Compassion in Primary Healthcare

• 10 Apr 2025

Compassion is a cornerstone of ethical healthcare, ensuring that patients receive not just medical treatment but also empathy and respect. Sympathy involves feeling for someone's suffering, while empathy goes further by understanding and sharing their emotions. Compassion, however, inspires action to alleviate the suffering, focusing on both emotional connection and practical intervention. 

When integrated into India’s primary healthcare system, guided by ethical principles, compassion can significantly enhance patient trust and outcomes. This can be achieved through targeted training, supportive policies, and active community engagement to promote health equity and well-being.      

What Ethical Challenges Hinder Compassionate Care in India? 

• Law of Double Effect: The Law of Double Effect states that if an action has two effects, one intended (the good) and another unintended but foreseeable (the bad), the action may still be morally permissible if certain conditions are met.  
  • During the Covid-19 pandemic, the goal was to develop herd immunity and save lives, while the unintended consequence was the adverse effects caused by Covid-19 related drugs.  
  • Indian hospitals exemplified this ethical principle, where healthcare providers, under immense pressure from high patient loads, faced difficult decisions. Their efforts to save as many lives as possible sometimes resulted in harm, including delays in treatment, inadequate care for some patients, and the negative impact of certain drugs. 
• Cultural and Socioeconomic Diversity: India's cultural and socioeconomic diversity requires sensitive care, but biases and misunderstandings can impact fair and compassionate treatment. Language barriers, differing beliefs about medicine, and stigma associated with certain illnesses (such as mental health disorders and HIV) can hinder the quality of care provided.       
  • Eg: The prevalent social stigma against transgender people leads to the absence of transgender clinics in India at both policy and practical levels, despite the Supreme Court's recognition of transgender individuals as the third gender. 
• Systemic Pressures and Burnout: Healthcare professionals in India often face systemic pressures such as inadequate infrastructure, bureaucratic constraints, and low wages, leading to burnout.  
  • Burnout can manifest as emotional exhaustion and depersonalization, reducing the capacity for compassionate care. 
  • Ethically, institutions have a duty to support their staff well-being to maintain high standards of patient care. A survey conducted by the National Institute of Mental Health and Neurosciences (NIMHANS) among 3,083 healthcare workers across India revealed that 26.6% and 23.8% of the respondents had anxiety and depression, respectively. 
• Inequities in Access to Care: Ethical healthcare systems must ensure justice, meaning fair access to quality care for all individuals. However, India’s rural areas often face a shortage of medical professionals and healthcare facilities, leading to disparities in healthcare access. Patients in underprivileged areas may experience dismissive treatment due to their economic status, which violates ethical principles of equity and justice. If equity and justice are compromised, it naturally reflects a failure of compassion as well.  
  • Rural regions in India face a pronounced deficit of healthcare professionals. A government report highlighted a 76.1% shortfall of specialist doctors at Community Health Centers (CHCs) in rural areas.  
  • This shortage not only violates the ethical principle of justice, ensuring fair access to care, but also undermines the core of compassionate healthcare. 

How Can Ethical Principles Guide the Promotion of Compassion in Health Care? 

