Editorial: Compassion - Beyond Constraint
Issue 4, August 2001
One of the themes frequently heard from hospice team members and from those who work in aged-care facilities concerns the constraints placed upon their work of compassion.
Some of these constraints are systemic and flow from the nature of healthcare delivery, while others come from further afield or from within the healthcare professional. Constraints may come from the endless paperwork and bureaucratic negotiations needed to secure adequate funding for healthcare delivery. For example, how does a hospice or aged-care facility maintain an overarching value of compassion and welcome in the face of very strict criteria for the acceptance or the non-acceptance of a particular patient? What do such criteria do to the philosophy and standard of care? Time spent on necessary administration can in fact seem far removed from the call to compassion. Then again, these institutions may have to face the very real constraint of donor fatigue – the eroding of financial support from established donors who cry "enough" when confronted by one more worthwhile cause in a tapestry of social needs. Do financial constraints impact adversely on the quality of the healing partnerships that are at the heart of hospice and aged care? Do financial constraints actually shorten the continuum of care that can be offered by healthcare workers or healthcare institutions?
Often these constraints come from within staff dynamics or from within the patients themselves or from within the healthcare professional. What impact, for example, does professional burnout have on compassion? The overfull calendar can easily become the constraint of busy-ness by another name. These and similar pressures can constrain the virtue of compassion.
It takes great skill to be present totally no matter what the constraint. It also takes great skill and compassion to rise above institutional, patient, and family dynamics in order to provide compassionate care.
During the 1980s I was a member of the Mary Potter Hospice chaplaincy team. During that time I recall meeting Kathleen. I well remember the day she died. That day had been a little quieter at the hospital and hospice leaving time to catch one's breath... with a short visit to the patients, and the celebration of evening mass for the sisters, the day would be free.
I always had a feeling of getting nowhere with Kathleen – she was more than a little sad and neither my brashness nor charm seemed able to pierce the all-pervading cloud of disappointment that she lived in.
"How are you feeling tonight Kathleen?" Nothing. I moved closer to the bed, "Have you had a good day?" "I'm dying!"
Her reply so stunned me that my reply was both inelegant and clumsy... "Does that worry you Kathleen... I mean are you feeling peaceful about it?"
Again the response came from the depths of her soul, "It is what I deserve!" Desperately trying to reassure her, I half-shouted back at her, "No Kathleen! No one deserves to die!"
She would not be put off, "But I do! I have been married twice, divorced twice. I just lived with my last partner – couldn't face trying again. We drank our lives, our money, our families away – and now I'm dying – it is what I deserve!"
I wanted to hug all the pain out of her. How sad to come to the end of three score and ten years and view death as a punishment for the twists and turns taken in the road.
"We need to talk about this Kathleen, and we will, but right now I have mass to celebrate. I will offer it for you and with you and then I will pop back and we can talk..."
"Well, if you like, but I don't know if I'll be there – can you hear my confession?"
I was a little late for mass but upon returning to Kathleen's room I had no regrets. She had already begun to lose consciousness, but was still very agitated – not in physical pain, but greatly distressed and very afraid. There was no time for talking now – Kathleen was beginning her final walk towards God. I knew that the sacraments of reconciliation and anointing had brought her peace with God, but I felt powerless in the face of her distress.
All I could think of was to dampen a face cloth with cold water in order to relieve her fever. As I was soothing her brow I began to reflect on the position of trust I was in. The nurses were busy with the evening drug round and were happy someone was with Kathleen. The appalling and frightening thought flashed through my mind that it would be so easy to smother her, to put an end to her distress, and an end to my feeling of hopelessness and helplessness. After all who would know?
Only me – I would know! I began to think of her story – her wanderings, her search for love, acceptance, and security.... I wasn't sure where her story ended and mine began. Perhaps I was guilty of projection that night, but it seemed to me that what she needed, what she had been searching for on the road, was someone to say, I understand, I accept you as you are, and I gently invite you to grow, to make the journey within, to discover God's presence, to discover your story belongs in the God story, to realise that your story, as it is, as it has been, can be the pathway to discovering mercy, forgiveness, compassion, hope, love....
