“Why do we need God for ethics, for the work of humanisation? Do not unbelievers do some things better?” [1]
Introduction
This address investigates issues of spirituality that arise in aged care and it invites participants at this conference to examine ways whereby people in the third age not only grow in prayerfulness, but also in resistance to social marginalisation and diminishment. [2] Just as ethics is the link between the mystical and the prophetic life of Christians, so an embodied spirituality of care offers a humanising link between an ethics of care and an ethics of justice. Three perspectives of God’s word at work in the world are discussed: fullness of life in a wounded world, a gospel reflection on “The Woman with the Ointment”, and a critique of ideology .
In John’s gospel, there is a moment when some of Jesus’ followers were put off by his claims and they ceased to be his disciples. Jesus asked of the Twelve, “Will you also go away?” Simon Peter readily answers, “Lord, to whom shall we go? You have the words of eternal life, you are the Holy one of God” (Jn 6:67-68). This was a pivotal moment of conversion and commitment whereby Peter’s confession of faith disclosed that Jesus reveals God’s truth. For 2000 years, belief in Jesus has given rise to countless ministries and agencies of care, including aged care. All health care professionals associated with aged care continue Jesus’ ministry as bearers of a wonderful “serving love” [3] that benefits the older person, their families and the wider community.
On the other hand, the American ethicist Richard McCormick argues that with the secularisation of medicine there can be a divorce from values that motivate a service-orientated profession. The move towards “medicine as a business”, causes many health professionals to regret the loss of the emotional and spiritual side of care in the interest of making money. People sense when professionals “don’t care as much as they used to”, or when the patient-carer relationship is reduced to viewing the patient as “the means” to further a “financial end”. McCormick believes that a spirituality of care rejects a creeping utilitarianism in health care that only gives support and protection on the basis of peoples’ ability to function, or because they add value to a consumer-based society. [4]
Within the context of human experience of elderly people it is important to consider the spiritual dimension of life. In a recent science programme in Australia claims were made that spirituality adds another five years to a person’s life. Even The Lancet has asserted that despite spirituality being the “forgotten factor” of contemporary medicine it is still relevant, and the authors hope that spirituality will be introduced into the curricula of medical studies. [5] Some may ask, “But why?” “What attributes is science discovering in the ‘forgotten factor’ of spirituality?”
It is well established that each significant encounter with illness or ageing generates new questions on the part of the person about the meaning of his/her new life situation and about the reality of death. And it is also well established that an active spiritual life equips people to deal with new situations. Many thinkers and writers have recorded aspects of their spiritual journey in the third age; for example, the novelist Morris West at eighty penned his thoughts as an ageing pilgrim in A View from the Ridge:
“I feel like a climber who, after a long and arduous ascent, has reached the high ridge of the range and now pauses to draw breath and get his courage up for the last stage of the journey. When I look back...I wonder why I have been spared to stand in this high place and contemplate my yesterdays. I am surprised that the moment is so calm. ...I cannot even stay here in the momentary, windless calm of this high place. The pilgrimage is not over yet. Before me the land falls steeply into a dark valley, beyond which I think I see - the lights of the city which is the goal of my pilgrimage. ...I am not afraid...I have accepted to trust that the city exists, that the lights are real and that what awaits the pilgrim is a homecoming. ...I am also familiar with the tears and the terrors of human life. ...On the other hand, the older I get the more I am confirmed in the conviction that all the saving graces in our lives are delivered to us in random moments of simple revelation: the smile of a sleeping child, [or in] the lined face of an old grandmother dozing in the sun. Yet, I am sure that…the living God is made flesh and dwells among us in our daily experience.” [6]
West’s view of the reality of life in the third age replaces negative images of ageing with images of wholeness. Spiritual growth in the older person can be a response to the reality of God’s presence in life, where God is known in the deepest dimensions of all experience and concerns. When this process is shared with companions who are willing to talk about God, prayer, and discernment, older people feel empowered to express their own spiritual legacy within the wider community. Such conversations bring to the fore difficult and painful experiences, but they also help the elderly to reclaim life-giving images of newness akin to re-birth or to the yeasting of bread. [7]
Holistic medicine has heightened our awareness of the physical, bodily aspect of care and gives greater attention to the whole person. Similar developments have emerged in psychology and psychosynthesis which have enriched forms of Christian spirituality through a renewed respect for the body, such as that expressed in the gentle, healing touch of Jesus of Nazareth. [8]
This conference confirms that health care is a bold assertion that Jesus Christ is part of the answer to questions surrounding care in the third age. Yet, in 2003, “Can we claim that Jesus Christ is the answer to questions concerning the frailties and vulnerabilities of older people?” For believers, the gospel way of living has always been a quest towards new ways of being that seek to humanise society. This way of living constantly raises new questions: “Why is spirituality the ‘forgotten factor’ in health care?” “ Why do we need God for ethics, for the work of humanisation? Do not unbelievers do some things better?” [9]
