Make Benevolence Great Again

A call to cultivate a more benevolent self, community, and world.

May 19, 2022

Oxford Dictionary Definition of benevolence:

the quality of well meaning; kindness.

Our modern language and linguistic patterns have not really included this incredible word. My goal is to highlight my deep consideration and personal understanding of its exceptional nature and meaning to outline why we ought to call it back into our present day culture.

Benevolence is a human virtue, that is to say, a moral excellence. A quick google search for “peer reviewed studies kindness in medicine” registers over 8 million results and “compassion and patient outcomes” yields an even larger selection. Needless to say, such virtues are a highly important and studied human characteristics. Benevolence is also found in compassionate acts.

Compassion can be defined as:

a deep awareness of the suffering of another coupled with the wish to relieve it. (oxford)

Yet, sincere benevolence is far more than just kindness or compassion, and even still, more than both combined. It is a love of all human beings, and an overall intentional awareness of each individual’s inherent value. Equality and fairness exist within, and exude from, benevolent sentiments and actions. When we step forward in our interpersonal relationships from a place of benevolence, we offer true connection, respect, generosity, and acceptance to all persons we encounter. It is a mindset, an inner understanding of the intrinsic value of all life. We all decide how we are going to consider and treat people in every moment of human exchange. Just as physical strength requires exercising our muscles, living benevolently requires intentional practicing and polishing to hone this human quality, and the presence or awareness to employ it in all of our interactions with others. As a palliative care physician, it has been my good fortune to experience diverse peoples, a wide array of situations and circumstances of the human condition, and as a result, strengthen my benevolent quality of being.

Charles Hume, an 18th century Scottish Enlightenment philosopher, placed benevolence as the leading moral virtue. He notes it is the sentiment of wishing

to promote the interests of our species, and bestow happiness on human society and generally to be useful to others. When properly developed, this sentiment is informed by reason to “ascertain . . . the true interests of mankind” so that we, for example, give charity only so far as to relieve the indigent and not to encourage idleness.

Benevolence is, as Confucius says, “the characteristic element of humanity”. I agree, and would argue, benevolence is analogous to the heart of our physical bodies and the North Star within our electromagnetic world. Without the pumping and continuous flow of benevolence in society, our collective (figurative) vital signs are abnormal, unstable. Similarly, without Polaris, our world, and all within it, would be lost. Benevolence requires self awareness and presence, a process that endows one with gratitude, joy, and peace as a result of its reverent actions. `

Aristotle said “educating the mind without educating the heart is no education”. He appropriately identifies the inextricable link between the thinking mind and the moral consciousness of each person. Our free will enables us to make choices and the most important decisions relate to how we treat other human beings in all circumstances, including during times of extreme crisis and war.

Acting in patients’ best interests is the panacea in medicine. At it’s core, it is providing patient-centred care.

In order to act in the patient 's best interests, or the patient 's good, the physician and patient [together] must discern what that good is. This knowledge is gained only through a process of dialogue between patient and/or family and physician which respects and honours the patient 's autonomous self-understanding and choice in the matter of treatment options. (Edmund D. Pellegrino, For the Patient's Good: The Restoration of Beneficence in Health Care - PhilPapers)

In a study on the effects of competence vs benevolence on return customers to private hospitals, the authors found that “doctor benevolence behaviours affect patient loyalty more than competence.” (Akbolat etal, 2019)

In medicine, every patient wants to be recognized and acknowledged for the person he/she is, and valued for his/her intrinsic nature. Researchers revealed

[t]heir comments express a need to be seen and accepted by the physician as the person one really is. Accordingly, the most consistent interaction related to the experience of positive communication is eye contact. The authors conclude that the needs expressed by the patients are quite elementary. Patients want to be treated as real persons.” (Rudebeck, 1992)

Medicine is both a science and a humanities’ art. Similar to Aristotle’s inextricable link noted above, these facets of medicine are necessarily inseparable. Positive effective care also requires an authentic connectedness between the patient and practitioner.

This experience of joining matters to both parties because, as the African concept of “ubuntu” explains, a person’s humanity depends on their connectedness to others. Kindness by the physician is ubuntu.” (Beutow, 2013). Physician kindness opens up a safe space for “a mutual experience of joining that results in a sensation of wholeness” (Suchman AL, Matthews DA, 1998).

