Making a Difference in Challenging Environments
Issue 30, April 2010
Keynote Address at "Together We Can..." National Conference of the New Zealand Council of Christian Social Services 2010
It is an honour for me to address this annual conference of the New Zealand Council of Christian Social Services (NZCCSS) this morning. The keynote speaker Governor John Lonergan of Mountjoy Prison in Dublin was to speak this morning but, like so many, is stranded in Europe. While I cannot speak in his stead, I would like to use a couple of his insights as a framework for this reflection on how we might make a difference as we work together in addressing the social, cultural, ethical and spiritual challenges of caring for our elders in healthcare delivery in Aotearoa New Zealand.
John Lonergan is "convinced that people change from the inside out and that the task for all of us is, first of all, to find the humanity in another human being and then to nurture it." He also argues that the "more a person becomes aware of their own humanity the more likely they are to treat others with respect", compassion, and a shared sense of justice. Essentially I see such a journey as a journey of the heart, a journey that encompasses the big picture as much as it reflects on the personal and what is deeply human. It is a journey of blessing, of loss and renewed insight, a journey of the soul and, fundamentally, a journey into the very life of God.
The Soul of Ministry
The volcano in Eyjafjallajokull provides a wonderful 'leit motiv' for our reflection, the colossal power and majesty of nature, lava spewing into the air and on down the mountainside, an all-pervading cloud of ash demanding our attention by grounding planes, silencing massive airports, stranding people everywhere and halting our ability to plan travel for leisure, business, or family celebrations and family necessity. So many airport lounges – places of farewell and welcome have become deserts of loneliness, vulnerability and uncertainty – feelings that are very familiar to us who work on the margins in our various Christian ministries.
The volcanic ash poses a risk to safety – when sucked into an engine the ash hardens and becomes like concrete eventually shutting down the engine's ability to perform...likewise us ... unless we take time out to address the soul – the inside out and the outside in – personally, professionally, and as healthcare providers – then the ethical, spiritual, cultural, legal, technological and social realities that we face in everyday ministry can easily overwhelm and swamp our resolve leading to a loss of hope. Essentially a loss of hope is a 'disconnect' from the soul, at either a communal, institutional or personal level, a very real danger in all ministry and in all healthcare delivery.
The Prophets in our Midst
If we do not tend to the soul of ministry, and to our own soul in ministry, then it is highly likely that we are overlooking the prophets in our midst.Prophets can be like volcanoes – they erupt when we least expect and stop us in our tracks. They are the people "least capable of becoming institutions" as Abraham Heschel reminds us, and yet they are essential to our life and maturity in ministry. Prophets continually call us back to the heart of our mission in Christ and remind us that "insight is a breakthrough" which requires "much intellectual dismantling and dislocation" [i] if we are to renew our sense of vision and deepen our understanding of our shared humanity.
One of the strengths of Christian Social Services in Aotearoa is when it enables the prophetic voices of the Church to be heard, especially for New Zealanders suffering from the 'sharp end' of the economic recession, and all who are vulnerable in society, including our elders. In its collaborative scholarship and research it provides a counter-cultural voice for vulnerable New Zealanders. That must continue, both at a macro and micro level, that is, at the level of leadership and governance and vision, as well as at the bedside and for this person in his or her particular circumstances and the particular circumstances of his or her whanau.
"Together We Can..."
In their meeting with the Prime Minister and Minister of Finance in April 2009 church leaders from NZCCSS presented a paper on responses to the recession from which this Conference takes its name, "Together We Can." The paper especially noted the link between child poverty and unemployment and the long-term consequences of both to society and to individual families. Surely another example of a short term funding cut with potentially chaotic and long term consequences for Aotearoa New Zealand?
What might some other implications of our Conference theme be? Allow me to suggest a few at a macro-level.
'Together We Can' means linking the inside with the outside; the soul with what is visible; the soul with a sense of hope.
