Spirituality and healthcare food for the journey

Spirituality and Healthcare: Food for the Journey

Spirituality and Healthcare Food for the Journey Edited by Jim McManus 2014


Contents Singing the Lord’s Song in a Difficult Landscape ................................................................. 3

Reflection: Health Care Workers as Ministers .................................................................... 7

Questions for reflection or discussion ............................................................................ 7

The Church Teaches: Voluntary Work in Healthcare .......................................................... 8

Spirituality and Education for Healthcare: A Perspective ................................................. 10

Reflection – Love, not just competence ........................................................................... 16

Questions for Reflection or Discussion ......................................................................... 16

The Church Teaches: The Healthcare Worker .................................................................. 17

Who is this Patient? A Spiritual Perspective ..................................................................... 19

The Church Teaches: Life-Threatening Illness .................................................................. 27

Mary, help of the Sick ....................................................................................................... 28

Prayer to Mary, Health of the Sick .................................................................................... 30

How do we get a Catholic Theology of Healthcare, and does it matter anyway? ............ 31

Reflection: A Charter for Catholic Healthcare Workers .................................................... 40

Questions for Reflection or Discussion ......................................................................... 40


Singing the Lord’s Song in a Difficult Landscape

Fr James Hanvey, SJ

A Problematic, Politicised Landscape The field of healthcare is an intensely politicised one. The danger is that the human face which is at the centre of all healthcare gets erased. While healthcare is a professional act requiring all our knowledge and skills it is also a personal encounter. Where it is politicised there is always the danger that the ‘professional’ is reduced to a purely instrumental relationship and the nature of the encounter is distorted. This ‘depersonalisation’ is a two way process: not only is the recipient ‘objectified’ but also the person administering the care is equality ‘objectified’ through a series of categories and statistics etc. Now, it is, of course, important that there are appropriate ways of measuring and tracking any system; also that there are high levels of accountability. But the process of politicisation here can turn these from means into ends. When this happens then there is also a fundamental transformation of the culture and its values. This can produce a displacement of the human person who, in this field, is one that is always encountered as vulnerable. What we miss is that those who care for them are also vulnerable in that such care, whatever the systems or levels of professionalism, is always an act of generosity – a response which always contains within it that desire to meet another person beyond the limits of the professional skills. In other words, healthcare is always ‘person care’ albeit within defined situations. At its heart is a human exchange.

Implicit or Explicit Theology We are all operating with an implicit theology of the human person. We should make some of this, at least, explicit. While we all have a unique and irreducible essence, a sense of self or ‘me-ness’, this never occurs in isolation but is always within the context of relationships. In some important sense our ‘personhood’ and the expression of our individuality needs and requires these relationships and is generative of them. We become and express ourselves in and through our relationships with others.

A person who comes to you for healthcare comes with a narrative, and comes connected to other people and communities, as well as being connected body and soul. Indeed, these two are integrally bound up so that one expresses the other. The notion of the soul grounds the reality of the person so that they cannot be reduced to a mere body; the transcendental dynamic of our live – the way in which we live and shape our existence in love, freedom and understanding, cannot be reduced to chemical actions in the brain. Such reductionist strategies are not only deficient in their ability to comprehend the rich complexity of a human life but tend to a sort of determinism which ultimately undermines the moral nature of the human person i.e. that people do desire and are capable of doing good. On the other hand, a dualism which sees the ‘soul’ as the only really valuable thing about us is another sort of reductionism. It denies the very nature of our embodied existence and the way in which that defines us and is also the way in which we live in the world and understand ourselves. We are not disembodied subjects but women and men, have


colour and shape, etc. Whatever conclusions we may come to about the way in which these physical dimensions are also socially constructed our bodies carry identity and meaning also. They literally locate us; in them and on them is the text of our lives Yet, despite first appearances, I suggest that the Christian understanding of health and healthcare is not predicated upon a reductive dualism of body and soul. One place to start from to understand this is the extraordinary reality of the Resurrection. You will recall that the philosophers of Athens laughed at Paul when he spoke of this? The reaction may still be the same today, yet it is the scandalous core of our faith. It maintains that our embodiment is not accidental to us but is part of our eternal as well as natural destiny. So all healthcare that grounds itself in some sense of Christian anthropology that has a profound non-instrumental view of the embodied human person. It will value and respect the body because it too is ordained to glory. It too is the work of grace which is mediated not just sacramentally but in relationships of respect, care, and love. Yet, it is precisely because of this understanding of our embodied reality that for us Healthcare, working with the human being, is working with an occasion of transcendence. In this sense, then, working in the healthcare arena is a deep and practical way of doing theology. That most beautiful sacrament of the sick points to this in its own way. It reminds us that no action of healing is ever just about the physical healing but about the restoration, in some way, of our sense of self, our integrity as a human being, our belonging, and, of course, our vocation to eternal life – which is not something that begins upon our death but is already present in our lives and is realised in each action of generosity, respect, care – each action which confers and recognises our value and our dignity.

Often this expressed just in those simple and routine ways: the thoughtfulness that attends to a person and just makes them that bit more comfortable, that takes just that little extra moment; the touch that consoles, etc. Also in the way in which people express gratitude and bonds of trust are built up. Now, this is not some idealised picture; it does not deny the complexity and the problematic nature of situations and relationships, but it somehow refuses to be bound by them. It always finds some way, no matter how small, of being unconstrained.

Witness and Resistance This is why such an understanding of healthcare which never loses sight of the human reality is also an act of witness and resistance. We must resist both the depersonalising of the receiver of healthcare and the depersonalising of the giver of healthcare. We forget that the giver too can be regarded as purely instrumental: they’re simply to dispense whatever people believe themselves to be ‘entitled to’. In these situations the appeal is often made a receiver’s rights, they are a ‘client’ or ‘customer’. We forget that in this very human exchange of healthcare the ‘carer’ also has rights. They cannot be required to forfeit conscience and the sense of their own dignity and humanity. In other words, those who are professionally engaged are also humanly engaged and they cannot be treated as purely passive instruments either of the one receiving care or by the system within which they work.

Retaining a vision that is always greater than that expressed implicitly and explicitly by policies resists depersonalising. It also helps us prevent the ways in which we are


“desensitised” to issues and questions because it allows us an alternative intellectual and linguistic ‘space’ – it allows us the possibility of understanding and interpreting ourselves, intuitions and actions in ways that are not completely absorbed by the language and concepts of the systems within which we have to work. I want to call this, Keeping of the Memory. The French sociologist of religion, Danièle Hervieu-Léger, in her book ‘The Chain of Memory’ argues that society has become ‘amnesic’. Her argument is that the structures and channels within society, which carries its ‘memory’ e.g., its traditions, customs, etc. has been eroded. It is not about staying in the past or about trying to stifle change; her point is that this sources of ‘memory’ are Utopian spaces i.e. they are the resources we have for envisaging a different sort of society. Far from being nostalgic, they are about the future for they keep alive and active the vision we have of something deeper, richer, better. Even though here analysis is of French society, I think it also has some validity for us. While reforms and changes are necessary, if they erode this sort of memory, they also diminish the creativity of the culture and that affects its values and the motivation of those who work in it. Often this exposes a paradox of the changes and reforms i.e. they erode the very values that the system depends upon in order to work and achieve its purpose. No system like the Healthcare system (and education, too) can work without the self-motivation and generosity of the staff. I would argue that, whether a person of faith or not, every person working within the system has some form of the values and the vision we have been exploring. That is why the whole thing works because it is that vision, however it is articulated, that inspires people to do what they do – often against the odds and at some personal cost. But if you disturb this, change it, or in some way diminish it, then you undermine the very culture or ethos on which the whole edifice depends. This culture is alike a living tissue, it can be destroyed as well as nourished. Keeping the memory, is keeping that unique tissue of human relationships, acts, understanding and vision alive by refusing to forget what is at its centre.

Keeping of the Memory is therefore a service we perform for everyone. We keep hold of the memory of the worth of the human being, and the importance of a healthcare system and process that affirms, remembers and embodies this.

The Community: It is interesting that in all his acts of healing – physical,

psychological, spiritual, Christ doesn’t see health in purely personal or spiritual terms. Healing is also social: it is also a restoration to the community, and so we should see healthcare as being part of restoration of the person to the community. This is a holistic vision of reality that affirms we exist to be part of the dynamic of being connected and in relationship.

To be able to understand the fullness of Healthcare in these dimensions requires an attentiveness to the person in all their contexts and this requires not only a more complete vision of what care is, but the time to allow the person to unfold.

In conclusion: All this is, I believe, capable of translation into other less religious language. In so far as I am only reacting to what you have been saying, it is clear that everyone here has their language and understanding of all these realities and much more experience of them than I have. However, from a much more explicit Catholic theological point of view, I have been trying to express what I would call a sacramental vision of reality. This is a sense that all reality can carry grace but especially the human. It is in the ordinary as well as the extraordinary human


exchanges at something of God’s presence and care is mediated. The ground of this vision is the Incarnation. The Human is sacred and sacramental precisely because the incarnation is the guarantee that the human, by virtue of being human, is where God dwells. Part of that attentiveness to the human in all its richness – which should be the mark of authentic healthcare – is the attentiveness to the vision of God in God’s world. In this way we are all ministers of his grace to one another. Perhaps this is being this that we have the deepest level of resistance to all the ways in which the human is diminished. It may also be that in such acts we also have the deepest expressions of our freedom. It seems to me that to be touched by these acts and by those who live out of this vision is genuinely health giving.


Reflection: Health Care Workers as Ministers

…the health care worker is “the minister of that God who in Scripture is presented as ‘a lover of life’ (Wisdom 11:26). To serve life is to serve God in the person: it is to become “a collaborator with God in restoring health to the

sick body” and to give praise and glory to God in the loving acceptance of life, especially if it is weak and ill.

