Journal of Medical Ethics and History of Medicine 

 

                                  
 

 

 

 

Viewpoint 

 

Compassion as the reunion of feminine and masculine virtues in medicine 
 

 

Kiarash Aramesh 

 
Associate Professor, Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, 

Iran; Scholar in Residence, Center for Healthcare Ethics, Duquesne University, Pittsburgh, PA, USA. 

 
 

 

 
Corresponding Author: Kiarash Aramesh 

Address: No.23, 16 Azar Ave, Keshavarz Blvd, Medical Ethics and History of Medicine Research Center, Tehran, Iran. 

Email: kiarasharamesh@tums.ac.ir 

Tel/Fax: +98 21 66419661 

 
Received: 30 Oct 2016 
Accepted: 20 Aug 2017 
Published: 7 Oct 2017 

 
 
J Med Ethics Hist Med, 2017, 10:8 

© 2017 Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences. All rights reserved. 
 

 
Abstract 
The central role of the virtue of compassion in the shaping of the professional character of healthcare providers is a well-

emphasized fact. On the other hand, the utmost obligation of physicians is to alleviate or eliminate human suffering. 

Traditionally, according to the Aristotelian understanding of virtues and virtue ethics, human virtues have been associated with 

masculinity. In recent decades, the founders of the ethics of care have introduced a set of virtues with feminine nature. This 

paper analyzes the notion of compassion as a common virtue between the traditional/masculine and care/feminine sets of virtues 

and shows that compassion is a reunion and merging point of both sets of human virtues. This role can be actualized through the 

development and promotion of compassion as an important part of the character of an ideal physician/healthcare provider. In 

addition, this paper argues that the notion of compassion can shed light on some important aspects of the contemporary debates 

on healthcare provider-patient relationship and medical futility. Despite the recent technological and scientific transformations 

in medicine, the interpersonal relationship between healthcare providers and patients still plays a vital role in pursuing the goals 

of healthcare. The virtue of compassion plays a central role in the establishment of a trust-based physician-patient relationship. 

This central role is discernible in the debate of medical futility in which making difficult decisions, depends largely on trust and 

rapport which are achievable by compassion in the physician and the recognition of this compassion by the patients and their 

surrogate decision makers. 

 
Keywords:  Compassion, Virtue ethics, Futility, Doctor-patient relationship, End-of-life care 

 

 

 

  



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Introduction 

Compassion has been called “the emotional and 

virtuous core of the desired professional attitude” in 

medicine (1). The Ethics Committee of the American 

Society of Academic Emergency Medicine (SAEM) 

considers compassion “a part of professional 

competence” which is “perhaps as important as 

technical competence” (1). These instances of 

emphasis on the central role of compassion in the 

shaping of the professional character of healthcare 

providers show the crucial importance of this 

concept in medicine and medical ethics. 

Compassion is the internal/subjective reaction to the 

suffering of another sentient being(s) and is 

conjoined with recognition of the suffering, 

detestation and disapproval of that suffering, the 

feeling of personal responsibility for and 

engagement with the experience, and tendency to 

relieve the suffering with good intentions toward the 

sufferer(s) (2). Therefore, one can argue that 

compassion is always a good trait and there is not 

such a thing as “bad compassion”. 

From the ancient times, the utmost obligation of 

physicians has been to alleviate or eliminate human 

suffering (3). Daniel Callahan calls this obligation “a 

foundation stone of the practice of medicine” (4). 

Patients’ suffering is not limited to pain or other 

symptoms of their diseases; it also encompasses their 

mental, social, and spiritual discomfort. This 

suffering originates from different sources including 

their disease, the treatment, their realistic or 

unrealistic fears and anxieties, their financial and 

social distresses, and other types of discomfort they 

experience through the course of their disease, 

treatment, and recovery (3). Alleviating patients’ 

suffering in a professional manner – not as a 

business – necessitates an ethical backbone that is 

composed of virtues such as compassion. 

The broadness and existential importance of the 

concept of suffering and its importance in the life of 

a patient show how crucial the virtue of compassion 

is in the practice of medicine and in the pursuit of its 

goals (3). Suffering elicits the “impulse of 

compassion” in almost every normal human being 

(4), but it should develop into a virtue in physicians 

in order to render them more similar to the ideal 

physician. 