'Together We Can' means - together - not instead of.
'Together We Can' means a shared and principled journey as stewards of this beautiful and God-given gift of life in all its stages. 'Aroha tetahi ki tetahi'. Let us look after each other.
'Together We Can' means an ongoing conversation and dialogue and working together, first and foremost among ourselves, as Christians who provide Social Services as well as informed analysis; a balance between justice as well as charity; faith combined with reason; and the ability to understand our society and our shared sense of humanity even as we are challenged to transcend its shadow-side at a personal, societal and institutional level.
To my mind during the 1990s the Churches of Aotearoa New Zealand were a most effective and prophetic voice precisely because they worked together. May we who have been blessed by the legacy of our forebears and elders in ministry do no less.
'Together We Can' does not mean ignoring or shutting down or side-lining the voices we don't enjoy hearing through fatigue, pragmatism, or though political expediency, or worse, as the National Government did in disestablishing the Bioethics Council - Toi te Taiao in 2009. This despite the establishment of the Bioethics Council being a key recommendation of the Royal Commission of Enquiry into Genetic Modification and despite Toi te Taiao's record of debating the spiritual, cultural and ethical issues of bioethics in an open and inclusive way.
'Together We Can' means acknowledging that people learn in different ways and at different stages of life's journey – hence the importance of night classes and ongoing education and rehabilitation into the community after wrongdoing as well as a growing need for restorative justice. Aotearoa-New Zealand does not need any more prisons public or private!
Adult literacy classes lost their government funding in 2009. In March this year the New Zealand Prisoners Aid and Rehabilitation Society (PARS) also lost its government funding. (Ironically the Wellington office of PARS closes its doors today)
Who will teach the first generation New Zealander now? If they are poor will they still be welcome as full citizens and not merely lowly paid healthcare workers? How might the migrant or unemployed learn to read and write now? Who will welcome the prisoner and the most vulnerable to the table now? And how will we nurture these brothers and sisters when they take their place among our elders? How will we nurture them and advocate for them as they work in our kitchens and as nursing aids? How will we honour their rights and their innate human dignity? How might we promote the dignity of work especially for those who have none despite exhaustive attempts to find it?
'Together We Can' means that each party works for the common good according to its particular duties, responsibilities and proper roles. 'Together We Can' does not mean offloading by government or an abdication of its social responsibilities to Non Government Organisations (NGOs), Churches and Welfare Agencies.
I received the following email from a friend the other day after telling him about preparing this keynote address. He called it: "The Pathetic Life of U No Who!"
"I am not a statistic - I figure in no survey, positive or negative news of any kind. I don't exist in any downturn or alleged economic recovery.
Since losing a very good marketing manager's role due to restructuring, I've applied for 423 positions in 28 months. These have ranged from senior marketing roles in a variety of industries to a customer services role in a supermarket, and everything you might imagine in between.
Of the 423 applications, I have received approx 30% acknowledgment or confirmation of the application - meaning that approx 70% do not reply to the often substantial effort, which can take up to three hours. I have an excellent CV, and references to die for. I've been very flexible about location, and have applied for jobs all over New Zealand, South Australia and the Gold Coast.
I have written to Work and Income's national commissioner, my local MP, have given my details to the local Work and Income office - to no avail. Because my wife earns approx $600 weekly I have no entitlement to unemployment assistance - or a sickness benefit, even though, as an ongoing cancer patient, I fit the criteria.
Fifteen years ago I was earning more than $100,000, which at the time was very good money. This last year I earned $437 + GST; we have had to sell our home, and now rent with what's left of our fast diminishing capital; the company for which my wife has worked for five and a half years today announced that it was 'outsourcing' its call centre jobs to Manila.
I turned 61 on Monday."
This is the story of an educated and articulate man which makes me wonder about the 19-24 year olds with little life experience who are over-represented in the unemployment statistics? If getting off a benefit and finding work is difficult what about those who have no work and do not receive a benefit? And what about the homeless and the poor? Surely in this land of plenty they challenge our sense of a shared humanity? Surely they also speak to our souls?
