There exists an unassuming tug-of-war between compassion and capitalism. Helping others is viewed as innate to humanity, but in various professions: therapy, medicine, education, and social work, it is also regarded as a business. Every act of care has a price; every hour of listening has a rate; and every fragment of compassion has to be accounted for, exported from head to page. What is the result? As a consequence, professionals confront competing desires to help and the requirement to bill, where they enter the profession to heal, not to sell, to help; however, the system values efficiency, not empathy. As they sit in front of a client under the fluorescent lights of “helping” occupations, many even contemplate: how does one remain human when humanity is their product?
Read More: The Compassion Trap: How Empathy Could Become a Liability
The Price of Empathy: When Care Becomes a Commodity
The caring professions, like therapy, nursing, and social work, are becoming more and more commercialised, creating tension between real compassion and economic rationality (Tronto, 2013). Compassion fatigue arises when compassion becomes quantified in billable hours and metrics such as patient volume (Figley, 2002). When care loses its relational trust and emotional availability, it is deconstructed into timed transactions, and human connection has become an accounting line.
For example, therapists in outpatient clinics may be pressed to schedule 25+ billable hours a week with no time to reflect, document, or “recover”; all are necessary to prevent burnout (Maslach & Leiter, 2016). Nurses, pushed to meet institutional quality metrics, sometimes have insufficient time per patient, which compromises the very components of care that research shows to be connected with healing, such as the capacity to be empathetic and listen (Joinson, 1992). Social workers manage caseloads such that every fifteen-minute increment must be justified, meaning that advocacy becomes an administrative endeavour.
The commodification of care transforms kindness from something done for one another as humans into something that is managed, monitored, and monetised as emotional labour (Hochschild, 1983). While caregivers may earn compensation, such as an hourly wage, the emotional toll of compassionate work rarely shows up on the paycheck. As a therapist noted, when they aren’t providing 20+ hours of direct service, they become a “husk” and, thus, their ability to be compassionate becomes unsustainable.
Is it possible to quantify kindness? While it may not be possible in dollars, one can assign a price in time, energy, and emotional cost. The difficulty comes with valuing care as both a human act and a professional act, resisting the systems that objectify empathy as a deliverable and stunt relationship development (Tronto, 2013).
Emotional Labour and the Hidden Costs of Care
As noted earlier, workers in caring professions often undergo an intense experience of psychological exhaustion due to emotional labour, or the process of emotionally regulating emotions to satisfy the requirements of a job (Hochschild, 1983). For example, in nursing, psychotherapeutic, and social work settings, empathy is necessary, but constant emotional regulation leads to burnout or compassion fatigue, a state of becoming emotionally numb, intrusive thoughts, and decreased abundance of empathy, not dissimilar to secondary traumatic stress experienced after hearing someone’s traumatic experience (Figley, 2002). Studies have demonstrated that when people display surface acting, a common expectation in hospices and emergency rooms, compassion fatigue becomes a greater issue (Brotheridge & Grandey, 2002).
1. The Moral Weight of Caring: When Values and Systems Collide
Moral distress adds another layer of burden to the suffering described above. When caregivers are unable to act on their personal ethical principles in the workplace due to policy or funding restrictions, or when a lack of staffing is present, there are feelings of guilt, shame, and loss of professional identity (Jameton, 1984). Studies have shown a correlation between moral distress and compassion fatigue, particularly in nursing interns and nursing staff in critical care units (Rushton et al., 2016).
Read More: Caregiver Burnout and Fragile X: The Hidden Strain on Families
2. Compassion as Calling or Performance? The Existential Divide
The stress arises from the contrast between viewing compassion as a vocation and treating it as a performance. When care is seen to be relational and intrinsic, this can lead to compassion satisfaction. When empathy is seen or perceived to be a controllable, billable or scripted act, then it often leads to emotional exhaustion and burnout–workers may be, as Sartre would describe, in “bad faith,” or they are “fake nice,” in an inauthentic experience that diminishes their own sense of self (Sartre, 1943/2007).
Some strategies can help alleviate these effects, including resilience, social support, and self-compassion (Neff, 2003). However, improvements must also occur in the system. Sustainable care demands that we value emotional labour as an essential part of our humanity, a capacity to be preserved and protected, not exhausted.
Institutional Dissonance: When Systems Undermine the Soul of Service
Bureaucratic and economically incentivised healthcare systems often put care providers in a situation of institutional dissonance (Kälvemark et al., 2004). In this case, ethical and moral instincts are at odds with business requirements. For instance, therapists are mandated to see a minimum number of patients in a week, resulting in a priority for billing over therapeutic or clinical depth, and physicians deal with arbitrary insurance limitations and denials for treatment of patients, a denial of treatment that may lead to death. Institutional dissonance can produce moral distress, the knowledge that one should ethically intervene and treat and the reality that one cannot and, in some situations, leads to moral injury, a more complicated injury, based upon guilt and shame, and a sense of broken professional identity (Dean et al., 2019).
Systemic Failures and the Commodification of Care
A nurse may observe a diabetic patient not take the proper amount of insulin based on the patient’s economic ability to afford it. A social worker may witness a homeless patient try twice to gain acceptance into a homeless housing program, only to ultimately be denied admission based on funding restrictions. These failures are systematic, not personal failures. They occur not because of an isolated situation, but symptoms of a healthcare model that treats care as a commodity. One study suggests nurses feel “moral compromise.” At the same time, certain ethical behaviour mandated the model of delivering care “according to need,” while the system is governed through “ability to pay” (Kälvemark et al., 2004).
