Cards displayed on the 
ward, chocolates in the common room… but there is an increasing trend to use Facebook as a collective noticeboard to proclaim gratitude. Showing Thanks is a recently established webpage for conveying gratitude to healthcare professionals involved in maternity care and childbirth. Mothers have been posting their stories on this Facebook site and then Rachel Ellie Gardner has taken it upon herself to let healthcare trusts know when a member of their staff has been thanked.
Anecdotally, we know that staff involved in obstetrics get a lot of gratitude. Even if a birth has been dramatic (and, let’s face it, most births have elements of trauma), the outcome is usually happy. The thanks logged so far are revealing of what women value as being worthy of gratitude. These tend to be making time in spite of being busy, compassionate touch (like giving a hug or holding someone’s hand), being supportive of choices, and being reassuring. Even when the outcome was tragic, women have still thanked healthcare teams for being kind and supportive.
My reading lately has taken me into the realm of the ethics of gratitude. A conundrum when considering gratitude in healthcare is that patients are not obliged to be grateful. After all, healthcare providers are paid to do a job of work in an institution which is funded by taxpayers. Therefore the care provided is a duty rather than a benefit. Alan Goldman (1980, The Moral Foundations of Professional Ethics, Totawa, NJ, Rowman and Littlefield), for example, argues that citizens have no debt of gratitude to the state because they collectively pay for public goods through taxes. This suggests the relationship between citizen and state resembles a commercial relationship (one does not feel gratitude to a store for selling you goods). However, it is clear that many patients do not see healthcare in this way. I think this is partly because there is a collective social resistance to political pressures to commercialise the NHS, but also because the benefit of healthcare is psychically distant from the funding of it through tax. Overwhelmingly though, gratitude is a culturally mediated, social action that takes place between people who have a shared emotional connection. Gratitude becomes an instinctive response to what we might generally call ‘humanity’ demonstrated that goes beyond obligatory professionalism.
Walker (1988, Political obligation and the argument from gratitude, Philosophy and Public Affairs 18: 359–64) argues that even if you have ‘paid’ for a service, gratitude may be warranted if the quality of the service is exceptional and the manner in which it is provided is special. This is borne out by the stories being told on sites like Showing Thanks.