Compassion in healthcare

WEEK 3
Compassion
15
Compassion in health care
A Bit Like Jesus

Some of the new and exciting developments in medical science – especially in the area of genetics and stem cell research – raise complex ethical issues. Developments in patient care also raise old problems in new forms. For instance, modern medicine seems to be capable of keeping people alive well beyond the point that many of us would wish. There are also major problems about priorities and even rationing. Should health services devote as many costly and scarce resources to the elderly as they do to the young?

Today medical ethics is an essential part of the training of doctors and nurses and there are numerous medical ethics committees to address the challenges that they face in their work and research. I am very privileged to be a member of several of these, albeit usually as the only theologian present. Of course some of the doctors, nurses and scientists on these committees may be privately religious, yet this cannot be assumed. There are also lawyers and philosophers present, some of whom are explicitly hostile to religion in any form. So what is the role of a theologian in this context?

Perhaps a theologian is there to oppose secular forms of ethics. Many decisions are made by such committees quite pragmatically by attempting to balance the risks involved in a particular form of treatment (all surgery and most medication do involve risks) with their benefit to the patient. There is also considerable discussion about patient autonomy, examining whether or not patients have been properly informed about the proposed treatment, given a free choice about having or not having it, and assured about confidentiality. All of this is now standard fare in medical ethics. Should a theologian be opposing it?

My answer is firmly ‘no’. I do not believe that theologians have a monopoly of wisdom in ethics and I do want all healthcare workers to act ethically, whether they are personally religious or not. I also believe that it would be irresponsible not to attempt to balance the risks and benefits of treatment, and unethical not to share this information properly with patients themselves.

So I do strongly support such considerations on medical ethics committees. What then is a theologian doing specifically on these committees? Does she or he have anything distinctive to add to their deliberations?

Perhaps a theologian is there to represent religious minorities. Conservative Jews, Catholics and Muslims are all likely to have pro-life views at odds with current medical practices relating to the beginning and end of life. For example, traditional Catholics are unlikely to agree with IVF in any form, or with barrier and hormonal means of contraception. Or possibly it is the demands of more sectarian groups that the theologian should be trying to represent. For example, the strong objection to blood transfusions by Jehovah’s Witnesses. A religiously pluralist society does need to be aware of groups that object conscientiously to otherwise widely accepted medical practices.


Yet my experience is that in reality most medical ethics committees are well aware of such conscientious objections and argue that (for adult patients at least) they must be respected. They are aware that doctors giving a blood transfusion to a Jehovah’s Witness patient would from her perspective endanger her prospects of eternal life. For many adult Jehovah’s Witnesses it is much better to die prematurely in this world than to lose the possibility of life in the next. That is precisely why Jehovah’s Witnesses were so courageous and unbreakable in Hitler’s concentration camps or in Stalin’s gulags. Threats in this world were as nothing compared with the prospect of rewards in the next.

A rather better explanation of the role of a theologian on medical ethics committees today may involve values. I share the values about autonomy, risks and benefits, and am pleased that many committees also consider issues concerned with wider justice. Yet I believe that there are some values involved in good medical practice that are not always well represented in ethical discussion. Compassion is one of these. Subsequent chapters will suggest that care, faith and humility are others. It will be proposed that these gospel values do still have an important contribution to make even in wider society today.

Compassion is sometimes mentioned in medical ethics. Yet it is seldom the explicit starting point and frequently it is swamped by other values. Some of my more robust secular colleagues even regard ‘compassion’ as being just too soft and irrational to be of much use in medical ethics. A few even dismiss compassion as a ‘slave value’. In contrast, I believe that it should have priority.

Whenever doctors and nurses are asked about why they chose to train for their profession in the first place they frequently mention compassion. Cynics might claim that money was their prime motivation. Or, less cynically, that popular acclaim was crucial: ‘This is my daughter, she is a doctor’, or ‘That is my son, he is a nurse’. However, doctors and nurses themselves often mention compassion, perhaps as a result of an early experience of compassionate healing or of a wider conviction about wanting to help those who are vulnerable.

It is widely considered that doctors or nurses who lack compassion are not good doctors or nurses. Many still talk about them as belonging to ‘caring professions’. Like the clergy they are regularly given high ratings by the general public as people who care and can be trusted. And when a Dr Shipman is discovered people are deeply shocked.

Of course doctors and nurses should be trained properly, and need to be knowledgeable about medical science. People today do want them to respect their autonomy as patients and to give them proper choices about the risks and benefits of treatment. Yet they also want them to be compassionate and caring human beings. They want them to be concerned about their patients as people and not just as objects of medical curiosity.

Compassion is not an optional extra for health-care workers.

Compassion is crucial and central.

MEDITATION
Psalm 63.3
Because your steadfast love is better than life,
my lips will praise you.

Sura 10.55
In the bounty of God, and his mercy – in that let them rejoice.
Taken from A Bit Like Jesus by Robin Gill