While we often forget, or perhaps even dismiss, the humanities’ sentiments in much of our current practice of medicine and treating patients, it is arguably the most important skillset to develop and enhance, given the enormity of known benefits. Compassionate focused care has shown in multiple studies to improve wound healing, diabetic control, reduced viral infections, reduced hospitalizations, improved adherence to physician recommendations, and according to Standford researchers, the statistical significance of compassion focused health care on patients reveals

improved outcomes is GREATER than the effect of aspirin on reducing a heart attack or smoking cessation on male mortality.

Benevolence is a broadly encompassing virtue present in a humanistic model of health care delivery. There has long been substantial changes made to “re-humanize” medicine and balance this with “compassion fatigue”. Such issues, I would argue, are one in the same by way of root cause. Paternalism and its hierarchy of authority, superiority and value judgements have created both of these strikingly similar issues. If we are able to reduce paternalism and increase sincere benevolence in physicians and health care workers we will see the disappearance of these “barriers” to providing humanistic model of care. “Rather than faking it, physicians’ kindness toward patients must be genuine and include an element of physician self-care.” Honest self awareness, reflection, and introspection are the most crucial first step in this development.

I will provide two patient scenarios that can highlight benevolence in action, specifically in my experienced medical practice.

An elderly patient of mine suddenly lost all access to his wife of 70 years as the world ‘locked down’ at the beginning of the pandemic response. He used to go daily to see her for lunch and dinner, stay into the evening, at her nursing home. There, he was provided with two fully prepared meals each day and the gift of time and connection with his greatest love. When he was stripped of his normal ways of living and all that he loved, he could not find purpose or solutions to the grave issues he now faced. Loneliness, isolation, loss of human connection and contact, and having to suddenly shop, cook, prepare, and clean up all meals for himself. Over the coming weeks and months, this beautiful man deteriorated before my very eyes. He lost 30lbs on a frame that had no business losing weight, he lost strength and mobility, began falling and having multiple new physical complaints. Within a year this previously well, independent, feisty 90 something year old became hospitalized and never returned home. All along this journey, my doors were open, we discussed the risks of such a sudden change and loss in anyone’s life. My staff and I had him come in regularly for weight checks, provided samples for meal supplements, offered resources for meal delivery services, requested home care services, and we updated family often. When he began falling, we sutured his tissue-paper thin skin as best we could, stopped his bleeding, bandaged him, encouraged safe mobilization with a walker, and hugged him to know he is cared for. We shared stories, poems he wrote, and had many many medical visits to investigate his changing physical condition. This man ended up in nursing home within 1.5 years of the crisis response implementation. He and his family knew I cared deeply about him and his well being.
Another elderly patient came to see me in my office for a routine checkup/physical. She had no new concerns or complaints really. Her medical conditions were unchanged and stable. Yet, there was a morose or melancholic nature about her. When asking about her obvious suffering, she eventually disclosed that she desperately missed her family and had not seen her children nor had a hug in over a year and a half. I informed her I am a hugger, and helped her stand from the chair for an authentic embrace. She sobbed, uncontrollably, for minutes in my arms. Human connection and contact is essential.

How do we cultivate benevolence? Perhaps if there is a way to focus on empowering more people with developing the skill and virtue of benevolence, the world could rid itself of most of the insatiable suffering as there is peace and equality within benevolence.

Moral values such as kindness can indeed be difficult to cultivate. However, physicians should have no less capacity than others to shape their own character, for example through training and practise in moral development and in felt attitudes such as sensitivity. (Beutow, 2013).

Both, historically and present day, humanity is rich with sincerely benevolent doctors, scientists, and prominent figures. Entire communities and cultures exalt benevolent sentiments and remain deeply connected moral and cultural roots within their groups.

Much of our human history involves narratives of guiding ourselves in communities based on moral principles and common values rooted in a larger system founded individual honour and integrity. Not based on artificial intelligence, computer modelling, and injectable technology. Within benevolence there exists the expressed understanding of the innate value of each individual. When society largely dismisses the individual and its unique complexity and diversity, the entire collective suffers and deteriorates. Medicine cannot be practiced benevolently whilst applying a blanket approach, treatment, and ideology to all people of the world. For then, that discipline negates the very essence and renders it completely void. To diminish harm and suffering, a genuinely benevolent method must be utilized in all decisions for public policy. A health care crisis, like the one we currently find ourselves in, is, arguably, the most appropriate time to be flexing our moral excellence. It is not the time, if there ever is one, to be silencing, censoring, cancelling, and removing the voices who are benevolent champions.

I will leave you with a challenge to explore your everyday life for benevolent sentiments in human behaviour and interactions. Share your findings in the comments below.

Dr. Crystal’s Perspective

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