Compassion is one of the most cherished virtues in medicine. It is the impulse that draws many of us into healthcare: to relieve suffering, to stand with patients in vulnerability, and to act with care.

But what happens when compassion – unexamined, unbounded – begins to justify harm?

We are living through a cultural moment in which compassion is not only valued, but expected. To question it is almost taboo. Yet history reminds us that even our highest virtues, when detached from truth and moral clarity, can become dangerous.

A Brief Historical Perspective

Compassion has not always meant what it does today.

In earlier medical and ethical traditions – whether rooted in the Hippocratic Oath or broader philosophical frameworks – compassion was inseparable from a commitment to do no harm. Acts that intentionally ended life, even when motivated by pity, were viewed with deep moral caution.

Over time, however, the meaning of compassion has shifted. Increasingly, it is interpreted not as standing with someone in suffering, but as removing the source of suffering at any cost.

That shift matters.

Because when compassion becomes primarily about eliminating discomfort – rather than upholding human dignity – it can begin to justify actions once considered harmful.

A Culture Compelled to Be Compassionate

Today, few would argue that compassion is anything but virtuous. But we may be entering a phase of what could be called compassion absolutism – a collective compulsion to affirm, validate, and alleviate suffering immediately, often without deeper ethical reflection.

This can be seen across multiple areas of public life.

In debates around identity, including aspects of LGBTIQA+ discourse, compassion is often framed as unquestioning affirmation. Raising concerns – whether clinical, developmental, or ethical – can be interpreted as a lack of care, even when motivated by long-term wellbeing.

Similarly, in areas such as end-of-life care, the language of compassion is increasingly used to support interventions that intentionally hasten death. Again, the underlying assumption is that relieving suffering justifies the means.

These are complex issues. But they share a common thread: compassion is invoked not only as a virtue, but as a moral trump card.

Abortion: From Moral Tragedy to Moral Good

Nowhere is this shift more evident than in how society speaks about abortion.

Historically, abortion was widely regarded – even by those who permitted it – as a tragic and morally serious act. In many traditions, it was understood as a grave wrong. Later, even as laws liberalised, the framing remained cautious: abortion should be ‘safe, legal, and rare’.

Today, the language has shifted again.

Abortion is increasingly framed not as a last resort, but as a positive good – an expression of autonomy, empowerment, and even, in some cases, something to be publicly celebrated.

This evolution in language reflects a deeper shift in moral reasoning. Compassion, once directed toward both mother and child, is now often framed in a way that excludes one entirely.

As healthcare professionals, we must ask: is this truly compassionate?

Evidence suggests the issue is not morally or medically neutral. Studies indicate that women who have undergone abortion may face increased risks in various domains, including physical complications and mental health challenges. For example, research has reported elevated risks of mortality, including from suicide and accidents, among women following abortion compared to those who carried pregnancies to term.

Similarly, emerging data on chemical abortion indicates notable rates of adverse events, including haemorrhage and infection, with some large-scale analyses suggesting that over 10 per cent of women may experience serious complications within weeks.

Mental health outcomes are also complex. While some women report relief, others experience anxiety, depression, or regret, highlighting that the assumption of abortion as a simple solution to crisis may be overly reductive.

None of this diminishes the real and often profound difficulties women face in crisis pregnancies. But it does challenge the narrative that abortion is inherently compassionate.

Medicine’s Shift: From Paternalism to Consumerism and the role of stigma

Part of this change reflects a broader transformation within healthcare itself.

Medicine has moved away from a paternalistic model – where clinicians guided decisions based on professional knowledge, skills and judgement – toward a consumer-driven model, where patient autonomy is paramount.

This shift has brought important benefits, including respect for patient rights. But it has also introduced new risks.

When healthcare becomes consumer-driven, compassion can be redefined as providing what is requested, rather than what is truly in the patient’s best interests. The clinician’s role shifts from moral agent to service provider.

