Background: Compassion-based practices in midwifery are the most important expression of the depth of care quality. This concept is insufficiently represented in literature, therefore, studies on this subject are of utmost importance. Objectives: This study aims to determine the levels of compassion of midwives working in the delivery room and the factors affecting these levels. The study was carried out in Kocaeli, Turkey. Methods: This descriptive study was carried out from 1 February to 15 April 2019 in delivery (...) rooms of six different hospitals located in the provincial centre of Kocaeli, Turkey, with 78 actively working midwives. Data were collected using a ‘Compassion Scale’ and analysed using the Mann–Whitney U test, the Kruskal–Wallis H test and the Spearman correlation test. Ethical considerations: This study was conducted according to ethical scientific guidelines. Results: The compassion score of the midwives were found to be 4.19 ± 0.39. The total compassion score was affected by professional factors such as number of patients, alternating shift work, number of traumatic births and work satisfaction. While the kindness subscores decreased depending on shift work and number of traumatic births, it was determined that the midwives who were satisfied with their work had higher kindness scores than those who were not. Also, as the age and professional experience of the midwives and the number of traumatic births increased, their indifference score also increased. Midwives who reported that they were not satisfied with their job had higher scores regarding separation and disengagement scores than those who were satisfied with their job. Conclusion: It was determined that the compassion levels of midwives were found to be negatively affected by factors such as age, professional experience, job satisfaction and number of monthly traumatic births in a month. They should be reminded that compassionate midwifery care for women is a basic human right. (shrink)

In this empirical paper, we present a model of the dynamic legitimizing processes involved in the receiving and giving of compassion. We focus on the idea of being ‘worthy of compassion’ and show how ideas on giving and receiving compassion are highly contestable. Recognition of a worthy recipient or giver of compassion constitutes a socially recognized claim to privilege, which has ethical managerial and organizational implications. We offer a model that assists managers in fostering ethical strength (...) in their performance by encouraging reflection on the ethical complexity involved in compassion relations. The model emphasizes the dynamics of both the givers and receivers of compassion and so can also be used by organizations to both assess how others may view the legitimacy of their compassion relations and also to develop a positive organizational ethic of compassionate conduct. (shrink)

Self-compassion (SC) seems to play an important role in improving Emotion Regulation (ER). Nevertheless, the results of previous studies regarding the links between SC and ER are not consistent, especially facing diverse models of ER (strategy-based vs skill-based). The goal of this prospective study was to evaluate the links between these three concepts, by testing the predictive roles of SC and ER skills on both ER adaptive and maladaptive strategies, using standardised questionnaires and visual analogue scales. Results of regression (...) analysis showed that self-compassion positively predicts cognitive reappraisal, acceptance, problem-solving, relaxation, self-support, tolerance and ER skills and negatively predicts behavioural avoidance, expressive suppression and ruminations. Results also showed that ER skills positively predict cognitive reappraisal, expression, acceptance, relaxation, self-support and tolerance and negatively predicts behavioural avoidance, expressive suppression and ruminations. Results from a mediation model are also promising regarding both the role of ER skills on the effect of SC on adaptive ER strategy use. Even if this study can be associated with common limits of self-report measures, it highlights the role of SC in a model of ER. (shrink)

In this article, I argue that the recent emphasis on compassion in healthcare practice lacks conceptual richness and clarity. In particular, I argue that it would be helpful to focus on a larger concept of empathy rather than compassion alone and that compassion should be thought of as a component of this larger concept of empathy. The first part of the article outlines a critique of the current discourse of compassion on three grounds. This discourse naturalizes, (...) individualizes, and reifies compassion leading to a decontextualized and simplified understanding of failures in healthcare practice. The second part uses resources from phenomenology and contemporary moral philosophy to construct a “hybrid” concept of empathy that includes both pre‐reflective/intuitive and cognitive/imaginative components. This “hybrid” concept of empathy leads to a more complex understanding of the multiple responses to others' distress. I conclude that there are no straightforward normative naturalistic responses to others' distress. Rather than conceptualizing compassion as a naturalistic impulse or a character‐based trait, we need to consider the complexity of our empathic recognition of vulnerable others. (shrink)

Compassion in healthcare has received significant attention recently, on an international scale, with concern raised about its absence during clinical interactions. As a concept, compassionate care has been linked to nursing. We examined historical discourse on this topic, to understand and situate current debates on compassionate care as a hallmark of high‐quality services. Documents we looked at illustrated how responsibility for delivering compassionate care cannot be consigned to individual nurses. Health professionals must have the right environmental circumstances to be (...) able to provide and engage in compassionate interactions with patients and their relatives. Hence, although compassionate care has been presented as a straightforward solution when crisis faces health services, this discourse, especially in policy documents, has often failed to acknowledge the system‐level issues associated with its provision. This has resulted in simplistic presentations of ‘compassion’ as inexpensive and the responsibility of individual nurses, a misleading proposal that risks devaluing the energy and resources required to deliver compassionate care. It also overlooks the need for organisations, not just individuals, to be charged with upholding its provision. (shrink)

Most approaches to animal ethics ground the moral standing of nonhumans in some appeal to their capacities for intelligent autonomy or mental sentience. _Corporal Compassion _emphasizes the phenomenal and somatic commonality of living beings; a philosophy of body that seeks to displace any notion of anthropomorphic empathy in viewing the moral experiences of nonhuman living beings. Ralph R. Acampora employs phenomenology, hermeneutics, existentialism and deconstruction to connect and contest analytic treatments of animal rights and liberation theory. In doing so, (...) he focuses on issues of being and value, and posits a felt nexus of bodily being, termed symphysis, to devise an interspecies ethos. Acampora uses this broad-based bioethic to engage in dialogue with other strains of environmental ethics and ecophilosophy. _Corporal Compassion_ examines the practical applications of the somatic ethos in contexts such as laboratory experimentation and zoological exhibition, and challenges practitioners to go beyond recent reforms and look to a future beyond exploitation or total noninterference--a posthumanist culture that advocates caring in a participatory approach. (shrink)