Fullness of life in a wounded world
In the gospels we are reminded that wherever people are overwhelmed by vulnerability, Christians must ask, “Where do we find God’s abundant and extravagant fullness of life?” Such reflections find that God is at work in the tension between suffering and liberation, so that, little by little God’s saving love makes present a sense of wholeness and healing. [10]
A spirituality of care is based on the revolutionary vision of human life that is anticipated in God’s promised kingdom which forms the basis of resistance against all forms of evil, and it raises questions about the transformation of spiritual and moral values in the social order. It implies a ministry of care informed by a deep perception of God at work in society and a social awareness that enables people to move towards greater freedom and wholeness. In aged care, spirituality lifts the level of self-awareness and clarifies aspects of life that may otherwise be overlooked, such as the authority of an individual’s spiritual experience. As older people struggle for full humanity and personhood they add new meaning to the Christian tradition. On the other hand, often they know only the pain of separateness, anxiety, fear and the loss of “voice” as they struggle for the survival of their inner self and values. Thus, they must learn again to speak, starting with “I”, starting with “me”. Starting as the infant does with its own hunger and pleasure and rage. [11]
If the older person’s experience becomes fragile or is allowed to be buried beneath layers of institutional and traditional interpretations, then they need the ear of a skilled and imaginative listener. Imagination knows the language of mystery and the sacred symbols and images that convey meaning even before we use words or refine our reasoning. Thus, storytelling offers a spontaneous way to name human experience. This honoured and ancient tool preserves a rich variety of experiences that are significant to the storyteller who begins with “Listen”... or “My life is... or “I feel like”. Through the process of listening and imagination the elderly are encouraged to befriend their own self-image in the third age even though at times they may feel like “a broken doll”, or “in a black hole”. [12]
Older people possess latent knowledge and often yearn for listeners to help them articulate the knowledge they carry. The opportunity to speak is also a way of recognising the spiritual dimension of the self. Through listeners, people learn to shape their questions, insights, and desires and in return they offer prayer, love, affirmation and affection to or for others. The third age of life is a new stage of growth and spiritual development which society can easily crush or deny. Alternatively, by attending to the person’s inner truth the carer can encourage a spiritual newness and tap into a strength that enables people to move towards greater inner freedom that transforms not only their own life but the lives of others, including the carer.
It is not uncommon in a culture of “having” rather than a culture of “being” that those in aged care develop symptoms of powerlessness, depression, and low self-esteem. [13] Some theorists locate all personal problems in the individual, but this approach often ends up blaming the victim. If the focus is on the social context, then analysis differentiates internal and external sources of diminishment. Analysis names that which marginalises the elderly and that which reduces them to total dependence by denying them the right to full participation in society. On the other hand, through insightful and imaginative guides, carers may have a change of heart and expand the range of choices available to those in residential institutions. Another function of imagination is memory, as Jesus said about the woman with the ointment, “What she has done will be remembered”. Through imaginative companions and collective stories the elderly maintain connections with their own life story, with precious memories, and with the wider human family.
Within an organic worldview none of us is totally free to choose relationships, but rather the human self emerges from within a complex of relationships. Saint Paul insists that we are all part of one body, even those parts of the body which seem to be weaker are not indispensable. God has composed the human body so that all the parts receive the same care from one another. If one part of the body suffers, all suffer together. If one part is honoured, all rejoice together. [14] Scripture adds that within the community, it is God who initiates the appointment of healers, helpers and administrators to care for diverse needs in society and to advocate for the rights of the weak as well as the strong.
Yet, a major critique of Christianity is that it leads older people to believe that their place in life is one of suffering and submission. Such attitudes blind them from recognising and naming oppression in their lives. The cross of Christ is one of those symbols frequently misused. The meaning of the cross changes over the lifetime of a Christian. An older woman in a nursing home who has experienced multiple losses over which she has no control relates differently to the cross of Christ than a younger person. Another may have internalised traditional interpretations of religious art in unhelpful ways, believing that it is necessary to endure pain, humiliation, and violation of one’s rights in order to receive God’s promise of resurrection. Others may view the cross, as a call to be courageous and struggle for liberation that does not glorify suffering. In aged care, the gospel comes alive most fully among those who struggle for a climate of mutuality that is open to dialogue so that hope for a fullness of life is lived out by communities who “choose life” in the face of death-dealing powers.