The therapeutic ministry of health care workers is a sharing in the pastoral and evangelising work of the Church. Service to life becomes a ministry of salvation that is, a message that implements the redeeming love of Christ.

Doctors, nurses, other health care workers, and voluntary assistants are called to be the living image of Christ and of his Church in loving

the sick and the suffering”: witnesses to “the gospel of life”.

Charter for Health Care Workers Pontifical Council for Health Pastoral

Care

Questions for reflection or discussion

1. In what way do you think the role of the healthcare worker can support the mission of the Church?

2. What are the challenges and barriers to this both in healthcare settings and the Church?

3. How could the Church help you live out this role more effectively?


The Church Teaches: Voluntary Work in Healthcare

Cardinal Angelo Sodano

There are people and associations that have chosen to work for the improvement of

the quality of our history and for the development of civilisation – voluntary workers.

They have embraced the banner of mercy – there are very ancient and glorious

associations which even have that name – and they seek to hear the cries of silence,

the voice of those without speech, and the cry of the land in order to find an answer

‘as long as this is possible’.

Interpreting one of the most involving tasks of Christianity, voluntary workers have

decided to place their own lives at the service of other people in order to construct a

‘civilisation of love’. Moved by religious faith or because they believe that a more

civilised world is possible, they want to give a hand to anyone who is experiencing a

situation of malaise and difficulty. Beginning with the organisation of that creative

micro-organism, the parish, or pushed forward by humanitarian movements,

voluntary workers struggle against the deleterious consequences of racial

discrimination, fight against social exclusion linked to a multiplicity of forms of

poverty, and promote campaigns to defend the right to the defence of human dignity

in every historical and geographical context.

Following the Christian vision of life, many are concerned with the ‘last’, who are the

privileged of the kingdom of God.

The Church immediately perceived the force present in the voluntary work movement

as a bearer of civilisation in care for the elderly, abandoned children, the chronically

ill, the disabled, the homeless and immigrants. This is a presence that wants to

create, and specifically in favour of the last, conditions of life that are more human,

out of respect for God, the only Father of all men.

When we reflect on the varying activities promoted by voluntary workers we suddenly

feel a sense of admiration, but also a certain fear because one asks oneself how

voluntary workers can carry out the tasks which society entrusts to them today. The

Church, which has created and nourishes at her breast many associations, points to

moral coherence and the promotion of Christian values as the inescapable point of

reference and the inspiration of every social activity, as can be deduced from the

encyclicals Centesimus Annus and Evangelium Vitae of the Holy Father, John Paul

II. Strong because of they belong to this solid inner structure, Catholic voluntary

workers through their action can give a soul to the civilisation of the third millennium


and encourage the advance of everyone without us falling into the brutal

dehumanisation to which so many wars have borne witness. Speaking about

possible regressions, we should not, however, yield to pessimism because, as we

can happily observe, today voluntary workers exist, and they have been defined as

the ‘flower in the buttonhole’ of the ecclesial community for the new millennium.

The Church looks with hope to voluntary work, which is the soul of solidarity and –

independently of the possible and various interpretations of this phenomenon – is

involved in spiritually guiding so many of her sons and daughters, by supporting their

organisation, forming their consciences, and encouraging the exercise of free-giving

in favour of one’s neighbour.


Spirituality and Education for Healthcare: A Perspective

Jim McManus

Spirituality and specifically religious faith are recognised as becoming increasingly important to the overall wellbeing of the person. This is recognised in NHS policy but presents a number of challenges for practice. An evidence base on spirituality and health needs to be available along with models for practice. Understanding spirituality and religion and being able to respond to the needs of patients is an important aspect of nursing. The paper goes on to discuss some issues in relationship between spirituality and health in Nursing Education and the KSF, and identifies some areas for further work.

Introduction

Beliefs can and do shape lives1. This is true of political beliefs but even more so of beliefs which we often call “spirituality” or religious belief. It is widely recognised that not all aspects of life are held by people to be of equal importance to their wellbeing2. Some place financial wellbeing at a higher level than others, while many place spiritual or religious beliefs higher. This is a dynamic position, with different aspects of one’s life taking importance at different points. But there is a growing body of evidence from the field of Quality of Life studies that spiritual and religious beliefs are important aspects of quality of life, and the process of recovery from illness, and inclusion of them within health care both facilitates a more holistic assessment and enables more holistic care3,4.

This has been recognised at policy level by the National Health Service(NHS) in the UK. The NHS Plan, Your Guide to the NHS5 and National Service Frameworks (NSFs) provide national standards for respect for privacy and dignity, religious beliefs and people’s spirituality. Meeting the varied spiritual needs of patients, staff and visitors is fundamental to the care the NHS provides.” Most recently this guidance includes NHS Chaplaincy: Meeting the Religious and Spiritual needs of Patients and Staff6, issued by the Department of Health in 2003. Another key policy document is

1 Koenig,, H, McCulloiugh, M, Larson, D (2001) Handbook of Religion and Health. Oxford: Oxford University Press 2 O’Connell,K and Skevington, S (2005) “The relevance of spirituality, religion and personal beliefs to health-related quality of life: Themes from focus groups in Britain.” British Journal of Health Psychology, 10, 379-398 3 Cohen, S; Mount, B, Tomas, J and Mount, L (1996) “Existential well being is an important determinant of quality of life. Evidence from the McGill quality of life questionnaire.” Cancer, 77, 576-586. 4 O’Connell,K and Skevington, S (2005) “The relevance of spirituality, religion and personal beliefs to health-related quality of life: Themes from focus groups in Britain.” British Journal of Health Psychology, 10, 379-398

5 The NHS Plan, Your Guide to the NHS. London : Dept of Health (2002)

6 NHS Chaplaincy. Meeting the Religious and Spiritual needs of Patients and Staff.London :

Dept of Health, 2003


Caring for the Spirit, issued with associated implementation guidance by the South Yorkshire Workforce Development Confederation as lead WDC for Chaplaincy and launched at the same time as NHS Chaplaincy. Finally, and more recently, Standards for Better Health7, a key document which the NHS will need to use in self-assessment of its performance, recognised the importance of meeting the spiritual and religious needs of patients by including Standard D2, which requires that:

Patients receive effective treatment and care that:

a) conform to nationally agreed best practice, particularly as defined in National Service Frameworks, NICE guidance, national plans and agreed national guidance on service delivery;

b) take into account their individual requirements and meet their physical, cultural, spiritual and psychological needs and preferences;

While the policy framework is there and helpful, there are still a number of key gaps. These gaps are understanding of spirituality and religion, and the way in which such issues are integrated into the KSF.

Understanding Spirituality and Religion Today

Spirituality and religious faith are not necessarily the same. Spirituality for the purpose of this article is being engaged in a search for the ultimate or sacred. Religious faith for the purposes of this article is similarly being engaged but with belief in a divine power or personal God, and some form of attachment, however loose, to a religious community.

This is where in the UK we make many mistakes in understanding religious belief. While some Christian Churches are in decline, and other organised religious like Islam and Sikhism are experiencing growth, people can and still do identify themselves as belong to a particular religion even though they may not practice its tenets8. This does not mean they have lost all belief, and often at times of personal crisis people return to their faith and take advantage of both their beliefs and the services of their faith community.

The UK has a huge current diversity of religious belief and faith, with the presence of many organised religions with belief in a God who is a person at their core9. Most numerous among these is still Christianity, with 37.3 million people in England & Wales identified themselves as Christian at the 2001 Census10. 6% identified themselves as part of other religions in England and at 3.1% of the English population, Islam is the most common organised religion after Christianity. Organised religious faith in the UK is still important to the lives of its citizens.

Equally there are many other forms of belief and spirituality which are more loosely organised, or eclectic. Some of these patterns rely on schools of thought which are of various ages. The attraction of eastern mysticism to many people can be seen by walking through the spirituality section of any bookshop. More recently, forms of

7 Department of Health, 2004. http://www.dh.gov.uk/assetRoot/04/08/66/66/04086666.pdf

8 Frances, L (2000) Religion in Britain since 1945 London: 9 Brierley, M (Ed) Religious Trends 2004//2005. London : CRA Publishing, 2004. 10 Office for National Statistics

http://www.dh.gov.uk/assetRoot/04/08/66/66/04086666.pdf


humanistic spirituality which focus on the human spirit have been rediscovered or developed11.

It is important then, both in terms of describing religious faith and spirituality; and in terms of nursing practice (understanding and properly valuing patient concerns, providing for spiritual needs) to be able to both define what people mean by their beliefs and ensure that we take their needs seriously while equally respecting our own.

One of the best typologies for differentiating between spirituality and religious belief is that of Larson et al12 They identified criteria for understanding the difference between “religious faith” or belief and spirituality. These are shown in table 1 below.

Table 1: A typology of Religion and Spirituality based on Larson et al

Larson et al’s Criterion

Religion Spirituality

Sacred core of feelings thoughts, experiences and behaviours which arise from a search for the sacred

Yes Yes

Search refers to attempts to identify, articulate, maintain or transform oneself with the sacred

Yes Yes – much recent interest in spirituality seems to be concerned with searching

Sacred refers to ultimate reality of ultimate truth as perceived by the individual

Yes – the sacred is related to the divine.

Larson et al state the term sacred should not be used for family, friends, our job but retained to the Divine. This may not sit well with what some people regard as sacred these days.

Some forms might involve non-sacred goals e.g. being part of a community of faith

Yes – for Christians, Jews and Muslims especially, being part of the worldwide community of believers is an important part of their faith.

