacy, teach the secrets of medicine to the next generation, and so on.(6) The American Medical Association's Code of Medical Ethics holds that, "The Oath of Hippocrates has remained in Western civilization as an expression of ideal conduct for the physician."(7)

The purpose of medicine, as described by the Hippocratic Oath, is timeless and universal because it is based on the activity of healing and caring for the sick, which has remained essentially consistent throughout the centuries. While the term is not used, the Hippocratic Oath exudes a strong sense of compassion with its emphasis on using one's ability to aid the sick, teach, maintain honor in the community, and protect the integrity and well-being of the patient. In Roman times:

[Stoicism] emphasized the shared humanity of all peoples and, for the first time, made healing a profession, one based on compassion and mercy for the sick. Some of the later Stoic writers expressed sentiments of love for the patient, identification with his or her suffering, and disdain for financial gain.(8)

The practice of medicine as a moral endeavor focuses on the lives and well-being of patients. According to medical historian Al Jonsen, the " Good Samaritan principle of compassion" establishes compassion as the spiritual component in the healing relationship between physician and patient.(9) The story of the Good Samaritan conveys that moral worth and respect should be granted to all fellow human beings in the form of compassion.(10) In applying this principle to the healing relationship, the practice of medicine should recognize and acknowledge the universal human reality of vulnerability and suffering. Jonsen argues that this teaching establishes healing and compassion as the moral work in the practice of medicine. To comprehend this moral endeavor, the implications of healing and spirituality in practice of medicine must be addressed.

Healing (Top)

Healing and curing are the two most important outcomes in healthcare. They are not synonymous. Healing is spiritual and is oriented toward the patient's well-being. Curing, on the other hand, is scientific, technological, and is directed toward the patient's body. Combining the two, however, results in the highest quality of patient-centered care. This outcome is often not achieved in modern healthcare institutions that focus solely on a patient's disease and neglects the patient's spiritual needs. As a result of this approach, a patient's disease may be treated successfully while his or her spirit remains unhealed. Or, if current medical technology cannot cure the patient, he or she may be left without an opportunity to experience healing on a spiritual level.

The science and art of alleviating the suffering of the sick is the central goal and duty of medicine. The science of medicine focuses on the mission to cure the sick, and restore their abilities to function. When the disease or injury is incurable, the science of medicine's sole mission is palliation: mitigating physical pain and suffering as much as possible. The term "palliation" comes from the same root as "pallor" and "pallbearer," implying the act of "covering over" or "making palatable" on the surface that which, beneath the surface, is beyond human control.(11)

Palliation also incorporates the art of medicine, which accentuates the working partnership between a patient and his or her physician. In order to accommodate this relationship, caregivers must understand the patient's experience, not merely the cause of the disease. The art of medicine complements the science that informs the physician's diagnosis and treatments by maintaining that awareness and acknowledgment of a patient's feelings and fears are equally as important. Thus, it is essential in understanding and improving patient care.

The goal of palliative care is to act in the best interest of the patient. The World Health Organization defines palliative care as "active, total care of patients whose disease is advanced, irreversible and non-responsive to curative treatment," and "the management of physical and emotional symptoms, as well as the provision of social and spiritual support for both patient and family during the course of progressive illness that is beyond the reach of cure."(12)

Hospice is a form of healthcare that has a spiritual mission in providing compassionate care to patients in the last phase of an incurable disease. Its philosophy of care is centered on the treatment of the whole person rather than the disease by emphasizing quality of life rather than length of life. Within this belief system, there is the understanding that suffering and pain is part of the patient's life experience, and that it may have spiritual meaning for the patient and caregivers involved. Hospice provides comprehensive palliative care to relieve symptoms and provide social, emotional, and spiritual support. Interdisciplinary healthcare team of physicians, nurses, social workers, counselors, home health aides, clergy, therapists, and trained volunteers care for patients and offer support based on their particular areas of expertise.

Hospice care is distinguished from mainstream healthcare in that it incorporates in its healing the spiritual needs of the patient and family. It recognizes that individuals maintain different spiritual convictions and have unique spiritual needs. Therefore, hospice provides individualized bodily and spiritual care to each patient.