Compassion is often understood as central to nursing and as important to ensure quality nursing and healthcare. In recent years, there has been a focus on strategies in nursing education to ensure compassionate nurses. However, it is not always clear how the concept of compassion is understood. Theoretical conceptualisations that lie behind various understandings of compassion have consequences for how we approach compassion in nursing education. We present some ways in which compassion is often understood, (...) their philosophical underpinnings and the consequences these understandings can have for nursing education. We argue that it is useful for nursing education to understand compassion as a cognitive emotion and discuss how such an understanding can inform educational approaches to compassion. (shrink)

Compassion in Healthcare gives an account of the nature and content of compassion and its role in healthcare based on notions of pilgrimage and civic life. Drawing on the author's real-world collaborations, the book proposes strategies for an improved understanding of compassionate relationships in healthcare practice.

This paper is a dialogue that considers compassion as a grounding for ethics. Its approach is thematic but it draws significantly from Arthur Schopenhauer’s account of compassion. In Schopenhauer’s thought, values are functions of a subject’s willing and therefore inevitably tied to an ego-centric viewpoint. Real ethics needs to find a good beyond subjective valuations. Schopenhauer finds an ethical phenomenon beyond values in Mitleid, “suffering-together,” compassion. Compassion is a pre-reflective benevolent feeling toward another’s suffering. Compassion (...) can occur only if the ego-world duality is overcome at least to some extent. In this way compassion is a metaphysical sentiment. (shrink)

When natural disasters strike, a network of individuals, aid agencies, and corporations join together in a humanitarian effort to provide relief and recovery to those in need. Corporations, in particular, have played an increasing role in disaster assistance by providing financial support, goods, services, and logistic coordination (Muller and Whiteman 2009). Previous research has addressed corporate responses to disaster by investigating the factors that impact the likelihood of giving. Instead of focusing on the likelihood of corporate action, or inaction, we (...) address how different types of compassion are employed by corporations when they engage in disaster relief. We investigate how the use of language signals either strategic or altruistic compassion. (shrink)

Socrates (in the Meno) denied that virtues like courage could be taught, whereas Protagoras defended this claim. Compassion is discussed below in this context; it is distinguished from related, but different, moral qualities, and the role of imagination is emphasised. 'Sympathy's and role-modelling views of compassion's acquisition are criticised. Compassion can indeed be taught, but neither by the example of a few, isolated physicians nor by creation of Departments of Compassion. In replying to one standard objection (...) to teaching compassion, it is emphasised that scientific competence and compassion aren't mutually exclusive. (shrink)

Contemporary moral philosophers and philosophers of the emotions widely agree that Kant’s discussion of compassion is an unfortunate byproduct of his rationalistic and legalistic account of ethics. In fact, Kant departs from the solid established rationalist tradition not only in distancing himself from dogmatic and perfectionist rationalism but also in claiming that there is a practical use of reason, which commits him to acknowledge that reason directly guides rational agents by furnishing them motives for action. Kant’s argument is that (...) reason is not assisted by sensibility in this function. The practical function of reason is ensured only if reason produces motives of its own, autonomously, rather than depending on the emotions. To highlight the role of these two concepts, I will focus on two distinct models of compassion which are said to sharply depart from Kant: I. Murdoch and T.W. Adorno. My conclusion is that despite overwhelming critiques, Kant provides us with a useful distinction between two kinds of compassion. I deploy the distinction between proximal and distal compassion to capture the significance of the much criticized—and admittedly obsolete, but also little understood— distinction between pathological and practical compassion, which takes center stage in Kant’s account of the duties of benevolence. Proximal compassion is felt in the presence of suffering and mandates immediate action. By contrast, distal compassion is directed to suffering that is distant, e.g. placed in a distant time, either future or past or felt by persons unrelated by proximity and intimacy. While proximal compassion is not a virtue, and may even have a bad impact on moral agency, distal compassion is a virtue that requires abstraction and the exercise of rational capacities. Kant’s complex account of compassion coheres with empirical psychology and succeeds in vindicating different roles of compassion in practical reasoning. (shrink)

BackgroundNurses provide the majority of health-care services and face numerous health challenges during an epidemic. During the COVID-19 epidemic, nurses are subjected to physical, mental, and social disorders that impair their quality of life and hardiness. Therefore, it is important to be aware of the situation of nurses. The current study aimed to compare the compassion satisfaction, compassion fatigue and hardiness among nurses before and during the COVID-19 outbreak.Materials and MethodsThis cross-sectional study included 508 clinical nurses from one (...) public hospital in southern Iran. The subjects were recruited using census sampling methods in 2019–2020. Sampling was performed before and during the COVID-19 with a 1-year interval. Although, the study setting was the same before and during the COVID-19, questionnaires were completed by different nurses before and during the COVID-19. Demographic questionnaire, professional quality of life questionnaire and Occupational Hardiness Questionnaire were used to collect data.ResultsThe scores of compassion satisfaction, compassion fatigue and hardiness did not differ significantly during the COVID-19 compared with before the COVID-19. Before COVID-19, hardiness and work experience predicted 11% of the variance of compassion satisfaction, whereas during COVID-19, hardiness and gender predicted 26% of the variance of compassion satisfaction. Before COVID-19, hardiness and work experience predicted 3% of the variance of compassion fatigue, whereas during COVID-19, hardiness, type of employment and gender predicted 6% of the variance of compassion fatigue.ConclusionThe current study found that compassion satisfaction, compassion fatigue and hardiness did not change during the COVID-19 outbreak compared with before the COVID-19 outbreak. However, during the COVID-19, the hardiness was a significant predictor of compassion satisfaction and compassion fatigue. The study results showed that it was possible to increase the compassion satisfaction and reduce the compassion fatigue by strengthening the hardiness of nurses. However, these results need to be considered in future studies, especially in crises such as COVID-19 disease. (shrink)

