Compassion and Responsibility

This chapter explores how responsibility, fault, and desert matter for the content of compassion with particular reference to the idea of rationing by fault, shared decision-making, and recent UK law regarding the relationship between responsibility, risk, and consent. Conceptual clarity is sought through exploring how tragedy differs from Christian theology by deploying the contrasting categories of the ‘undeserving sick’, the ‘obstinate sick’ and the ‘sad sick’, as applied to clinical communication, pastoral discretion, and mercy. The chapter considers what may be learnt for the interrelation of responsibility with compassion from the Book of Job. This analysis deepens the earlier account of second-person relatedness and compassion, by considering the category of ‘remonstration’. This is then applied to practice through a discussion of the constraints on certain forms of public and preventive healthcare. The chapter concludes by drawing on ecclesiological motifs to describe how compassionate relationships can persevere over time.

Introduction

This chapter situates the enquiry by considering the transitions which healthcare practice is undergoing because of turns in healthcare thinking towards philosophy, person-centredness, and social theory. Such changes accentuate a problem inherent in other trends in modern healthcare which have tended to reduce the scope for exploring the human condition and morally worthy ways of living life within it. The historic response of Christian ethicists to such transitions and trends is reviewed as a kind of cautionary tale which, by distinguishing different theological approaches, discloses the contested nature of an enquiry such as this. Options for the proper mode of the enquiry are thereby considered, with an argument made for a version of ‘faithful secularity’ being predominant, drawing on Nigel Biggar and Luke Bretherton, while incorporating other insights. The structure of the book is then outlined, the political context is introduced, some distinctions are highlighted, and a guide to reading is offered.

Compassion in Civic Life

This chapter completes the therapeutic task by critically examining the impact on compassionate relationships of various forms of healthcare citizenship, from the consumer-citizen to the responsibilised citizen to the cosmopolitan citizen. Reflecting the peregrinatio motif, an associative mode of civic life is advocated in which civic society actors have a pivotal role in forming compassionate relationships and sustaining ‘collaborative deliberation’, primarily locally or regionally. A civic life of this sort shares ‘secular’ time, in which people with differing beliefs and experiences meet in respectful if sometimes critical conversation amidst the plurality of civic life. A key source for developing civic life is the democratic capabilities of health professionals and institutions in modelling and shaping compassionate relationships. In this way, a ‘faithful secularity’ fit for healthcare can emerge, keeping faith and full of faith, interweaving the streams of thought about human suffering whereby compassion is filled with content in practice.

Compassion and Peregrinatio

This chapter begins to describe the response to Chapter 1’s diagnosis. The core of a social theory which will provide therapy is introduced, namely, peregrinatio, the wayfaring and pilgrim experience of life. Peregrinatio is explained and deployed to show how it reframes healthcare encounters, illuminating the nature of compassion, its civic context, and its everyday practice and fostering six attitudes which conduce to compassion: (i) interest in the human life-course; (ii) patience with plurality of perspective; (iii) curiosity in human encounter and companionship; (iv) humility in conversation; (v) recognition of the proper value of healthcare; and (vi) perseverance in preserving the communal nature of human life amidst suffering. The benefits of such a framing of the human condition for three aspects of healing are considered: (i) the healing of the affections; (ii) the healing encounter with God amidst suffering; and (iii) the healing role of healthcare professionals. Objections to peregrinatio are considered and addressed.

Compassion in Healthcare Policy and Practice

This chapter considers three areas of healthcare practice and policy, selected because of collaborative work that has been pursued by the author and in light of the challenges they pose to compassion. For the first, healthcare professionalism, it draws on work with the Royal College of Physicians London to consider how the doctor’s roles as healer, patient-partner, advocate, and innovator, matter for compassionate relationships in practice, addressing especially the challenge of machine learning. The second concerns marketisation in healthcare, including both its corrosive and beneficial effects on compassionate relationships. The role of faithfulness and covenant in healthcare practice is explored, resulting in a recommendation for a Healthcare Covenant binding together public, healthcare professionals, researchers, and corporate actors. The third, drawing on partnership with biomedical researchers and clinicians, concerns the technologisation of healthcare, specifically in the field of precision medicine. The discussion examines problems with the culture of precision medicine and practical ideas to strengthen compassionate relationships.

What’s Wrong with ‘Compassion’?

This chapter diagnoses various ills which beset the language and practice of ‘compassion’. To begin with, problems in the political context for compassion in healthcare are considered, especially the complex relationship between patriotism, political liberalism, and health. In light of this, problems for compassion which require therapy are diagnosed. To some people, compassion seems an unreasonable demand to place on healthcare workers in modern, liberal democracies. This seems to be corroborated by the indeterminacy of compassion’s meaning, leading to a corruption in practice whereby compassion becomes acquiescence to the wishes of sufferers. Moreover, placing a demand for compassion upon healthcare workers seems liable to lead to burn-out. Two contrasting trends in healthcare practice exacerbate problems for compassion further: first, the possible decomposition of healthcare roles in light of machine learning, stripping out previous expectations for compassionate relationships, and, second, the overwhelming challenge of social death among the frail elderly.

Epilogue

The Epilogue is a meditation on old age, combining further policy thinking on compassion and civic life with a reflection on how the terror of social death can be addressed through the life of the body politic and the body of Christ. The chapter sets an agenda for enquiring into three areas of urgent practical concern: (i) why and how the middle-aged and strong who are in government are investing across the different stages of the life-course; (ii) how growing old can be so consciously embedded as part of civic life’s self-understanding as to enable citizens to live in compassionate relationship to the end of their lives; and, (iii), how an innovative democratic professionalism will be important for the way policies and practices are reformed, especially with a view to collaborating with social movements such as churches in their work of diakonia. On this basis, the emphasis on the role of health professionals as innovators can, therefore, be expanded to include innovation in civic life. To the question of what narrative will bring healing and direction to wayfarers and pilgrims in the remains of their days, the response of the church has been a continual meditation on a particular second-person encounter of new birth amidst old age: Lord now lettest thou thy servant depart in peace.

Compassion and Time

This chapter explores how differing views of time and narrative give rise to different objects of hope and corresponding content to compassion. Reflection on the human life-course, increasingly influential in policy, practice, political thought, and ethics, provides a frame of reference for interrelating different interpretations of human life from conception to death. A faithfully secular enquiry is pursued to explore this possibility, being capacious enough to interweave various ways of conceiving the human condition. To show how compassion’s content is differentiated by varying accounts of time, the chapter examines the interrelation of tragedy, Christian theology, and compassion in conversation with Martha Nussbaum, with an excursus on Buddhism. The aim is to clarify how creation, sin, Christ’s death, and Christ’s resurrection influence the content of compassion. The account of time’s relationship to compassion which emerges—‘time suspended and reconciled’—is defined by Christ’s life-course and applied to obstetrics and palliative care.

Compassion’s Nature

This chapter builds on Chapter 2’s therapy by specifying compassion’s nature. The distinction is drawn between compassion’s nature and its content. The former is common to the quality of all relationships characterised by compassion while the latter is constituted by the interaction and negotiation between what people bring to such relationships by way of specific beliefs, doctrines, or practices concerning suffering and the human condition. Compassion’s nature is defined as, paradigmatically, a quality of intersubjective relationships formed as wayfarers and pilgrims with diverse views about suffering encounter each other in the course of their lives. As such, compassion is described as cognitive, normally consensual, affective, typically bodily or intercorporeal, alleviative and, in principle, persuasive, and narratival. While compassion is primarily a quality of second-person relatedness, it is also a personal character excellence, which decentres the agent in ways which are conducive to such relatedness.