As I wiped her brow I began to recite phrases from Isaiah, "Do not be afraid, for I have redeemed you: I have called you by your name, you are mine. Should you pass through the sea, I will be with you... you are precious in my eyes...and I love you... Do not be afraid, for I am with you... When your hair is grey I shall still support you..." In between, I prayed, "Holy Mary, Mother of God, pray for us sinners, now, and at the hour of our death..."
In the reciting of the Word with Kathleen, I witnessed peace descend into the very recesses of her heart. She became transfigured into peace and serenity and when she died a couple of hours later I knew she was meeting God in a wholly new way - in such a profound way that I could not even begin to comprehend. Death became for her the moment of complete relaxation, integration, and healing – a moment in which she and I understood that death is not what we deserve, but the very gateway into God and into eternal life.
The experience of being with Kathleen that night, and so many like her during my three years in chaplaincy at Wellington Hospital and the Mary Potter Hospice, left a profound effect upon me. I saw so powerfully the hand of God at work in peoples' lives - from birth, right up to, and including, the moment of death. It was also the first time I understood, in a thoroughly grounded way, the perspective of those who favour euthanasia or physician assisted suicide. The realisation that the case for physician assisted suicide was so complex was a very sobering feeling indeed for me. It meant I had to confront many of the issues that such a case raised. I had once naively thought that my Christian faith would protect me from such issues!
To accept physician assisted suicide as an option is to place a constraint upon our compassion. It is to say, in effect, "your journey is too difficult for you to face... and it is too difficult for me to accompany you on..." What I learnt that night from Kathleen was although her journey was undoubtedly difficult, both of us could find healing from the completed journey.
The virtuous care of the dying and the elderly provides a countercultural model to the false compassion of physician assisted suicide. Such virtuous care is the antithesis of abandoning the patient who suffers. Euthanasia is a false compassion because it uses the complexities and difficulties of the dying process as reasons for withdrawing a healing presence from the one who suffers.
Compassion does not yield to constraints. It puts them into a larger picture by creating a sacred space despite them. In doing this compassion goes beyond constraint to a place of virtue where myriad stories and the twists and turns of the journey can all belong. That is the irony of compassion. It brings healing to the one in need, but also strengthens the one who is compassionate. Equally, acts of compassion strengthen the community.
In his Apostolic Letter on Human Suffering, Salvifici Doloris, Pope John Paul II writes: "The parable of the Good Samaritan belongs to the Gospel of suffering. For it indicates what the relationship of each of us must be towards our suffering neighbour. We are not allowed to 'pass by on the other side' indifferently; we must 'stop' beside him. Everyone who stops beside the suffering of another person, whatever form it may take, is a Good Samaritan. This stopping does not mean curiosity but availability. It is like the opening of a certain interior disposition of the heart, which also has an emotional expression of its own..." 
An essential ingredient of compassion is availability. Physical presence is a part of our availability but of even greater importance is our interior availability. Most constraints on compassion are, in fact, from within ourselves. For example, in tending to the patient's physical needs we may be closed to the deeper concerns of the patient. Our bright and cheery manner could be another way of preventing the deeper discussion. Then again, we may not have the interior resources to be available at this particular time and to this particular person. That is why teamwork is essential. A coherent team enhances the virtue of compassion in action while nurturing the caregiver at the same time. Teamwork allows particular team-members to have interior space when it is required.
Hospices and aged-care facilities have always faced constraints – constraints from within and constraints from further afield. Nevertheless, many have become icons of compassion in New Zealand because they have tried to meet patients and their families and carers at their point of need. Good facilities for the aged or dying embody a moral community of care – one that is specifically shaped by a compassionate paradigm of caring over curing. Such a paradigm neither hastens death when a person's condition has become onerous, nor does it prolong dying in order to preserve life at all costs.
Often our compassion becomes the only means for people at the end of life to discover the very face of God. If not us – then who?
 Pope John Paul II, "On the Christian Meaning of Human Suffering" "Salvifici Doloris" n. 28. Vatican City: Vatican Polyglot Press, 1984: 64
Rev Michael McCabe, PhD
The Nathaniel Centre