Contradictions

For one of my theology courses, I have the task of interviewing at least one ministry professional and/or end of life lay care professional per unit; ideally, this is meant to demonstrate some above and beyond level of commitment to the course material to my course instructor, and more to the point, it’s probably meant to reinforce ideas learned from the material itself in order to cement a learned understanding of the doctrine.

However, that just hasn’t been… exactly what’s come of it.

“I want us to keep in touch.” That was what Chaplain P said after I pushed the ‘end’ button on my recorder. “I want to keep in touch over this summer and have you shadow our chaplains after your surgery.”

Later, she emailed me into a cc’d email to a colleague at the hospice I’m already volunteering at. I replied saying ‘thank you’ and told her I was in the process of transcribing out interview. She replied back. “You have the heart for this work. You definitely have the desire and the compassion for the area you are pursuing.”

When I had called Chaplain P the week prior to arrange for me to come in, she asked how much time she should block off. I assured her that I’d only need an hour of her time, and that I’d pre-send the questions and presentation materials for her review. She blocked off an hour and a half for our meeting. Maybe she could hear my guilt and felt the instinct to validate me, or maybe she was legitimately interested in my project and didn’t want to miss out on the opportunity.

The day of our interview, Chaplain P presented me with the complete binder of onboarding materials for all Spiritual Care program volunteers.

And when I say “presented,” I mean that Chaplain P called another chaplain and said, verbatim, ‘Listen, I’m giving the finished binder away, so we’re going to need to prepare another one, alright?’ She smiled, rolled her eyes and shook her head listening to the speakers on the other line.

This binder is more svelte than the binders I’ve received while onboarding in other programs, but only because it’s more to the point. Inside are program policies and procedures, education materials on several dozen cultures and religions and highlights of their moral customs regarding medical treatment as well as forms, need-to-know contact numbers and gentle reminders to practice self care.

Without prompting, Chaplain P began a monologue that was recognizably guided by the itinerary of my interview questions. She introduced herself (a woman who left her native congregation to push the boundaries of her permissions), her role at the hospital(more investigator than theologian), how the program came to be (out of necessity–very unromantic, but very Romantic).

Frequently, Chaplain P would remind me of her conservative roots, probably because her staunch (S-T-A-U-N-C-H) personality was anything but. But if there’s anything I’ve learned from networking with chaplains, priests, rabbis and other faith leaders, it’s that there’s no such thing as a ‘typical’ spiritual leader (which of course makes the ‘rogue priest’ archetype in media far lose its appeal on this side of my discipline, sigh).

I knew that nothing about Chaplain P was orthodox. I knew that nothing about her program was orthodox—how could it be? It was unlike anything else. Not even secularized—just uniquely Orlando.

It was during this point that I admitted to being nervous about how the candor of these subjects would be received for this… particular course. (I hadn’t received any feedback from my professor at this point, but from his format, and his tendency to juxtapose rather than complement secular thinking, I was gathering that he was closer to the conservatism that Chaplain P bowed away from.) She asked me what discipline I was studying under.

“Catholic.” (I paused, and she smiled. I can confirm that this isn’t just for dramatic effect–that’s exactly how it pans out on the recording.) “Because I think I’m a masochist or something.”

She was gentle. She shook her head, still smiling. “That’s fine.”

I felt obligated to clarify. “Well, I mean… I’m Jewish. I’m ostensibly a Jew. Patrilineal. My mom wasn’t. My parents… have a difficult marriage. They converted to Catholicism. We all did, because, you know, that’s the nature of it. But then we all fell out with the Church.

She nodded like she understood. It was a technique from her ‘ministry of presence’. This is best explained in her own words:

I come from a very conservative background, but this ministry is a ministry of presence. It’s not the same as evangelical ministry. I’m here for the patient. I’m asking them to help me help them. Sometimes churches reach out to me and ask to bring their congregation here to pray over our patients, and I tell them ‘no,’ because that’s not what our ministry is about. Some folks are referred here from their churches and have it in their head that they’ll do things a certain way, and out of maybe the 12 that show up on the first day, one or two might make it through our training. And I want to reiterate, this is not your church’s ministry. This is ministry of presence. I believe that God brought our patients here to us, and our job is to come to them as we are and as they are. I believe that we die the way we live. It’s important to be genuine and authentic when we accompany patients in the dying process.

Ministry of presence. She was good. I felt heard. I felt validated. I didn’t feel inclined to share anymore, since I didn’t need to explain. “It feels like the right place to pick up.”

In almost every single way, the unique beliefs and practices Catholicism are diametrically opposed to everything in Judaism—its cores and foundations, implicitly my cores and foundations.