Compassion is a word we use frequently but rarely precisely. One reason we lack a philosophically precise understanding of compassion is that moral philosophers today give it virtually no attention. Indeed, in the predominant ethical traditions of the West, compassion tends to be either passed over without remark or explicitly dismissed as irrelevant. And yet in the predominant ethical traditions of Asia, compassion is centrally important: All else revolves around it. This is clearly the case in (...) Buddhist ethics, and compassion plays a similarly indispensable role in Confucian and Daoist ethics. In Compassion and Moral Guidance, Steve Bein seeks to explain why compassion plays such a substantial role in the moral philosophies of East Asia and an insignificant one in those of Europe and the West. The book opens with detailed surveys of compassion’s position in the philosophical works of both traditions. The surveys culminate in an analysis of the conceptions of self and why the differences between these conceptions serve either to celebrate or marginalize the importance of compassion. Bein moves on to develop a model for the ethics of compassion, including a chapter on applied ethics seen from the perspective of the ethics of compassion. The result is a new approach to ethics, one that addresses the Rawlsian and Kantian concern for fairness, the utilitarian concern for satisfactory consequences, and the concern in care ethics for the proper treatment of marginalized groups. Bein argues that compassion’s capacity to address all of these makes it a primary tool for ethical decision-making. (shrink)

Background: Compassion fatigue, moral distress, and moral injury are interconnected phenomena that have a detrimental impact on the delivery of nursing care. Nurses possess the inherent resilience necessary to effectively handle these three adverse occurrences. Aim: To determine the mediating impact of resilience on compassion fatigue, moral distress, and moral injury among nurses in Saudi Arabia. Design: The final product was a structural equation model (SEM) generated using a quantitative correlation cross-sectional design, and we followed the STROBE guidelines (...) for this study. Methods: The study involved a sample of 511 staff nurses, who were selected using consecutive sampling. The study was conducted in three government hospitals in Saudi Arabia. Ethical considerations: This study received approval from Ethics Committee under approval number H-2021-151 on March 5, 2021. The survey’s description and consent statements were clearly presented on Google survey forms in both English and Arabic. Results: Results showed that resilience negatively influenced moral distress, while compassion fatigue and moral injury had a positive influence. Likewise, compassion fatigue had a direct, positive effect on moral distress and moral injury, and moral distress had a direct, positive effect on moral injury. Analyses also showed that resilience had positive, indirect effects on moral injury through the mediation of both compassion fatigue and moral distress. Similarly, compassion fatigue had a positive, indirect effect on moral injury through the mediation of moral distress. Conclusion: Because resilience enables nurses to adapt, it helps them overcome obstacles in their career and professional lives. Resilience is frequently cited by nurses as a protective quality. Moral injury, compassion fatigue, and moral distress can negatively impact the health of nurses. Implications for the profession and/or patient care: Nurse leaders should develop programs and initiate efforts to improve nurses’ resilience as an important protective trait against compassion fatigue, moral distress, and moral injury. Patient or Public Contribution: There was no public or patient participation in this study. (shrink)

Despite common assumptions that capitalism and compassion are contradictory, we theorize that compassion can be compatible with capitalism, and may either manifest or be inhibited within capitalistic society through a range of organizational approaches. These, in turn, result in varying consequences for employees’ experiences, feelings, and behaviors. In this article, we examine the perceived support provided to employees by their organizations during the 2011 Brisbane flood. Analysis of interview data identifies a continuum of organizational responses: from neglect to (...) ambiguity to compassionate care, each of which engendered various employee experiences, feelings, and behaviors toward themselves, their organizations, and the community at large. The empirical findings lead to theorizing that the perceived organizational responses are consonant with a range of capitalistic tendencies. Perceived organizational neglect is most consonant with neoclassical capitalism, understood as having a primary focus on self-interest and profit maximization. Perceived ambiguity tends to fit with a supplemental capitalism that adds social responsibility to the baseline of classical capitalism. Organizational compassionate care fits with a transformed or conscious capitalism that considers value creation in society to be an organization’s primary purpose. (shrink)

As interpersonal, racial, social, and international conflicts intensify in the world, it is important to safeguard the mental health of individuals affected by them. According to a Buddhist notion “if you want others to be happy, practice compassion; if you want to be happy, practice compassion,” compassion practice is an intervention to cultivate conflict-proof well-being. Here, compassion practice refers to a form of concentrated meditation wherein a practitioner attunes to friend, enemy, and someone in between, thinking, (...) “I’m going to help them.” The compassion meditation is based on Buddhist philosophy that mental suffering is rooted in conceptual thoughts that give rise to generic mental images of self and others and subsequent biases to preserve one’s egoism, blocking the ultimate nature of mind. To contextualize compassion meditation scientifically, we adopted a Bayesian active inference framework to incorporate relevant Buddhist concepts, including mind, compassion, aggregates, suffering, reification, conceptual thoughts, and superimposition. In this framework, a person is considered a Bayesian Engine that actively constructs phenomena based on the aggregates of forms, sensations, discriminations, actions, and consciousness. When the person embodies rigid beliefs about self and others’ identities and the resulting ego-preserving bias, the person’s Bayesian Engine malfunctions, failing to use prediction errors to update prior beliefs. To counter this problem, after recognizing the causes of sufferings, a practitioner of the compassion meditation aims to attune to all others equally, friends and enemies alike, suspend identity-based conceptual thoughts, and eventually let go of any identity-grasping belief and ego-preserving bias that obscure reality. We present a brain model for the Bayesian Engine of three components: Relation-Modeling, Reality-Checking, and Conflict-Alarming, which are subserved by the Default-Mode Network, Frontoparietal Network and Ventral Attention Network, and Salience Network, respectively. Upon perceiving conflicts, the strengthening or weakening of ego-preserving bias will critically depend on whether the SN up-regulates the DMN or FPN/VAN, respectively. We propose that compassion meditation can strengthen brain regions that are conducive for suspending prior beliefs and enhancing the attunements to the counterparts in conflicts. (shrink)

Compassion is mentioned in the Principles of the American Medical Association but not in the Code of Ethics of the Canadian Medical Association. In this article, we assess the case for including compassion in a code of ethics for physicians. We argue that, properly understood, there is a strong case for including compassion in codes of ethics for physicians on the basis that it is both clinically and ethically central to the practice of medicine.