Jesus of Nazareth called his followers to a change of heart, to a conversion of life-style and openness to God’s transforming power. His words brought fragments of heaven to earth when he told his disciples to “Go and tell”…“what you have seen and heard: the blind receive their sight, the lame walk, lepers are cleansed, and the deaf hear, the dead are raised up, the poor have good news preached to them” (Lk 7:22). Jesus called for a new way of being in the world, so that God’s redeeming action can take place right now among the so-called difficult and marginalised people in the third age. Older people need to speak out against structures that dominate and demand submission to organisational necessity, which raises the question: “How does the spirit of Jesus guide our ethics of care?”
Gospel reflection: “The Woman with the Ointment” [15]
In the quest for an embodied spirituality that links an ethics of care with an ethics of justice let us consider the well-known scene in the New Testament i.e. The Woman with the Ointment. [16] This is a story of role reversal. Jesus has not long to live. An unnamed but historical woman ignores cultural conventions. Unperturbed she anoints Jesus with a tenderness and love that express her care for him. Jesus the “giver” of life becomes a “receiver”; his co-operation established a model of mutual relationships. He commissioned his disciples to “Go and tell” what they had seen.
The woman enters Simon’s house and pours precious oil on Jesus. Through her “serving love”, this woman’s dramatic act was a critique of prevailing structures and attitudes. Jesus sat at the supper table, an event that excluded women except as hostesses. But this woman walked straight into the group of men dining with Simon. In the house of a leper touching was taboo. Yet, in Simon’s house the woman touches Jesus. The gesture of touch establishes a physical intimacy with Jesus who will soon be led away to his death.
The woman was neither calculating nor worried. She gave all she had, but she suffered the indignation of the other guests who tried to send her away. The woman pays no attention, completely absorbed in what she is doing. Her “serving love” and “solidarity” with the mission of Jesus was a political statement. Her act was extremely extravagant and a catalyst for change. As the woman poured the oil, she set herself free from social and cultural constraints and liberated Jesus for his mission.
During the feast Judas grumbles that the oil should be for the poor! Jesus responds “the poor are always with us” and that “by pouring oil on my body she has prepared me for death”. By anointing Jesus’ body this woman treats the one who will soon be executed like a king. The woman’s act of anointing celebrates Jesus’ life in the face of his death; wordlessly and extravagantly she expresses her love for him and at the same time gives great value to human life.
In a world where economic rationalism has turned caring for the aged into a business this woman’s useless, self-forgetful actions in which being and doing become one show a lack of concern about cultural niceties and offer instead a humanising view of life. The woman did not ask about the cost of the oil, what reward this act would bring her, or about what effect the anointing would have. In fact, her mystical and prophetic love crossed the border of caution, prudence and concern for self-esteem, nor did she abandon her life-giving deed for the sake of a purpose-orientated rationalism. [17]
Jesus saw his anointing as preparation for his forthcoming mission, suffering and death. His statement “you will not always have me with you” shows him to be acutely conscious of the shortness of time left for him. At the same time he highlights the significance of the woman’s public, prophetic, and subversive act that not only liberated the woman from the law, but also set Jesus free to complete God’s mission. Jesus responded to her care by telling his disciples to “Go and tell” what they had seen: “Wherever this good news is proclaimed in the whole world, what she has done will be told in remembrance of her” (Matt 26:13).
