Day for Life: care for the body

The fuss over the theme for this year's Day for Life has reminded me of a piece of work that I did some years ago now. This work looked in a detailed way at the different aspects of the Church's mission with regard to healing. In one section I argued that the Church was committed to the care of the physical body, particularly of the person coming to the end of their life, because that provided a testimony to her belief in the resurrection of the body. As the last sentence of this section suggests, the call to value the physical body in the light of the resurrection of the body represents a theological principle for the provision of bodily care for the person coming to the end of their life, and so for the opposition of the Church to euthanasia and assisted suicide.

The mission of physical healing is often undertaken in the light[1] of death or serious suffering.  For the Christian, the ministry of health care takes place in the context of the mystery of sin and redemption, of suffering and death. 

“…especially when faced with the mystery of physical and spiritual suffering and death - we must preach ‘Christ crucified’ and with the words of the prophet Isaiah teach people to turn their gaze to Christ who was ‘wounded for our transgressions, he was bruised for our iniquities’.  This truth is the central point of what we would call drawing near in dialogue to, and the real accompanying of, sick people and all those who suffer (and in a special way the dying), aware that only in the passion and death of Christ, and as we will see below, in his glorious resurrection, is it possible to discover a ‘why’ for these dramatic companions of the human condition..”[2]

Health care ministry is undertaken in the light of the resurrection - that is, in the hope that the body cared for in its suffering now will be raised up in glory in the future.  When healing occurs, it is a very visible testimony to this hope in the resurrection of the body.  When healing does not occur, the care shown for the body of the sick person, that is also a care for the very person himself, remains a witness to the faith of the Church in the resurrection of the body. 

“On caring for the sick, you know that one day they will discover the attention now being given … This weakened and broken body we now care for with veneration will rise again, glorious and radiant.  The traces of our affection and attention will remain thereupon forever.”[3]

This understanding of health care as being undertaken in the light of the resurrection of the body gives a rich meaning to the care of those who are terminally or chronically ill.[4]

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[1] Faith in the resurrection prompts the use of the word “light” rather than “shadow”.

[2] Cardinal Rodolfo Quezada Toruno “Palliative Care in the Light of the Death and Resurrection of the Lord”, in Dolentium Hominum: Church and Health in the World  No.58 (2005 n.1) p.64.  See also Oswald Gracias “Identity in Faith in Catholic Hospitals”, Dolentium Hominum: Church and Health in the World  No.52 (2003) pp.86-92.

[3] F S Aguilara in “Christian Attitudes in Care for the Elderly who are Terminally Ill”, Dolentium Hominum: Church and Health in the World  No.29 (1995 n.2) p.23.

[4] It also represents a positive statement of the Church’s teaching that euthanasia and assisted suicide are not morally permissible.

Faith in Health Conference 2010: what makes a medical professional?

Though the question of what constitutes medical professionalism was not prominent in the titles of the sessions, it did nevertheless arise in more than one of the plenary lectures. The quality of the contributions on this point was, in my view, disappointing; but I should perhaps qualify that by recognising that those speakers who did touch on the question were not addressing it directly or fully.

Introducing one of the plenary lectures, Baroness Cumberlege referred to the report of a working party that she had chaired for the Royal College of Physicians in 2005, a report entitled Doctors in society: Medical professionalism in a changing world. The report can be downloaded in .pdf format from the website of the Royal College. Baroness Cumberlege cited its definition of medical professionalism, from chapter 5 of the report:

Medical professionalism signifies a set of values, behaviours, and relationships that underpins the trust the public has in doctors.

In itself, this didn't sound very useful (my notes taken at the time used the word "poor") because it does not define the "values, behaviours and relationships"; but it does need to be read with the description that follows immediately in the RCOP report:

Medicine is a vocation in which a doctor’s knowledge, clinical skills, and judgement are put in the service of protecting and restoring human well-being. This purpose is realised through a partnership between patient and doctor, one based on mutual respect, individual responsibility, and appropriate accountability.

In their day-to-day practice, doctors are committed to:

• integrity
• compassion
• altruism
• continuous improvement
• excellence
• working in partnership with members of the wider healthcare team.

These values, which underpin the science and practice of medicine, form the basis for a moral contract between the medical profession and society. Each party has a duty to work to strengthen the system of healthcare on which our collective human dignity depends.

In the same session of the conference, Sr Margaret Atkins talked about how Catholic health practitioners might preserve the sense of purpose which they had on entering the medical profession in a working environment that pressures them to move away from that purpose towards purposes driven by their employers or by government policy. Though not offering it as a definition of what medical professionalism is, Sister identified the healing vocation as having three elements: the making better of people who are sick (cure or healing), the provision of care and comfort, and the preventing of illness or keeping of health. The medical professional has responsibility for the patient in terms of their health, that is, in terms of these three elements.

At the beginning of her talk, Sr Margaret indicated that what she was going to talk about was, firstly, how those present as health care workers could keep their sense of purpose and secondly, and in my view quite significantly, how they might pass on that sense of purpose to others following them into the medical profession. This idea of "passing on" indicates that there is something that is permanent and unchanging in the idea of what it means to be a medical professional, and that that something is determinative of the nature of the profession. The implication of the RCOP working party report is quite the opposite. It suggests that the defining of medical professionalism needs to be responsive instead to the wishes of society around us.

I was a little disappointed that, in the discussion on professionalism in medicine, no reference was made to Luke Gormally's chapter "Medicine as a profession and the meaning of health as its goal" in the Linacre Centre publication Issues for a Catholic Bioethic. In that chapter, Luke Gormally is very critical of the World Health Organisation definition of health in terms of human well-being, the term that is adopted by the RCOP report. He argues instead that it is somatic health - the well-ordered organic functioning of the body - that is the proper goal of medicine as a profession. The purpose of the medical professional is then the restoration and maintenance of health defined in this way. It is this purpose that is the basis of the relationship of trust between the health professional and the patient. The professional is dedicated to the restoration and maintenance of health, and will not act in a way opposed to this, even if asked to do so by a patient; and the patient is deserving of courteous and just conduct from the professional out of respect for his dignity as a human being. The language of partnership and mutual respect in the RCOP description allows for something completely different.