This paper analyzes the notion of compassion as a 

common virtue between the traditional/masculine 

and care/feminine sets of virtues and shows that 

compassion as a reunion and merging point of both 

sets of human virtues has a crucial role in pursuing 

the goals of medicine and healthcare. This role can 

be actualized through the development and 

promotion of compassion as an important part of the 

character of an ideal physician/healthcare provider. 

In addition, this paper argues that the notion of 

compassion can shed light on some important 

aspects of the contemporary debates on healthcare 

provider-patient relationship and medical futility. 

Compassion as a virtue 

The main goal of medicine is to alleviate or 

eliminate suffering. Therefore, compassion is one of 

the most crucial virtues in pursuing the goals of 

healthcare and medicine. According to Alasdair 

MacIntyre, a virtue is a developed trait of a human’s 

character that tends to qualify him/her to realize the 

goals of a certain practice (in our case, medicine and 

health care) with excellence (1). Traditionally, 

according to the Aristotelian understanding of 

virtues and virtue ethics, human virtues have been 

associated with masculinity (5). This notion of 

ethical virtues had bestowed by dominance in the 

realm of philosophy for several centuries. 

In the recent decades, however, the founders and 

advocates of the ethics of care have described and 

introduced a set of virtues with feminine nature (see 

below). This part of the paper portrays compassion 

as a common virtue between these two sets of 

universal virtues. Both the traditional and feminist 

theories of virtue ethics emphasize the importance of 

the virtue of compassion when it comes to healthcare 

ethics and healthcare provider-patient relationship. 

At the end of this part, one can conclude that 

compassion as a virtue is the merging point of the 

masculine and feminine virtues in the realm of 

medicine and healthcare and is of crucial importance 

in shaping the character of a virtuous 

physician/healthcare provider. 

Compassion as a masculine virtue  

The traditional masculine virtue ethics is a moral 

theory mainly formulated by Aristotle. According to 

this moral theory, moral goodness and badness 

depends on the moral agent, and the development 

and establishment of moral virtues can empower a 

moral agent to act ethically in every practical 

situation. 

Andre Comte-Sponville argues that contrary to 

sympathy, compassion is a virtue (6). Other scholars 

have also noticed the difference of concepts like 

sympathy, empathy, and pity with the concept of 

compassion (1). This differentiation, as described 

briefly below, shows how one can consider 

compassion as a virtue, not a feeling that can be 

morally good or bad. 

Comte-Sponville differentiates sympathy and 

compassion in the following way. Sympathy, which 

means “fellow feeling”, is not a virtue by itself. Its 

goodness or badness depends on the “feeling” which 

is being shared between fellows. Having sympathy 

to malice intents is not good; therefore, sympathy, by 

itself, can never be a virtue. Compassion, however, 

is sympathy in suffering, and every form of 

suffering, even those originated from wrong causes 

such as wrongful jealousy or rivalry, deserves 

sympathy (6). In addition, compassion encompasses 

other specifics such as benevolence and an 

inclination to relieve the suffering (2). 



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Comte-Sponville brings Christ’s compassion for his 

executioners as an example of the goodness of 

compassion even for evil people who suffer because 

of their evil and malice acts, intents, and character 

(6). Andre Comte-Sponville argues that compassion, 

simultaneously, is a feeling and a virtue because we 

can feel it as a feeling and we can want and gain the 

capacity of being compassionate (6). In this sense, 

compassion is similar to love. In Buddhism, 

compassion is regarded as a great virtue. In 

Christianity and Islam, charity has the same status. 

However, charity is not mutually exclusive to 

compassion. As a matter of fact, the feeling and 

capacity of compassion can lead to and resemble 

charity (6). 

As a virtue in its traditional/masculine sense, 

compassion is in close relation with biomedical and 

healthcare ethics. As mentioned above, the 

alleviation of suffering is a core obligation/goal in 

medicine and healthcare. The virtue which targets 

suffering is compassion. Therefore, the pursuit and 

realization of this main goal of medicine depends on 

the establishment of this virtue in healthcare 

providers/physicians. 

Feminine virtues vs. masculine ethics  

The ethics of care is among the most recently 

emerged moral theories and has attracted a large deal 

of attention in the recent decades (7). Its new and 

innovative approach and viewpoint in dealing with 

ethical issues has shed light on some formerly dark 

and overlooked parts of human beings’ moral 

obligations and duties.  

