Lying Down in the Ever-Falling Snow: Canadian Health Professionals’ Experience of Compassion Fatigue

What Is Compassion?

Before exploring the experience that is called compassion fatigue, compassion itself must be looked at. Compassion manifests in contemporary health care amid ambiguity and paradox. Some argue that the very means by which institutional care is offered makes compassion impossible,1 while others go as far as to say that the dawn of institutionalized care in Roman Christendom began the death knell for the ancient virtues of compassion and hospitality.2 There is yet another response (often expressed in the null curriculum of clinical education)3 that maintains compassion and other emotional attachments are not virtues of the health professional but WHAT IS COMPASSION? It is a feeling common to all mankind that they cannot bear to see others suffer....This feeling of distress is the first sign of humanity. Mencius PHOTO BY ESTHER M C DONALD 12 What Is Compassion? liabilities that cloud clinical judgment. Such attitudes might interpret compassion as a vestigial appendage of the ancient Hippocratic tradition, no more relevant in modern health care than swearing an oath to Apollo. Amid the compassion pessimists, there are adamant defenders of compassion who characterize it as an essential moral and professional virtue ,4 if not the very ground of care itself.5 There are others who refrain from use of the term, hoping to replace it with a more sanitary and safe modern substitute such as empathy.6 Nevertheless, there is no doubt that the founders of modern Western health systems saw a guiding role for compassion, as can be witnessed in the present nomenclature of hospitals and health systems (Caritas, Misericordia, etc.). Compassion is also commonly and explicitly mentioned as a virtue and goal of care in numerous professional codes of ethics and even in organizational codes of conduct and mission statements. If compassion is indeed a virtue in health care, is it one that can be taught or learned? If the very system that sees compassion as a virtue also prevents or frustrates its manifestation or experience, which ought to be protected: the system or the clinician? If compassion’s role is indeed the sentimental vestige of previous ineffective healing traditions, how can such sentimentality be purged from an evidence-based, technologically oriented healing science? Defining Compassion Vestige or not, the concept of compassion is ancient enough to coincide with any historical healing tradition. It is one of the few universal, crosscultural , ancient virtues that has survived into the modern world (unlike the virtue of hospitality for instance),7 and it is at the centre of transitions between cultural and philosophical worldviews. The understanding of compassion at any one time is always inherently connected to a predominant theory of identity and human nature; hence, the understanding of compassion is a reflection on human nature itself. While what follows may appear to be a trek through the dense terrain of moral philosophy, it is merely a peak at what is essential for understanding how compassion can be conceived as meaningful, possibly even fundamental, to human experience. Compassion is old enough to have borne witness to the birth of Western culture as well as a majority of world religions. It is likely the case that careful attention to and deep reflection on What Is Compassion? 13 our relationships to one another may still be as relevant and meaningful to us as they were to Aristotle, Jesus, Hippocrates, or the Buddha. The English and French words “compassion” and the German Mitleid mean literally to “suffer with.” The Oxford English Dictionary definition is broader in that it adds a secondary function: “The feeling or emotion, when a person is moved by the suffering or distress of another, and by the desire to relieve it; pity that inclines one to spare or to succour.”8 The term compassion , then, captures two separate notions: an identification with the suffering of others and a motivation or response to act to relieve this suffering. In its origins, compassion bears close affinity with mercy, which cannot simply be felt but must be enacted. This twofold meaning can be traced back through Latin to the concept’s ancient Greek and Hebrew origins. In the Latin, compatior is the word’s literal root, but misericordia is typically interpreted as compassion or mercy. In the interpretation and translation of biblical texts, this relationship between compassion as a feeling and as a motivation to action is consistent, and it is often the case in New Testament translations that...