Not according to Larson et al

The use of rituals or prescribed behaviours

Yes – organised public worship, prayer, way of

Not according to Larson et al

11 Koenig,, H, McCulloiugh, M, Larson, D (2001) Handbook of Religion and Health. Oxford: Oxford University Press.pp12-49. 12 Laron, DB, Swyers, JP and McCullough,M (1997) Scientific Research on Religion and Spirituality: A Consensus Report. Rockville MD : National Institute for Healthcare Researc.


life, etc

Religious belief, therefore, is usually associated with belief in a divine power or person to be worshipped and some form of organisation or ritual. This may entail that specific sacred spaces or access to specific sacred rituals are important for some people, and not others. This presents a Challenge and an opportunity to nursing practice13. The Challenge is to be sufficiently sensitive to the needs of individuals and their loved ones, and enable them to express these14. The opportunity is one of enabling people to integrate their experience of using healthcare systems with all their beliefs and priorities.

Addressing Needs, Enabling Health?

It follows that there is a need for both Nursing Practice, and nursing education, to address spirituality.

The KSF has two units which mention spirituality, HWB4 - enablement to address health and wellbeing needs and HWB5 – provision of care to meet health and wellbeing needs. Neither of these units really provides what, in light of Larson et al, could be described as a really adequate framework for the outcomes expected by Standards for Better Health. For these, and especially in training of practitioners, it might be well to have regard to the competencies frameworks and occupational standards issued by bodies such as Skills for Health. Their current Mental Health framework contains a dimension on spirituality in Unit M94, which is about enabling people to recover from distressing mental health experiences15. This dimension runs as follows:

K19. A working knowledge of the importance of spirituality in people’s lives and ways in which the development of spirituality can be developed and supported.

This presents well the key task of spirituality in nursing practice. The advantage of this is that it sits well with the nursing role (although arguably sits across nursing practice rather than just in mental health) and has a practical, patient oriented context. Underlying this, of course, is a key set of knowledge about spirituality and the interpersonal skills and intrapersonal awareness and togetherness to work on the issues. In some ways this very simply stated dimension has significant advantages over the KSF and its rather clumsy way of addressing spirituality.

The benefit of the KSF is that it fits well with a holistic model of health which includes spirituality. As we move to greater acceptance of a biopsychosocial model of health16,17 the importance of spirituality included in this has been highlighted, and

13 Govier I (2000) Spiritual care in nursing: a systematic approach. Nursing Standard. 14,

17, 32-36.

14 Koenig,, H, McCulloiugh, M, Larson, D (2001) Handbook of Religion and Health. Oxford: Oxford University Press.pp408 –437 15 http://www.skillsforhealth.org.uk/viewcomp.php?id=3832 16 Engel, G. E (1977) The need for a new medical model. Science, 196; 129-36 17 Slade, M. (2002) Biopsychosocial psychiatry and clinical psychology. Clinical Psychology, 9, 8-12

http://www.skillsforhealth.org.uk/viewcomp.php?id=3832


even the development of a biopsychosocial-spiritual model has been postulated from recent research on quality of life.18 The importance of spirituality in biopsychosocial considerations of health and wholeness is on the research agenda, and on the practice agenda too19. Its position on the learning and development agenda remains patchy, however20.

McSherry21 identified that nurses do have concerns about being able to address spirituality issues in their work, and concerns about learning. The KSF does not eliminate these concerns, and in some ways could be perceived to marginalize spirituality.

There is some good practice from other professions, and from nursing itself, in addressing spirituality. The Bearings project22 at Nottingham University has involved development of models for addressing care for people. One difficulty with this project, and several others, however, is that they have largely addressed spirituality as something too homogeneous.

Govier23 produces an interesting and useful typology for nursing in relation to spirituality, focusing on four dimensions:

_ Assessment.

_ Planning.

_ Intervention.

_ Evaluation.

Training for delivering these will be extremely important24 and while some nursing curricula deliver separate spirituality “days” or seminars, more space could be given to integrating spirituality across the curriculum.

Training in spiritual assessment for nurses which focuses on assessing spirituality and religion while being aware of its differences and dimensions (as per larson et al above) is an important foundation. Awareness of the differences of spirituality and religion is too25. But these are only a part of the story. Enabling nursing staff to address reflectively the place of spirituality and religion in their own lives, while finding a way of integrating it into practice could bring significant benefits. This is a

18 O’Connell,K and Skevington, S (2005) “The relevance of spirituality, religion and personal beliefs to health-related quality of life: Themes from focus groups in Britain.” British Journal of Health Psychology, 10, 379-398 19 Palafox N.A.; Buenconsejo-Lum L.; Riklon S.; Waitzfelder B (2002) Improving Health Outcomes in Diverse Populations: Competency in Cross-cultural Research with Indigenous Pacific Islander Populations Volume 7, Number 4, 2002, pp. 279-285(7) 20 Robinson, Kendrick and Brown (2005) Spirituality and the Practice of Health Care Basingstoke: Palgrave Macmillan. 21 McSherry W (1998) Nurses' perceptions of spirituality and spiritual care Nursing Standard.

13, 4, 36-40. 22 http://www.nottingham.ac.uk/nursing/staff/academic-staff/an-bearingsproject.html 23 Govier I (2000) Spiritual care in nursing: a systematic approach. Nursing Standard. 14, 17, 32-36. 24 Sister Mary Hubert, 'Spiritual Care for Every Patient', The Journal of Nursing Education, May-June 1963. 25 Govier I (2000) Spiritual care in nursing: a systematic approach. Nursing Standard. 14, 17, 32-36.

http://www.nottingham.ac.uk/nursing/staff/academic-staff/an-bearingsproject.html


model which has worked in management of diversity, especially in relation to dealing with difference and finding ways of working positively with it while maintaining one’s own integrity26. Some nursing projects have found placements with Chaplaincy teams to be partially useful in this, but more important will be focusing on the ability to work with patients around spiritual issues27.

The existence of the KSF may spell out some issues in spirituality, but what it does not do is provide us with the solutions of how to do it. For that, as for many things in nursing, the nursing literature and experience has models built on the foundations of reflective practice28. Nurse educators would do well to joint together in their efforts.

26 Stockdale, M and Crosby, F (2005) The Psychology and Management of Workplace Diversity. Oxford: BPS Blackwell 27 http://www.hpw.org.uk/images_client/Dave%20Pointon.pdf 28 McSherry W (1998) Nurses' perceptions of spirituality and spiritual care Nursing Standard.

13, 4, 36-40.


Reflection – Love, not just competence

While professional competence is a primary, fundamental requirement, it is not of itself sufficient. We are dealing with human beings, and human beings always need something more than technically proper care. They need humanity. They need heartfelt concern.

Those who work for the Church's charitable organizations must be distinguished by the fact that they do not merely meet the needs of the moment, but they dedicate themselves to others with heartfelt concern, enabling them to experience the richness of their humanity. Consequently, in addition to their necessary professional training, these charity workers need a “formation of the heart”: they need to be led to that encounter with God in Christ which awakens their love and opens their spirits to others. As a result, love of neighbour will no longer be for them a commandment imposed, so to speak, from without, but a consequence deriving from their faith, a faith which becomes active through love (cf. Gal 5:6).

Pope Benedict XVI, Deus Caritas Est, 31

Questions for Reflection or Discussion

1. Pope Benedict talks of those working in Catholic charities. Does what he says apply also to healthcare?

2. The Pope says you need not just competence, but compassion, which comes from Love of Neighbour. Is it possible to be competent in healthcare without being compassionate?

3. Where do we see compassion in healthcare today? What can we

4. What are the key parts of “formation of the heart” to work in healthcare?

5. Whose responsibility should this be?

6. What practical steps towards formation of the heart can you take?

7. What would change in healthcare if compassion based on love of neighbor were visible everywhere?


The Church Teaches: The Healthcare Worker


Charter for Healtcare Workers

Pontifical Council for Health Pastoral Care


Who is this Patient? A Spiritual Perspective

Fr James Hanvey, SJ Within organizations, how we name people encodes the status and the relationship that we have with them. Whether it’s a hospital, a church, a university, or a practice, we have titles which identify us, our level of competence and authority as well as our obligations; titles also indicate expectations on both sides of the relationship they name. If it is a hierarchical organisation, and most professions are, titles and names come with identities that give us access to the products of the organization whether they are material, social, intellectual, or spiritual. Hence, accurate naming is not just a matter of courtesy or professional hauteur. Naming is also an exercise of power. One of the ways in which we make people, jobs, etc. disappear is by refusing to name them or by naming them incorrectly. Naming is a sort of calling into existence, a making present, hence a refusal to name someone or to give him or her the right name is an erasure or a de-formation. For this reason the title or name that we are given and with which we appear before another person encodes a very substantial amount of information.

Who is this patient?’ is not just an odd and teasing question. It indicates the juxtaposition of persons and categories and the different sets of relationships and expectations entailed in each. Medical practitioners may find it a strange question. It appears to combine two entirely different realms of discourse and enquiry. The ‘Who?’ question normally entails a personal enquiry sometimes going beyond the obvious inventory of identity indicators – name, age, family, race etc. - to the more personal disclosures in which a life and its relationships begin to emerge. The ‘Patient’ question already sets the parameters of a professional relationship. The relationship between the ‘patient’ and the practitioner has, to a large extent, already been determined simply by this relational designation. There are often good reasons for remaining within the realm defined by ‘patient’. It establishes a professional relationship with clear legal and ethical obligations. It also designates the reason for the relationship and therefore makes us focus on the patient’s need and the practitioner’s expertise. It serves to limit and focus knowledge, resources, expectations and obligations in an efficient way to the mutual benefit of all concerned. Yet, there are other important dimensions which get excluded and other unintended effects which may not be so beneficial.

In this paper I wish to argue for the importance of keeping the ‘who’ part of the question in view and indicate the consequences when it is excluded. Drawing upon insights from the French Philosopher Michel Foucault, I will suggest three ways in which the ‘who’ comes to be erased. These three strategies are not exhaustive, of course, but they can usefully serve to illustrate the matter at hand.29

1: ‘Who’ in pieces.