The concept, benefits and recommendations for the cultivation of compassion have been recognized in the contemplative traditions for thousands of years. In the last 30 years or so, the study of compassion has revealed it to have major physiological and psychological effects influencing well-being, addressing mental health difficulties, and promoting prosocial behavior. This paper outlines an evolution informed biopsychosocial, multicomponent model to caring behavior and its derivative “compassion” that underpins newer approaches to psychotherapy. The paper explores the (...) origins of caring motives and the nature and biopsychosocial functions of caring-attachment behavior. These include providing a secure base (sources of protection, validation, encouragement and guidance) and safe haven (source of soothing and comfort) for offspring along with physiological regulating functions, which are also central for compassion focused therapy. Second, it suggests that it is the way recent human cognitive competencies give rise to different types of “mind awareness” and “knowing intentionality” that transform basic caring motives into potentials for compassion. While we can care for our gardens and treasured objects, the concept of compassion is only used for sentient beings who can “suffer.” As psychotherapy addresses mental suffering, cultivating the motives and competencies of compassion to self and others can be a central focus for psychotherapy. (shrink)

Background The Covid-19 pandemic has impacted compassion fatigue and the mental health of health care providers, particularly midwives and nurses. Although there are studies involving health workers such as nurses and physicians affected by the pandemic’s compassion fatigue, few studies include midwives. Research objective The present study seeks to investigate the effects of compassion fatigue experienced by midwives working under intense stress during the third wave of the COVID-19 pandemic on the level of moral sensitivity. Research design (...) This is a descriptive-correlation study. Participants The statistical population consisted of all the midwives in Türkiye hospitals in 2021. This cross-sectional study was collected through a questionnaire using convenience sampling. Three hundred and ten midwives working in different units of the country participated in the study. Ethical considerations Approval from the researcher’s university Institutional Review Board for ethical review was obtained with the code of IRB 20/510. Findings The average age of the midwives is 34.29 ± 8.39. It has been noticed that 43.5% of the midwives work in public hospitals and 38.1% in family health and community health centers. Midwives’ mean MR-CS score is 67.11 ± 25.13, secondary trauma sub-dimension average 15.77 ± 6.23, and occupational burnout sub-dimension 40.69 ± 16.35. The mean moral sensitivity questionnaire score is determined as 93.86 ± 19.51. It has been observed that the working style and working time are effective on compassion fatigue. In the linear regression model, 98% of compassion fatigue was explained. Age, secondary trauma, and occupational burnout sub-dimensions affect the model. Discussion Working year, working style, second trauma, age, and occupational burnout parameters may help explain some of the links between midwives’ symptoms of compassion fatigue. Conclusion The pandemic affects the compassion fatigue of midwives. It is crucial to provide social support to midwives and health workers to prevent compassion fatigue and examine and control groups at risk in mental health. (shrink)

Recent research has demonstrated the importance of positive emotions, and especially compassion, for well-being. Via two investigations, we set out to determine if facial expressions of happiness,...

This article describes compassion as perceived within the relationship between nurses and older persons with a chronic disease. The aim of the study is to understand the benefit of compassion for nursing practice within the context of long-term care. The design of the study involves a qualitative analysis of in-depth interviews with nurses and patients in three different care-settings. Results show the nature of compassion in seven dimensions: attentiveness, listening, confronting, involvement, helping, presence and understanding. Analysis of (...) the data also shows in what way opinions of participants relate to issues raised in a previous literature study, for example the difference between pity and compassion. The conclusion states that compassion is a valuable process which motivates patients as well as nurses to cooperate in achieving relevant outcomes of care. The discussion involves some methodological issues. For one thing, further confirmation of the dimensions found is recommended. (shrink)

Over the past years the relevance of compassion for society and specific practices such as in healthcare is becoming a focus of attention. Philosophers and scientists discuss theoretical descriptions and defining characteristics of the phenomenon and its benefits and pitfalls. However, there are hardly any empirical studies which substantiate these writings in specific societal areas. Besides, compassion may be in the eye of attention today but has always been of interest for many contemporary philosophers as well as philosophers (...) in the past, David Hume amongst them. Three themes related to Hume’s hypotheses on compassion are discussed and compared to outcomes of an empirical study amongst nurses and patients with a chronic disease. This comparison gives insights into the perception of those for whom compassion is of specific importance in their daily lives and into the usefulness of Hume’s notions on compassion. (shrink)

The following three papers focus on compassion, an issue well worth our consideration in our contemporary age, and most especially during our recent national tragedy. It is hoped that these philosophical discussions of compassion may help us as we, on personal and societal levels, come to grips with immense human suffering. The topic of compassion brings us into an exploration of a cluster of related philosophical issues and is thus a good stepping off point for inquiry. The (...) role of the first paper is that of stage setting, to simply layout an approach to compassion presented by Aristotle and developed by Martha Nussbaum. This approach served as the introductory consideration in a course on compassion, taught by the first two commentators. Initially we wondered if we could sustain discussion on this narrow topic over fourteen weeks, but found the course left students with numerous questions worth their further consideration. So too in these papers, a number of issues will remain untouched, such as the relation of compassion and public policy and specific approaches to the cultivating of compassion, both of which are explored at length by Martha Nussbaum. This first paper frames our discussion, by presenting in outline form key points addressed in Martha Nussbaum’s Aristotelian discussion of the emotion of compassion, and touches upon issues developed in the next two papers. (shrink)

ABSTRACTPast research reveals important connections between meditative practices and compassion. Most studies, however, focus on the effects of one type of meditation (vs. a no-intervention control...