For McCormick, care and trust include a movement of “giving and receiving”. At the beginning of life and at the end of life “receiving” predominates over and even excludes giving. But the value of human life does not depend only on our capacity to give. Love is an attitude to other human beings independent of their particular characteristics. Love extends to the helpless and hopeless, to those who have no value in their own eyes and seemingly none for society. Such love is costly and easily destroyed. In the “giver” it demands unlimited caring, in the “recipient” it requires absolute trust. [18]
A critique of ideology
The starting point for a spirituality of care is not so much preserving good “order” in society, but expressing indignation over human beings being hurt through a lack of order in our hearts and in the wider community. The threat to the well being of humanity leads to indignation and raises the question “What kind of humanity do we want?” It becomes an ethical challenge arising here and now amidst negative experiences of unhappiness and injustice. [19]
Although we do not need God as a direct foundation for our ethical decision-making and actions, this does not exclude God from ethical life. There is an intrinsic connection between ethics and Christian spirituality. Christian ethics arise out of experiences of faith, hope and love of God, which we reflect in our lives and actions. Unless Christians take into consideration the relationship of Jesus to God, Jesus’ liberating life never leads us to an understanding of who Christ, the “anointed one of God” is, nor what God desires for humanity. [20] Through belief in God’s Gospel, Christians stand in a critical relationship to the prevailing culture. When they ask, “What can we do?” [21] they provoke reflection that leads to an ethics of care based on mutual relationships and an ethics of justice informed by philosophical principles that offer personal freedom. [22]
For Schillebeeckx, ethics without spirituality can become “graceless”, so that there can be ethics without the element of love which is necessary to bring about human happiness. Without spirituality informed by the Gospel, ethics may foster revenge or retribution. Too often, religions distort the name of God and their ethics embitter people by diminishing human worth and happiness. [23] From a Christian viewpoint, “ethics need a God who as the ultimate source of all ethics is more than ethics” such a God prevents people from delivering themselves into the hands of false prophets. [24]
Christians have a duty to further truth and justice in the world. Through their spiritual, critical and ethical way of life they keep alive in the heart of humanity the will to form society into a place which is good for young and old. While the world we live in is precious to the heart of Christians, Christians cannot be taken over by the marketplace. The churches must be active in politics by asking the question “What kind of humanity do we want?” What we need is responsible argumentation that is open to discussion. Yet, we cannot preserve unity of thought and expression at the expense of the Gospel. [25]
One way to achieve a balance between understanding and action is to move beyond theory towards “reflection gatherings” that are impassioned by the belief that the gospel is an instruction for contemplation and action. Various forms of “reflection gatherings” allow God’s gospel to be known and proclaimed in health care, in local communities and in the wider society. Ethics are the product of a human process. There is no revelation direct from God. God does not say “This is ethically permitted or forbidden”. It is human beings who reflect on their experience and decide what is good for people. [26] Today, being sent as God’s witnesses necessitates an active political response: “What can we do?”
“Reflection gatherings” attract health care staff, supporters and the elderly to regular meetings. Like the original Christian communities such gatherings are the result of active co-operation of ordinary people engaged in a mutual quest for truth. A shared leadership allows participants to put forward suggestions on the basis of new information gained through reflection. Such gatherings enable professionals, family members, volunteers, chaplains and the elderly to analyse the present situation and to point out possible social and cultural activities to bring about life-giving change in the lives of people in care. The greatest risk surrounding “reflective gatherings” is that sceptics, who, in arguing from a purely utilitarian or functional position, consider such activities to be a waste of time and seek to undermine them.
Ideally, an embodied spirituality of aged care liberates the whole community to search for comprehensive programmes and processes which promote policies that better educate and prepare people in the first and second stage of life to deal with the questions surrounding the third age. If people are encouraged to live healthier, happier lives, then maybe they will be able to stay at home and age in their own place with minimal reliance on children and extended family. Families are a social investment that cost parents dearly in the early years, but by planning for the three phases of life including the spiritual dimension, they have the potential to deliver exceptional returns at the other end of life.
As we struggle to fashion a better quality of aged care we cannot dismiss democratic processes. Instead, we must engage the imagination of multigenerational communities of care to resist political forces, including the media, which play along with the state machinery and shape public consciousness on how care of the elderly is to be given. Within “reflection gatherings”, spirituality and shared vision offer a model of care that seeks a fullness of life wherever marginalisation and injustice exist. We become fully Christian as the whole community grows into a movement of spirituality and resistance, that is, into the body of Christ. [27]
Conclusion
This address proposes that God’s Gospel is the source of an embodied spirituality of care that offers a humanising link between an ethics of care and an ethics of justice. In answer to the question, “ Why do we need God for ethics, for the work of humanisation? Do not unbelievers do some things better?” [28] w e have considered perspectives of aged care through: Morris West’s testimony of being an aged pilgrim; Jesus of Nazareth’s reception of anointment by the unknown woman; and an ethics of care that promotes “reflection gatherings”.
We are invited during this conference to view spirituality of care through the perspective of God’s eyes, to listen and hear with God’s ears, to name oppression, diminishment and marginalisation in all its forms; [29] to set free the power of faith experiences and the gift of bodiliness by empowering older people to live in multigenerational communities and to resist dehumanising forces that seek to undermine God’s vision for them.