29

Cf. Michel Foucault, 'Power', The Essential Works 1954-1884, Volume 3. Penguin Books. 1994. Also 'Ethics', The Essential Works Volume I 1994.


The first way in which I believe the who can be erased or submerged is through dissection and fragmentation. This happens in two ways: First, in a general cultural and professional process which analyses wholes into parts that subsequently ground specialism. Second, through bureaucratic regimes which keep things in separate compartments so that information is rarely coordinated or assembled into a whole. Foucault, in his studies of systems and the structures of power, devotes a lot of time to the creation of asylums in the18th and 19th century and the ways in which sickness is as much a social construct as it is a physical reality.30 His particular concern is with the construction of madness and the birth of the clinic. Part of this involves the status of the body, which develops in medicine and medical science.

Foucault argues that increasingly with the scientific approach there is a loss of the unity

of the person and his or her illness. Both the body and the disease become objectified and in this way power is gained over both. The body ceases to be person and becomes object, which can be studied and analyzed. In The Birth of the Clinic, he documents the transformations which took place towards the end of the 18th century, concerning the ways in which medicine analyzed and read the body, in particular the development of the new anatomical atlas of the body which began to emerge at this time.31 The body begins to be read through what he calls the ‘clinical gaze’ of the doctor.32 With the advent of this clinical gaze comes the idea of pathology. Diseases are localized in specific organs and tissues, as opposed to general disturbances in the patient’s body. The patient’s role in the diagnosis of disease is diminished—the sick man or woman disappears from the medical cosmology, dissipating at first into the clinical case and later still through the advent of laboratory medicine into the complex of cells.33 It is clear that there is much to be gained in understanding diseases, their control and cure from these developments and we may wish to disagree with Foucault’s analysis, but he does alert us to a process of ‘dis-integration’ which continues. Especially with the increasingly technological approach to analysis, intervention and treatment. The danger is that we see only the stats or cells and lose the ‘face’ and the life; the person is reduced to pieces. There is a subtle pull for all professionals, and particularly healthcare practitioners, to become technicians, to relate to data, to organs, and cases, rather than people. The ‘who’ question is never allowed to surface; indeed, it is deliberately suppressed in the interest of dispassionate diagnosis and treatment. The dominant assumption is that of objectivity and the strange belief that ‘neutrality’ or the ‘clinical gaze’ can guarantee it. The fear is that the loss of this objectivity will result in clouding of clinical judgement and scientific rigor. But the danger is that objectivity makes the person into an object that can be understood, whose processes can be manipulated,

30

For a survey of the sociology of human illness, see Simon J. Williams and Gilian Bendelow The Lived Body, Sociological Themes and Embodied Issues, Routledge, London and New York, 1998, which includes discussion of ontological status of the body, social constructionist accounts of medical knowledge, the metaphorical nature of disease, medicalisation, surveillance and control of bodies, and the dilemmas of high-tech medicine. 31

See Foucault, M. The Birth of the Clinic: An Archaeology of Medical Perception, ET 1973 A.M. Sheridan Smith, London: Tavistock. Discussion can also be found in Armstrong, D. (1983) Political Anatomy of the Body: Medical Knowledge in Britain in the Twentieth Century, Cambridge: Cambridge University Press 32

In The Birth of the Clinic (p.146), Foucault quotes the nineteenth-century pathologist, Bichat: 'Open up a few corpses: you will dissipate at once the darkness that observation alone could not dissipate.' He comments (p.195): '… the whole dark underside of disease came to light, at the same time illuminating and eliminating itself like night.' 33

See Jewson, N.D. (1976) 'The Disappearance of the sick man from medical cosmologies: 1770 – 1870', Sociology, 10: 225-44


improved, or repaired. It gives the clinician a sovereign command of the object that has come into his or her power. Of course, I am not denying or critiquing the good aspects of this and the enormous benefits that accrue to professional expertise and knowledge and skill. And faced with a serious illness, I would, I think, rather have a competent professional who may treat me like an object but cure me, than someone who has a wonderful bedside manner and has considerable sympathy with my suffering but is not much good at relieving it. However, I wish to suggest that this ‘clinical gaze’ risks losing sight of the person at a cost to its own therapeutic capacity. Moreover, if the person is reduced to a ‘case’ or an ‘object’ that needs to be repaired, corrected or in some way improved, then practitioners can risk being seduced into crossing ethical lines in the advancement of their knowledge and skill or in their version of what is in the best interests of ‘the patient’

2: Subject and Subjection.

The second move that Foucault identifies lies in the relationship between subject and subjection.34 In naming me, any system or organization creates me as a subject of that organization or system. It gives me an identity and with that come benefits and rights. However, in making me a subject, it also places me in subjection. In clearly naming me a patient, it is not just making me an object, but a particular type of subject. Part of becoming ‘a patient’ is recognising the ways in which my responses have been encoded in my status and with that comes the relationship with those who are caring for me: I will behave appropriately. This will involve a transfer of power: I grant power to those who have responsibility for my treatment and care. They, in turn, promise that they have the power to heal or ameliorate my condition. In exchange for being placed in this subjection all the competence of the organization is placed at my service. This exchange of power also has its rituals: the transfer of knowledge which begins with the unexceptional taking of details and the creation of ‘histories’; the exchange of clothes, the putting on the patient’s uniform and the handing over of personal items; the induction into the regimen of care and treatment with its calibration of dependency.

Naturally, it is important to allow the competent authorities to have that power so that they can do what is good for us and so there is normally a willing exchange. In the majority of cases, I am sure that this transfer of power is experienced as beneficial. However, we also need to be conscious that such exchanges entail very considerable concentrations of power. Although the exchange assumes an altruistic intention, the power ‘to act for’, it can also become ‘power over’. Our ‘need’ cannot be dealt with by our own knowledge and resources and so we require the great knowledge and resources of the system. Being a ‘patient’ gives us access to these. This being so, the power relationship between ‘the patient’ and the healthcare practitioner is almost always asymmetrical.35

34

Especially developed in Discipline and Punish, The Birth of the Prison, ET. Penguin 1977 cf. esp. pp25-26. For an important discussion of this question cf. Judith Butler, The Psychic Life of Power. Stanford University Press. 1997. 35

Foucault’s analysis of power is significant not only in its tracing of the negative dynamics of power but especially in his understanding of its positive distribution. Although Foucault draws upon Nietzsche for some of his central insights into the relationship between power and body in his understanding of the ubiquity of power relations he rejects a purely hierarchical account of its distribution. He argues that power so permeates all aspects of human interaction that it creates a multiplicity of power relations other than those that are configured to domination – power is something that circulates rather than follows a chain. (cf. Power/Knowledge,


In such a subtle and complex relationship there have to be certain principles which prevent exploitation on either side. One fundamental principle, I would suggest, must be that the person who places themselves in subjection to the other as patient, can expect that the other will always seek to act in the best interests of the patient and will not take any course of action which will harm or deliberately deprive them of life. Even supposing the ‘patient’ has sufficient knowledge or expertise, it will always be a relationship of trust because they also rely on the judgement of the practitioner. We can now come to see that this relationship of power is not just one of utility ordered to effective treatment, but is a moral or ethical one predicated also on trust. Trust, however, is not something that can be generated in the abstract or something that comes automatically even when it is assumed. Trust is a personal relationship and disposition which is always tested in every therapeutic encounter. It carries with it a personal ‘ascesis’ or moral discipline which means that the interests of the physician or carer will always come second to those of the patient and it is this that allows the exchange of power to happen. Interestingly, it is also the voluntary reversal of its asymmetry. The ‘who’ is always implicit on both sides – ‘who is this woman or man who treats me?’ ‘Can I have confidence in them?’ The refusal to allow this question to arise or to be answered effects a dehumanisation which, even when the patient is ‘healed’, can leave them brutalised. Trust is an integral part of the healing potential itself and that is why it can never be just a relationship of practitioner and patient but persons. Moreover, not allowing the who in that question, “Who is this patient?” to disappear, and extending it to, ‘Who is this doctor or nurse?’ is an important way of reminding us that all power has a purpose and is subject to accountability. 36

3: Papering over the Face. The third strategy in which person is lost is, what I call, papering over the face. This is the process of submerging both the patient and the health carer in bureaucracy. It is perhaps the most insidious of all processes of depersonalization and subjection—because it actually affects not just the patient but everyone working in the system.

