John Gregory’s medical ethics elucidates the concepts of compassion and empathy

Abstract

Purpose

This paper draws on eighteenth-century British medical ethics to elucidate compassion and empathy and explains how compassion and empathy can be taught, to rectify their frequent conflation.

Compassion in the History of Medical Ethics

The professional virtue of compassion was first described in eighteenth-century British medical ethics by the Scottish physician-ethicist, John Gregory (1724–1773) who built on the moral psychology of David Hume (1711–1776) and its principle of sympathy.

Compassion and Empathy Defined

Compassion is the habitual exercise of the affective capacity to engage, with self-discipline, in the experience of the patient and therefore become driven to provide effective care for the patient. Empathy is the habitual exercise of the cognitive capacity to imagine the experience of patient and to have reasons to care for the patient. There are rare clinical circumstances in which empathy should replace compassion, for example, in responding to abusive patients. Because the abstract concepts of medical ethics are translated into clinical practice by medical educators, we identify the pedagogical implications of these results by setting out a process for teaching compassion and empathy.

The Task Ahead

Eighteenth-century British medical ethics provides a clinically applicable, philosophical response to conflation of the moral virtue of compassion and the intellectual virtue of empathy and applying them clinically.

Keywords:

• Compassion
• empathy
• history of medical ethics
• professional virtue
• virtue

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Glossary

Compassion: The professional virtue of compassion is the habitual exercise of the affective capacity to engage, with self-discipline, in the experience of the patient and therefore become driven to provide effective care for the patient.

Additional information

Funding

Departmental funds supported the research for and preparation of this paper.

Notes on contributors

Laurence B. McCullough

Laurence B. McCullough has more than four decades of experience as a philosopher-medical educator. In 2013 he received the highest teaching award at Baylor College of Medicine, the Barbara and Corbin J. Robertson Presidential Award for Excellence in Education. In 2014 he received the Excellence in Teaching Award by a Non-Pediatric Faculty Member from Baylor’s Department of Pediatrics, in which he taught for 28 years before his retirement from Baylor and becoming Distinguished Emeritus Professor in the Center for Medical Ethics and Health Policy.

John Coverdale

John H. Coverdale has more than three decades as a psychiatrist-medical educator. In 2016 he received the highest teaching award at Baylor College of Medicine, where he has taught since 2000, the Barbara and Corbin J. Robertson Presidential Award for Excellence in Education. In 2016 he received the Vestermark Award for excellence, creativity, and leadership in psychiatric education from the American Psychiatric Association. In 2017 he received the Association of Medical Colleges Presidential Award, the Alpha Omega Alpha Robert J Glaser Distinguished Teacher Award. He is Deputy Editor of Academic Psychiatry and Associate Editor of Academic Medicine.

Frank A. Chervenak

Frank A. Chervenak has more than three decades of experience as an obstetrician-gynecologist medical educator and academic leader. In his current position, he has supported the creation of a new residency program. He also serves as a core ethics faculty member in the Zucker School of Medicine and leads activities in international medical education.