'Together We Can' but one-way traffic is not partnership. It is not protection. It is not participation and it is not justice. In short, one-way traffic is not living up to the principles of the Treaty of Waitangi. And neither is it adequate as a response to the call of Christ...
The Essence of the Person
So how might we as members of the Body of Christ respond to these challenges? How might we care for our elders in a way that shows we share a common humanity and in ways that cross the boundaries of race, gender, health, personal circumstance and beliefs?
Earlier this week my colleague John Kleinsman and I attended the first part of a two week seminar at Victoria University on commercial surrogacy and transnational adoption. [ii] Much of the discussion centered around the questions of connectedness and relatedness and the impact of technology on traditional understandings of the family and kinship. While the focus of the seminar was on the ethical, social and anthropological issues affecting children born as the result of surrogate arrangements, or adopted internationally, I was struck by the similarities with our subject, namely, the care of the elderly: the foundational questions at the beginning and end of life are essentially the same.
This is beautifully encapsulated in the oft quoted Maori proverb, 'Ko te wa ki mua e whai ake nei ki muri' is variously translated as 'the time that is before us – the future – builds on what has gone before'. Simply put, 'the future is behind us', that is, the essence of the child cannot be separated from the essence of the elder because they share a common humanity. The essence of the mokupuna and the essence of the kuia or kaumatua is exactly the same. This connection is evidenced by increasing numbers of grandparents who are actively raising their grandchildren – several of whom are also caring for their aged parents at the same time.
But even as we advocate at a macro and leadership level we carry the plight and humanity of those who have little or no voice. We need constant reminding that many of the vulnerable actually appear in seemingly sophisticated disguises – so sophisticated that we don't even notice them. I suspect that they appear sophisticated because their humanity and their sense of hope in the transcendent has been lost or is under severe attack.
Like volcanoes the poor and the vulnerable can be 'hiding' out in the open – just part of the landscape really - their plight largely ignored and no longer finding any echo in our souls. And even as we strive to grow in our sense of shared humanity through ministry we only ever see a snapshot of a person's life – we can know biographical details and moments of significance but we can never fully appreciate the depth of a person's story. The depth of their humanity is known only to God even though we may indeed be privileged to catch glimpses of this in our journey with them.
And if the humanity of another is essentially mysterious surely it doesn't take a volcano to remind us that ours is also? That is the power of the human story – it's about soul, it's about going to the very heart of things, it's about entering into the heart of God's love for the many in Christ and rediscovering the essence of the person. It is so easy to be put off by the appearance of the poor and pass them quickly by or cross over and walk on the other side of the road.
I recall as a gangly 17 year old apprentice gardener going into Wellington with my older bother Pat to a movie. From a shop doorway on Lambton Quay a homeless and drunk man yelled out to my brother, "Gidday Patrick!" I took fright and walked on ahead pretending to 'window shop'. When my brother eventually left the man I asked him, rather impolitely, "Who was that?" He replied, "Oh that's old Jim he's a friend of mine...I know him from 'Varsity..." My response was less than gracious and, I added; "besides we are running late for the film!"
Whereas I could only see a drunk that evening Pat was meeting an old friend and, at 18, was teaching me a very valuable lesson – a lesson for my soul – simply this: We can never judge by appearance because the vulnerable, like us all, can be used to hiding and afraid to ask for help, even for a food parcel - not just when the fridge is empty, but also, when their own family is on holiday in the Bahamas! The airport lounge is not the best place to tell the family you cannot put food on the table!
Ethical issues are embedded within a wider social context as well as a deeply personal context which is why the issues affecting the care of our elders is complex -not just for the more obvious issue of the goals of care at the end of life and the euthanasia debate, but also for the major issue of the allocation of healthcare resources. These ethical issues are interwoven, not separate which is why the bigger picture must necessarily be informed by a sense of our shared humanity.
