Templeton World Charity Foundation has recently launched a new five-year strategy to discover, develop, and launch innovations for human flourishing. As part of this, we are reaching out to leading scholars in a range of fields to learn how they think about and understand a concept as complex and multifaceted as human flourishing. Articles in this series are not intended to be definitive or limiting, rather, their purpose is to explore some of the many possible approaches to human flourishing. We invite readers to suggest additional perspectives as well.
Flourishing can be relatively easy to define in certain areas of life. In business, for instance, it could easily be thought of as a state of financial growth and expansion. Yet in matters of health, where we are always in the process of aging and life constantly serves up slings and arrows, what does it mean to flourish? The way the coronavirus has cut across society and spread around the world has brought an unpleasant subject — the inevitability of suffering — to the fore for many people who have spent lives in states of relative privilege. If flourishing is “a state in which all aspects of a person’s life are good,” what hope do we have of flourishing during a pandemic?
The existence and inevitability of suffering, whether as a result of old age, disease, heartbreak or our own inner demons, has been remarked upon numerous times over the ages, from the Book of Job to Epicurus to the Buddha. Health workers, more than most people, are confronted with the reality of suffering on a daily basis. Even interventions intended to save the life of a patient, such as chemotherapy, may bring suffering with them.
Yet we have all seen people in good physical health who cannot be described as flourishing at all, and terminally ill people who exude a sense of well-being in multiple dimensions. As the Buddhist monk Thích Nhất Hạnh noted, “The seed of suffering in you may be strong, but don’t wait until you have no more suffering before allowing yourself to be happy.” In our years of working as public health physicians at the CDC, the Healthcare Federation of Ghana and at the World Health Organization, we have met people with incredible resilience and an ability to thrive or even flourish even in the context of what others might describe as conducive to extreme suffering. Are there key ingredients within such a milieu that allow this flourishing to occur? Is there perhaps an entry point for compassion within this quest for human flourishing?
Historically, and particularly recently, doctors have been taught to keep social and emotional distance from their patients. When faced with constant suffering, doctors and other health workers can become numb to the emotional state of their patient. As many as 50 percent of doctors report symptoms of burnout in many countries. Our current systems of heath care often focus on curing or managing specific diseases, rather than on the needs of people. Promoting flourishing and ameliorating underlying causes of suffering are not addressed in many cases.
What is the key to flourishing in the presence of suffering, as in our health care systems? We believe that there is a fundamental link between compassion — both giving it and receiving it — and true flourishing. Anecdotal evidence and a growing body of research has led us to believe that even subtle expressions of compassion can radically shift patients’ experience of suffering, even if their medical condition cannot actually be cured. Further, compassionate interactions between health workers can shift the experience of suffering. And there are resources to help health care workers deepen and more readily express their compassion.
Compassion can be taught to those who want to learn. With compassion training, the brain can be ‘rewired’ to strengthen compassionate responses to suffering. Compassion training is increasingly being offered in medical and nursing schools, and it provides students with the skills and motivation to deliver compassionate care and authentic human connection with each patient interaction as well as in interactions with fellow health workers. In their recent book, Compassionomics, Drs. Stephen Trzeciak and Anthony Mazzarelli review the substantial scientific evidence that compassion enhances the quality of care, improves specific health outcomes, increases provider wellbeing, and yields efficiencies in healthcare delivery.
We believe there is a need for a fundamental shift in how health services are delivered across the world to place compassion at the heart of health service reform. Each element of health service quality — effectiveness, safety, people-centeredness — can be enhanced through injections of compassion. Other elements, such as timeliness, equity, integration, and efficiency, also have very strong linkages to focused attention to compassion. Of course, these linkages only mean something when it positively affects human lives where services are being provided. This is where our efforts in improving quality of care really need to be strengthened. Indeed, we are at a critical juncture in quality health services globally. As we continue to struggle with COVID-19, we also recognize the opportunity for post-COVID future health systems to be designed with compassion embedded within their DNA.
But human flourishing in healthcare depends on more than compassionate individual health workers. It requires compassionate organizations, with systems, norms, and policies that promote flourishing. Compassion must be intentionally embedded into all aspects of the healthcare organization and supported through sustained commitment. And beyond healthcare, there is a growing movement for compassionate communities, which are setting agendas and establishing goals to enable all community members to flourish.
True flourishing requires more than material or physical wellbeing. Even in the presence of inevitable suffering — such as has been clearly evident during the COVID-19 pandemic — compassion can be a key to human flourishing, whether in individual human interactions, within healthcare systems or in the larger societal context. Compassion is about setting free our humanness.
David Addiss, MD, MPH is Director of the Focus Area for Compassion and Ethics (FACE) at the Task Force for Global Health in Decatur, Georgia, USA.
Dr Shams B. Syed is the Unit Head for Quality of Care at the World Health Organization in Geneva, Switzerland.
Dr. Gilbert Buckle is an independent consultant in public health with interest in health systems strengthening and healthcare quality.
