Summer Newsletter 2014

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Human Values in Healthcare Forum
Working to promote ethical and humane heallthcare

Summer Update 

Greetings from Dr Paquita de Zulueta, Convenor.

Free membership!
First of all I would like to warmly thank all of you who continue to support us. I am also pleased to inform you that the option of free membership is now available, and we welcome new members.
The larger the membership, the stronger we can be as a community of influence, so please do recruit on our behalf!
Signing up is easy. For those who wish to be more engaged and enjoy additional benefits, a low cost (£20) 'gold membership' is available. The more financial support we receive from subscriptions and donations, the greater the repertoire of activities we can offer, including subsidised workshops and conferences, so please donate if you can! The Forum is entirely non-profit based and dedicated to humanising healthcare.

More information on how to become a member can be found on our website.
Compassionate resilience – why we need it in healthcare
The Forum continues to be engaged in the promotion of compassion in the context of healthcare.
In the past months, I have run workshops for GPs and senior clinical educationalists and given presentations at conferences on the theme of 'compassionate resilience' for healthcare and allied professionals.
This incorporates two strands: firstly, self-compassion (often low in healthcare professionals) as key to resilience, and secondly, learning how to maintain resilience in order to sustain compassion towards others, even in challenging circumstances.
A key factor that is often omitted or ignored in the compassion discourse is that medicine, by its very nature, is often frightening and very challenging. Clinicians have to confront death, dying and decay on a regular basis in a way that the general population is often protected from. This may lead psychological defence-systems to manage anxiety that are detrimental to patients and professionals alike, as highlighted in the excellent book Intelligent Kindness by Penny Campling and John Ballatt.
Furthermore, expectations are frequently unrealistic and institutions unsupportive as shown by several surveys and NHS whistle-blowers’ disturbing stories.
Meanwhile patients are often vulnerable, afraid, and in need of compassionate competent care. Although the promotion of autonomy and dignity is essential – this does not mean that patients (literally ‘those who suffer’) are necessarily the confident rational ‘consumers’ obsessed with ‘choice’ as they are sometimes portrayed.
In essence, healthcare workers need to have high levels of emotional resilience and capacity for compassion – not necessarily required in many other jobs – and for this they need to work in a supportive environment and maintain adaptive strategies for wellbeing.
The Forum has been working closely with Dr Chris Manning who is leading a large multidisciplinary group championing wellbeing for the NHS workforce. Dr Manning writes further about this new initiative in his article for the HVHF blog. 
Compassion, politicisation and regulation  
But is the word compassion overused and abused?  As Professor Harry Cayton said in his illuminating talk on the 24th July - part of a series of lectures on compassion and resilience at the University of Westminster “compassion is now part of political currency”. There is talk of selection and mandatory training for compassion, as well as measuring, regulating and even incentivising compassion – yet more tick-boxing. But, as Cayton pointed out, problems and failures are always particular, and regulation is “a very, very blunt instrument”. One simply cannot ignore the working environment as this has a huge impact on how people behave.
Why incentivisation of compassion won’t work

In a talk on the Art of Compassion at Southampton University, I spoke of how compassion cannot be incentivised by external rewards or threats as research evidence shows that these can actually demotivate people from complex, creative or ‘noble’ tasks (Ryan & Deci’s self determination theory, 2000) and reduce intrinsic motivation. In fact, there is fascinating research that shows that even the evocation of money makes people less altruistic and empathic towards others (Vohs, 2006 The psychological consequences of money). Rather, I argue, compassion needs to be enabled in a supportive nurturing environment in order to flourish. ‘Big data’, consent, patient confidentiality & trust has not gone away. September 1st looms and is the theoretical date GPs will be mandated to upload selected personal medical information of their patients onto a huge database hosted by the Health and Social Care Information Centre (HSCIC) - although apparently this is to be deferred. This data will be linked to existing hospital patients’ data but will not be available to doctors and nurses working at different sites wishing to obtain patient information in order to optimise care.
It will not be anonymised, but ‘pseudo-anonymised’ and will, in expert hands, readily be de-anonymised. Despite a tightening up of safeguards, its security simply cannot be guaranteed, and the broad definition of its usage for ‘health purposes’ does not exclude sale to private insurance/health companies and pharmaceutical companies. Patients are given the option to opt out, but there is evidence that a large numbers of people have absolutely no idea what it is about or how it could affect them. They cannot be said to be informed or to have given valid consent. Once uploaded, the records cannot be retrieved. The great majority of GPs have requested for patients to opt in – i.e. to give explicit consent to the uploading of their data. The HVHF wrote a letter to the chair of the RCGP on the 12th June but has received no reply to-date. A blog with more details is forthcoming.