Self-compassion is considered to be a healthy and adaptive attitude towards oneself, occurring both as a feature, as well as a state. Self-compassionate attitude towards oneself is composed of: a) kindness and understanding given to oneself b) mindfulness of one’s own experiences and c) a sense of community of experiences with humanity. Compassion towards oneself is structurally and functionally distinct from the self-commiseration and self-pity that lead to worse adaptation. Research shows that self-compassion is associated with better (...) regulation of negative emotions. Neff in her theoretical assumption states that due to more effective emotion regulation, people with a higher level of selfcompassion can generally cope better with reality. Therefore a question arises as to what the relationship is between a compassionate attitude towards oneself and social functioning of people. This article is a review of research that has been conducted so far regarding relations between self-compassion and the various dimensions of social functioning. (shrink)

Compassion: A Tibetan Analysis. Guy Newland. Wisdom Publications, London 1984. 167 pp. £6.95.

Speaking of the public response to the deaths of children at the Bristol Royal Infirmary before 2001, the BMJ commented that the NHS would be ‘all changed, changed utterly’. Today, two inquiries into the Mid Staffordshire Foundation Trust suggest nothing changed at all. Many patients died as a result of their care and the stories of indifference and neglect there are harrowing. Yet Bristol and Mid Staffordshire are not isolated reports. In 2011, the Health Services Ombudsman reported on the care (...) of elderly and frail patients in the NHS and found a failure to recognise their humanity and individuality and to respond to them with sensitivity, compassion and professionalism. Likewise, the Care Quality Commission and Healthcare Commission received complaints from patients and relatives about the quality of nursing care. These included patients not being fed, patients left in soiled bedding, poor hygiene practices, and general disregard for privacy and dignity. Why is there such tolerance of poor clinical standards? We need a better understanding of the circumstances that can lead to these outcomes and how best to respond to them. We discuss the findings of these and other reports and consider whether attention should be devoted to managing individual behaviour, or focus on the systemic influences which predispose hospital staff to behave in this way. Lastly, we consider whether we should look further afield to cognitive psychology to better understand how clinicians and managers make decisions? (shrink)

Compassion and Benevolence reveals the heart of early Buddhist and classical Confucian ethics in a comparative way. It explores compassion (karuna) and benevolence (jen) by analyzing their mechanisms, their moral groundworks, their applications, and their meta-ethical nature. This exploration intends to reject the popular theses: early Buddhism is only self-liberation-concerned soteriology and classical Confucianism is only society-concerned thought requiring self-effacement.

Background: Compassion is seen as a core professional value in nursing and as essential in the effort of relieving suffering and promoting well-being in palliative care patients. Despite the advances in modern healthcare systems, there is a growing clinical and scientific concern that the value of compassion in palliative care is being less emphasised. Objective: This study aimed to explore nurses’ experiences of compassion when caring for palliative patients in home nursing care. Design and participants: A secondary (...) qualitative analysis inspired by hermeneutic circling was performed on narrative interviews with 10 registered nurses recruited from municipal home nursing care facilities in Mid-Norway. Ethical considerations: The Norwegian Social Science Data Services granted permission for the study (No. 34299) and the re-use of the data. Findings: The compassionate experience was illuminated by one overarching theme: valuing caring interactions as positive, negative or neutral, which entailed three themes: (1) perceiving the patient’s plea, (2) interpreting feelings and (3) reasoning about accountability and action, with subsequent subthemes. Discussion: In contrast to most studies on compassion, our results highlight that a lack of compassion entails experiences of both negative and neutral content. Conclusion: The phenomenon of neutral caring interactions and lack of compassion demands further explorations from both a patient – and a nurse perspective. (shrink)

The paper presents a perspective on our relation to our environment that is inspired by Confucian thought and that stands in contrast to certain common strands in contemporary philosophical discussions. It conceptualizes our relation to what we encounter on a day-to-day basis primarily in terms of the way we experience and respond to situations, rather than to the objects affected in the situations. From this perspective, the contemporary philosophical distinction between a first- and a third-person point of view is often (...) not suited for describing our responses to situations. Instead, our responses to situations can vary along different dimensions, including the way we direct our attention, our thoughts and sentiments, our motivations, etc., and these variations admit of degrees. Such variations depend on various factors, such as the different ways in which one relates to the object affected in a situation and the kind of person one is. and cannot be adequately described in terms of a shift from one point of view to another. The paper discusses two examples, anger and compassion, to illustrate this alternative perspective, but the discussion can be extended to other areas such as gratitude. (shrink)

The idea that ethics is a matter of personal feeling is a dogma widespread among medical students. Because emotivism is firmly rooted in contemporary culture, the authors think that focusing on personal feeling can be an important point of departure for moral education. In this contribution, they clarify how personal feelings can be a solid basis for moral education by focusing on the analysis of compassion by the French phenomenologist Emmanuel Housset. This leads to three important issues regarding ethics (...) education: the necessity of a continuous attention for and interpretation of the meaning of language, the importance of examining what aspect of “the other” touches one and what it is that evokes the urge to act morally and the need to relate oneself to the community, both to the medical community and to collectively formulated rules and laws. These issues can have a place in medical education by means of an ethical portfolio that supports students in their moral development. First, keeping a portfolio will improve their expression of the moral dimension of medical practice. Second, the effects of self-knowledge and language mastery will limit the pitfalls of emotivism and ethical subjectivism and will stimulate the inclination to really encounter the other. Third, it will show medical students from the start that their moral responsibility is more than following rules and that they are involved personally. (shrink)