Allocating Healthcare Resources
There is general agreement that there is a basic right to healthcare. In Catholic Social teaching the statement that healthcare was a basic human right because it was necessary for human flourishing was first articulated in 1963 by Pope John XXIII in his encyclical letter, "Pacem in Terris." Every "person has the right to life, to bodily integrity, and to the means which are necessary and suitable for the proper development of life [these are] particularly food, clothing, shelter, rest, medical care, and [finally] the necessary social services." [iii]
Complexities arise in the implementation and application of the principle – simply put – "who should get what healthcare resource and how and under what circumstances and where should this be provided?" "Who? What? Where? How? Why?" What challenging questions in an already challenging environment! Allow me some general comments.
A number of foundational figures in bioethics such as Daniel Callahan and Norman Daniels say that the allocation of healthcare resources presupposes the question of the meaning of life and its value. In other words without a unifying vision of old age and its meaning and value – and for ourselves that vision is necessarily informed by principles from the Christian healthcare and ethical tradition – then we cannot engage in profitable debate on allocation of resources or indeed on assisted suicide.
To paraphrase Norman Daniels, a unifying vision of old age is one that does not view different groups in society competing for the same limited resources, but is one that sees all groups as sharing in the same resources over a whole lifespan, and therefore, accepts the need for prudential rationing over the lifespan. [iv]
Thus, a unifying vision of old age faithfully expresses the wisdom of the Maori proverb that the essence of the child is the same as the essence of the elder. 'Ko te wa ki mua e whai ake nei ki muri' means that the issues around the immunization of children in Northland finds an echo in the issues surrounding hip replacements in Southland. It also means that our aged care facilities must not be 'deserts of loneliness' where our elders are increasingly isolated but homes where their humanity and dignity is honoured by all in the community.
Without such a vision we will create what Mark Waymack calls the "social distancing between generations" which diminishes the ability of the younger generation "to imagine the predicaments, hopes, and fears of the elderly." Likewise, social distancing between generations diminishes the ability of the elderly to fully appreciate the problems, needs, and constraints facing their families." [v]
Right to the very end the soul can grow and flower and mature. That is why we need safe places such as hospices and the social services offered by the Body of Christ, and represented here this morning, for this work to occur. Ultimately, the work of aging and the work of dying is fundamentally the work of living life and depthing our shared humanity in all its fullness. It is a work that can only be done together.
Allow me to conclude with a little poem:
Once again I confess
That this is my vocation
My only one – to love them,
To love the many...
So many that my heart
Becomes like a doorstep
Trodden on by everyone in the street...
I pray that at the end of my life
It will be worn thin as a wafer
And broken in two
So as to belong to him irrevocably...
This poem comes from an article called "Between the Hammer and the Anvil: Thoughts about Community..." It was written by my brother Pat's friend – Jim - who was also known as James K Baxter. At age 17 I was yet to understand, as Heschel reminds us all, that the prophet is a person first and foremost, not a microphone. By focusing on how he looked I missed the only opportunity I ever had to meet him!
God bless you.
This article is based on an address given on 22 April 2010.
Rev Dr Michael McCabe is Director of The Nathaniel Centre
[i] Abraham J Heschel, The Prophets: An Introduction, Volume I.
[ii] "Making Babies: Surrogacy, Reproductive Tourism and Transnational Adoption in the Contemporary World." 20, 27 April 2010. The lecturer was Dr Catherine Trundle, Department of Anthropology, Victoria University of Wellington.
[iii] Pope John XXIII, Pacem in Terris, 11 April 1963. n.11.
[iv] Norman Daniels, Lifespan Approaches to Health Care in Jecker, Nancy, ed. Aging and Ethics New Jersey: Humana Press 1991.
[v] Mark Waymack, Old Age and the Rationing of Scarce Health Care Resources in Jecker, op. ed.