End of life, clinician-assisted dying/suicide

This highly controversial and emotion-laden issue is back in the limelight. On July 18th, a packed House of Lords debated for ten hours the second reading of the Assisted Dying Bill proposed by Lord Falconer – essentially clinician-assisted suicide in defined circumstances.
Underpinning this bill is the fear of a ‘lingering death’ combined with unrelieved and prolonged suffering. It only applies to those who are judged to be terminally ill i.e. within six months of death (not always a reliable or easy judgment to make) and fully competent and settled in their decision.
It would not apply to those with non-terminal neurological disorders, such as the late Tony Nicklinson who suffered from locked-in syndrome. Over 120 peers took the opportunity to speak - an unprecedented number. ‘Compassion’ was used on both sides of the debate, with the focus on autonomy and choice on the one side and on community and vulnerability on the other. Almost all the peers referred to personal experiences and anecdotes. The position for and against was fairly evenly split, but agreement was given for the bill to be transferred to committee for further scrutiny.
Paquita de Zulueta attended a large part of the debate and will be writing a blog shortly. The Forum has not issued a consensus statement and plans to hold a round table discussion in the autumn for interested members and invited guests regarding this very important issue.
If interested in participating to this discussion, please send expressions of interest to the HVHF Administrator, Jo Seed at  

The ethics of war

Given the events of recent weeks and the harrowing photographs and accounts of killed and wounded civilians, particularly children, in Gaza as well as Iraq and Syria, the ethics of war and military intervention are being widely debated, with emotions running very high and narratives widely diverging. War ethics is an issue that the Forum has addressed in the past and will no doubt again.
In 2003, the Forum led a colloquium entitled War, Justice and Public Health. Professor Richard Norman, author of Ethics, Killing and War and Carolyn Stephens, now Chair of Ecology and Public Health at The London School of Hygiene and Tropical Medicine, shared their deep insights and reflections.
It is a sad fact that despite our acknowledgment of the terrible waste of life in the First World War a hundred years ago, we still bear witness to the cruel and destructive sequelae of war and conflict in several countries, the loss of countless innocent human lives and the wasted opportunities for peace and flourishing.
As proponents of human values, the Forum members cannot ignore these issues or the role that health care professionals should play in advocating for peace as well as preventing and helping those who suffer from the ravages of war. 

And finally.. 

Congratulations are in order for HVHF's Dr Joshua Hordern and partner Claire, as they celebrate the birth of their new addition, Luke, born 17th July.  Additionally, the same goes for Dr Andrew Papanikitas on his new appointment as NIHR Academic Clinical Lecturer in General Practice at Oxford University.

Dr Paquita de Zulueta 
Chair, HVHF 
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Upcoming Events

Mind Full or Mindful?, 17th Sep
For GP teachers and tutors on ‘Paying attention on purpose in the present moment with compassion, curiosity and acceptance’.
Booklaunch: A Flourishing Practice by Dr Peter Toon
16th October, St Alban's Centre.  More details to follow.
Educating Compassion in Healthcare: Is it possible and what would it mean?
Join us on 3rd December for a conference organised by the University of Oxford & the Royal Society of Medicine Open Section and in association with HVHF.
Civilians, Atrocities and the Nazis, 3rd Dec
Join HVHF's Chair, Dr Paquita de Zulueta, for an evening addressing key humanitarian and ethical issues in medicine and medical research in the context of the harshest of human experience. 
Ethical and Emotional resilience workshops for doctors and nurses in training
The Forum, in association with other organisations, is planning a series of skills-based workshops for ethical and emotional resilience for foundation year doctors and training/recently-qualified nurses.
Clinician Assisted Suicide
HVHF round table discussion planned. Watch this space! 
More Upcoming events of interest
Check out our events calendar for the latest upcoming medical ethics events, courses and seminars.

Past Events

RSM 4th Annual primary care ethics conference – Ethics, Education and Lifelong Learning
On 30th April, HVHF members participated in a meeting organised by the General Practice with Primary Healthcare Section in association with the Open Section. 
The Heart of Healthcare
On Friday 20th June, HVHF’s Chair Dr Paquita de Zulueta presented at ‘The Heart of Healthcare‘  conference hosted by Heartfelt Consulting at Dillington House in Somerset.

The Art of Compassion: The Association of Medical Humanities Annual Conference
This multidisciplinary conference, rich in ideas and perspectives, took place from 7-9th July at the University of Southampton and included a presentation by HVHF's chair on incentivising compassion.
Westminster University Centre for Resilience – July Lecture series
This series entitled 'Resilience and Compassion in the NHS' had a line up of superb speakers, all experts in the field.  

Upcoming Courses

Medical Ethics course at Imperial - 15-19th Sep
Spend a fruitful, thought-provoking and an enjoyable week with a professionally diverse group to develop and debate your ethical thinking.


Burnout amongst doctors – why we need to be ‘bovvered’?
HVHF's Dr Chris Manning writes for the HVHF blog.
Ethics and Human Values in Healthcare Connections
Dr Andrew Papanikitas writes for the HVHF blog.

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