Spirituality (Top)

The spiritual as a component of healing must not be neglected. Spirituality may enable some patients to acquire higher esteem; accept their physical ailment; surrender control of their illness; and/or find peace in the healing process. Thus, healthcare providers ought to consider the healing effects of spirituality and learn how to address the patients' spiritual needs in the practice of medicine.

Spirituality is a constituent of the healing processes, which facilitates one to move closer to life's central meaning. S pirituality focuses on intangible elements that impart vigor and meaning to life's events.(13) It is an inner quest for contact with the divine. Unlike religion, which is based on set beliefs, values and practices, it common to all human beings.(14)

W hen examining modern medicine, many consider spirituality to be an alternative therapy to traditional medicine. Spirituality investigates the nature of the intangible and offers insight into the meaning of life, whereas, science unveils the workings of the material world. Yet , for centuries, various traditions have used spiritual healing as a viable therapy to complement other treatments. From the early dynasties of China to the indigenous empires of the Americas, holy men in ancient societies ministered not only to the spiritually fallen but to the physically ill as well. For centuries, it was often the priests, monks, rabbis, and nuns who ministered to both the soul and the body. In western society, the earliest hospitals were built, staffed, and maintained by religious people. Implying that the physical and spiritual components of healing could not be separated.

In the practice of medicine, spirituality entails reaching out and connecting with other human beings. It involves relieving suffering of all kinds and encouraging patients to heal themselves through human and divine connections. It also enables physicians to grow in compassion and understanding through their interaction with patients.(15)

Spirituality becomes very important to those who seek meaning in their suffering, especially when cure is unattainable. P rofessionals claim that the spiritual beliefs and practices of patients have a profound effect on their experience with illness and the threat of dying.(16) Since religious affiliation is often correlated with one's meaning, purpose and value of human life. For example, patients facing a terminal illness often rely on spiritual factors, such as their belief in an after life, to make important decisions about treatment, life support, and living wills.

Although spirituality is important in the lives of many patients seeking medical care, especially those facing serious or chronic illness, yet a number of physicians are uncertain about whether, or how, to address spiritual or religious issues. Physicians are trained to diagnose and treat disease and have little or no training on how to relate to the spiritual side of the patient. Moreover, the physician's ethic requires that the physician not impose his or her beliefs on patients who are particularly vulnerable. Complicating it further, in today's culture of religious pluralism, there is a wide range of belief systems ranging from atheism, agnosticism, to an assortment of religions. No physician can be expected to understand the beliefs and practices of so many differing faith communities.

At first consideration, the simple solution suggests that physicians should avoid spiritual content in the physician-patient relationship. However, this solution may not always be favorable. Within the boundaries of the medical profession, healthcare providers may find ways to engage the spiritual beliefs of patients in the healing process.

Healthcare providers often initiate spiritual healing unknowingly. For instance: walking with the patient can become walking meditation; holding a patient's hand can be spiritual touch; acknowledging a patient by looking at him can be spiritual recognition; sharing something from nature can spiritually revitalize the patient; encouraging a patient to do a simple act and witnessing the patient's inner joy when the act is performed. These simple acts facilitate spiritual healing by reducing the patient's fears. Gandhi once said, "Fearlessness is the first prerequisite of a (person's) spiritual life."

Compassion in Medicine (Top)

The work of compassion requires a just healthcare system structured for its work. In any hospital or healthcare facility, two different worlds coexist side by side: the highly physical, technological world of busy health care professionals and the spiritually fearful, uncertain world of the ill patient. Compassion creates a bridge between the two. When compassion is present, a patient feels supported and cared for as a human being in the midst of a threatening situation.

Karen and Simon Fox, developers of The Medicine of Compassion , identify four principle elements of compassion that make it possible to bridge the void of isolation that commonly surrounds those who are suffering, especially from a serious or chronic illness: attention, acknowledgement, affection, and acceptance.(17) Attention is being aware of the signs, signals, and clues that indicate what is important to others. Acknowledgement is letting others know that they are respected and appreciated as unique individuals. Affection is the human touch of warmth, humor, comfort, and kindness. Acceptance is allowing things to be the way they are. When these four elements are practiced in the health care field patients are put at ease, feel encouraged and begin to trust, open up and thrive.

