In 2012, chief nursing officers (CNO) in England published a policy on compassion in response to serious criticisms of patients’ care. Because their objective is fundamentally to shape nursing, this study argues, following Popper, that the policy should be analysed. An appraisal tool, developed from Popper, Gadamer, Jauss and Thiselton, is the framework for this analysis. The CNO policy document identified six values and behaviours, termed ‘6Cs’, required by all nurses, midwives and care staff. The document contains no data, references (...) or acknowledgements, but is similar to the 6Cs defined by the Canadian nursing nun, Sister M. Simone Roach, in her theory of caring published 30 years earlier. Roach considered caring and the components of it, including compassion, to be moral virtues, an inner motivation to care. This study suggests that without explicit reference to Roach's ideas, and her underlying theoretical base, the CNO requirement has the effect of turning virtues into commodities and a form of external control, described by Ritzer as a McDonaldized dehumanization. This study, which has international relevance beyond England and the UK, suggests that the CNO revise their policy by acknowledging Roach's 6Cs and openly discuss the implications of her work for their policy. (shrink)

Recent UK reports have revealed extensive evidence of unethical care practices. Older and vulnerable patients in some British health services have experienced appalling and avoidable suffering. Explanations for, and solutions to, these care failures have been proposed with wide-ranging recommendations. Many of these have direct implications for clinical ethics with additional frameworks for ethical values proposed, a heightened awareness of the moral culture of organisations acknowledged and a renewed interest in the ethics component of professional education debated. In this paper, (...) I suggest that we integrate insights from the slow movement into clinical ethics practice. Distinctions are made between fast and slow healthcare practice and between fast and slow ethics. I argue that, whilst there is a place for both, slow ethics enables us to assume a more positive stance in relation to ‘crisis’, and requires that we learn from past accounts and scholarship and consider the role of clinical ethics in sustaining caring cultures. (shrink)

The discretionary powers of welfare state professionals are in tension with the requirements of the democratic Rechtsstaat. Extensive use of discretion can threaten the principles of the rule of law and relinquish democratic control over the implementation of laws and policies. These two tensions are in principle ineradicable. But does this also mean that they are impossible to come to grips with? Are there measures that may ease these tensions? We introduce an understanding of discretion that adds an epistemic dimension (...) (discretion as a mode of reasoning) to the common structural understanding of discretion (an area of judgment and decision). Accordingly we distinguish between structural and epistemic measures of accountability. The aim of the former is to constrain discretionary spaces or the behaviour within them while the aim of the latter is to improve the quality of discretionary reasoning. The focus in this article is on epistemic measures that are internally related to the main characteristic of accountability, namely justified use of discretionary power. (shrink)

In this paper, I will explore ideas advanced by Bradshaw, Pence and others who have written on compassion in healthcare. I will attempt to see how and whether their assumptions about compassion can be justified, and explore the role compassion should play in a modern healthcare system. I will justify scepticism at the idea of attempting to incentivise compassion through metrics. The Francis Report raises important questions concerning the nature of a healthcare system that harms rather than helps patients. If (...) something is failing in modern healthcare, those in charge should naturally seek to remedy it. I will investigate whether this is due to the disappearance of compassion, and if so, what is it that is emerging to fill its place. I will consider whether we need to rehabilitate or enforce compassion in the system, or to acknowledge that our modern healthcare systems are incompatible with compassion and how we can make the best of what remains. (shrink)

Coriolanus, the legendary fifth-century BC general who turned against his native city for banishing him, is painted by Shakespeare as the paragon Stoic warrior. Physically strong and detached, at home in the battlefield, he is the military man par excellence. Fearless, he sheds few tears. But the turning point in Shakespeare's play comes when Coriolanus remembers how to weep. He admits that "It is no small thing to make mine eyes sweat compassion."The absence of compassion in health care is increasingly (...) remarked upon. In 2009, it led to a campaign to broaden New Zealand's Code of Patients' Rights to include the legal right "to have services provided with compassion, including a prompt and humane response to .. (shrink)

This paper discusses compassion failure and compassion deficits in health care, using two major reports by Robert Francis in the UK as a point of reference. Francis enquired into events at the Mid Staffordshire Hospital between 2005 and 2009, events that unequivocally warrant the description ‘appalling care’. These events prompted an intense national debate, along with proposals for significant changes in the regulation of nursing and nurse education. The circumstances are specific to the UK, but the issues are international.I suggest (...) that social psychology provides numerous hints about the mechanisms that might have been involved at Mid Staffs and about the reasons why outsiders are blind to these mechanisms. However, there have been few references to social psychology in the post‐Francis debate (the Francis Report itself makes no reference to it at all). It is an enormously valuable resource, and it has been overlooked.Drawing on the social psychology literature, I express scepticism about the idea that there was a compassion deficit among the Mid Staff nurses – the assumption that the appalling care had something to do with the character, attitudes, and values of nurses – and argue that the Francis Report's emphasis on a ‘culture of compassion and caring in nurse recruitment, training and education’ is misconceived. It was not a ‘failure of compassion’ that led to the events in Mid Staffs but an interlocking set of contextual factors that are known to affect social cognition. These factors cannot be corrected or compensated for by teaching ethics, empathy, and compassion to student nurses. (shrink)

Is it helpful to model the idea of professional formation on ethical formation?ing from the specifically ethical interest of Aristotle's own doctrine, in the ?narrow?, ?moral? sense of ethical, and aiming at the same time for an inclusive, ?broad? formulation which extends to various types of métiers (occupations/professions), this paper argues that an Aristotelian perspective offers a more robust concept of personal, professional and civic responsibility??responsibleness??than any that our present ?managerial? rationality can promote. Drawing on some Aristotelian texts, I show (...) that the practical knowledge of one with ?formation? (appropriate to the métier in question) enables an agent to find the relevant end and the appropriate act in the name of that end?as if simultaneously. The end and the means to the end are perfectly suited to one another. Crucially, the structure of the agent's practical reasoning is grounded on the telos which guides the agent and this is summoned implicitly from formation. This Aristotelian model of practical rationality stands as a rival to the public rationality that now predominates, a rationality which sees the meeting of explicit, pre-specified outcomes, objectives or targets as the chief way in which the accountability of agents may be secured. (shrink)

In June 2008 the UK government, supported by the Royal College of Nursing, stated that nursing care would be measured for compassion. This paper considers the implications of this statement by critically examining the relationship of compassion to care from a variety of perspectives. It is argued that the current market-driven approaches to healthcare involve redefining care as a pale imitation, even parody, of the traditional approach of the nurse as “my brother’s keeper”. Attempts to measure such parody can only (...) measure artificial techniques and give rise to a McDonald’s-type nursing care rather than heartfelt care. The arguments of this paper, although applied to nursing, also apply to medicine and healthcare generally. (shrink)

Being formed through learning a practice is best understood within a constitutive theory of meaning as articulated by Charles Taylor. Disengaged views of the person cannot account for the formative changes in a person’s identity and capacities upon learning a professional practice. Representational or correspondence theories of meaning cannot account for formation. Formation occurs over time because students actively seek and take up new concerns and learn new knowledge and skills. Engaged situated reasoning about underdetermined practice situations requires well-formed skillful (...) clinicians caring for particular patients in particular situations. (shrink)