Compassion - Bridging Practice and Science - page 209

Understanding and Cultivating Compassion in
Clinical Settings
Compassion should be the basis of medical care[1].And yet, in Western medicine, too often
clinicians suffer from a deficit of compassion. Curing without caring causes not only patients to
suffer, but clinicians and family members as well. This chapter brings into focus three perspectives
related to compassion in relation to training clinicians in compassionate end-of-life care. The
chapter begins with an exploration of types of compassion relevant for clinicians and others. It also
unpacks a heuristic model of compassion that makes it possible for clinicians to see how to work
with those faculties that foster compassion[2]. These three perspectives are the bases of the
professional training program developed at the Upaya Institute, where hundreds of clinicians have
been educated in compassion-based ethics, communication and contemplative interventions[3].
Compassion is often associated with religion. It is also believed to be, at times, the cause of
distress in those who experience it [4].And yet, recent research suggests that, on the contrary,
compassion might be a source of hardiness, resilience and well-being[5].It is, as well, an important
feature of socialization essential to our individual and collective well-being [6], [7],[8].
Neuroscience research on compassion is in its early stages. For example, small numbers of
meditation adepts have participated in neuroscience research so scientists can map the neural
substrates of compassion[9], [10]. Other research projects have involved explorations of immune
response [11].
Compassion seems to be an important mental, psychophysical and social feature in our human
experience, and there appears to be a deficit of it in our society, including in our medical system,
which is why the research on compassion has become more concerted in the past several
years [12](see also for more detail about the science underlying compassion chapters 13 to 19).
As someone in the compassion training field, I felt it was important to understand the components
of compassion, then develop a simple intervention that primes compassion, particularly for
clinicians. This intervention is called G.RA.C.E. and is currently used by physicians, nurses, social
workers, psychologists and chaplains in various fields of patient care (see more details to this
program in Box VI).
In the spring of 2011, I spent several months at the Library of Congress as a Distinguished Visiting
Scholar writing a journal article on a heuristic model of compassion[2]. I did not feel that
compassion had been sufficiently examined in order for adequate training approaches in the end-
of-life care field to be developed. For many decades, I have been engaged in an exploration of
compassion by examining the literature on compassion; analyzing my own experience as a
meditation practitioner; receiving teachings on compassion from Buddhist adepts; being present for
the profound suffering encountered in the end-of-life care field and in the prison system; studying
the results of neuroscience and social psychology research in the areas of empathy, altruism and
compassion; and training caregivers and patients in approaches to compassion. These combined
experiences led me to question how we define compassion in our culture. This work encouraged
me to explore the effectiveness of how we train others in compassion and to develop a
compassion intervention for those in the healthcare field.
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