Compassion in Medicine: Toward New Definitions and New Institutions

Abstract

In the traditional pattern of doctor-patient relation, the appropriate form of compassion is paternalistic benevolence. It is the physician—active, decisive, individualistically responsible—who defines and dispenses compassionate care. The paternalism of the older, established patterns of social relations in medical care is manifest throughout the long history of codes of medical ethics. Most people brought up in an established system of social relations can be expected to adhere to it. The weight of authority and the consequent power to change medical-care relations lies with the established medical professionals. Compassion in medicine is best understood as a component of the complex social relations that exist among doctors, patients and the many other participants in health care; the nature of these relations determines the nature of compassion. Medical compassion in the newer pattern is expressed by actions based on the dying patient's capacity to engage in meaningful social relations.