The Advent of Palliative Care

The Advent of Palliative Care

On that day  I will gather the lame, and I will assemble the outcasts, and those whom I have afflicted. I will make of the lame a remnant, and of the weak a strong nation.  Micah 4:6-7

Palliative care makes of the weak a strong nation by gathering those who are cast out of the high stakes game of modern life, in which only the fit and un-afflicted can participate successfully, and placing them beneath the pallium, or cloak, of meticulous clinical, psycho-social and spiritual care. That cloak of attention and accompaniment dissolves the “structures of sin” that configure the sufferings of poverty, pain, disability, and stigma, replacing them with resilient structures of grace and solidarity.  The hands that are feeble are strengthened, the knees that are weak made firm, and those whose hearts are frightened hear the comforting words, we are with you: “Be strong, fear not.”  (Isaiah 35).

Structures of sin are those policies and institutions Catholic social teachings describe as producing injustice, such as the inequity in global palliative care provision that afflicts more than 70% of the world’s population. Social (as opposed to personal) sin, is defined as “sins of commission or omission-on the part of political [..] leaders who, though in a position to do so, do not work diligently and wisely for the improvement and transformation of society according to the requirements and potential of the given historic moment.” (Reconciliatio et paenitentia

The given historic moment we have arrived at now is one wherein political leaders and the medical profession have all the legal, clinical, and pharmaceutical tools they needs to relieve preventable health related suffering.  The development of palliative care in the last half century provides the opportunity to develop the necessary policies — to make the rough ground experienced by so many patients and families become a plain, and the rugged terrain of illness they struggle through, a broad valley (Isaiah 40:4).  

The Advent message of palliative care calls those immersed in social sin, to repentance, or metanoia, a change of heart that will enable them to develop publicly funded palliative care policies to relieve the suffering of all those in need. This message challenges the modern neo-liberal narrative that those who have lost social, political and economic agency through life-limiting illness, are not worth investing in.

The agency of the remnant honored by palliative care with clinical, psycho-social and spiritual services to strengthen them for the journey, is a collective voice crying out in the wilderness, calling health and pharma-industrial systems that invest only in cure at any cost, to take wider perspective that perceives the suffering of others as potentially their own. “Those who err in spirit shall acquire understanding, and those who find fault shall receive instruction.” (Isaiah 29)  This is agency in the truest sense.

Palliative care is prophetic, not profitable or prestigious, although the evidence does show that palliative care services save money by preventing unnecessary hospitalisations and what economists call “downstream spend.” Palliative care’s ethic of meticulous attention and inclusion erases the margins and categories of otherness, patient by patient, family by family, embodying the Beloved Community, in Dr. King’s words, to make each patient’s and family’s world a better place for as long as possible. It heals and strengthens the body politic in the same way stem cell therapy heals broken limbs and diseased organs. It makes straight the way of the Lord. 

Not home alone: Christmas eve dinner in Budapest with Agi, Emmanuel and Toby

Because I am without family and close friends this Christmas, I had invited people from my English mass community who would otherwise spend Christmas eve alone, to come over for dinner.  At first no one responded to the general email invitation sent out to the list serve, and then at tea after mass the other night, a couple of people told me they would come.  I also asked three young students from Cameroon what they were doing and gave them my email when they said they had nowhere to go. But I didn’t hear from them until the afternoon itself, when one of them wrote and said five of them would come. I replied that five was too many because we already had four confirmed including me, and I didn’t have food for nine. In retrospect, that was very ungenerous of me! We could have stretched the food, but I didn’t trust that I was up to loaves and fishes.

Since the students didn’t want to leave any of their flatmates behind, they decided to stay home and celebrate together. It turned out that they thought I meant the dinner was Christmas day, not Christmas eve. Refusing to have all of them seemed like a failure of hospitality, though, which I value as a major virtue.  It bothered me all afternoon.

But two other people  from the English mass came over — Toby who works at the US embassy, and Agi, a Hungarian woman who speaks fluent English and sings in the choir. The third guest was Emmanuel, a young Pakistani man who is a friend of Sr. Mary, one of the Franciscan Missionaries.  When I told her I was cooking for strays, she thought of him right away. Emmanuel is a computer engineer by training who now works in an Indian restaurant and speaks Hungarian. Astonishingly, he learned after he became friends with her here, that Sr. Marjeen, one of the Franciscan missionaries, knew his sister in Lahore when they nursed together at the hospital there.

I roasted two ducks, made braised red cabbage and apples the day before, and Hungarian mashed potatoes with smoked paprika. Agi brought a delicious, rich traditional desert made with butter, sugar and biscuit crumbs, Toby brought a white raspberry cheesecake, and Emmanuel brought apple juice. We said grace, chowed down, and talked about our lives, but mostly about Pakistan, and why Emmanuel had chosen to leave — “it was too hard to be a Christian there — I hate that about my country.”

After dinner, we went to the living room and  sat around the lit advent wreath singing carols. Agi, the cantor, led us through most of the old favourites. What a miracle! Because it was Emmanuel’s birthday, we lit a candle on the cheesecake Toby had brought and sang happy birthday. It was interesting to hear about how the besieged Pakistani Christian community celebrates Christmas, singing carols as they go door to door and collecting each family at their house, making their way as an ever growing group, to midnight mass. Christians are 2% of a majority Muslim country, and only continue the faith through family lines, not conversion, since anyone who converts from Islam faces death at the hands of the community.

Toby and Emmanuel

Emmanuel told us that most Pakistani Muslims blame Christianity as a whole for the US military actions against Pakistan that have killed many civilians since 9/11. They identify Christianity with militarism and the west, just as many westerners identify jihadist groups with all Arabs and Islam.

After they left, and I had cleaned up and loaded the dishwasher, I read the evening Scripture, which was the beautiful first letter of John 4:7 “anyone who loves …knows God.” It was such a lovely surprise and gift to read. I hadn’t expected it at all, after the weeks of reading the prophets, and the Christmas narrative, to get straight to the heart of it all, love.

KP Christmas