• Summum Bonum: It refers to the "greatest good" or the ultimate good, to which all other goods are subordinate and from which they derive their value or share of goodness.  
  • It represents the highest ethical goal or the ultimate aim in moral philosophy, often seen as the ultimate end that justifies all other actions and goals. 
  • The principle emphasizes that policies should prioritize public health and address the needs of vulnerable populations, rather than serving as a means to achieve other objectives, such as global fame or commercial interests, which may undermine the principle of summum bonum. 
  • For example: Government vaccination programs like Universal Immunization Programme (UIP) aim to protect the most vulnerable (Women and Children), ensuring health for all, not just the privileged. 
• Sanctity of Human Life: The belief that every life has intrinsic value encourages healthcare systems to treat all individuals with dignity and respect. Compassionate care ensures no one is neglected.  
  • Example: The Aravind Eye Care System exemplifies the sanctity of human life by providing high-quality, affordable eye care to all, regardless of financial status.  
    • Their model ensures that every patient, irrespective of their background, receives dignified and compassionate treatment. This commitment reflects the core belief in the intrinsic value of every life.  
  • Providing emergency medical services like  ambulance services and availability of generic medicines and low cost medicines from Pradhan Mantri Bhartiya Janaushadhi Pariyojana regardless of the patient's socio-economic status reflects respect for the sanctity of life. 
• Beneficence and Non-Maleficence: Healthcare professionals are ethically obligated to act in ways that benefit patients and avoid harm due to Hippocratic Oath. This extends beyond medical treatment to ensuring that patients feel understood, respected, and cared for.  
  • Compassionate care can reduce patient anxiety, improve adherence to treatment plans, and ultimately lead to better health outcomes. AYUSHMAN BHARAT (Pradhan Mantri Jan Arogya Yojana - PMJAY), India’s largest health insurance scheme for the underprivileged ensures not just financial protection but compassionate access to quality care without discrimination. 
• Ethical Governance: Ensuring transparency, accountability, and fairness in healthcare management promotes compassionate care. Ethical governance prioritizes patient well-being, ensuring resources are allocated fairly.  
  • For example, equal access to ensure healthcare facilities in rural areas is crucial in bridging the gap between urban and rural health services. 
  • India should establish a body like the WHO Office of Compliance, Risk Management and Ethics (CRE) to promote transparency, manage risks, and uphold ethical standards in primary healthcare, ensuring compassionate care, accountability, and equitable access. 
• Principle of Altruism: The principle mandates prioritizing selfless service to society, such as dedication to the well-being of others, and encourages healthcare professionals to act in the best interest of patients, even at personal cost. 
  • Initiated by the Delhi Government, Mohalla Clinics provide free consultations, medicines, and diagnostic tests to all, especially targeting slum areas and economically weaker sections.  
  • These clinics represent compassionate care at the doorstep for those who earlier could not afford private healthcare. 

How Can Policy and Governance Support Ethical Compassionate Care? 

• Policy Interventions: Compassionate and executable Citizen Charter outlines the rights and services citizens can expect from a public institution, along with timelines and standards for service delivery.  
  • A well-structured charter helps improve compassionate care by setting clear expectations and ensuring accountability in healthcare services.  
  • Example: The Delhi Metro Rail Corporation (DMRC) has a citizen charter that ensures punctuality, cleanliness, and accessible services for all passengers, fostering an environment of care and respect. 
• Feedback Mechanism: A robust feedback mechanism allows patients to voice their concerns and experiences, enabling institutions to identify areas for improvement and enhance compassionate care.  
  • For example, AIIMS Delhi has a structured feedback system where patients can submit their opinions on treatment quality, waiting times, and staff behavior, leading to continuous improvements and greater patient satisfaction.        
• Accountability and Ethical Oversight: Regulatory bodies like the Ethics & Medical Registration Board of National Medical Commission should enforce ethical guidelines to ensure that healthcare providers uphold compassionate care principles.  
  • Mechanisms for patient grievance redressal and professional accountability should be strengthened.  
  • Ethical oversight committees within hospitals can monitor adherence to compassionate care standards and provide guidance on handling ethical dilemmas. 
• Encouraging Ethical Leadership in Healthcare: Healthcare administrators and policymakers should lead by example, promoting ethical practices and patient-centered care models.  
  • For example, during the Covid-19 pandemic, Kerala's Health Minister K.K. Shailaja demonstrated exemplary leadership. The state's proactive measures, including extensive community education and robust surveillance systems, resulted in one of the lowest casualty rates globally.  
  • These examples underscore the impact of ethical leadership and interdisciplinary collaboration in enhancing compassionate and effective healthcare delivery.  

Conclusion 

Compassion is not merely an aspirational value but an ethical imperative in India's primary healthcare system. Addressing the ethical challenges and implementing strategies to promote compassionate care can lead to more equitable and effective healthcare delivery. By integrating ethical principles into training, policy-making, and institutional practices, India can move toward a healthcare system that prioritizes empathy, dignity, and justice for all patients. A commitment to compassionate care is ultimately a commitment to ethical excellence in healthcare