Healthcare and medicine are essentially about people and the quality of relationships

between them. Bureaucracy exists to serve and facilitate these relationships; it assists in their ordering and accountability so that we can have confidence in them and so that the asymmetries of power are regulated to serve the best interests of all. This is why systems need bureaucracies. It is important to have proper procedures which are documented and recorded, but, as we all know, bureaucracy can become an end in itself. When this happens, we are faced with a solipsistic logic: it only makes sense in terms of itself; it loses transparency and its procedures become mechanisms of occlusion and control. In this way the bureaucracy transfers power to itself. Its procedures generate more administration, duplication, and triplication; they become self-generating and self-justifying, and that, I would argue, begins a form of pathology. There is an obsession with documenting,

Selected interviews, 1972-77. ed. C. Gordon. p.98). Given this, he argues that we should conduct and analysis of this circulation not from ‘above’ which is essentially a functionalist analysis but from ‘below’ – the ‘microphysics’ of power. (Essential Works, Vol. 3 pp.123-124) That is why he chooses the site of the body and introduces the notion of ‘biopower’ or the disciplining of the body. CF. Discipline and Punish, 1977. However, Foucault is disinclined to give much weight to the ‘intention’ of those who exercise power. In these remarks I am suggesting that that is a mistake as in certain exchanges of power there are presuppositions about intentions which actually facilitate the movement and are necessary for the positive exercise of power. 36

For a useful discussion of the significance of Foucault’s thought for organisations and the dynamics of power cf. Stewart Clegg et. al. Power and Organisations. London, Sage Publications. 2006. Pp 228 ff.


recording, tracking, and measuring, but these procedures become less about efficient care-giving and more about satisfying the illusion of omnipotence and omniscience in the system. The procedures become emotional rituals that have to be experienced to keep levels of anxieties down. Often the reason for them is lost. Yet, they have discernable effects: first, they create hierarchies which disperse responsibility while concentrating power in particular people or offices. They depersonalize relationships and also distance people psychologically because the interpersonal has become mediated by the bureaucratic. What happens is the erasure of the human in all of this. The bureaucrat continues to fill in the forms, not noticing the tears of the person in front of him or her because the bureaucrat, too, has also become depersonalized. The concentration on ‘team building’ can be a symptom of such impoverishment, not an antidote. The cumulative effect is to numb relationships so that the transmission of information and knowledge is impaired. People become de-motivated, reluctant to accept responsibility, encouraged to develop a false dependency on the adequacy of the system and collude in its illusion of omniscience: ‘some one, some where, higher up will know the answer.’ The capacity of people to learn and respond to new challenges, which is vital for the health of the system and its survival, is lost as is its claim to competence. When this loss of learning capacity is sensed, it is not unusual for the system to develop a corresponding compensatory growth in bureaucratization, believing it to be an answer rather than a problem. 37

4: The task of Spirituality as the guardian of ‘who’ in patient and health carer. These three strategies, in which the human face, the who, is submerged or erased, describe movements of estrangement. At different levels, where the ‘who’ is forgotten or suppressed persons are estranged from each other and from themselves. Without the who, I am a stranger to the person before me and they to me. Whatever the benefits in terms of professional competence, there is an impoverishment of the human. When the ‘who’ is separated from ‘patient’ everyone in the organisation lives in a permanent paradox, if not a contradiction: they are asked to care for someone without a face. This is where our faith traditions and their spiritual richness become important, for they carry the memory of the ‘who’. They remind us always that it is a human person with which we deal. We come to them first and foremost as whole persons, in need to be sure, but with histories, memories, relationships and connections that go beyond the immediate disease or problem. Spirituality, especially when it is grounded in a faith tradition and subject to that tradition’s critique, precisely because it can keep before us the wholeness of the person, becomes part of a genuine and deep therapeutic process. Part of any such process is the restoration of integrity, helping people discover it again in the midst of illness, and a reconnection with the value of their lives and relationships which illness can threaten or destroy. It also enables us to see a much larger picture of recovery which goes beyond physical cure. It may not be possible to restore a person to complete health or heal a diseased body but it may be possible to effect a therapeutic adjustment, a spiritual and psychological development or realignment which means that a person’s ability to live with significant disability is not only improved but their sense of life is deepened. On the other side of the relationship, Spirituality can assist the healthcare practitioner, too, in keeping their integrity and honouring the trust which is placed in them. It is only when medicine honours its own integrity that it can really help, heal, and honour the integrity of the human person its serves.38 That takes us beyond respect and trust. I suggest that we

37

For an insightful discussion of the function of bureaucracy in organisations cf. Yiannis Gabriel et.al. Organisations in Depth, London, Sage 1999. esp. pp. 103 ff. 38 See Alistair V. Campbell, Professional Care: Its Meaning and Practice, SPCK, London and Philadelphia, 1984, pp. 17 – 33, for a discussion of medical power. For diverse perspectives


move beyond these covenants and contracts, when we allow our spiritual traditions to transform them into reverence. All our faith traditions have ways of doing this. One example from within the Catholic tradition is the sacrament of sick.39 Correctly, it is a very physical sacrament; it involves prayers, touch and anointing. It also entails the healing of relationships through the forgiveness of sin and the making explicit of the presence of the whole community of faith. At its centre is the reality of Christ’s presence and the Spirit’s consolation. In all these ways the person is reverenced.40 Spirituality recontextualises the relationship of power. When we reverence the body, even the damaged and dying body, it can unite us and the people we are called to serve in common love, the seeking of bodily integrity, no matter how fragile and however impermanent it may be. Often in this context, nurses come closest to the patient because nursing is essentially the skilled companionship and accompaniment of reverencing the person. Such acts of reverence and the services that they entail involve what I call an ethic of attentiveness. The Jewish Christian writer/ mystic Simone Weil gives central place to this disposition. It stands at the opposite end of the spectrum from scientific detachment, but it is no less observant and desirous of understanding. Essentially, this attentiveness is a contemplative gaze which commits us to that upon which we look. It means we come primarily to that which we gaze upon with a loving freedom to act. It is a disposition of love and it is already an act of reverencing, because such a disposition entails a prior valuing of that to which we attend. In this action of reverencing, the eyes of loving attentiveness redeem the clinical gaze. It is the look that a mother gives her new born child. It is has an innocence and therefore can see the sacred. Such attentiveness becomes a way of being towards people—a presence to them. We already have a disposition to act on their part. We can see the tears in the person in front of us, even while we fill out the forms. I would argue that if a healthcare practitioner has that fundamental disposition of reverence, it does not matter whether they have faith or not, they have a spirituality. That disposition of reverence is something that cannot come from training, no matter how good or thorough it may be. It can only come from seeing the who before us. If we come with the disposition of reverence we never erase or diminish the inestimable value of the patient.

Finally, one aspect that we have not touched upon but should be acknowledged is the

aesthetics of healthcare. It demands a much fuller exploration than is possible here but it may be useful just to set down a mark for future reflection. The concentration on healing as

on theology and medicine, see Theological Analyses of the Clinical Encounter, ed. McKenny, Gerald P. and Sande, Jonathan R., Theology and Medicine, volume 3, Kluwer Academic Publishers, Dordrecht, Boston and London, 1993 39

The Pastoral Care of the Sick, Rites of Anointing and Viaticum. ET from Ordo Unctionis Infirmorum, Vatican Polyglot Press. 1982. Especially useful for understanding the sacrament is the introductions, The Apostolic Constitution, promulgated by Paul VI which sets out the basis of the sacrament in scripture and tradition and General Introduction, which also gives significant indications concerning the ministry of caring for the sick. 40

In this sacramental context which I take to be determinative, the biblical sense of ‘reverence’ being awe, respect, and fear is transposed into the richer understanding of God’s self-revelation as the carer of his people. This reverencing is an honouring whose inspiration is love. It reaches its fulfilment in Christ’s revelation of the Father’s love. In this sense, a much closer approximation to the sense and the action of reverence/reverencing lies in the notion of God’s trustworthiness, loyalty, fidelity which carries with it a future assurance – God’s unswerving reliable ‘chesed’ or loving kindness – that which is lasting and true (in Hebrew, ‘aman/’emet). The wonderful parable of this is the Good Samaritan, in which the Samaritan’s care is a reverencing which mirrors God’s care, even making provision for the future process of recovery.


a restoration of health at all the different levels we have touched on can blind us to the fact that healing has a sort of beauty. Healing is a restoration or discovery of beauty in us. In giving us another range of vision, Spirituality can help us grasp the aesthetics of this process, not only for the ‘patient’ but for the practitioner. Leaving aside the debates about the essence of beauty, whether it is something universal and essential or a matter of social taste and convention, when we experience something beautiful we experience in some way something which has a transcendence, a gratuity. In some sense, in our experience of illness we suffer the loss of beauty and consequently the loss of value. Part of the work of healing, it seems to me, is to overcome that disfigurement—whether it is the inner disfigurement that only we can see and experience, or the external disfigurement of the body. Part of the task of healing – spiritual, psychological and physical - is helping people discover their beauty again.

We commonly say that ‘beauty is in the eye of the beholder.’ Often the saying used to

dismiss beauty as a matter of personal taste or subjectivity. Yet, from within our Christian traditions we understand that beauty is essentially a grace and grace is a gift. This changes our understanding of beauty as a relationship of beholding and being beheld. Beauty is in the eye of the beholder, but far from being something to dismiss it is something to marvel at —beauty is conferred upon me, by the way in which people see me. If I can see myself through their eyes, then I can see myself and know myself in a new way. Equally, there is the gift of self- disclosure, someone can look at me, but it does not mean to say that they see me, because being seen is not just a passive state. All great works of beauty are not just ‘seen’ they disclose themselves – beauty communicates itself and requires receptivity of the one who beholds. This is the ‘grace’ that happens in the relationship of seeing and being seen. I suggest that it is a sort of blessing. All blessing is the affirmation and conferring of the good and so there is a deep existential as well as essential connection between beauty and goodness but it comes by way of blessing. (By contrast, cursing is a severing of that unity – a dis-integration). Blessing is an act which we can all perform. The American poet Galway Kinnell captures all of these connections in a lovely poem called, Saint Francis And The Sow:

The bud stands for all things, even for those things that don't flower, for everything flowers, from within, of self-blessing; though sometimes it is necessary to reteach a thing its loveliness, to put a hand on the brow of the flower and retell it in words and in touch it is lovely until it flowers again from within, of self-blessing; as Saint Francis put his hand on the creased forehead of the sow, and told her in words and in touch blessings of earth on the sow, and the sow began to remember all down her thick length, from the earthen snout all the way through the fodder and slops to the spiritual curl of the tail,


from the hard spininess spiked out from the spine down through the great broken heart to the blue milken dreaminess spurting and shuddering from the fourteen teats into the fourteen mouths sucking and blowing beneath them: the long, perfect loveliness of sow.

