Education not regulation: Why you can’t regulate for virtuous compassion

In the aftermath of the scandal of poor care at Mid Staffs and the Francis reports that followed, there were calls for more compassion in nursing. The Prime Minister wanted to reward it with increased pay, and the Government nursing strategy is centred around it as one of the ubiquitous 6Cs. As well as renewed interest in education in the virtues in general and compassion in particular, there has also been interest in regulation for compassion, and for the first time the word appeared in the UK regulators code in 2015.
This paper argues that any attempt to regulate for compassion is misguided, and three arguments will be presented. First there is a mismatch between ethical aspirational codes and quasi-legal conduct codes. Virtuous compassionate practice is a feature of aspirational codes but not conduct codes which are designed to protect the public from not-good-enough nurses rather than require good nursing. This distinction survives the conflation of the two types of code within regulatory the NMC code.
Second, compassion requires an emotional response and this cannot be under conscious control. Patients report that small acts of kindness are perceived as compassionate, but I argue that they need not be. Education and regulation focussing on these behaviours rather than their motivation promotes acts that look like compassion rather than fully compassionate acts. People cannot be required to be emotional and you cannot make people be what they are not. You can make people write with their left hand but this doesn’t make them left handed.
Thirdly, it has been argued that requiring compassion in regulation simply does not work. It promotes faux compassion of the sort which, it is claimed, is similar to the forced bonhomie of the coffee ship waitress. This has the potential of harming professionals who are forced to have a disconnection between how they feel and how they act, and also promotes cynicism in patients who believe that professionals behave in the prescribed way just because they have to.
In the UK the word compassion is found only in regulatory code written by the nursing and midwifery regulator. Its inclusion is in response to severe failures in nursing practice but is ill considered and incoherent and should be removed when the code is next reviewed.