In this environment, difficult ethical questions can be sidelined in favour of meeting expectations. Coupled with this is a further concern seen in the push for reducing stigma as there is growing emphasis on this in healthcare. While the intention to ensure patients feel safe and supported is admirable, it can have unintended consequences. In some contexts, the drive to normalise certain procedures or choices can discourage full transparency about risks, complications, or alternative perspectives. When clinicians feel pressure to present only reassuring narratives, or when adverse outcomes are underreported or minimised, patients are deprived of truly informed consent. Compassion, in this sense, risks becoming performative through prioritising emotional comfort over honesty. But ethical healthcare depends on trust, and trust requires candour. If reducing stigma comes at the cost of truth, it may ultimately enable harm rather than prevent it.

When Compassion Turns Selective: Prenatal Testing and the Return of Eugenics

There is another area where our modern understanding of compassion deserves careful scrutiny: prenatal screening.

Advances in medical technology have made it possible to detect a growing number of genetic conditions before birth. This is often presented as progress – and in many ways, it is. But what follows diagnosis is where the ethical question begins.

In practice, prenatal screening is frequently paired with termination.

For conditions such as Down syndrome, this has led to striking outcomes. In several countries, the vast majority of pregnancies diagnosed with Down syndrome end in abortion – often exceeding 90 per cent. In Iceland, for example, reports have indicated that close to 100 per cent of babies diagnosed prenatally with Down syndrome are not carried to term. This has led to widely publicised claims that the condition has been ‘virtually eliminated’ in the population – not through treatment or cure, but through selective termination.

Importantly, Iceland has not mandated abortion, nor has it legally ‘eradicated’ Down syndrome. Rather, the outcome reflects a combination of widespread screening and strong clinical and social pressures following diagnosis.

This distinction matters.

Because it highlights how a system can produce eugenic outcomes without explicit coercion.

The language surrounding these practices is almost framed in terms of compassion: sparing a child from suffering, protecting families from hardship, preventing difficult lives.

But we must ask: compassion for whom?

When entire categories of people are systematically prevented from being born, we are no longer simply responding to individual cases of suffering. We are making collective judgements about which lives are worth living.

Historically, that is the essence of eugenics.

It rarely begins with malice. It begins with good intentions – paired with a narrow definition of wellbeing.

For those living with genetic conditions such as Down syndrome, and their families, the message can be deeply confronting: that their lives are viewed, at a societal level, as burdens to be avoided.

As healthcare professionals, this should give us pause.

Because a compassion that leads us to eliminate the vulnerable, rather than care for them, is not the kind of compassion medicine was built upon.

A Contemporary Test: Sex-Selective Abortion

These tensions are not theoretical. They are now playing out in legislative debates.

In New South Wales, Libertarian MP John Ruddick is introducing a bill aimed at preventing sex-selective abortion.

Why is such a bill necessary?

Because evidence suggests that sex-selective abortion – long recognised as a form of discrimination against girls – is not confined to overseas contexts. Australian research has identified imbalances in sex ratios at birth among certain populations, consistent with sex selective practices.

This raises a profound question: if abortion is justified on the grounds of compassion and autonomy, how do we respond when it is used to eliminate children based solely on their sex?

At this point, the language of compassion begins to fracture.

Because compassion, if it is to mean anything, must be consistent. It cannot affirm dignity in one context while permitting discrimination in another.

Reclaiming a Compassion That Does Not Harm

Compassion is not the problem.

But compassion untethered from truth, from ethical reflection, and from a commitment to protect the vulnerable – that can become dangerous.

As healthcare professionals, we are called to a deeper form of compassion: one that does not simply remove suffering, but accompanies patients through it; one that does not sacrifice one life for another; one that is willing to ask difficult questions, even when they are unpopular.

We must be willing to examine whether, in our desire to be compassionate, we have accepted practices that ultimately harm.

Because true compassion does not abandon the vulnerable.

It protects them.

Ms Naomi Bunker is a Registered Nurse and an Executive member of Pro-life Health Professionals Australia (PHPA).

Ms Louise Adsett is an Endorsed Midwife, the Executive Secretary of PHPA.  

Dr Melissa Lai is a senior Neonatologist and the President of PHPA.