We have moved a long way from the strategies of submerging the ‘who’, but through

exploring them we may have come to understand more of the beauty that we are engaged in. Surely, in its essence all therapy is to help to re-teach people their loveliness, and the way we do that is by seeing the person, the ‘who’, and the beauty in them? The practice of medicine constantly needs to attend to its own deepest human and ethical sources. These cannot be codes and conventions only, for such things can be easily changed or undermined by cultural shifts or political convenience. The ‘who’ question stands at the heart of all medical experience because such experience touches upon the mystery of the human person and human life. Medicine knows what it is to be human in its most physical and material finitude and frailty; it knows it too in its courage and generosity. The ‘who’ invites a reflective practice upon the mystery of the human person in all the circumstances that a person is prone to and out of which comes an inviolable reverence not just for humanity but for the particular person – the patient, before us, the mystery of a life, a body, a subject that can never be captured by subjection. In attentiveness to the ‘who’ in the patient, medicine continues to offer a blessing.


The Church Teaches: Life-Threatening Illness

Sickness inevitably brings with it a moment of crisis and sober confrontation with one’s own personal situation. Advances in the health sciences often provide the means necessary to meet this challenge, at least with regard to its physical aspects. Human life, however, has intrinsic limitations, and sooner or later it ends in death. This is an experience to which each human being is called, and one for which he or she must be prepared. Despite the advances of science, a cure cannot be found for every illness, and thus, in hospitals, hospices and homes throughout the world we encounter the sufferings of our many brothers and sisters who are incurably and often terminally ill. In addition, many millions of people in our world still experience insanitary living conditions and lack access to much-needed medical resources, often of the most basic kind, with the result that the number of human beings considered “incurable” is greatly increased.

The Church wishes to support the incurably and terminally ill by calling for just social policies which can help to eliminate the causes of many diseases and by urging improved care for the dying and those for whom no medical remedy is available. There is a need to promote policies which create conditions where human beings can bear even incurable illnesses and death in a dignified manner. Here it is necessary to stress once again the need for more palliative care centres which provide integral care, offering the sick the human assistance and spiritual accompaniment they need. This is a right belonging to every human being, one which we must all be committed to defend.

I would like to encourage the efforts of those who work daily to ensure that the incurably and terminally ill, together with their families, receive adequate and loving care. The Church, following the example of the Good Samaritan, has always shown particular concern for the infirm. Through her individual members and institutions, she continues to stand alongside the suffering and to attend the dying, striving to preserve their dignity at these significant moments of human existence. Many such individuals – health care professionals, pastoral agents and volunteers – and institutions throughout the world are tirelessly serving the sick, in hospitals and in palliative care units, on city streets, in housing projects and parishes.

Pope Benedict XVI, World Day of the Sick, 2007


Mary, help of the Sick

Fr James Hanvey, SJ There are many icons of Catholicism. Apart from the crucifix, the statue of Our

Lady of Lourdes might qualify as one of the most common. It can be seen in Churches or in homes and whether it takes the form of high accomplished art or just the plastic statue bottle that holds the Lourdes water that thousands of pilgrims bring home with them, the image and the reality to which it points remains constant. Lourdes is the great place of pilgrimage for the sick. Over the centuries Mary, the Mother of God, has acquired many beautiful titles that celebrate her continuing place in the unfolding of our redemption and in the community of faith, but in Lourdes we can see that she is ‘mother of the Kingdom’. It is there, most vividly and practically, that the beatitudes can be experienced, for Lourdes is about a reversal – here the sick, whatever the manner of their illness or physical condition, ability or social standing, all have first place. Here, too, you can see the healthy – of every age and nation – practically employed in care. Lourdes is an experience of an unembarrassed Catholicism and an unapologetic faith.

February 11th is the feast of Our Lady of Lourdes; it is also the day which the

Catholic Church has marked as the World Day for the Sick. It is especially dedicated to people who are incurably sick or terminally ill. Although the whole Church is asked to make it a special day of prayer for the sick, it will be celebrated in Seoul with a series of liturgical events and conferences. Such days deepen our consciousness of a daily reality which is not just physical but spiritual and social. As always in the Church, liturgy and prayer lead to action and sustains it. It is a call to transform and transcend those structures and attitudes that block our human solidarity and deprive people of basic needs. The World Day for the Sick reminds us that so much sickness is preventable through basic hygiene and clean water. So much sickness and suffering is preventable if medicine is made affordable and available. In the case of terminal illness, we are asked to extend the great well of practical compassion and care, so evident at the waters of Lourdes, to all in society. In our own country and through the world so many die alone or without adequate palliative care, not because we do not have the economic means to prevent it, but because we do not have the vision to see them. How we die is as important as how we live and how we care for a person in the final stage of life is a measure of how we value every person in their vigour and productivity. The World Day for the Sick is a moment when we experience the fact that sickness, even terminal illness, does not cut us off from the community. It also reminds us that illness is never just a physical event, it is unavoidability spiritual even when we don’t believe. Within it hovers the reality of our own frailty and mortality, our value and purpose. We realise that ultimately we are not autonomous and in control but dependent and in need – as the Zulu saying has it, ‘people are people through people’. Even more than in its physical dimension, sickness is a counter-cultural moment of terror. But within it comes this other reality, that there are those, maybe even those we do not know, on whom we have no special claim, who care for us. They will spend their time and energy in seeking our good and care enough to want


what is right and just for us. Sickness crosses all our boundaries and opens up a world of unexpected gift. This world surrounds us even in our moment of dying, and whether we are conscious of it or not, keeps a vigil for us. All our life is lived in this communion. It does not come just from our common humanity but from the Love in whose image we are made.

This communion means that sickness, even if it leads to death, is never useless.

In such moments Christian faith is not some ‘opiate’ for those who have not the stoic’s strength. Faith does not pretend that illness is other than it is, nor does it celebrate suffering. It just tries to let it become a moment of encounter. At this point faith must let itself become mystical.

Christianity does not ask that we should be heroic and self-determining when

faced with suffering or death, only that we should trust and step out into the mystery of Christ – it is a moment when our life is given a Eucharistic form: “Through Him, with Him and in Him, the unity of the Holy Spirit, All Glory and Honour is Yours, Almighty Father.” Through such and offering in faith, a life can catch, hold, and reflect the redemptive light for us all.

The state of societies can be measured in many ways, but it may be in our care

of the sick and the dying that we have the one of the best indications of our social health. The feast of our Lady of Lourdes and the World Day of the Sick may point us towards the sources of healing that we all need.


Prayer to Mary, Health of the Sick

O Virgin Mary, «Health of the sick», you who accompanied Jesus on the way to Calvary and remained near the cross on which your Son died, participating intimately in his suffering, take our suffering and unite them with His, so that the seeds sown during the Jubilee continue to produce abundant fruits in the coming years. Most tender Mother, we turn to you with confidence. Obtain from your Son the strength to return soon, completely restored, to our duties, so that we be useful to our neighbour through our work. Meanwhile stay with us at the moment of trial and help us to repeat everyday with you our yes, sure that God will bring out from every evil a greater goodness. Immaculate Virgin, may the fruits of the Jubilee Year be for us and for our dear ones a pledge of renewed vigour in Christian life, so that in the contemplation of the Face of the Risen Christ we will find the abundance of the mercy of God and the joy of a more complete union with the brethren, the beginning of the joy without end in heaven. Amen.

Pope John Paul II


How do we get a Catholic Theology of Healthcare, and

does it matter anyway?

Jim McManus

Most of us are familiar with concerns around areas of bioethics from genetics to euthanasia, principles of double effect, end of life issues and so on. But this isn’t the beginning and end of Catholic theology around healthcare.

But the field of Bioethics has, for some at least, dominated Catholic thought on healthcare with concerns ranging from rationing care to reproductive ethics41. The recognition that there are ethical issues for Catholic institutions and programmes in healthcare is nothing new42 The US Catholic Bishops in 1981 produced a series of guidelines Health and Health Care43 which “ presented the theological principles that guide the Church's vision of health care, called for all Catholics to share in the healing mission of the Church, expressed our full commitment to the health care ministry, and offered encouragement to all those who are involved in it.”44

This concern may quite properly extend itself into a consideration of issues of health economics, such as managed care in the US, and consider issues from the perspectives of Catholic Social Teaching, such as Justice45. In fact, the Natural Law Tradition and Catholic Social Teaching have been prominent in Catholic discussions on issues of access to and equity in provision of healthcare46. Denz feels that Catholic Social Teaching has an enormous potential to assist in the “formation of ‘intentionally Christian institutions’ 47” But there are some serious obscurities in how Catholic Social Teaching accounts for the derivation and interrelation of various rights. From this he concludes that “it is not altogether clear what ideal CST is seeking to promote in the public order48.”

Lustig asserts that There are numerous challenges posed to Roman Catholic health care institutions by recent developments in health care delivery. Some of these are profoundly practical, such as discussing the acceptable limits of accommodation to and collaboration with secular networks of health care delivery. Others are explicitly

41

Kelly, D. F (2004) Contemporary Catholic Health Care Ethics. Washington DC : Georgetown University Press

42 USCCB (2001) Ethical Ethical and Religious Directives for Catholic Health Care

Services,Fourth Edition http://www.usccb.org/bishops/directives.htm

43 USCCB(1981) Health and Health Care. At the time of writing a copy of this had not been

obtained

44 USCCB (2001)

45 Lustig, B.A. (2000) Managed Care, Catholic Vision and the Claims of Justice. Christian

Bioethics. Vol 6, No 3, pp 219-229.

46 Denz D. (2000) Catholic Social Teaching and Healthcare: Some Reservations Christian

Bioethics, December 2000, vol. 6, no. 3, pp. 251-266(16)

47 Denz, op Cit, p.257

48 Ibid

http://www.usccb.org/bishops/directives.htm


theological. “What does it mean to be a distinctively Roman Catholic health care institution? What are the nature and the scope of Roman Catholic institutional identity? More broadly, what is the moral relevance of themes in Roman Catholic social teaching to the provision of health care? 49“

The importance of bioethics and Catholic Social Teaching for the derivation of ethical principles for Catholics in healthcare cannot be underestimated50,51, but it is not the whole story. We need to identify some foundational teaching and insights which can help us identify why “health” is important to us, and why “healthcare” is important to us on a theological level.

