Since the “religionless palliative care” blog I published last week got quite a few likes and shares, I thought I might try for a second installment. I was surprised by the positive response, as I was unsure how the conversation between Bonhoeffer (DB), palliative care, and the WHO would come off. This essay tries to explain and go deeper.
Palliative care provision enacts what DB calls “earthly affection,” in his notion of polyphony. As a Christian, Bonhoeffer identifies the “cantus firmus,” of this polyphony as Love of God, and the other melodies of life (the earthly affections) provide “a contrapuntal” that “enjoys autonomy of its own.” (Prison Letters) The religionless provision of palliative care is earthly affection grounded in a cantus firmus of love (agápē) for suffering humanity.
Palliative care’s core commitment is to relieve the suffering that accompanies serious illness, a feature of the human incarnation, of all sentient beings. Although each individual’s suffering is uniquely his/her own, skilled palliative care practitioners can accompany it, and often relieve it, through evidence based practice grounded in agápē.
Structurally, the multi-disciplinarity of palliative care echoes the polyphony Bonhoeffer talks about. As a volunteer on palliative care teams, I have often been struck by how open team members are (from physicians to volunteers) to listening, and to co-creating a melody that allows patients and families to realise their goals of care. Palliative care curates an ethic of polyphonic conversation that attempts at least, to align with truth: not Truth, but the truth of the unique configuration of patient and family relationships, prognosis, and team resources.
When I reread Bonhoeffer this time, the notion of “responsibility,” jumped out at me, since it also applies to religionless palliative care. He says,
The ultimate question the man of responsibility asks is not, How can I extricate myself heroically from the affair? but, How is the coming generation to live?
Palliative care practitioners ask
How is the coming generation — and the earlier generation — to die?
This question makes us persons of responsibility. Palliative care fosters an ethic of service and civic responsibility that is anomalous in these times of hyper-individualism. Almost by definition, palliative care attracts practitioners who favor the common good over their own career and advancement. In general, providers receive lower pay and have less recognition and prestige than their colleagues in other specialties. In some cases they are downright despised and marginalised within healthcare systems.
In this sense, Bonhoeffer’s notion of transcendence as “being for the other,” applies to the palliative care workers it is my honor to know. Fr. Alfred Delp, SJ, another Christian martyr sent to the gallows by the Nazis, also noted that,
“Man is truly human when he transcends himself. He becomes small when he is content with things and values from is own life sphere.” (Advent of the Heart)
Transcendence is “holy worldlessness,” which is the key to Bonhoeffer’s religionless Christianity. One of his biographers, Williams Kuhn, says,
By the term [holy worldlessness] he (DB) means a complete dedication to life, a commitment in one stroke to a man’s own potential and the needs of the world,
Religionless palliative care is chock full of practitioners who are dedicated to life, which of course includes suffering and dying; and who are dedicated to man’s [sic] potential to help systems evolve to serve the most vulnerable, as the WHO Draft Program of Work (see Religionless Palliative Care Part 1) commits to do.
The needs of the world at this moment clearly include the provision of public health palliative care, which we will all of us eventually be clamouring for, unless blessed with sudden death (less than 12% of deaths these days).
To the attract the sustainable government funding it will need to cover the majority of the population, palliative care must be inherently religionless, even though faith-based groups will certainly continue to provide it as a corporal work of mercy.