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"Without compassion, we look past someone’s needs. We misjudge their problems and diminish our capacity for empathy and I believe empathy is crucial for healing and effective health care."
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Presuming Innocence: Bryan Stevenson on Justice and Health Care

By IHI Multimedia Team | Thursday, October 5, 2017


Bryan Stevenson is founder of the Equal Justice Initiative, an attorney, and a best-selling author. In a recent interview with IHI, Stevenson described the connections between striving to improve health care and fighting injustice, including the need for compassion and the risk of burnout. Stevenson will be one of the keynote speakers at the 2017 IHI National Forum (December 10–13, 2017).

What is the link between your criminal justice work and the efforts of people working to improve health care?

To me, there is a direct connection between health care and criminal justice. Both systems are very wealth-dependent when it comes to quality of services and outcomes, which creates a kind of structural inequality that we need to address. Our criminal justice system often treats you better if you are rich and guilty than if you are poor and innocent.

Many people with serious health problems and disabilities go untreated until those medical issues manifest into other problems. Many of my clients could have avoided engagement with the criminal justice system if they could afford to treat mental health disabilities, drug dependency, trauma disorders, or health problems triggered by childhood adversity. Both systems also rely on a lot of actors with enormous discretion, which frequently means that people of color or other disfavored people can sometimes receive inadequate attention or care.

You’ve written that “An absence of compassion can corrupt the decency of a community, a state, a nation.” How can the absence of compassion corrupt the health care system?

Whenever we approach someone who is in need of care or attention with a presumption that they are guilty of something, undeserving, or disfavored in some way, we undermine our ability to be our best.

Without compassion, we look past someone’s needs. We misjudge their problems and diminish our capacity for empathy and I believe empathy is crucial for healing and effective health care. When we routinize this lack of compassion, we create systems and care providers who are much less successful than a decent system requires.

In Just Mercy, you write that “brokenness” (how we’ve been hurt and have hurt others) is “the source of our common humanity, the basis for our shared search for comfort, meaning, and healing.” How can understanding this idea help people working in health care?

We are bodies of broken bones, as Thomas Merton once wrote. Health care professionals have a unique opportunity to be attentive to the brokenness that is inseparable from the human condition and be agents of healing and mercy. In that way, it’s such a privilege to serve those who are sick or afflicted because a life of service can be inspiring and rewarding in ways that few things can approximate.

Those of us working in health care don’t like to think of ourselves as biased, and yet there is no lack of evidence that health inequities exist. How do you convey the idea that discrimination is not just about intent?

In America, we all live in a society that has been burdened with a history of racial inequality. There are narratives of racial difference, ideologies about the poor and those who are “other” that make it very difficult for us to avoid bias. It takes a real commitment to overcome the explicit and implicit bias that inevitably compromises how we treat one another, something we won’t achieve if we tell ourselves we’re not at risk of bias if our intentions are good.

I do think that understanding our history and truth-telling about the legacy of that history can motivate us to do the reparatory work that is needed to eliminate bias and discrimination. This is one of the reasons why my work is now so focused on truth and reconciliation and confronting our history of racial inequality.

There is a lot of burnout among people working in health care today. You have to fight a lot of uphill battles. How do you avoid burnout?

I reflect a lot on the people who have come before me, those who frequently had to say “my head is bloodied but not bowed.” They inspire me to appreciate that they did so much more with so much less.

An understanding of my foreparents who were enslaved, terrorized, and segregated tempers my own sense of frustration and recalibrates what I can properly categorize as “too much” when I fight against inequality. I also am privileged to have the ability to take moments during the week to exercise. I’m very fortunate to have come from a musical family where stepping into music for some period of time can be deeply affirming, energizing, and inspiring. Finding the things that help us stay strong and focused is an important task for people trying to do difficult work.

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