Health as a state or a quality is something which is difficult to define. At one point St Thomas debated whether “health” in fact was a habitus52. There have been various other attempts to define health as a state, an attribute, or a quality. The World Health Organisation defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.53”

While the bringing together of a theology of health from the Scriptures is fundamental to this exercise, but beyond the scope of this paper, and has been done elsewhere54 In Particular, Pilch (2000)55 undertakes an attempt fo provide a social-scientific/medical anthropological criticism of the New Testament healing stories.

The WHO vision has an intuitive closeness to the vision in the scriptures of shalom (Rev 22.) and the practice of both Jesus and the early church. Health, for the Scriptures, is intrinsically a part of what it means to be human, and in relationship with God. The Concept of health is a part of the concept of shalom, peace and wholeness. While in the Old Testament disease is sometimes understood from a punitive standpoint (Duet 28.22) as the consequence of alienation from God, a state of shalom is also seen as an important aspect of being in relationship with the God who saves. This imagery is continued in the prayer of intercession in the 1662 Book of Common Prayer which asks that “thou wouldst make thy ways known unto them, thy saving health unto all nations.” God promises to heal every illness in Isaiah (33:24.)

This imagery is in the New Testament too, who not only modified the punitive concept of disease as consequence for sin (John 9) but highlighted the importance of restoration of people to health as part of ushering in the kingdom of God both in the gospels (Matt 9:2-8; Luke 4 : 18-27) and into the early apostolic era (Acts 3 : 1 – 11,

49

Lustig, Op Cit, p221

50 Linacre Centre (2001) Response to Human Bodies, Human Choices

http://www.linacre.org/humbod.html#anchor76756

51 Kelly, D. F (2004) Contemporary Catholic Health Care Ethics. Washington DC :

Georgetown University Press

52 Summa Theologiae, Iae IIae, q50, art 1

53 Preamble to the Constitution of the World Health Organization as adopted by the

International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.

54 D’Atri, K (2002) Health and Healing in the New Testament.

http://www.socwel.ku.edu/candagrant/Papers/NewT.htm

55 Pilch, J (2000) Healing in the New Testament. Mineappolis : Fortress Press

http://www.linacre.org/humbod.html#anchor76756

http://www.socwel.ku.edu/candagrant/Papers/NewT.htm


9:33-41, 20:9-12.) The famous injunction in James 5:14-15 to pray over and anoint the sick is one such example of this. St Paul continues this image with a duty to preserve and protect one’s own health. He says that the love Christ has for the church is analogous to the love we should have for our own body. (Ephes 5 : 29-30.) William Frend’s magisterial work on early Christianity describes miracles as being a continuing sign of the church’s mission and its implicit vision of human beings as called to right relationship, and called to health as part of that56. But the ambiguity of health as almost an implicit concept and somehow bound up with sin and guilt remained through much of Christian history. This leads Pattison57 to conclude that Christian thought on health seems to have “gotten stuck” at the imperative to health the sick, and hasn’t moved much beyond that. This is probably a slight overstatement but it is true that we seem to need to hold clearly, even if in tension, how some of our concepts can relate to one another. We need somehow to address these fundamental issues:

Health as part of human identity – vs – organic decline and illness as a part of natural existence

Healthcare as part of the Christian mission and healthcare as a charism

The problem of evil and the issue of divine action (miracles)

The imperative to heal – vs – the inability to achieve physical healing

Rights to health – vs – death as an inescapable

Rights to healthcare provison – vs – individual responsibility

The Catechism of the Catholic Church explicates the paradox that is still within Christian thinking on health. While on one level it affirms that “the risen Lord renews this mission” (of calling us to heal) and “The Holy Spirit gives to some a special charism of healing” so too,

“even the most intense prayers do not always obtain the healing of all illness” and “thus St Paul must learn from the Lord that ‘my grace is sufficient for you, for my power is made perfectr in weakness,’ and that the sufferings to be endured can mean that ‘in my flesh I complete what is lacking in Christ’s afflictions for the sake of his Body, that is, the Church” (2 Cor 12:9, Col 1:24.)

58

All of these issues need to be addressed in a coherent theology of health and health care. This is beyond the scope of this paper. But this paper will contend that there are resources within official church teachings which can elucidate this work.

There are essentially two ways in which a project to elucidate official church teaching on health can proceed. The first is to seek to find where concepts of health and wholeness as bound up within the nature of being human are located, and create an elucidative theology from there. The starting point is to seek to draw together an authentic Christian anthropology which includes health. This would proceed to identifying what different streams of church teaching (sacramental, moral, doctrinal, social) contribute to this. A second approach is to begin with a more explicitly Christocentric approach. An example of this Christocentric approach is the Catechism of the Catholic Church’s moving portrayal of Christ as physician (CCC, para 1503ff.)The first approach, for sake of space and time, will be taken here.

56

Frend, W.H.C. (1984) The Rise of Christianity. Mineappolis : Fortress Press

57 Pattison , S (1989)Alive and Kicking. London : SPCK

58 Catechism of the catholic Church, para 1508 – 1510.


At first sight we may not find much on health and health care in the official teachings of the Church. But there are several themes which can build to a theology. The issue is one of integrating and interplaying the Church’s doctrinal teaching on the nature of humankind, with the Church’s moral teaching on human actions, and the Church’s social teaching on the rights and dignity of the individual. This is embodied not just in the Church’s social ministry and witness, but in its sacramental life. Having identified these four strands, Table 1 below seeks to lay these out.

Table 2 : Catholic Sources for a Theology of Health and Health Care. CCC refers to the

Catechism of the Catholic Church

Strand of

our Theology

What the Text Says

[unless otherwise specified]

Source

Doctrinal

Teaching on

the Nature of

Humankind

Human Life comes from God, it is His gift, His image and imprint, a sharing in His breath of life. God, therefore, is the sole Lord of this life; we cannot do with it as we will.

Human Life is sacred because from its beginning it involves the ‘creative action of God’ and it remains forever in a special relationship with the Creator, who is its sole end. God alone is the Lord of life from its beginning until its end: no one can, in any circumstance, claim for themselves the right to destroy directly an innocent human being.

With these words [i.e. those directly above] donum Vitae sets forth the central content of God’s revelation on the sacredness and inviolability of human life.

Evangelium Vitae, 39

Donum Vitae, 7

Evangelium Vitae, 53


Social

Teaching on

the rights and

dignity of the

individual; the

right to

healthcare and

access to it.

Individual people are necessarily the foundation, cause, and end of all social institutions.

It is a strict duty of justice and truth not to allow fundamental human needs to remain unsatisfied, and not to allow those burdened by such needs to perish.

Arising from our duty of respect for health, society must have regard to the health and wellbeing of its citizens

Every human being has the right to life, bodily integrity, and to the means suitable for the proper development of life [including] medical care [and] social services.

Any Human Society..must lay down the principle…that every human being is a person…and precisely because he is a person, they have rights and obligations…

Scientific, medical or psychological experiments on human individuals or groups can contribute to healing the sick and the advancement of public health

Mater et Magistra, 219

Centesimus Annus, 34

CCC, 2288ff

Pope John XXIII, Pacem in Terris, 11

Pope John XXIII, Pacem in Terris, 9

CCC, 2292 [obviously this is within certain moral limits and CCC 2293ff is important context here.]

Moral Teaching

on human

actions

[not a quotation from CCC] Health is an important part of the Good of human life, which can fulfil a human person59

Persons have not only a duty not to kill but a duty to preserve and safeguard their own health.This can be derived from the Fifth commandment

CCC, 2288ff

The Life of the

Church –

We too are called to incarnate Christ’s ministry of healing and compassion within the Church and in our

CCC 1506, 1509

CCC.

59

Grisez, G 1997) Christian Moral Principles. Quincy ; Illinois. Vol 1 : pp 121-124. See also Vol 2, p.519-535


sacrament and

witness

lives

[not a quotation] The sacrament of the sick has an important part to play in healing, and models the Church’s healing ministry; setting health in context of relationship with God and a part of the human condition. The grace of strengthening and peace which come from this sacrament is just one example of the grace of strengthening and peace which comes from the church’s ministry and witness as a whole.

, 1511ff

So we can say that the Church acknowledges that health is a part of what it is to be human, that human beings have a sacred character, that they have a right to life, and that states have certain obligations to provide healthcare and the means to access it. Further, we have a duty to preserve our own health and the Church is called to a ministry of healing and healthcare as a part of its very character and existence, a character which is incarnate in its life and explicitly part of its life of grace in the sacraments.

A difficulty remains over the issue of everyone’s call to health. If health is conceptualised as the WHO conceptualise it, then there are many in the body of Christ who are unhealthy, living with chronic or life-threatening illnesses. Some theology60 has sought to address the issue of health as a satisfactory adjustment to the changed condition of health. This equates with recent work on living with chronic pain or chronic conditions, for example, in the field of psychology61. There is potential here for this concept of health as adjustment to changed realities of bodily existence to have value, especially given the Church’s defence of everyone’s right to life, and the value of all human beings, precisely because they are human beings, and not because of what they can do, or how economically active they can be.

There is some scope for taking this further arising from some recent work by theologians and others. In 2001 the Pontifical Academy for Life health a major assembly, the proceedings of which were published as The Culture of Life L Foundations and Dimensions62. In separate papers in this volume, J Lozano Barragan63 and Maurizio Faggioni64 powerfully argue for the concept of Life and a culture of life to be at the Centre of the Church’s mission and ministry in healthcare, because it is at the centre of our understanding of what it means to be human. Our concern for bioethics arising from a concern for life has, paradoxically, sometimes

60

Pattison, 1989, op Cit.