When treated with compassion, patients are more likely to consider their own reasons and resources for healing and take greater responsibility for their own health. Health care professionals also experience greater job satisfaction and less stress when working in a dynamic partnership with patients, rather than in the one-way, provider-consumer model of care. Compassion, therefore, positively influences medical outcomes and increases patient satisfaction.(18) To facilitate compassion in the practice of medicine a new model of healthcare must be enacted that honors both science and spirituality. The patient must be viewed as a multidimensional being who expresses him or herself on a physical, emotional, mental and spiritual level.

Footnotes

(1) Scientific basis for compassion in health care proven by studies reported in the following journals: UCLA Neuropsychiatric Institute: American Journal of Psychiatry-2002; Standford Medical School study: The Lancet-1989; Harvard Medical School study: Psychology and Health-1988. Cited by: Fox, Karen and Simon (2004). The Medicine of Compassion . Santa Barbara, California: Adventures in Caring Foundation.

(2) Merriam-Webster Online Dictionary. www.m-w.com

(3) Ibid.

(4) Oliver O'Donovan, Begotten or Made? Oxford: Clarendon Press, 1984; 11.

(5) Rita Charon, "Let Me Take a Listen to Your Heart," in Caregiving: Readings in Knowledge, Practice, Ethics, and Politics , ed. Suzanne Gordon, Patricia Benner, and Nel Noddings (Philadelphia: University of Pennsylvania Press, 1996), 304.

(6) Code of Medical Ethics (1996). The American Medical Association: Physicians Dedicated To The Health Of America. Retrieved from www.ama-assn.org .

(7) Ibid.

(8) Edmund Pellegrino and David Thomasma, The Christian Virtues in Medical Practice. Washington, DC: Georgetown University Press, 1996; 46.

(9) Jonsen, Albert R. "The Good Samaritan as Gatekeeper." The New Medicine and the Old Ethics . Cambridge, MA: Harvard University Press; 38-60, 1990.

(10) The story of the Good Samaritan (Luke 10:30-37). Jesus said: "A man was going down from Jerusalem to Jericho, when he fell into the hands of robbers. They stripped him of his clothes, beat him and went away, leaving him half dead. A priest happened to be going down the same road, and when he saw the man, he passed by on the other side. So too, a Levite, when he came to the place and saw him, passed by on the other side. But a Samaritan, as he traveled, came where the man was; and when he saw him, he took pity on him. He went to him and bandaged his wounds, pouring on oil and wine. Then he put the man on his own donkey, took him to an inn and took care of him. The next day he took out two silver coins and gave them to the innkeeper. 'Look after him,' he said, 'and when I return, I will reimburse you for any extra expense you may have.' "Which of these three do you think was a neighbor to the man who fell into the hands of robbers?" The expert in the law replied, "The one who had mercy on him." Jesus told him, "Go and do likewise." The Holy Bible: New International Version , 1984. Grand Rapids: Zondervan.

(11) Merriam-Webster Online Dictionary. www.m-w.com

(12) D. Doyle, G. Hanks, and N. MacDonald, eds., Oxford Textbook of Palliative Medicine (Oxford: Oxford University Press, 1993).

(13) Maugans TA. The SPIRITual History. Archives of Family Medicine. 1996; 5: 11-16.

(14) Thompson CL, Brody H. Inclusive Spirituality. J Fam Pract 1999; 48: 96-7.

(15) Ellis MR, Vinson DC, Ewigman B. Addressing Spiritual Concerns of Patients: Family Physicians' Attitudes and Practices. J Fam Pract 1999; 48 105-9.

(16) Vanderpool, HY, Levin JS. Religion and Medicine: How are they Related? Journal of Religion and Health. 1990; 29: 9-17.

(17) Karen and Simon Fox, "The Medicine of Compassion." Santa Barbara, California: Adventures in Caring Foundation, 2004.

(18) Scientific basis for compassion health care proven by studies reported in the following journals: UCLA Neuropsychiatric Institute: American Journal of Psychiatry-2002; Standford Medical School study: The Lancet-1989; Harvard Medical School study: Psychology and Health-1988. Cited by: Fox, Karen and Simon (2004). The Medicine of Compassion . Santa Barbara, California: Adventures in Caring Foundation.

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