Health care professionals discover God’s liberating word in questions raised from what is heard and seen in the suburbs, in people’s lives and homes, and in the hospice or rest home. Such perspectives grow out of human stories that make social victims visible. Within an ethics of care and an ethics of justice attentive to human need, carers engage in a second step, analysis, which asks who among the elderly are excluded from social and economic well-being in the community. A third step brings into play a liberating embodied spirituality formed through personal experience and prayer, which becomes self-critical through knowledge of Catholic and Protestant traditions as well as other faiths and cultures. Finally, a renewed praxis promotes “reflective gatherings”, whereby the elderly and marginalised are the teachers. What they say and do humanises us.
This article is an edited version of the keynote address given by the author at “Ethical and Spiritual Issues in Aged Care” the inaugural Health Professionals Conference organised by The Nathaniel Centre and held in Wellington on 7/8 November 2003.
Ann-Marie Harvey PhD rsm is a lecturer who has taught Health Care Ethics and Theology at Australian Catholic University, Queensland. In 2004 she takes up a teaching position with the Wellington Catholic Education Centre.
©
2003
[1] Schillebeeckx , E. On Christian Faith: the Spiritual, Ethical and Political Dimensions, translated by J. Bowden. N.Y.: Crossroad (1987), 50. See also Evangelium Vitae , n. 101 “The Gospel of life is not for believers alone: it is for everyone”.
[2] Honings, B. “The Church and the Ethical and Cultural Challenge of the Marginalisation of the Elderly Person”. Chalon et. al., eds. Dolentium Hominum (Journal of the Pontifical Council for Pastoral Assistance to Health Care Workers), Proceedings of the XIII International Conference-The Church and the Elderly 40, 1 (1999), 85.
[3] Schillebeeckx, E. Church: the Human Story of God, translated by John Bowden. N.Y.:Crossroad (1990), 218.
[4] McCormick, R. “Value Variables in the Health-Care Reform Debate”, in America 168, 19 (1993), 7-13.
[5] See reference to The Lancet in M. Petrini, “The Elderly Facing Death” in C. Chalon et. al., eds. Dolentium Hominum 40, 1 (1999) 92.
[6] West, M. A View from the Ridge: The Testimony of a Pilgrim. N.S.W.: HarperCollins (1996), 1-3.
[7] Fischer, K. Women at the Well: Feminist Perspectives on Spiritual Direction. N.Y.: Paulist (1988), 195-215.
[8] Hay, D. and Hammond, J. “When You Pray, Go to Your Private Room” in British Journal of Religious Education (1991-2), 146-7.
[9] See Schillebeeckx, E. On Christian Faith (1987), 50.
[10] Soelle, D. Window of Vulnerability: A Political Spirituality, translated by L. Maloney. Minneapolis: Fortress (1990), 20.
[11] Piercy, M. “Unlearning to Not Speak” (poem) in To Be of Use. N. Y.: Doubleday (1977), 38.
[12] Fischer, K. (1988), 11.
[13] McCormick, R. in America 168, 19 (1993), 11.
[14] For just as the body is one and has many members, all the members of the body, though many, are all one body, so it is with Christ (Cor 1:12).
[15] Soelle, D. et al., in Great Women of the Bible: in Art and Literature. Grand Rapids, Michigan: Eeardmans (1994), 262-267.
[16] The Gospel accounts of this narrative differ widely and are open to different interpretations. I approach this narrative not as a scripture scholar but from the perspective of theology and an ethics of care.
[17] Soelle, D. et al., in Great Women of the Bible (1994), 264.
[18] McCormick, R. supports an Anglican group’s affirmation of “giving and receiving” May (1993), 11.
[19] Schillebeeckx, E. On Christian Faith (1987), 82.
[20] Schillebeeckx, E. On Christian Faith (1987), 13.
[21] Soelle, D. Political Theology (1974), viii.
[22] Van Den Broek, K. “A Critical Look at Ethics of Care”, in L. Shotton, ed. Health Care Law and Ethics. Katoomba: Social Science Press (1997), 201-221.
[23] Schillebeeckx, E. On Christian Faith (1987), 54.
[24] Schillebeeckx, E. On Christian Faith (1987), 53.
[25] Schillebeeckx, E. On Christian Faith (1987), 80.
[26] Schillebeeckx, E. I Am a Happy Theologian, translated by J. Bowden, London: SCM Press (1994), 70.
[27] Soelle, D. Against the Wind, translated by B. and M. Rumscheit. Minneapolis: Augsberg Fortress (1999), 99.
[28] See n. 9.
[29] Buber, M. Ecstatic Confessions, ed., Paul Mendes-Flohr, translated by Esther Cameron. San Francisco: Harper & Row (1985), 63.
