Professional medical ethics demands of health care professionals in addition to specific duties and rules of conduct that they embody a responsible and trustworthy personality. In the public discussion, different concepts are suggested to describe the desired implied attitude of physicians. In a sequel of three articles, a set of three of these concepts is presented in an interpretation that is meant to characterise the morally emotional part of this attitude: “empathy”, “compassion” and “care”. In the first article of the (...) series, “empathy” has been developed as a mainly cognitive and morally neutral capacity of understanding. In this article, the emotional and virtuous core of the desired professional attitude—compassion—is elaborated. Compassion is distinguished from sympathy, empathy and pity. Several problems of compassion as a spontaneous, warm emotion for being a professional virtue are discussed: especially questions of over-demand, of justice and of concerns because of a possible threat to the patient’s dignity and autonomy. An interpretation of compassion as processed and learned professional attitude, that founds dignity on the general idea of man as a sentient being and on solidarity, not on his independence and capacities, is developed. It is meant to rule out the possible side effects and to make compassion as a professional attitude and as professional virtue attractive, teachable and acquirable. In order to reach the adequate warmth and closeness for the particular physician-patient-relation, professional compassion has to be combined with the capacity of empathy. If appropriate, the combination of both empathy and compassion as “empathic compassion” can demand a much warmer attitude towards the patient than each of the elements alone, or the simple addition of them can provide. The concept of “care” that will be discussed in a forthcoming article of this sequel is a missing necessary part to describe the active potential of the desired moral attitude of the physician more completely. The reconstruction of the desired professional attitude in terms of “empathic compassionate care” is certainly not the only possible description, but it is a detailed proposal in order to give an impulse for the discussion about the inner tacit values and the meaning of medicine and clinical healthcare professions. (shrink)

Compassion unites people during times of suffering and distress. Unfortunately, compassion cannot take away suffering. Why then, is compassion important for people who suffer? Nurses work in a domain where human suffering is evidently present. In order to give meaning to compassion in the domain of professional care, it is necessary to describe what compassion is. The purpose of this paper is to explore questions and contradictions in the debate on compassion related to nursing care. The paper reviews classical philosophers (...) as well as contemporary scientists' main arguments on compassion. First, I will examine the relationship between compassion and suffering. Second, how does one recognize serious suffering? This issue raises questions about the role of imagination and the need for identification. Third, literature describes compassion as an emotion. Some philosophers consider emotions uncontrollable feelings; others see a clear rational dimension in emotions. In order to determine what compassion is, it is necessary to weigh these contradictional arguments. Fourth, I will discuss motives for compassion. Is compassion an act of altruism or egoism? In this debate Nietzsche and Schopenhauer are well‐known opponents. Today, analysis of their arguments leads to some surprising conclusions. Fifth, there is the issue of fault and compassion. Can we only feel compassionate when people who suffer are not to blame for their own suffering? Such a condition faces professional caretakers with a dilemma which needs a thorough analysis if compassion is to be of use in the field of professional care. Finally, I will explore the moral meaning of compassion. Compassion, described as a concept with cognitive as well as affective dimensions, also has volitional and behavioural aspects. These aspects specifically are of importance to nursing care and further research of compassion in the nursing domain. (shrink)

Pity is an emotion which is intimately connected with virtue. If I were impervious to anger I could still be a paragon of rectitude. My emotional peculiarity might even be explained by moral saintliness. If I had a pitiless heart my entire life would surely be an abject moral failure. The imputation of an inability to pity strikes us as a damning moral criticism; it is one we are likely to make, for example, against those who commit acts of extreme (...) cruelty. Yet pity is hardly ever welcomed by its recipients, and for that reason it differs in a puzzling way from other emotions which are closely associated with virtue, such as gratitude or compassion. The prospect of becoming an object of pity is alarming, and not merely because we fear the misfortune that would evoke pity in others; it is alarming in part because we suspect that being on the receiving end of that emotion could seriously aggravate our plight. We also regard an aversion to being pitied as commendable, perhaps even morally commendable. There is something shameful in wanting to be pitied, just as there is in the indulgence of self-pity. The aged and the physically disabled do not want our pity, as a rule, and we think better of them for not wanting it. Finally, we know that those who give pity are frequently guilty of serious wrongdoing. A pitiless heart may be a terrible thing, but a fondness for dispensing pity is scarcely any better. (shrink)

Doing violence and evil always indirectly or directly leads to making someone else suffer. Such is the dialogical structure of evil and it seems to be the dialogical structure of elder abuse as well. There is a perturbing sameness between definitions of evil and definitions of elder abuse. It is hard at times to see how or if there is any line of demarcation between the subjects. Two modern‐day philosophers, Paul Ricoeur and Simone Weil have delved particularly into the concept (...) of evil. The symbolism Ricoeur analyses in depth is that of defilement, sin, and guilt and the concept of the servile will. Integral in Weil's description of evil are the concepts of suffering and the special situation of extreme suffering, termed affliction. Grounded in the writings of Ricoeur and Weil, this paper is a series of reflections on the intersection of evil and elder abuse as exemplified in the narrative of an abused older woman. This woman provided around the clock care at home for her husband who had vascular dementia. She was also abused by her husband. This was witnessed by both family and others but no one intervened. In her narrative there were indications of defilement, sin, guilt, and true affliction as a servile will. This paper illuminates the evil of elder abuse that is harm and suffering, and the challenge of untangling issues of blame, free will, responsibility, and self‐determinism. When engaging with abused, older persons it can be worthwhile for nurses to enter the encounter with non‐judgemental compassion founded on the human to human connection and recognition of our mutual fallibility and potential for evil that is part of our human fragility. (shrink)