Against Compassion?

By Dr Anna Smajdor, Lecturer in Ethics, Norwich Medical School, University of East Anglia

Against Compassion?

Uttering the word compassion seems to give one a short cut to the moral high ground. Politicians know this and make use of it. When the Francis Report was published, in response to ‘systemic failings’ at Mid Staffordshire NHS Foundation Trust, it detailed in a number of places how patients and relatives had complained of a lack of compassion. David Cameron’s response was to urge that nurses should be hired and promoted on the basis of having compassion as a vocation and not just academic qualification’.

If you ask a theologian, a philosopher, a psychologist, a neurologist, a politician, a nurse or doctor, a member of the public, what compassion is, you may get very different answers. Compassion is a contested term and people get very territorial about their favourite interpretations.

In some respects, references to the lack of compassion such as those in the Francis Report might be understood as an outburst of emotion, expressive of shared vulnerability and humanity. If so, these statements are not amenable to analysis any more than other emotive expressions, such as laughing or crying. Yet when appeals to compassion acquire political power, they do require analysis.

Such analysis needs to address the reasons for seeking to instill compassion, the likelihood that we can do so effectively, and the probability that this will bring about the desired results. Is compassion always and intrinsically good? From the Aristotelian, or virtue ethics perspective, attributes such as courage or compassion are not intrinsically good; their value depends on when and how they are exercised.

Kant makes a similar point, though where Aristotle emphasises wisdom, Kant regards the essential quality as being a good will: “nothing […] can be called good, without qualification, except a good will. Intelligence, wit, judgement, and the other talents of the mind, however they may be named, or courage, resolution, perseverance, as qualities of temperament, are undoubtedly good and desirable in many respects; but these gifts of nature may also become extremely bad and mischievous if the will which is to make use of them, and which, therefore, constitutes what is called character, is not good.” [1] In short, one must be a good person for compassion to be good.

It may be hard to see how compassion could be associated with anything bad or mischievous, to use Kant’s terminology. However, as Bernard Williams observes: ‘[i]f it is a mark of a man to have a conceptualised and fully conscious awareness of himself as one among others, aware that others have feelings like himself, this is a precondition not only of benevolence but … of cruelty as well.”[2]

I don’t take these points to be decisive, but clearly they give grounds for further consideration. If in fact, we want people to be GOOD – and if we believe that compassion is often, but not necessarily a part of this, we need to think carefully about why we are focussing on compassion. The other thing to consider here is that if compassion is intrinsically good, then it goes without saying that healthcare professionals, as well as everyone else, should be compassionate. We should all be good. Should healthcare professionals be especially good, or is it more important that they should be good than other people? Again, this is something that needs careful thought. I am not at all convinced that it is the case.

Finally, when asking whether we value compassion as something intrinsically or instrumentally good, it is possible to test one’s intuitions on this by asking: suppose if we knew for sure that compassion had NOT been present in a particular health trust over a certain period, during which all patients and their relatives pronounced themselves satisfied with the care provided, and all safety requirements had been met – would we be pushing for additional measures to promote and incentivise compassion?

If not, this shows us that compassion is not functioning purely as an intrinsic good or absolute moral goal here: we are valuing it at least in part, because we believe that it is associated with other goods. And if this is so, it is highly questionable why we choose to look for compassion instead of establishing what these other goods might be, and whether we could achieve them more directly than through agonising about compassion or its lack.

[1] Kant I. Groundwork for the Metaphysics of Morals. Yale University Press, 2002.p10

[2] Williams B. Morality: An introduction to ethics. Cambridge University Press, 2012.p60

Anna Smajdor's relevant publications:

Smajdor A. Reification and compassion in medicine: A tale of two systems. Clinical Ethics (2013)8;4:111-118

Smajdor A. Should compassionate practice be incentivised? Nursing times (2012)109;49-50:18-19

Smajdor A, Stöckl A, Salter C. The limits of empathy: problems in medical education and practice. Journal of Medical Ethics (2011)37:380-383.