editorial · Journal of Paediatrics and Child Health · 2021
Compromise
Cited by 1Open access
Abstract
The word compromise is a strange beast. It can be used both as a verb and as a noun. It derives from the Latin comprissum meaning a mutual promise, through Old French compromis and late Middle English when compromise meant mutual consent to arbitration. Like so many English words in current use, it was introduced into the vernacular by William Shakespeare. In The Merchant of Venice, Shylock tells Antonio a story about how Jacob and his uncle Laban compromised over a flock of sheep (Fig. 1). Here, Shakespeare uses the word as meaning to reach an agreement, a negotiation. In Greek mythology, Persephone, the daughter of Zeus and Demeter, goddess of fertility and crops, was abducted by Hades and taken into the Underworld. Her mother's pining resulted in eternal winter. Zeus pleaded with his brother Hades to free Persephone, but Hades tricked her into eating six pomegranate seeds. Anyone who has eaten in the Underworld cannot leave. However, Zeus persuaded Hades to compromise. Persephone could remain in the Underworld for 6 months each year (one for each pomegranate seed), the winter, and could roam the Earth for the other 6 months, bringing spring, summer and the flourishing of crops. Nowadays, the idea of compromise can have either positive or negative connotations. In political negotiation, particularly in warfare or where military engagement is imminent, compromise may be the only way of achieving a result that saves lives on both sides, in which instance it may be ethical to compromise. There is, however, an implication that compromise suggests weakness. Addressing this construct of compromise as potential weakness, President John F Kennedy said: ‘Let us never negotiate out of fear. But let us never fear to negotiate’. Compromising one's principles, on the other hand, is ethically suspect. Mahatma Gandhi said ‘All compromise is based on give and take, but there can be no give and take on fundamentals. Any compromise on mere fundamentals is a surrender. For it is all give and no take’. Here, the word compromise is used to denote a lowering of moral standards. In health care, the concept of compromise is complex. Public hospitals' funding is determined by governments, which may leave the hospitals susceptible to political influence: if the hospital is seen as supporting views that do not align with those of the government, the government may covertly reduce funding. The threat of being underfunded may put pressure on public hospitals to compromise their principles. In 2018, when children were transferred from Nauru to Australia for urgent medical care, children remained in immigration detention whilst in hospital. The government insisted that each child and each parent needed two guards. Even a 6-month-old infant being treated for an infection had two guards, presumably to prevent the baby from making a roll for freedom. A number of children were transferred from Nauru because they had stopped eating and drinking.1 Border Force guards insisted they had orders to keep adult and child detainees in line of sight day and night. Some guards interpreted this to mean they must sit in the ward corridor outside the patient's room, others wanted to remain inside the room of adolescents, even at night. When children were detained in adolescent wards, the guards' presence was also intimidating to other patients, many of whom had psychiatric problems such as eating disorders. The parents of hospitalised child detainees and adult detainees admitted to adult hospitals sometimes needed to attend outpatients or pathology. Some guards treated them in the most demeaning ways, handcuffing them or, if this was refused, marching them through hospital corridors holding their upper arm and muttering to passers-by: ‘They're illegals’ or ‘We're protecting Australia's borders’. Hospital responses varied. Some hospital administrators listened to staff working in refugee health and stood firm, insisting that they made the rules inside hospitals and that guards could not enter patients' rooms and could stay outside the ward, not in the corridor. Some hospitals refused to allow guards to demean adult detainees and infringe their dignity. Other hospitals, however, preferred to compromise with Border Force and accept some degree of infringement of the dignity and privacy of detainees, an approach which those of us caring for refugees thought lacked courage and was ethically highly suspect. Hippocrates advocated that physicians should put their patients first. However, hospital administrators may be prepared to compromise that primary tenet of health care in order not to jeopardise their relationship with the government. Advocacy is one of the central tenets of the health profession, who have a long-standing moral obligation to give a voice to those with no voice.2 There is a lamentable lack of community support for the humane treatment of those seeking asylum.3 It is a compromise too far to purport to advocate for refugees while failing to act when their human rights are being infringed.3 Another hospital issue where compromise is contentious involves parents who are highly and aggressively critical of staff. Such parents often try to split teams.4, 5 The situation is particularly difficult when a parent makes frequent complaints to the Health Department and threatens to go to the press. The hospital executive has divided loyalties, torn between listening to and upholding the parent's complaints and supporting stressed hospital staff.5 The Health Department, fearing adverse publicity, may side with the complainant. In such circumstances, it is wise to focus on the best interests of the child. The child's welfare is compromised if parents continually criticise and undermine staff, who are then more likely to make mistakes. We should certainly be open with parents about our mistakes. But hospital executive need to support staff by endorsing them setting limits on aggressive behaviour and enforcing those limits. This might involve developing a plan of graded warnings, with exclusion first from the bedside and then from the hospital for increasing periods of time for repeated infractions.5 Politicians may talk about the art of compromise. Paediatricians should be more concerned about the ethics of compromise. If compromise would result in an outcome that we consider ethically unacceptable, then we should refuse to compromise our principles. I thank Stephen Isaacs, Henry Kilham and Anne Preisz for constructive comments.
Cite this paper
Isaacs, D. (2021). Compromise. Journal of Paediatrics and Child Health, 57(8), 1162–1163. https://doi.org/10.1111/jpc.15377
Isaacs, David. “Compromise.” Journal of Paediatrics and Child Health, vol. 57, no. 8, 2021, pp. 1162–63, https://doi.org/10.1111/jpc.15377.
Isaacs, David. 2021. “Compromise.” Journal of Paediatrics and Child Health 57 (8): 1162–63. https://doi.org/10.1111/jpc.15377.
Isaacs, D. (2021) ‘Compromise’, Journal of Paediatrics and Child Health, 57(8), pp. 1162–1163. Available at: https://doi.org/10.1111/jpc.15377.
@article{isaacs2021compromise,
title = {{Compromise}},
author = {Isaacs, David},
journal = {Journal of Paediatrics and Child Health},
volume = {57},
number = {8},
pages = {1162--1163},
year = {2021},
doi = {10.1111/jpc.15377}
}Made from the index record. Check names, capitalisation and page numbers against the paper. Need another style? AI for Research has over 10,000.