Flourishing in Adversity: The Crucial Role of Compassion in Healthcare Settings

By David Addiss, MD, MPH
November 30, 2021
Compassion is the authentic response of love to suffering. How can we harness its power to promote flourishing for healthcare staff, patients, and systems?
The Crucial Role of Compassion in Healthcare Settings

This post is the ninth in a series from the 11 Awardees of the Templeton World Charity Foundation's Grand Challenges for Human Flourishing. The Foundation is investing US $60 million to grow the field of human flourishing to encompass scientific research, practice, and policy. Check back as we launch further requests for proposals under this important rubric.


What does it mean for humans to flourish? One generally accepted definition of human flourishing is “a state in which all aspects of a person’s life are good.” (VanderWeele, T).  While this framing makes intuitive sense, it ignores the fact that mental and physical ‘states’ are, by definition, impermanent and fleeting. The full range of human experience includes positive peaks, during which we feel energized and fully alive, as well as deep valleys of suffering and decline. If flourishing is not possible in the context of adversity (e.g., struggle, illness, grief) when all aspects of a person’s life are not objectively ‘good,’ it will be attainable only intermittently.

Most of us have encountered people who appear to possess everything that we consider necessary for flourishing – friends, health, financial wealth, social connections and influence, meaningful work – yet they are inwardly miserable. We have also known people who, even with severe illness, deprivation, or impending death, radiate a sense of well-being and flourishing. Anthony de Mello, a Jesuit spiritual teacher, describes his encounter with Ramachandra, a rickshaw puller in Calcutta who suffered from late-stage tuberculosis. Despite Ramachandra’s extreme poverty and poor health, de Mello describes him as being at peace, saying “nothing seemed to faze him.” De Mello, who had devoted his professional life to the study of theology and psychology, suddenly realized that he was in the presence of a spiritual giant: “I was in the presence of life,” he said. “It was right there. He was alive. I was dead.” (De Mello, A). Despite his elite education, good health, and privileged status, De Mello recognized that Ramachandra’s capacity for flourishing far exceeded his own.

As part of the Innovations for Human Flourishing Initiative at the Templeton World Charity Foundation, we are exploring how humans flourish in the context of suffering. Healthcare settings, broadly considered, offer a rich environment for studying the relationship between flourishing and suffering. Can humans flourish while suffering from acute physical pain or injury? From chronic diseases, disabilities, or challenges with mental health? What might enable flourishing in these circumstances?

Suffering in healthcare settings, particularly since the beginning of the COVID-19 pandemic, is not limited to patients. Over the last two years, hospital staff have suffered from unprecedented overwork, exhaustion, moral injury, and unremitting stress, prompting many to leave the field. Paradoxically, systems that were established to alleviate (patient) suffering are finding it difficult, if not impossible, to effectively promote and support human flourishing for their staff.

Yet there are individual healthcare providers and institutions that are remarkably effective as agents of human flourishing, even in the midst of terrible suffering. What is the ‘secret sauce’ that allows them to accomplish this? While there is much yet to learn, we suggest that what these ‘positive deviants’ have in common is embodiment of extraordinary compassion.

Compassion can be defined as awareness of suffering coupled with the desire to alleviate that suffering and its causes. (Harrel E, Berland L, Jacobson J, Addiss D). Simply put, compassion is the authentic response of love to suffering. Compassion is a means to foster human flourishing in the midst of suffering. During a recent hospitalization for spine surgery, I received excellent medical care and reasonably effective pain control, but my suffering was not adequately addressed. Even with quality medical care, I was not flourishing and I did not have a sense of well-being – until an unexpected experience of compassion. Each night, around 2 AM, a phlebotomist entered my room, working quickly and efficiently. Somehow, through her calm presence in the two minutes that it took to draw my blood, I experienced a sense of human connection that, itself, facilitated healing. I felt that she really ‘saw’ me as a human being. Understanding these moments of compassionate presence, which involve both the intention of the ‘giver’ and the receptivity of the ‘receiver’, can lead to more effective ways to promote flourishing in healthcare settings.

Research by Shane Sinclair and colleagues involving cancer patients receiving palliative care reveals a rich, nuanced understanding of compassion from the patient perspective (Sinclair, S., et al). In addition to specific actions to alleviate pain, patients recognized compassion in their health care providers through the virtues they expressed, such as authenticity, acceptance, and kindness; their relational, earnest style of communication; and their attentiveness to the patients’ emotional, spiritual, and family-related needs. Patients receiving such care reported enhanced wellbeing (Sinclair, S, et al). This research supports the view that compassionate healthcare care extends beyond relieving physical or mental pain; it attends to the multi-faceted experience of suffering and actively works to support human flourishing.

A growing body of evidence suggests that compassion may be the key to promoting flourishing in healthcare and other settings of adversity. It is not yet entirely clear how this works, or what intrapersonal, relational, and systemic elements are needed to fully realize the power of compassion to cultivate human flourishing. Additional work is needed to refine conceptual foundations, develop and test new metrics, and learn from the experience of ‘positive deviants.’

Our health systems are in crisis. They are increasingly characterized by a lack of compassion and by the suffering of staff as well as patients. With compassion, we can reimagine healthcare centers as places that foster human flourishing. In a darkened hospital room at 2 AM, I found myself – no doubt like many others – the recipient of an individual’s compassion, and I recognized its power to heal me in ways that medicine alone could not. Understanding how compassion unleashes human flourishing and incorporating this knowledge into the values, structures, and day-to-day practices of healthcare systems holds transformative potential for us all: the promise of flourishing in – and through – adversity.


David Addiss, MD, MPHD at The Task Force for Global Health is director and founder of The Task Force’s Focus Area for Compassion and Ethics. Through interdisciplinary research, his team’s focus is to discover the meaning and mechanisms of human flourishing in the context of suffering; to understand how compassion alleviates suffering and promotes flourishing in healthcare settings; and to develop large-scale evidence-based programs to promote compassionate, high-quality national health systems.


References

  1. VanderWeele, T. On the promotion of human flourishing. PNAS 2017; 114(31): 8148–8156.

  2. De Mello, A. Rediscover Life: Awaken to Reality. New York: Image Books, 2012, pp. 19-21.

  3. Harrel E, Berland L, Jacobson J, Addiss D. Compassionate leadership: Essential for the future of tropical medicine and global health. Am J Trop Med Hyg 2021 (ahead of print). DOI: https://doi.org/10.4269/ajtmh.21-0832

  4. Sinclair S, McClement S, Raffin-Bouchal S, Hack TF, Hagen NA, McConnell S, et al. Compassion in health care: an empirical model. J Pain Symptom Manage 2016; 51:193–203.

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