Setting our faces toward Jerusalem

Today I was in bits reading the news about our US President’s ban on individuals from specific (Muslim) countries entering the US, even if they were US citizens, or held legal immigration status. My social media feeds are outraged. The fact that the administration announced it on Holocaust Remembrance Day made the order particularly ominous.  Several federal judges have already blocked the order on grounds of unconstitutionality, and there have been large demonstrations at international airports around the country where citizens and residents are being illegally detained.

This feels like a constitutional crisis.  It feels like the period before the Third Reich consolidated power, when many thinking people could not believe what was happening, that the situation would blow over, etc.

What particularly undid me was a photo I reposted on FB, a poster that read “First they came for the Muslims…not this time motherfucker!”

I don’t know if everyone will get the reference to Brecht, or to Martin Niemöller but I grew up in post-WW2 Europe always wondering how I would react if I had been faced with the moral choices that the Holocaust presented to ordinary citizens. The “this time” in the poster I shared says that some of us at least learned the lesson, and will resist. That feeling resonated with who I am now, a christian called to give up her life for her friends, who prays for the courage to do just that. I am called to witness, we are called to witness, and turning away makes me guilty of the crimes against mercy, or at least an accessory. 

It was no accident that today’s readings (fourth Sunday in Ordinary Time) were from Psalm 146-7: “The Lord loves the just/the Lord protects strangers,” and Corinthians 1:28 “God chose the weak of the world to shame the strong, and God chose the lowly and despised of the world, those who count for nothing, to reduce to nothing those who are something,” AND the Beatitudes.  Slam dunk.    I have great role models — Fr. Maximilian Kolbe, Dietrich Bonhoeffer, Edith Stein, Alfred Delp SJ and many other christians who could not remain silent when gospel values were systematically violated by the state.

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Fortunately, inspiringly, some church leaders are speaking out: Pope Francis and Fr. Jim Martin, SJ to name only two. I trust that US religious leaders are planning an ecumenical rally at the Capitol to protest this scandal and remind the administration about the law of hospitality. I was just listening to Congressman John Lewis, veteran of the violent US civil right struggles, telling Krista Tippett that the march from Selma to Montgomery was “love in action. We do it not simply because it’s the right thing to do, but it’s love in action. That we love a country, we love a democratic society, and so we have to move our feet.”

Moving our feet can also involve dancing, as Rumi sings: “Dance, when you’re broken open. Dance, if you’ve torn the bandage off. Dance in the middle of the fighting. Dance in your blood. Dance when you’re perfectly free.”  So we march, we dance, we write, we mourn, and are blessed in so doing, according to today’s readings. Continue reading Setting our faces toward Jerusalem

Palliative care as transformative practice: dedicated to my hospice/palliative care friends and colleagues around the world

Palliative care transforms everyone who participates in it — who gives and receives it — from the inside out.  It also has the power to transform systems from the inside out.  Palliative care practitioners need public recognition and funding to accomplish these transformations for the benefit of patients, families, and health systems around the world.  Palliative care ethics cut against the grain of profit-oriented systems that reward individualistic, rather than socially embedded, conceptions of health and wellbeing.

Palliative care values people as human beings, as ends in themselves. Its ethical compass overrides the dominant system priorities, being pointed at the moral imperative of alleviating vulnerability and distress.

By identifying and attending to pain along multiple dimensions — to “total pain” — palliative care affirms the inherent value of the person.  Its concern with suffering amounts to a declaration that our common mortality makes us all, no matter how ill or debilitated, equal. In that sense, palliative care is profoundly democratic and non-elitist.  That in itself is transformative.

The qualities and virtues palliative care builds in practitioners at the bedside (the microcosm) have the power to shift world views in the macrocosm. It is not overstating the case to say that the development of palliative care represents the beginning of a paradigm shift. Unlike their patients, palliative care practitioners and advocates have voice and influence in the public world, and are using it to call for the discipline’s integration into national and global health systems as a matter of justice.

Palliative care advocates such as myself and my colleagues who work at the international level, remind countries of their human rights obligation to institutionalise palliative care as part of the right to the highest attainable standard of health. This requires that they develop policies and allocate funds to support it.

The strategy of presenting palliative care as a human right, rather than as an option, allows policymakers to see it as a universal need rather than a political football. Populations all over the world are rapidly ageing, the prevalence of non-communicable diseases such as cancer, diabetes, and heart conditions, is increasing. Funders and policymakers realise that they and their families will also need palliative care in the not so distant future. Universally recognisable needs rarely cause political fights.

Palliative care practice is politically subversive, although not in the conventional sense of political campaigns that cause harm by seeking power or shaming opponents. Its virtues and ethics are deeply political in the classical sense though, a sense that has been largely forgotten, but is immanent in our political DNA. These virtues are expressed in the friendship, courage, and honesty (truth-telling) that exemplify best practice palliative care.

When the ancient citizenship virtues are practiced in the modern context of the private realm, at the beside, palliative care communities are actually reconstructing the genetic material of the public sphere, much as stem cells do. They are rebuilding damaged ethical tissue from the inside out, causing the dominant system or politeia — body politic — to shed its old skins, and reorient itself toward the common, rather than the private good.

Snake_skin_coil

Palliative care and hospice practice inspires learning along spiritual, as well as clinical and psycho-social dimensions. Practitioners’  proximity to death and embrace of vulnerability, advances the emotional intelligence of society as a whole.  We have the privilege of accompanying people who are journeying between the worlds, our ‘patients.’ They and their personal caregivers have so much to teach us about what is really important during their final months and days.

Those teachings usually concern the values of surrender and open-heartedness, as well as struggle. Surrender, paradoxically, opens human consciousness to truths and realities that are not otherwise apparent when we are immersed in the more “worldly” dimensions of achievement and commerce.

Bedside practice teaches us to slow down, listen, and be respectful of both the “undignified” and the unfathomable.  What we learn there informs our family and public lives. It creates a ‘meme’ that can replicate effectively, transforming other key domains of our worlds.

May the vision of universal palliative care can become a reality!