Just compassion: implications for the ethics of the scarcity paradigm in clinical healthcare provision

Abstract

Primary care givers commonly interpret shortages of time with patients as placing them between a rock and a hard place in respect of their professional obligations to fairly distribute available healthcare resources (justice) and to offer a quality of attentive care appropriate to patients' states of personal vulnerability (compassion). The author argues that this a false and highly misleading conceptualisation of the basic structure of the ethical dilemma raised by the rationing of time in clinical settings. Drawing on an analysis of the Aristotelian virtue of nemesis, or "the sense of justice", it is argued that, far from being a moral orientation distinct from justice, compassion is a justice response insofar as it is conceptualised as a rational, appropriate response to others' adversity. The author then proceeds to point out that the perspective on justice and compassion as attributes of healthcare professionalism suggests a novel critical viewpoint on the ethics of managed forms of clinical rationing and the "scarcity paradigm" they engender: clinical conditions where primary care givers' time is intentionally rendered a commodity in chronically short supply run a deficit of justice, because they fail to make adequate accommodations for the provision of the quality of care human beings deserve in situations of illness and injury, and when they are dying.

Falling Down the Rabbit Hole: Child and Family Experiences of Pediatric Hematopoietic Stem Cell Transplant

“…The central position of the medical treatment within the transplant room also seemed to be at play in family members not fully seeing or understanding the experiences of other members of their family. Similar to a camera that focuses intensely on one image, blurring other images from view, efficiency and disease-focused discourses in health care (Basu et al, 2017; Maxwell, 2009) may be partially obscuring the experiences of family members who exist outside of the transplant room. Furthermore, clinicians focused primarily on the treatment and daily physical care of the ill child with the “parent caregivers” living in the transplant room.…”

Compassion in primary and community healthcare

“…These multiple cultures nonetheless share a common political identity and, in many European contexts at least, a socialised healthcare system, albeit to varying degrees. Health, being 'a basic socio-personal good', 9 valued variously by all cultures, therefore provides a point of reference in political life, in which the beliefs and practices of plural societies can meet in disciplined conversation.…”

The bedside rationing paradigm and the shortcomings of modernist ethics

“…Being loyal to the traditional ethos of the medical practice -in short, to be as good doctor as possible for the patient in front of you -is important for professional flourishing. 11,12 Summing up, I consider it ideal to give the doctor what is due to the doctor and the politician what is due to the politician. It is ideal for the physician to attend to the societal role as a Good Samaritan, intending to serve the individual person in need; it is ideal for the politician to attend to the societal role of executing power, intending to reach legitimate decisions on rationing.…”

“…Rather, justice is regarded a virtue -a trait of human personality. [12][13][14][15] Hence, just actions are performed by those people who have cultivated the virtue of justice; accordingly, a just society is promoted by just individuals. In this way, the ethics of virtue is not a near-sighted or naı¨ve position.…”

“…Being loyal to the traditional ethos of the medical practice – in short, to be as good doctor as possible for the patient in front of you – is important for professional flourishing. 11,12…”