The word palliative is derived from the Latin palliare, or cloak. Cloaking, or palliative care teams, manage the pain and symptoms suffered by patients diagnosed with life-limiting illnesses. Pain is often a complex synergy of the physical, emotional, spiritual, and social issues a person and family are undergoing, and because few modern medical students are trained to treat such pain and symptoms, doctors feel unprepared to address it. Palliative care teams intentionally address pain and symptoms: they include specially trained doctors, nurses, pharmacists, social workers, and spiritual care advisors who providing care beyond cure, as necessary. Palliative care, not medically assisted dying or euthanasia, is the appropriate response when doctors concede “there is no more we can do.” Provision of palliative care requires policy, though: budgets, training, and accreditation of providers These, in turn requires advocacy to build political support. Without that, the default rational option for long-suffering patients is support for medically assisted dying and euthanasia.
Palliative care has value in itself, though, apart from serving as an ethical foil for the medically assisted dying movement. It heals the deficits of bio-medicine and preserves the profession from harm by completing it, expanding it to its natural limits, restoring it to its original self as holistic practice. As such palliative care is the salvation of medicine, from the Greek sótéria, which also means deliverance. When biomedicine runs out of cures for the chronic conditions afflicting moderns, particularly the elders among us, and mortality inevitably asserts itself, palliative care delivers medicine of its self-imposed fear of failure to cure.
The spread of palliative care in the 21st century represents an evolutionary turn in dark times. It has the potential to honour and heal body politics damaged by the centuries of systematic indifference to all modern culture deems unworthy and unsuccessful: sickness, death, disability, old age. Palliative care, as a socio-spiritual-clinical praxis of love in action, honors and heals the worm at the heart of modernity. It does this by promoting an inclusive attitude that sends grace and healing to the parts of the body politic that are hurt and weak, rather than rejecting them as a cause of pain and disgrace.
Palliative care is a secular instantiation of the originally faith based hospice movement, the “Omega point,” described by paleontologist and Jesuit priest Teilhard de Chardin: the fruit of evolution that works “through an organized system of awareness, a combined operation of knowing, feeling, and willing. [This] gives rise to new patterns of cooperation, new organizations of awareness, where new and often wholly unexpected possibilities have been realized.” Palliative care is one such new organisation of awareness that gives ground for hope in dark times.
The resonance patterns palliative care produces have political, as well as ethical significance in that they create new markers, set new bars, for policymakers. The palliative care approach proclaims, through praxis, that how individuals die matters to the well being of the healthcare institution, society, polity, or state. Simply put, the how, why, and wherefore, of every single death, however anonymous, humble, or exalted, either damages or dignifies the body politic as a whole. Many centuries ago, the poet John Donne wrote, “Any man’s death diminishes me, because I am involved in Mankind.” But really, peoples’ deaths only diminish us (individually or collectively) when we fail to attend to them in a meticulous and reverential manner. Properly attended, a death enriches the caregivers and bystanders: instructing, sharpening gratitude for the gift of service.
Contemporary palliative care perfects the ancient (classical) virtues of practical wisdom (techné), generosity, courage, and friendship. It generates new algorithms within communities that provide an interpretive key to optimal (evolving) human functioning that perfects and complements, rather than challenges, curative medicine.
Modern medicalised cultures falsely separate reason and mystery, disdaining death by disease a failure, and the dying process disgraceful. The growing political power of the medically assisted dying and euthanasia movements attest to the power of this perspective. These movements provide moderns rational choices in an era of public policies that ignore and marginalise the old (because they are closer to dying), and seriously sick people in general. Palliative care is a sideways, counter-cultural, move that accepts the difficulties of dying, and attends to the physical, emotional, spiritual, and psycho-social suffering it generates.
Palliative care’s privileging of presence and accompaniment through the dying process supports family members and caregivers, rather taking their unpaid labour for granted. For many patients and unprepared families, the prospect of intimate caregiving represents a dreaded multi-year chore, understandably relieved by easy access to medically assisted dying. The policy challenge of presenting palliative care in a positive light, as a public health platform, rather than an expensive add-on or extra burden for already burdened healthcare systems, are significant. Palliative care’s inclusion of families and caregivers into the circle of concern is a key advocacy point.
Besides the preventive implications for stress and anxiety induced co-morbidities such as heart disease and cancer, the psycho-spiritual expertise of team members can heal multigenerational wounds and fractures that drive endemic substance abuse and violence. Mimetically, the palliative care perspective calls for the development of a palliative culture that will challenge dominant consumer culture to transform organisational priorities.
Palliative care services are available to only 20% of the world’s people who need them. Fulfilling the evolutionary curve through training and advocacy will serve the remaining 80%, whose physical pain (owing to lack of access to controlled medical opioids), is compounded by unrelieved psycho-social, and spiritual pain. Alleviating it calls for the input of transnational, multi-disciplinary, teams that exist throughout the wealthy countries. What is necessary is a palliative care peace corps of sorts. The international law principle of “mutual and shared responsibility” can assist countries to develop locally based palliative care teams where these are lacking. Transnational non-governmental communities of practice are already sharing their expertise to care for the pain of one another’s desperately ill and dying, but long term sustainability entails the support of governments and publicly funded programs.
Once governments shoulder this responsibility, the healing process begins from within. Just as the hologram fragment contains the entire original picture, each palliative care team at each bedside of each terminally ill person, contains the image of the Beloved Community that can “salve” or heal the wounds of abandonment and neglect. Thus it completes, heals, delivers, the biomedicine that cures.
The grace that is the health of creatures can only be held in common/In healing the scattered members come together/In health the flesh is graced, the holy enters the world. (Wendell Berry, What People are For)