Friday, November 18, 2016

Unifying Our Fragmenting Society – “Who Cares?”

In his recent blog post, “How Do You Get the U.S. off Life-Support?” (referring to the growing incivility in public discourse that has been exacerbated by the examples set before us during this most recent election cycle), Paul Louis Metzger (disclosure: Dr. Metzger is my faculty mentor in my doctoral program) notes the position taken by Dr. Robert Potter (again, disclosure: Dr. Potter is the other academician reader of my dissertation/ministry project paper). Drawing an analogy to palliative care (seeking to alleviate a patient’s symptoms and pain, separate from addressing curative measures), Dr. Potter seeks a solution to the pressing question, “What needs to be done?” by framing the questions “What am I missing?” and “Who am I missing?” These are essential questions. In pain management and end-of-life care, the holistic approach to the mental, emotional, spiritual, and social dynamics of the patient and their family can often be even more important than the physical processes being treated.

As I have written elsewhere, addressing these multiple areas of concern is difficult, requiring in hospice care an interdisciplinary team that (by law) must at least include a physician, a medical social worker, and a pastoral counselor/chaplain in addition to the hospice manager. The intensive and extensive level of care provided through hospice during the final weeks and months of life is nearly impossible to provide elsewhere. Likewise, it often may seem as though the answers to “What am I missing?” and “Who am I missing?” are not only daunting in the depths of their complexity, they may be endless in breadth. It may seem impossible to determine, much less include all that is missing, and all who are missing from the equation. In such cases, we may be tempted to take license to disengage from the process, allowing ourselves the escape clause: “We’ve done all that we can do.”

Why would I demand of us that we try any harder than that—either in treating a dying patient or in seeking to bring unity to a fragmenting society? Because I believe that beneath the questions “What am I missing?” and “Who am I missing?” lies a motivation that is, in my experience, so often unclear in both discussions. The question “Why is this pursuit so terribly important to you?” might be boiled down cynically to “Who cares?” But whether conservative or liberal, whether focused more exclusively on any few or encompassing all the “moral intuitions” that Dr. Potter cites (care, fairness, liberty, loyalty, authority, and sanctity), the answer is simply this: “You care.” For different reasons, at different levels, and from sometimes vastly divergent perspectives, it is impossible to deny that we have clear and passionate positions on most of the issues being discussed.

If you doubt whether you have such passions, simply put yourself in the place of those who are adversely affected by any of the issues. Start by asking yourself what levels of pain relief and symptom management (think uncontrollable nausea, for example) you would be willing to forego if your hospice team needed to cut back on their agency’s overtime. Questions of healthcare rationing may bore you. But faced with a decision on whether to pursue expensive treatments that have only the most miniscule chance of curing your disease? You may find yourself paying closer attention to the discussion.

The unifying issue for many participating in hospice care, as providers as well as for patients and their families, is that we generally acknowledge the reality of mortality. We not only provide care to the dying and bereaved, we number ourselves among them. Even when we are not among the most imminently dying, we willingly bereave ourselves, intentionally forming close personal friendships with people we know are going to die soon. The unity we find in that mutual mortality and shared grief allows us to discuss matters that nearly all others in our circles of influence work hard to avoid. (Most of them wish that we would avoid those topics, too.) But in caring about the issues, despite divergent positions, relative to hospice care, we are unified by our commitment to solidarity with and around the patient and their soon-to-be-bereaved family, knowing that we eventually will be one or the other or both.

So next, in the broader conversation about our national priorities, I would ask that you think about liberties you particularly enjoy. Would you care if they were being as maligned and restricted as those of others? Try considering your economic well-being threatened by those who would re-zone their neighborhoods to eradicate “your kind.” Imagine your religious affiliation (or lack thereof) as a reason to discredit and persecute you. And visualize yourself amidst the confrontation that would occur if armed authorities denied you your right to express your position on these or any other matters. You do care…if it’s your ox that’s being gored.

We all care. We merely subvert our engagement of these issues behind a pretense of apathy. Apathy, the lack of caring, is not what I find to be the cause of inaction. Instead, we choose not to engage on the basis of what I would call the economy of futility. We do not invest in solutions because we believe the problems to be insoluble. Therefore, we fail to recognize the undeniable unity of our concerns. At their core, our conflicts are universally compelling, if only we would admit how much we care about our own positions on the issues.

Will we agree on these positions? If you demand that I agree with your position, or I demand that you agree with mine, probably not. But we must agree, if we will admit that these are issues on which we each cannot help but have positions. Then, and perhaps only then, we might be willing to listen, understand, and collaborate in ways that resolve our conflicting positions on the issues themselves. Only then can we claim that “we’ve done all that we can do.”

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