As a moral theory, ethics of care has implications 

and influences on biomedical ethics. Healthcare is 

one of the most prominent manifestations of care and 

caring relation in the world of humanity (8). 

Therefore, it is evident that ethics of care has much 

to say when it comes to health, healthcare, and the 

goals of medicine. 

The ethics of care, as a distinct moral theory, was 

born inside the feminist ethics. The founders of this 

theory were feminist philosophers who found the 

caring nature of femininity of enormous ethical value 

(9). As described above, traditionally, in moral 

theories and even in moral psychology, it was taken 

for granted that ethical virtues are stronger in males 

(5). This was because ethical norms and virtues like 

justice and impartiality were consistent with the role 

of males as hunters and breadwinners. The role of 

females, as caretakers, had almost always been 

underestimated, morally speaking. According to the 

founders of the ethics of care, however, this caring 

nature of the female role is of utmost moral 

superiority and importance and can be considered as 

a basis for a self-sufficient moral theory. Although 

some of them believe that the ethics of care is not a 

category of virtue ethics, still it is clear that this 

moral theory is founded based on considering care 

and compassion as unambiguous virtues.  

One of the main themes of the ethics of care is 

considering partiality as a virtue. In the 

traditional/masculine virtue ethics, justice and 

impartiality have always been indubitable virtues. 

However, in the ethics of care, special caring 

relations accompany the obligation of special care 

and partiality. This is true in the case of physician-

patient relationships. 

Compassion as a feminine virtue 

Medical ethics and professionalism ask physicians to 

always prioritize the health and health needs of their 

own patients. This priority stems from a relationship, 

the physician/doctor/healthcare provider-patient 

relationship. It seems that the typical model of the 

ethics of care shows itself in this case. The physician 

should be partial and prioritize his/her patients 

because of the specific relationship established 

between them.  

This partiality is demonstrated in the forms of care 

and compassion. Therefore, one can argue that 

compassion is a virtue that has a central role in 

feminine virtue ethics or ethics of care. The virtues 

of care and compassion are aimed at the realization 

of the goals of medicine as described below. 

Compassion and the goals of healthcare 

Daniele Callahan specifies the goals of medicine as 

the prevention of disease and injury and the 

promotion and safeguarding of health, relief from all 

kinds of suffering resulted by maladies, the treatment 

of disease and provision of care for non-curable 

diseases, and the evasion of a premature death and 

the pursuit of a serene death (10). It seems that the 

virtue of compassion plays crucial roles in the 

realization of all of these four goals of 

medicine/healthcare. In this part of this paper, the 

role of compassion in realizing these goals is 

described under two major topics of healthcare 

provider-patient relationship and medical futility. 

Compassion and healthcare provider-patient 

relationship 

The root of the word “compassion” is in Latin where 

it means “suffering with”, equal to the Greek root of 

the word “sympathy” (2). It is interesting that 

compassion shares its Latin root with the word 

“patient” meaning sufferer (6). This common root 

symbolically shows the relation between compassion 

and caring for parents and relieving their suffering as 

embodied in healthcare and medicine. 

Medicine relies on science, but is not merely a sort 

of science. It is also an art; the art of establishing a 

healing and trust-based relationship with the patients. 

This art depends on certain virtues in physicians, 

among which is the crucial one of compassion. 

Recent developments in medical technologies along 

with reliance on science have transformed the 

doctor-patient relationship in the post-World War II 

era (3). However, these changes and evolutions have 



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not led to the elimination of humanistic aspects of 

the doctor-patient relationship and its transformation 

into a mechanical/machine-like relationship. 

Therefore, the therapeutic relation still depends 

largely on development of trust and rapport between 

physician and patient. This trust and rapport are 

achieved when patients realize that their doctor 

recognizes their suffering, feels for them, and intends 

to alleviate or eliminate their suffering. This is the 

definition of compassion as previously described in 

this paper. Therefore, it seems that despite all the 

evolutions and transformations in modern medicine, 

the cornerstone of the doctor-patient relationship is 

still personal virtues, and among them, the important 

one of compassion. 

Compassion and the notion of medical futility 

Medical futility refers to that sort of medical 

interventions that do not have any benefit for the 

patient, and therefore, should be forsaken (11). 