Background Nurses provide care to meet the complex needs of patients in the increasing workload in the health system and are at risk of compassion fatigue. The concept of compassion fatigue has begun drawing attention in the last decade, as it negatively affects nurses' physical and mental health, job performance and satisfaction, and therefore patient care quality. Objectives This study was to examine compassion fatigue and predictive factors in paediatric surgery nurses. Participants and research context The study (...) was cross-sectional, predictive and quantitative. It was conducted with the 135 paediatric surgery nurses. The data were sent to the email addresses of the members via Google Survey. Research data were collected with the Nurse Information Form, Compassion Fatigue Scale, Life Satisfaction Scale and Multidimensional Perceived Social Support Scale. Ethical considerations After obtaining the approval of the University’s ethics committee, the study was carried out after obtaining participants’ informed written and verbal consent. Results There was a difference between the level of compassion fatigue according to the paediatric surgery unit that worked the longest and the thought of changing their profession. Burn unit nurses and nurses who were considering changing professions have higher compassion fatigue scores. When the predictors of compassion fatigue were examined, the thought of changing the nursing profession and life satisfaction were significant predictors of compassion fatigue. The thought of changing the nursing profession and life satisfaction explained 22% of compassion fatigue. The same variables and the longest working period of the paediatric surgery unit were the estimators of the level of occupational burnout; explaining 29% of occupational burnout. Conclusions Compassion fatigue, life satisfaction and perceived social support of paediatric surgery nurses are moderate. Compassion fatigue is affected by working time, the thought of changing the profession, life satisfaction and perceived social support. (shrink)

We need modal imagination in order to extend our conception of reality - and, in particular, of human beings - beyond our immediate experience in the indexical present; and we need to do this in order to preserve the significance of human interaction. To make this leap of imagination successfully is to achieve not only insight but also an impartial perspective on our own and others' inner states. This perspective is a necessary condition of experiencing compassion for others. This (...) is the primary thesis I will try to defend in this discussion. (shrink)

This paper is a discussion of the emotion of compassion or pity, and the corresponding virtue. It begins by placing the emotion of compassion in the moral conceptual landscape, and then moves to reject the currently dominant view, a version of Aristotelianism developed by Martha Nussbaum, in favour of a non-cognitive conception of compassion as a feeling. An alternative neo-Aristotelian account is then outlined. The relation of the virtue of compassion to other virtues is plotted, and (...) some doubts sown about its practical significance. (shrink)

One may say that The Open Society and Its Enemies (OS) offered in 1945 the first complete elaboration of the general approach proposed by Karl Popper, namely his ‘critical rationalism’, a bold generalization of the fallibilist falsificationism in the domain of the empirical sciences masterly proposed in Logik der Forschung (1934). The political content of The OS has been critically discussed. Nevertheless, not all people insist on the equally important moral dimension of the book, giving it its unity, I submit. (...) Without morality, no critical discussion, no reason, no open society, let us say in a nutshell. I would argue that according to Popper, a strictly Christian morality of love would not be the appropriate emotional companion of critical rationalism, but that the less demanding moral emotion of sympathy or compassion is perhaps necessary to give it its force against violence. I give some support to this line of argument. In my view, Popper proposed a somewhat unarticulated critical rationalist ‘emotivism’ of sorts. The emotion of compassion is necessary for triggering our moral decisions and values, which are the ultimate basis of the choice for a reason against violence. (shrink)

The following three papers focus on compassion, an issue well worth our consideration in our contemporary age, and most especially during our recent national tragedy. It is hoped that these philosophical discussions of compassion may help us as we, on personal and societal levels, come to grips with immense human suffering. The topic of compassion brings us into an exploration of a cluster of related philosophical issues and is thus a good stepping off point for inquiry. The (...) role of the first paper is that of stage setting, to simply layout an approach to compassion presented by Aristotle and developed by Martha Nussbaum. This approach served as the introductory consideration in a course on compassion, taught by the first two commentators. Initially we wondered if we could sustain discussion on this narrow topic over fourteen weeks, but found the course left students with numerous questions worth their further consideration. So too in these papers, a number of issues will remain untouched, such as the relation of compassion and public policy and specific approaches to the cultivating of compassion, both of which are explored at length by Martha Nussbaum. This first paper frames our discussion, by presenting in outline form key points addressed in Martha Nussbaum’s Aristotelian discussion of the emotion of compassion, and touches upon issues developed in the next two papers. (shrink)

This paper will discuss the role of compassion in ethics in general and in healthcare ethics in particular. My thesis is that compassion:1) as Rousseau pointed out, is a natural trait common to all higher animals ;2) can and does serve as one of the most important motivators and modulators of ethics in both theoretical and applied aspects;3) must be controlled by, and in turn control, reason if it is to serve its ethical as well as natural purposes; (...) and4) as a natural trait has survival value and, by virtue of being a natural trait, cannot be an obligation although there may very well be an obligation to do all that is necessary to nurture and not crush this sentiment. (shrink)