Institutional dissonance renders compassion into an act of performance. A clinician might “bend the truth” in their notes to abide by the regulations for reimbursement, continuing to wear away at professional integrity and ethical practice. After all of these challenges have gone on for some time with repeated dissonance of the professionals’ values, emotional withdrawal, burnout, and can lead to an existential crisis (Rushton, 2018).
Restoring Integrity: Finding Humanity Within the System
Care professionals can recover their integrity despite systemic stresses using deliberate, habitual practices (Shanafelt & Noseworthy, 2017). The value clarification process can assist professionals in grappling with what aspects of their daily work align with their moral and ethical values in a way that they can develop a certain endurance. Ethical advocacy transforms passive discomfort and discontent into an active belief system that catalyses the demand for equity and fairness in the allocation of economic and healthcare resources (Cribb, 2019). Due to moral injury, a lack of compassion and hope, isolation, and continued woundedness can dissipate as they formulate their values with supervision and peer support. Boundary setting is equally important; all emotional, physical, and professional boundaries must be adequately set to build capacity and resilience, while preserving integrity and individual authenticity (Neff, 2003).
Structurally rewarding compassion with professional time or compensating with incentives and framing compassion as a healthcare priority over profit maximisation is imperative to an organisation (West et al., 2018). Compassionate care can be incorporated more fully into everyday institutional culture by training the staff on compassionate communication and systemic empathy. Compassion and capitalism can coexist peacefully when systemic redesigns are made with the recognition of human dignity (Tronto, 2013). In the redesigns, caring can be ensured when the focus is on comfort and consideration rather than efficiency and cost containment. The next step for healthcare organisations and professionals is to employ intentional re-alignment, realising and recognising empathy is not a deficit, but rather the underlying meaning of human healing.
Read More: Understanding the Rights of Persons with Mental Illness: A Guide to Dignity and Equality
Conclusion
In a monetised helping profession, the real struggle isn’t about choosing between compassion and capitalism. The struggle involves learning how to exist in both worlds. Your work environment may demand productivity, but true service lies in being fully present, patient, and emotionally available. Even if you cannot change the policies and the procedures you operate within, you can change your understanding of how to work within your systems. You can take a measured approach and, when you can, advocate for change. You can remember that care is not a product of your efforts.
FAQs
1. What does “compassion–capitalism conflict” mean?
It refers to the tension between the human desire to help and the economic systems that monetise that help, creating moral and emotional strain for professionals.
2. What is emotional labour, and why is it important in helping professions?
Emotional labour is the process of managing feelings and expressions to meet job expectations. It’s crucial in care work, but can cause burnout if unacknowledged.
3. How does moral distress differ from burnout?
Moral distress arises when professionals know the ethical action but are unable to take it due to systemic or institutional constraints, whereas burnout stems from chronic overwork.
4. Can compassion and capitalism coexist in healthcare or therapy?
Yes, but it requires systemic reform, ethical advocacy, and intentional boundaries that protect empathy and authenticity from becoming purely transactional.
5. What can individuals do to protect their compassion in monetised systems?
Clarify personal values, seek supervision or peer support, set emotional boundaries, and engage in self-compassion practices that preserve empathy and meaning.
References +
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Cribb, A. (2019). Healthcare in transition: Ethical and policy dilemmas. Cambridge University Press.
Dean, W., Talbot, S., & Dean, A. (2019). Reframing clinician distress: Moral injury, not burnout. Federal Practitioner, 36(9), 400–402.
Figley, C. R. (2002). Treating compassion fatigue. Brunner-Routledge.
Hochschild, A. R. (1983). The managed heart: Commercialisation of human feeling. University of California Press.
Jameton, A. (1984). Nursing practice: The ethical issues. Prentice Hall.
Joinson, C. (1992). Coping with compassion fatigue. Nursing, 22(4), 116–121.
Kälvemark, S., Höglund, A. T., Hansson, M. G., Westerholm, P., & Arnetz, B. (2004). Living with conflicts—Ethical dilemmas and moral distress in the health care system. Social Science & Medicine, 58(6), 1075–1084.
Maslach, C., & Leiter, M. P. (2016). Burnout: A multidimensional perspective. In C. L. Cooper & P. C. Quick (Eds.), Handbook of stress and health (pp. 123–147). Wiley.
Neff, K. D. (2003). Self-compassion: An alternative conceptualisation of a healthy attitude toward oneself. Self and Identity, 2(2), 85–101.
Rushton, C. H. (2018). Moral resilience: Transforming moral suffering in healthcare. Oxford University Press.
Rushton, C. H., Batcheller, J., Schroeder, K., & Donohue, P. (2016). Burnout and resilience among nurses practising in high-intensity settings. American Journal of Critical Care, 24(5), 412–420.
Sartre, J.-P. (2007). Being and Nothingness (H. E. Barnes, Trans.). Routledge. (Original work published 1943).
Shanafelt, T. D., & Noseworthy, J. H. (2017). Executive leadership and physician well-being: Nine organisational strategies to promote engagement and reduce burnout. Mayo Clinic Proceedings, 92(1), 129–146.
Tronto, J. C. (2013). Caring democracy: Markets, equality, and justice. New York University Press.
West, C. P., Dyrbye, L. N., & Shanafelt, T. D. (2018). Physician well-being: Expanding the triple aim. JAMA, 317(5), 519–520.
