Palliative care and spiritual friendship

widow-of-nain

One of the main reasons I am an advocate for global palliative care is that palliative care is a unique medical discipline whose practitioners see spirituality as an essential element of being with dying. Not being with “the dying” necessarily, but being with dying as a process to which all life is, without exception, subject. http://www.japantimes.co.jp/news/2014/11/27/national/hospice-care-providers-learn-lessons-dying-patients/#.VHmK8L4-Bpl. Spiritual care includes both providers and patients, and creates provisional communities, or ecclesias of care. Ecclesia originally meaning “those who are called out, or summoned.” Palliative care practitioners are “summoned” to accompany those who are seriously ill, and to alleviate their suffering, physical, emotional, and spiritual.

Moreover, palliative care teams that escort the dying and their loved ones to the frontiers of the unknown, exemplify what ancient and medieval philosophers called the virtue of friendship, or being for the other. Aristotle described friendship as a relationship that wants only the good of the other, for the friend [not for oneself] http://plato.stanford.edu/entries/aristotle-ethics/#Fri. In the Christian context, the virtue of friendship, or spiritual friendship, prefigures the friendship with, and of God. Indeed, in the Sufi spiritual tradition, Rumi calls God “the Friend.” http://beautywelove.blogspot.hu/2012/04/this-moment-this-love.html

Both secular friendship and friendship with God demand commitment and practice. As the ancients saw it, the virtues had to be practiced in order to take hold in an individual or a community. When I was taking my RCIA (Roman Catholic Initiation for Adults) courses before my baptism several years ago, my teachers told me that friendship with God was like any friendship, requiring dedicated time, maintenance, attentive conversation, etc. And just as human friendships die when those things are neglected rather than nourished, so does friendship with God. Or it just never gets off the ground. The bottom line is that unless we get naked with God, whether in prayer, or in intentional activities embodying service and love of neighbour, we simply can’t think of ourselves as God’s friends.

It seems to me that we can practice for, or rehearse this friendship with God by hanging out and speaking our truth with our friends in this world. Our friends are people who challenge us spiritually, emotionally, and intellectually. They challenge us while loving us for who we are. And by loving them for who they are, we imitate what scripture tells us is God’s love for us. This sort of friendship in the world gives us, or at least gives me, the fortitude to be out in the world and to toil, as Jesus describes it, in the vineyard, one of the metaphors for the kingdom.

Palliative care volunteers, clinical providers, spiritual counselors, and social workers accompany, or escort, patients and families to the frontiers of the kingdom, whatever any of their individual conceptions of that unknown space happen to be. The gospels describe the kingdom as an energetic space where there is no fear. “Fear not” are the two words spoken most authoritatively throughout the New Testament, often by angels, God’s ambassadors.

The kingdom of Jesus’ praxis — he doesn’t just talk about it, he enacts it — is a space where the outsider, the weak, the vulnerable, and the dependent, are accepted and welcomed. It actually invites the seriously ill, weak, paralysed, and actively dying, to enter this space configured and prefigured by the frequencies of committed friendship. Palliative care is a practice, or praxis, of committed friendship, based on truth-telling, courage, and generosity, the other cardinal virtues.

Of course the more secularly minded can take God and the kingdom out of the equation altogether, and make the practice of escorting the dying and their families, both spiritually and clinically, a practice of friendship tout cort. Many palliative care providers I know do that. That would be enough. It is more than enough, given that so much energy is needed for palliative care to take root in the world, and for its potential as an agent of social change to grow and flourish. http://www.who.int/cancer/publications/palliative-care-atlas/en/. Palliative care prefigures the kingdom whether or not its practitioners think of themselves as “spiritual” or religious. It simply emerges from their work.

One of the hardest aspects of friendship is allowing it to go, either when the friend dies, or when the friendship itself dies a natural death. This is the “black river of loss” Mary Oliver talks about and the need to do three things:

to love what is mortal;
to hold it
 
against your bones knowing
your own life depends on it;
and, when the time comes to let it
go,
to let it go.
http://www.phys.unm.edu/~tw/fas/yits/archive/oliver_inblackwaterwoods.html

But what about loving the immortal? Practicing friendship, the loving and the letting go, both among ourselves and with our patients and families, brings what Jesus called “the kingdom” to life, and teaches practitioners, through many fits and starts, to be friends of God’s. That is a status I covet, meaning I have a lot of spiritual work still to do!!

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kpettus

I am a political theorist, oblate in the Order of St.Benedict, and advocate for universal rational access to essential controlled medicines for pain and palliative care in the lower and middle income countries. I work a lot in Vienna at the Commission on Narcotic Drugs, and in Geneva at the World Health Organisation, and the Human Rights Council representing the International Association for Hospice and Palliative Care. Right now I am full time caregiver to my sister Ruth, who has brain cancer and lives in Baltimore. I am also writing a Catholic Caregiver's blog to document the experience.

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