Iatrogenic kindness

Iatrogenesis is a recognised aspect of healthcare. But could kindness, a prized ingredient in such work, be implicated in some of the iatrogenic harm? In a recent paper, I noted how healthcare professionals and institutions that appear to value and vaunt kindness can, in practice, fall not just occasionally short, but often systemically so. Rather than insisting on these as aberrations, I wondered whether, our practice of kindness may, as with use of antibiotics or X-rays, have its own less considered but nonetheless harmful side effects. Here, encouraged by the resulting interest, I reflect further, including on two quite different responses to my paper from Cheung, and from Tan and Neo. In some aspects, we hold common ground. Cheung agrees the discretionary nature of kindness can pose ethical problems. Moreover, none of us are arguing kindness should be abandoned, cannot be virtuous, is merely favouritism, or forms the sole or proven cause of healthcare failures. Cheung suggests we infuse our practice with curiosity, reducing harms from discretionary kindness. Tan and Neo appear reluctant to concede such harms. They argue kindness is protected against these, including by its virtuous nature. Seasoned doubters might respond ‘the road to hell is paved with good intentions’. In real-world conditions, when healthcare professionals and their institutions profess kindness but behave differently, is it sufficient for our learning simply to condemn them as unvirtuous? Cautiously, we could be more curious. We could ask if, by offering kindness to those close around them, this carries the side effect of depriving others, people perhaps wider afield and less considered.