The Ethics of Compassion

This article appeared in the most recent issue of Dispatches,The Newsletter of the International Health Division, Canadian Physiotherapy Association.

The Ethics of Compassion
By Virginia Lockett, PT
President, Steady Footsteps, Inc.

compassion n. Deep awareness of the suffering of another coupled with the wish to relieve it.

I embarked on my career as an American physical therapist over thirty years ago, imbued with a vague sort of idealism and a notion that the field of physical therapy would allow me to use my body, as well as my voice, to teach the most motivated students in the world—people who wanted to regain control over their own bodies.

As a young therapist, youth and inexperience limited my appreciation for the suffering of others. The distress of my patients was, to some degree, an abstraction to me. I could not fully appreciate the distinction between the experience of acute pain, for example, and the dark terror accompanying chronic pain associated with irresolvable physical deterioration and the impending dependence that that might imply. I could not, until I had children of my own, read the anguish in the eyes of the parents of teen-aged accident victims. And I could not fully share in the ambivalent feelings of middle-aged children of frail, aged parents until I had walked a mile in their shoes.

The accrual of life experiences helped me empathize with my patients and their families as I grew older. But something else happened along the way: I became a “professional.” Precise documentation, efficient time management, technical expertise and emotional detachment were considered the hallmarks of a good therapist in the facilities where I worked. Only within the framework of my last American job, where I treated patients in their own homes, and was paid on a per-visit basis, did I feel free to spend extra time and, occasionally, a bit of my own money, to help my patients beyond the role defined by my profession. In essence, it was the first job where I felt I could—on a fairly regular basis—fully exercise my compassion without being viewed as behaving “unprofessionally.”

In 2006, I moved to Da Nang, Vietnam, and established my own NGO, Steady Footsteps, Inc., in order to further exercise that compassion. According to the terms under which my organization is partnered with the Da Nang Rehabilitation-Sanatorium Hospital, if I identify a need—patients lacking walkers or canes or appropriate footwear, for example—it is understood that I, in my capacity as the director of Steady Footsteps, may address that need. I’m not stepping outside my professional mandate—this is part of my role as a humanitarian.

As my schedule is my own, and I do not charge for my services, I can take all the time I wish to address the concerns of a particular patient and family. Because I cannot speak Vietnamese—let alone write it—there is no expectation that I will spend my time producing volumes of documentation, as I did on my American jobs. A side benefit of not sharing a common language with my patients is that every encounter is slowed down by the translation process. And when things slow down, you can see a lot more. It’s much easier to read facial expressions and body language when you’re not constantly engaged in talking, measuring and taking notes. And that’s where compassion has its roots--in our innate ability to read facial expressions and gestures. I read the patients, and they read me. Ironically, because I strive to establish eye contact, use visual demonstrations, and focus on functional activities, I can often elicit better responses from the brain-damaged patients at our rehabilitation facility than can the Vietnamese therapists who tend to rely on verbal instruction and cardinal plane range-of-motion exercises, as the patient lies supine and stares at the ceiling.

Many of the patients at our hospital are the same age as our young therapists. Two months ago, they were riding motorbikes to work and to the market, just as these therapists do. They might have passed each other on the street or sat sipping coffee in the same cafĂ©. A simple motorbike mishap was all it took to set their lives upon a radically different trajectory. It would seem that compassion—if not for the patients, who might now be drooling and inarticulate, then at least for the desperate and ever-present family members who care for their loved ones at the hospital--would be a young therapist’s inevitable response.

But it’s not.

Even in a place where physical therapy skills are rudimentary and where therapists enjoy no particularly elevated status, there’s often a remarkably wide gulf between these white-uniformed professionals and the patients and family members who turn to them for help.

It’s worth considering, I think, as we contemplate the education of young physiotherapists, just what aspects of our profession we want to model and encourage. Did you become a therapist merely in order to demonstrate technical virtuosity and professional detachment? I did not. We may assume that the fact that we are engaged in the “healing arts” is evidence that we are compassionate people. But I invite you to examine once again that definition of compassion at the start of this essay:

compassion n. Deep awareness of the suffering of another coupled with the wish to relieve it.
How can we develop “deep awareness of the suffering of another” without being fully present for that human being? Our years of education and experience should certainly inform our assessment and management of the patient’s condition, but they in no way substitute for that “deep awareness” which comes only from paying attention to the patient and his loved ones. “Pathways” and treatment protocols may have their place, but they are no substitute for the compassionate eye and caring touch of an experienced therapist. Let’s make sure that compassion lies at the heart of the legacy we pass on to the next generation of therapists.