Medical futility encompasses a wide range of routine 

and common instances of medical care such as 

prescribing antibiotics for the common cold to some 

sensitive and emotional instances like withdrawing a 

life sustaining treatment at the end of life (12).  

Even if the patients or their families ask, the 

healthcare providers have no obligation to provide a 

futile treatment. Instead, they are ethically obliged to 

refuse to provide any futile interventions (11). 

Determining which intervention is futile for a given 

patient, however, is not always easy and 

straightforward and cannot be decided upon by only 

the physicians (12). As a matter of fact, both the 

technical/scientific knowledge of the 

physician/healthcare provider and the perception of 

the patient/surrogate decision maker(s) of his/her 

suffering are important in making an ethical 

decision.  

The virtue of compassion is crucial in optimizing the 

role of the physician in such a situation. The 

physician’s sympathetic and compassionate 

understanding of the patient’s suffering is the 

cornerstone of a constructive dialogue which leads 

all the involved parties through the difficult course 

of decision making on medical futility, especially in 

sensitive and emotional cases such as those related to 

end-of-life care and withholding or withdrawing life-

sustaining interventions. 

It seems that compassion, as a virtue can be helpful 

in decision making regarding medical futility 

through the following aspects: 

1- Compassion helps the physician to understand 

the needs, fears, urges, and desperations behind 

the decisions of the patient or the surrogate 

decision-maker.  

2- Compassion, when realized and recognized by 

the patient and his/her surrogate decision-maker, 

helps to establish a relationship based on trust 

between two parties and facilitates dialogue, 

common decision-making, and the obtaining of a 

consensus. Because in this case, the patient and 

his/her relatives feel that the decisions and 

suggestions of the physician are in the best 

interest of the patient. Otherwise, they might 

doubt that there may be financial or other 

unrelated goals behind the suggestions of the 

physician that is very destructive to trust and 

relationship. 

 

Conclusion 
Taking a look at the history of debates in 

contemporary biomedical ethics clearly shows that 

no single moral theory has a monopoly on the realm 

of truth in biomedical and healthcare ethics. Instead, 

in each situation and in analyzing each specific issue 

or searching for each specific ethical solution, one or 

more of ethical theories are shown to be helpful and 

reliable. In this paper, the viewpoint of virtue ethics 

has been used and analyzed to shed light on some 

aspects of biomedical ethics and to show that 

compassion as a virtue plays a vital role in the 

pursuit of the goals of healthcare and medicine. 

Healthcare, in practice, involves a great deal of 

interpersonal involvements and interactions. 

Therefore, the character of the physician/healthcare 

provider is of crucial importance. This importance 

paves the way for virtue ethics to play a considerable 

role in analyzing and problem-solving in healthcare 

provider-patient issues. In this context, compassion, 

as a virtue, is of importance in pursuing the goals of 

medicine/healthcare as described above. 

Compassion is a common virtue between the 

traditional/masculine and feminist/feminine theories 

of virtue ethics and, according to both of them, is a 

crucial virtue in biomedical ethics and medical 

professionalism. The traditional/masculine sense of 

the virtue of compassion can strengthen the 

relationship between physician and patient with trust 

and mutual understanding. In addition, the partiality 

resulted from this relationship shows itself in the 

form of prioritizing one’s own patients and is 

compatible with the feminine account of virtues such 

as compassion and care.  

Despite the recent technological and scientific 

transformations in medicine, the interpersonal 

relationship between healthcare providers and 

patients still plays a vital role in pursuing the goals 

of healthcare. The virtue of compassion plays a 

central role in the establishment of an effective and 

trust-based physician-patient relationship. This 

central role is discernible in the debate of medical 

futility in which making difficult decisions, 

especially in emotional situations such as end-of-life 

care, depends largely on trust and rapport which are 

achievable by virtue of compassion in the physician 



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and the recognition of this compassion by the patient 

and his/her surrogate decision makers. 

Finally, compassion can be called the merging and 

reunion point of the feminine and masculine virtues 

in pursuing the goals of healthcare and medicine. 

Developing and strengthening this virtue should be a 

part of both formal and hidden curriculums in 

medical education in every medical school all over 

the world. 

 

Acknowledgement  
The author of this paper would like to extend his 

appreciation to Dr. Henk ten Have and Dr. Joris 

Gielen for their so valuable and helpful guidance and 

comments. 

  



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