Compassion in Healthcare: Practical Policy for Civic Life

Compassion in healthcare has rightly been of major concern in recent years. The Francis Report into the mid-Staffordshire NHS Foundation Trust highlighted this matter clearly. However, the nature of compassion has typically not been sufficiently thought about or worked out in practical detail in institutional, professional and public settings. Rather compassion's meaning and practice have been thought obvious and not a matter for sustained reflection.

Historically, compassion has often been conceived in religious terms. Where serious scholarly reflection has been conducted on compassion, it has commonly been shaped by theological, philosophical or other religious commitments. Prominent contributions, differing significantly in their analyses, have come from streams of Christian and Buddhist thought.

More recently, a belief in the storied or narratival nature of human self-understanding has informed much medical humanities thinking about compassion. Parallel policy turns have included an emphasis on 'patient-centred care' (seeing patients as persons with stories and wishes) and the overall 'life-course' of patients (seeing patients in the here and now in terms of their needs for care over the course of their lives). Moreover, while underlying Christian ideas of solidarity and co-suffering have to some extent endured, versions of Buddhism have become more influential for how compassion is conceived in healthcare, accompanied practically, for example, by 'mindfulness' training. Finally, in academic reflection on healthcare, philosophy of emotion has emphasised the cognitive nature of compassion and thus its crucial role in institutional life and professional training.

This analysis highlights the diversity of meanings attributed to compassion and so complicates public discourse about health and suffering, providing it with points of reference whereby suffering's individual, social and political significance can be explored. It remains important in a plural, democratic society that debate is constantly stimulated about the interpretation of compassion and the pathways to its social and political realisation. If it is to be conceptually rich and practically useful, this debate should be interdisciplinary, research-intensive and attentive to the experience of both healthcare workers and patients.

The research to be conducted in this project will significantly advance this debate, drawing Christian traditions into constructive 'secular' conversation with Buddhist and philosophical interpretations of compassion. By 'secular' here, the research will not mean non-religious but rather what the Augustinian Christian tradition has intended, namely a humble, shared, critically respectful civic life which does not exclude either religious or non-religious voices but seeks common ground, better quality disagreement and advanced understanding through rigorous conversation.

This project will focus on four themes to organise this secular conversation and construct its own account of compassion: time, responsibility, personalisation and privatisation. Through analysis of these themes, it will seek greater clarity on the variety of ways in which compassion is conceived while at the same time constructing and advocating a specific account of compassion, shaped primarily by Christian moral theology, as a contribution towards the formation of healthcare policy concerning institutional organisation, professionalism and the role of citizenship in healthcare.

The project's goals will be achieved through reflective research, informed by knowledge exchange with relevant project partners especially the Oxford University Hospitals NHS Foundation Trust. Collaborative, knowledge exchange seminars in partnership with healthcare workers will be focussed around how the four themes noted above provide conceptual pathways towards a better understanding of compassion and its realisation in practice.

This research into compassion in healthcare aims to be well informed by healthcare practice and to effect beneficial change within it. It has the potential to contribute significantly to healthcare's culture and effectiveness by deepening understanding of compassion's nature and practical outworking among healthcare workers, policy makers, the general public and the commercial private sector.

The first group of non-academic beneficiaries are healthcare workers such as doctors, nurses and managers, national policy makers, regional healthcare commissioners and local authorities. Impact will be sought by pursuing the practical outworking in policy of the PI's research regarding compassion in relation to time, responsibility, personalisation and privatisation. The pilot phase of the project has indicated how well-informed, collaborative conceptual analysis can open up pathways to practical change in specific areas: for example, theological discussion of responsible leadership can help departments in hospitals put into systematic practice commitments concerning compassion for one's colleagues by focussing more attention on training for those moving into senior clinical positions; or again, theological analysis of interpersonal solidarity can shape professional bodies' public statements concerning the healthcare profession's compassionate social contract with patients in addressing the challenges of shared responsibility for healthcare and the promise of personalised medicine.

Impact in these specific areas and others will be sought through structured interventions within healthcare institutions via partnerships already forged by the PI at local, national, regional and international levels and any which may form during the project. The project partners are the Oxford University Hospitals NHS Foundation Trust, the Royal College of Physician and the Stratification in Colorectal Cancer Consortium. Collaborators include the European Alliance for Personalised Medicine. The impacts aimed at include improvements to institutional organisation, teamwork, care for colleagues, professionalism, training, patient-centred care and policy in personalised medicine. These cultural benefits to healthcare institutions may, over time, lead to enduring change.

Non-academic beneficiaries will, secondly, be the general public, especially those who happen to be patients. A deep understanding of diverse interpretations of compassion will be crucial to the effectiveness of healthcare in plural democracies. Patients will benefit through institutional change and staff training which enable such enhanced understanding. The significance of how people feel about the healthcare they receive lies in an enriched healthcare culture and in clinical outcomes with studies indicating that, when people feel cared for, they are more like to adhere to agreed treatment plans, which are especially important in relation to personalised medicine. A further indirect benefit may thus be improved patient health and thus the wealth of the United Kingdom.

The third group of non-academic beneficiaries are the commercial private sector and policy makers working therein. These might include clinicians operating privately or private medical institutions which seek to understand how their work may be both compassionate and financially profitable. In particular, the research focus on personalised medicine will benefit pharmaceutical companies who wish to reflect on the need for societal trust for patient participation in screening and treatment pathways and thus for the successful and ethical deployment of commercial products. Government-funded entities such as the Precision Medicine catapults which seek to promote the commercialisation of personalised medicine research may benefit from this work. Since the UK government is partnering with such bodies and has appointed a Minister for Life Sciences to support them, government and policy makers may benefit from the research.