The central role of the virtue of compassion in the shaping of the professional character of healthcare providers is a well-emphasized fact. On the other hand, the utmost obligation of physicians is to alleviate or eliminate human suffering. Traditionally, according to the Aristotelian understanding of virtues and virtue ethics, human virtues have been associated with masculinity. In recent decades, the founders of the ethics of care have introduced a set of virtues with feminine nature. This paper analyzes the notion (...) of compassion as a common virtue between the traditional/masculine and care/feminine sets of virtues and shows that compassion is a reunion and merging point of both sets of human virtues. This role can be actualized through the development and promotion of compassion as an important part of the character of an ideal physician/healthcare provider. In addition, this paper argues that the notion of compassion can shed light on some important aspects of the contemporary debates on healthcare provider-patient relationship and medical futility. Despite the recent technological and scientific transformations in medicine, the interpersonal relationship between healthcare providers and patients still plays a vital role in pursuing the goals of healthcare. The virtue of compassion plays a central role in the establishment of a trust-based physician-patient relationship. This central role is discernible in the debate of medical futility in which making difficult decisions, depends largely on trust and rapport which are achievable by compassion in the physician and the recognition of this compassion by the patients and their surrogate decision makers. (shrink)

The philosophy of animal rights is often characterized as an exclusively justice oriented approach to animal liberation that is unconcerned with, and moreover suspicious of, moral emotions, like sympathy, empathy, and compassion. I argue that the philosophy of animal rights can, and should, acknowledge that compassion plays an integral role in animal liberation discourse and theory. Because compassion motivates moral actors to relieve the serious injustices that other animals face, or, at the very least, compassion moves (...) actors not to participate in or cause these injustices, the philosophy of animal rights can and should recognize both a duty to cultivate compassion and a duty to promote compassion. Contra to feminist critiques of Regan’s justice-approach to ethics, the philosophy of animal rights is not committed to eschewing the moral emotions. (shrink)

The pastoral ministry of caregiving inevitably implies a cost. The spiritual ethos in the Christian ministry implies a huge sacrifice. Dietrich Bonhoeffer described this ethos as ‘the cost of discipleship’. Very specifically in the case of unexpected and the so-called ‘undeserved modes of suffering’, the meaning framework of the caregiver is being interpenetrated, causing a kind of ‘depleted sense of being’. It is argued here that an appropriate diagnosis, and a description of the phenomenon of compassion fatigue, can help (...) caregivers to better understand their sense of being depleted. Instead of leaving the pastoral ministry, this can help them to attend anew to their spiritual capacity. In this regard, a theology of compassion, framed by theopaschitic theology, can help pastors to become ‘healed’ in order to re-enter the pastoral ministry and regain a sense of parrhēsia. (shrink)

Primary care givers commonly interpret shortages of time with patients as placing them between a rock and a hard place in respect of their professional obligations to fairly distribute available healthcare resources (justice) and to offer a quality of attentive care appropriate to patients’ states of personal vulnerability (compassion). The author argues that this a false and highly misleading conceptualisation of the basic structure of the ethical dilemma raised by the rationing of time in clinical settings. Drawing on an (...) analysis of the Aristotelian virtue of nemesis, or “the sense of justice”, it is argued that, far from being a moral orientation distinct from justice, compassion is a justice response insofar as it is conceptualised as a rational, appropriate response to others’ adversity. The author then proceeds to point out that the perspective on justice and compassion as attributes of healthcare professionalism suggests a novel critical viewpoint on the ethics of managed forms of clinical rationing and the “scarcity paradigm” they engender: clinical conditions where primary care givers’ time is intentionally rendered a commodity in chronically short supply run a deficit of justice, because they fail to make adequate accommodations for the provision of the quality of care human beings deserve in situations of illness and injury, and when they are dying. (shrink)

Philosophical and scientific understandings of compassion converge, both stressing its necessity for the moral life and human flourishing. I conceptualise a dynamic and frangible account of professional virtues, including compassion, and propose that mechanistic organisational systems of care and the biomedical paradigm create a strong risk of dehumanisation and the obliteration of compassion in healthcare. Additionally, the neoliberal market ideology, with its instrumental approach to individuals and commodification of healthcare creates a corrosive influence that alienates clinicians from (...) their patients and severely curtails the scope for compassionate practice. The tension between efficiency and patient orientated care – although they need not be mutually exclusive – has become more acute in the current economic climate, at a time when the boundaries of medicine have broadened and expectations for healthcare have risen. This has created an unsustainable dynamic within which alienated healthcare professionals struggle to fulfil their healing roles and patients experience abandonment and more anxiety. (shrink)

Background: Compassion fatigue is recognized as impacting the health and effectiveness of healthcare providers, and consequently, patient care. Compassion fatigue is distinct from “burnout.” Reliable measurement tools, such as the Professional Quality of Life scale, have been developed to measure the prevalence, and predict risk of compassion fatigue. This study reviews the prevalence of compassion fatigue among healthcare practitioners, and relationships to demographic variables. Methods: A systematic review was conducted using key words in MEDLINE, PubMed, and (...) Ovid databases. Data were extracted from a total of 71 articles meeting inclusion criteria, from studies measuring compassion fatigue in healthcare providers using a validated instrument. Quantitative and qualitative data were extracted and compiled by three independent reviewers into an evidence table that included basic study characteristics, study strength and quality determination, measurements of compassion fatigue, and general findings. Meta-analysis, where data allowed, was stratified by Professional Quality of Life version, heterogeneity was quantified, and pooled means were reported with 95% confidence interval. A table of major study characteristics and results was created. Ethical consideration: This paper contains no primary data obtained directly from research participants. Data obtained from previously published resources have been acknowledged within references. Psychological distress, particularly compassion fatigue, can be insidious, no health profession is immune, and may significantly impact the ability to provide care. Results: A total of 71 studies were included. Compassion fatigue was reported across all practitioner groups studied. Relationships to most demographic variables such as years of experience and specialty were either not statistically significant or unclear. Variability in reporting of Professional Quality of Life results was found. Interpretation: Compassion fatigue exists across diverse practitioner groups. Prevalence is highly variable, and its relationship with demographic, personal, and/or professional variables is inconsistent. Questions are raised about how to mitigate compassion fatigue. (shrink)