61 Ogden (2002) Chapters 11 and 13

62 Vial Correa, J and Sgreccia, E (Eds) (2001) The Culture of Life: Foundations and

Dimensions. Rome : Libreria Editrice Vaticana.

63 Op Cit, pp 19-28

64 Op Cit, pp 67-103


obscured the value of our insight on the value of life for health and healthcare as a whole.

These notes can only be provisional, and point towards further work which needs to be done, but it is hoped that even these brief notes demonstrate there is much within Tradition which can influence a theology of health and healthcare.

A further issue remains : the issue of evidence. An empirical evidence base is an important background for a theology of health and health care. Increasingly, health care needs to demonstrate it comes from a credible base in the evidence65. The issue of whether spiritual care / chaplaincy can be evidenced based and whether we can utilize empirical evidence on spirituality in addressing the spiritual needs of patients is one which is attracting greater attention. St James O’Connor in a recent paper on this identified that this is becoming a more important issue, though objections to the whole concept of evidence based spiritual care include issues of methodology and ethics66. St James O’Connor concludes by noting that we are at the beginning and need a new scientific/theological paradigm that integrates rather than separates science and theology. It seems obvious from this that Catholics need a theological language and apparatus to dialogue in this field from a perspective of faith, just as they need a scientific language and apparatus to dialogue in this field from the perspective of their professional competence.

Good theology often integrates the best findings from the human, social and life sciences67. There is a developing evidence base on the relationship between religious belief and health. 68 The importance of spirituality in coping with pain, and as a protective factor in illness is gaining interest in fields of medicine, health psychology and public health.69 A theology of health and health care needs to integrate this methodological dialogue about sources and norms for practical theology into a dialogue with the evidence-based agenda in healthcare.

Catholic tradition has long held the value of spiritual interventions to improve a person’s health, affirming the unity and integration of the human person as body and soul. Saint Thomas Aquinas asserted that the effect of the sacrament of the sick is

65

Muir Gray, J (1999) Evidence-Based Health Care: How to Make Health Policy and Management Decisions. Edinburgh : Churchill Livingstone. Hurwitz (2004) Does evidence based medicine do more good than harm? BMJ 2004;329:1051

66 St. James O'Connor, (2002) T Is Evidence Based Spiritual Care an Oxymoron? Journal

of Religion and Health Vol 41, No 3, pp 253-262

67 Van der Van, J.A. (1993), Practical Theology: an empirical approach, Kampen, Kok Pharos

. See Also Ballard, P. and Pritchard, J. (1996), Practical Theology in Action, London, SPCK and Cartledge, M.J. (1999), Empricial theology: inter- or intra- disciplinary? Journal of Beliefs and Values, 20, 98-104.

68 See the Center for Spirituality, Theology and Health.

http://www.dukespiritualityandhealth.org/research/ . See also Koenig, Harold G. (Editor)

andCohen, Harvey J (Editor) (2002) The Link between Religion and Health:

Psychoneuroimmunology and the Faith Factor. New York : Oxford University Press

69 Ogden, J (2003) Health Psychology. Buckingham : Open University Press.

http://www.dukespiritualityandhealth.org/research/


important in healing and health. He says that “.. this sacrament causes an inward healing by means of an outward sacramental healing70 In recent years, with the advent of the biopsychosocial model of health71 which holds the integration of the person and health as a state which has biological, psychological and social dimensions, health care science has produced a perspective which has powerful potential for integrating theological insight with scientific evidence.

In the field of72 oncology a recent paper produced 43 primary research studies that investigated psycho-spiritual well-being in patients with advanced cancer. Each report was read, critiqued and systematically assessed for purpose statement or research questions, study design, sample size, characteristics of the subjects, measurement of independent and dependent variables, sample attrition, method of data analysis and results. Major themes and findings were identified for each of the studies. Six major themes emerged as essential components of psycho-spiritual well-being: self-awareness, coping and adjusting effectively with stress, relationships and connectedness with others, sense of faith, sense of empowerment and confidence, and living with meaning and hope.

The authors concluded that

patients with an enhanced sense of psycho-spiritual well-being are able to cope more effectively with the process of terminal illness and find meaning in the experience. Prognostic awareness, family and social support, autonomy, hope and meaning in life all contribute to positive psycho-spiritual well-being. Emotional distress, anxiety, helplessness, hopelessness and fear of death all detract from psycho-spiritual well-being. The research indicated that health professionals can play an important role in enhancing psycho-spiritual well-being, but further research is needed to understand specific interventions that are effective and contribute to positive patient outcomes

73.

Given the recent development of the field of health psychology in particular, the interest in the relationship between integrating spiritual dimensions of health with physical and psychological dimensions has become a “respectable” topic for interest in mainstream health academia. The affinity in particular can be seen from considering how Matarazzo’s foundational definition of health psychology has scope for integration with the work of theologians seeking to dialogue with health and healthcare to produce an understanding both theologically and scientifically coherent:

'Health psychology is the aggregate of the specific educational, scientific, and professional contributions of the discipline of psychology to the promotion and maintenance of health, the prevention and treatment of illness, the identification of etiological and diagnostic correlates of health, illness and related dysfunction, and the analysis and improvement of the health care system and health policy formation.74

70

Summa Theologica, Pars Supplementa, Q 30, art2

71 See Ogden (2002) Chapters 1 - 3

72 Lin H-R; Bauer-Wu S.M. (2003) Psycho-spiritual well-being in patients with advanced

cancer: an integrative review of the literature. Journal of Advanced Nursing. Vol 44, No 1, pp 69 – 80

73 Lin and Bauer, Op Cit, p 80.

74 Matarazzo, J.D. (1983). Behavioural health and behavioural medicine. Frontiers for a new

health psychology. American Scientist, 35, 807-817.


I have tried here to provide some insights toward a theology of health and healthcare which can serve us in working towards engaging healthcare workers, the healthcare system and those of our own and other faiths. Our starting point in doing so is our conviction that God calls us in Christ to serve others. This will require us to become much more proactive about our needs, rights and perspectives as Catholic Christians. The issue of faith must be placed firmly on the healthcare agenda in a constructive way which values those working in healthcare and those who are using the system. Examples of this exist from the field of regeneration in the work of the Faith Based Regeneration Network, for example. But a specific example exists of a report from a small scale qualitative research study into Muslim parents' experiences of maternity services. The report sought to raise awarenes amongst health professionals who work with pregnant Muslim women about models of good practice in maternity care. The report concluded with a series of recommendations on how the NHS can deliver more accessible and better quality maternity services that meet the diverse needs of a multi-ethnic and multi-faith society.75

It also raises issues of how the way we educate laity, clergy and religious for clinical pastoral work must be re-evaluated. Lee identifies that “the transformation of hospital chaplaincy into “spiritual care services” is one means by which religious healthcare ministry negotiates modernity, in the particular forms of the secular realm of biomedicine and the pluralism of the contemporary United States healthcare marketplace. “Spiritual” is a label strategically deployed to extend the realm of relevance to any patient's “belief system,”regardless of his or her religious affiliation. “Theological” language is recast as a tool for conceptualizing the “spiritual lens.” Such moves transform chaplaincy from a peripheral service, applicable only to the few “religious”patients, into an integral element of patient care for all. Such a secularized professional practice is necessary to demonstrate the relevance and utility of spiritual care for all hospital patients in an era of cost-containment priorities and managed care economics.” This, if nothing else, demonstrates that our work must be not just theological, but tactical. It is not enough to think through the issues theologically, but we must engage corporately with the healthcare system and its policies.

In reality, we don’t have a theological understanding as Catholics of health and healthcare. We have many. Health and Healthcare are important to us. But we need to be better at being more explicit about these values, and the theology lying behind them.

75

The report can be accessed at http://www.maternityalliance.org.uk/documents/Muslimwomenreport_000.pdf

http://www.maternityalliance.org.uk/documents/Muslimwomenreport_000.pdf


Reflection: A Charter for Catholic Healthcare Workers

The points below are taken from the Catholic Health Association of Texas. They have devised a statement of faith for Catholic presence in Healthcare. This covers both their healthcare facilities and their staff, as well as how they will deliver healthcare in a setting with a strong, visible Catholic Ethos.

We believe in the dignity of the human person and in the resulting holistic approach to patient care which recognizes and integrates the physical, spiritual, emotional and psychological care of both patient and family.

We believe in those Catholic/Christian principles and standards, which create a total environment which assist administration and medical staffs in making difficult ethical decisions.

We believe in justice and equity for associates in the workplace that foster personal and professional development, accountability, innovation, teamwork and commitment to quality.

We believe that advocating for social justice can enable the neglected in society to empower themselves and their communities.

We believe that the Catholic health ministries must recognize their social accountability to the communities they serve, developing policies and procedures to ensure this accountability, and responding pro-actively to engage in community outreach.

We believe each Catholic in healthcare is directly participating in the healing ministry of Christ and the mission of the Holy Spirit

We believe the Church should foster and maintain collaborative linkages with the broader community - Catholic, ecumenical and community-based to re-humanise healthcare.

We believe that to be effective stewards of our ministry, we must develop organizational structures that promote management effectiveness, continuous quality improvement, well-trained medical staffs, and comprehensive programs and services.

Questions for Reflection or Discussion

1. What is specifically Catholic about this understanding? Is it about the value we put on people?

2. What would be your guiding principles and beliefs in healthcare work?

3. Does healthcare in the UK need a statement of faith and values? If so, what can we add to that?

Spirituality and healthcare food for the journey

Health & Medicine

Transcript of Spirituality and healthcare food for the journey