Globalization, with its undisputed benefits, also presents complex moral challenges that business leaders cannot ignore. Some of this moral complexity is attributable to the scope and nature of specific issues like climate change, intellectual property rights, economic inequity, and human rights. More difficult aspects of moral complexity are the structure and dynamics of human moral judgment and the amplified universe of global stakeholders with competing value claims and value systems whose interests must be considered and often included in the decision-making (...) process. While managing moral challenges is considered in management literature to be a legitimate and crucial function of business leadership, the complexity of moral challenges in a globalized business culture stretches the managerial capacities of individuals who rely on a personal moral compass and their own wisdom traditions of philosophy or religion for guidance. The Global Moral Compass introduces an expanded epistemic value framework as an aid to understanding and managing moral complexity in a globalized business culture. (shrink)

Background: Nurses who are constantly being exposed to patients’ suffering can lead to compassion fatigue. There is a gap in the latest research regarding nurses’ experiences of compassion fatigue. Little is known about how compassion fatigue affects the nurse as a person, and indications of how it affects the profession are scarce. Aim: The aim of this study was to explore compassion fatigue experienced by nurses and how it affects them as persons and professionals. Research design, (...) participants, and research context: A qualitative explorative approach was used. The data consisted of texts from interviews with seven nurses in various nursing contexts. Content analysis was used. Ethical consideration: Ethical approval was sought and granted from an ethics committee at the university where the researchers were based, and written, informed consent was obtained from all the participants. Findings: Five themes were discovered: Compassion as an empathic gift and compassion fatigue as a result of compassion overload, Compassion fatigue as exhausting the nurse as a professional and private person, Compassion fatigue as a crisis with potentially valuable insights, Compassion fatigue can be handled by self-care and focus on self, and Compassion fatigue is affected by life itself and multifaceted factors. Discussion: Compassion stress and overload can lead to compassion fatigue. Compassion fatigue affects the nurse’s ability to compassion, and the caring is no longer experienced in the same way; the nurses experienced it as being deprived of the gift of compassion. Compassion fatigue implicates a crisis with potentially valuable insights. Conclusion: Compassion fatigue can be symbolized as bruises in the soul, hurtful, but with time it can fade away, although it leaves a sense of caution within the nurse, which can affect the suffering patient. (shrink)

Being compassionate and empathic while making rational decisions is expected from healthcare workers across different contexts. But the daily challenges that these workers face, aggravated by the recent COVID-19 crisis, can give rise to compassion and decision fatigue, which affects not only their ability to meet these expectations but has a significant negative impact on their wellbeing. Hence, it is vital to identify factors associated to their exhaustion. Here, we sought to describe levels of compassion and decision fatigue (...) during the pandemic, and to identify factors related to these forms of exhaustion. We collected data using self-reported questionnaires to measure compassion fatigue, decision fatigue, and grit in five intervals from April to November, 2020 (N = 856). Our results showed a negative correlation between grit and compassion and decision fatigue. We also found that under the circumstances studied grit tends to be higher in technicians, nurses, other professionals (psychologists, social workers), and workers at the Emergency Room (ER), and lower in general practitioners. Compassion fatigue tend to be higher for technicians, whereas decision fatigue was lower for specialists, general practitioners, and technicians, and higher for those working at private hospitals. (shrink)

The term compassion fatigue has come to be applied to a disengagement or lack of empathy on the part of care-giving professionals. Empathy and emotional investment have been seen as potentially costing the caregiver and putting them at risk. Compassion fatigue has been equated with burnout, secondary traumatic stress disorder, vicarious traumatization, secondary victimization or co-victimization, compassion stress, emotional contagion, and counter-transference. The results of a Canadian qualitative research project on nurses? experience of compassion fatigue are (...) presented. Nurses, self-identified as having compassion fatigue, described a change in their practice by which they began to shield and distance themselves from the suffering of patients and families. Time to help patients and families cope with suffering seemed unavailable, and many felt they were running on empty and, ultimately, impotent as nurses. Feelings of irritability, anger, and negativity arose, though participants described denying or ignoring these emotions as a way to try to survive their work day. Difficulties with work carried over into the nurses? personal lives, affecting their relationships with family and friends. Such experiences invariably called into question the participants? identity, causing them to reflect on the kind of nurse they were. The participants? compassion fatigue created a sense of hopelessness regarding positive change, although some nurses described strategies that seemed to help alleviate their compassion fatigue. (shrink)

Background With an increasing older population, the pressure on home care resources is growing, which makes it important to ensure the maintenance of quality care. It is known that compassion and ethical sensitivity can improve the quality of care, but little is known about care leaders’ perceptions on ethical sensitivity and compassion in home care and how it is associated with staff competence and thus quality of care. Aim The aim of the study was to explore home care (...) leaders’ perceptions of ethical sensitivity and compassion associated with care quality in home care. Research design, participants, and research context A hermeneutical approach with a qualitative explorative design was used. The data consists of texts from 10 in-depth interviews with home care leaders. Content analysis was used as a method. Ethical considerations The study was conducted following the ethical guidelines of the Declaration of Helsinki and the Finnish Advisory Board of Research Ethics. Research ethics permission was applied for from a Research Ethics Board. Findings One overall theme and four subthemes were found. The overall theme was: “Compassion provides deeper meaning and ethical sensitivity provides means for knowing how to act”. Discussion If nurses fail to be sensitive and compassionate with patients, good and high qualitative home care cannot be achieved. Ethical sensitivity and compassion can be seen as resources in home care but the organization and the care leaders need to provide the support for these to develop. Conclusion This study provides an understanding of the meaning of ethical sensitivity and compassion as sources of strength and their link to quality of care in a home care context. Further studies could focus on how to build compassion and ethical sensitivity into home-based care and how to ensure adequate support for healthcare professionals’ compassion and ethical sensitivity. (shrink)