But they’re also remarkably compatible with the trends of the mainstream world. Catholic bioethics and medical culture go hand in hand.

catholic-funeral-traditions-bible-cross-rosary-main

Really. They do.

The dialogue between medical science and Christian faith has for its primary purpose the common good of all human persons. … Both are grounded in respect for truth and freedom. As new knowledge and new technologies expand, each person must form a correct conscience based on the moral norms for proper health care.

Per the 5th edition of the Ethical and Religious Directives for Catholic Health Care Services.

This is unsurprising. Western scientific advancement and theology have almost always enjoyed a symbiotic relationship, give or take some minor differences. Particularly if we can forgive the whole Galileo thing. (Some folks just really want to go down that road again, though.)

Life-prolonging medicine has, from a religious standpoint, blessed us with longer lifespans and broader opportunities to live spiritually fulfilling and stimulating lives and to correct the accumulated sins that meet us early on in our mortal journeys. Such opportunities are gifts that the saints would never confess to wishing they had for their own existences, but gently alluded to in hopeful remarks to their successors, such as in the case of Cafasso, who awaited spiritual cleansing through death but hoped that others who saw his example might attune themselves to start this process in life so as to avoid what he felt to be his most unholy qualities, or in the case of the surviving Ambrose, who navigated his grief by projecting how he and his sister might be able to account for the loss of their most pious brother and his dutiful disposition.

However, the prolonging of pious suffering extends into a new dimension of suffering that would have been inconceivable, not to any divine being but certainly to our spiritual ancestors. We outlive infections and cancers only to die of debilitating chronic diseases (physical and psychological); the sacred bodies of incorruptible martyrs like the ones described in Augustine’s reflections seem improbable in (super)natural origin despite the effort to replicate the effect.

Medicine culture, much like Westernism and Christianity, is at once overbearing and also unapproachable. With the promise of a cure or a prolonging agent for every ailment or inconvenience, we overwork to afford access to medical care or plunge ourselves into incomprehensible amounts of medical debt and hope we live long enough to negotiate with bailiffs over the phones. Sometimes, when the stakes seem too even, those promises are just outright broken.

The ethical quandary isn’t lost on the Church. Nor is the difficulty to validate the narrative. Consider the formative attitude toward death before we even broach the topic of prolonging life:

The Jewish way of negotiating death is very direct. In this life, we carry out the mitzvot. After death, we are rewarded for our service to Hashem. (Very ‘Lifetime Achievement Award’-y.) The body is watched for its passing. The corpse is handled with swift care by the chevra kadisha as the once-vessel of the soul. It is interred as soon as possible with minimal adulteration. The bereaved are guided by the follow the schedule of aveilut. The period of intense morbidity is brief. Mourners may revisit the gravesite on a momentous day to leave cairn, but they also may not. There is no debt to death, or to the dead.

The Catholic way is the way of death. The entire premise of Christianity is a covenant of mortal sacrifice, and the promise of redemption through death.Through death is resurrection. Death is a very exuberant occasion for the Church, and it is celebrated on a weekly basis at mass. Barring occasions where the fear of disease (or opposition to the smell) triumphed, churches handled interments on-site, either within the church foundations themselves, or on the immediate periphery. Preference was accorded to economic statues, of course. Tokens of the saints’ deaths, relics, were handled as charms of fortune.

Of course, being rooted in Judaism, Catholicism has had to manage several loops to differentiate its death fixation from morbid obsession. *If* such a distinction can be made.

In the introduction to the famous ERDs, it is suggested that “While the Church cannot furnish a ready answer to every moral dilemma, there are many questions about which she provides normative guidance and direction. In the absence of a determination by the magisterium, but never contrary to church teaching, the guidance of approved authors can offer appropriate guidance for ethical decision making.”

The Church and the individual struggle with the word ‘dignity,’ a shared symbol for two diametrically opposed interpretations.

‘Dignity’, in a Catholic sense, is paired with ‘vocation,’ as in the divine purpose and common destiny; while it can be negatively impacted by sin, it is inherent and constant. But the individual has learned that dignity is conditional and earned from earmarks of value and milestones in society, and, most importantly, not inherent. Furthermore, it believes that some lives are incapable of having as much dignity as other lives. This dignity discourse is the most divisive between Catholic and non-Catholic persons, almost definitely because of this subtle, but serious difference.

However, even with its own clear working definition of dignity, the Church’s logic seems at odds with itself. The use of medical technology to aid heterosexual couples in overcoming issues with procreation is ‘undignified’; ruefully, the Church admits, “While we rejoice in the potential for good inherent in many of these technologies, we cannot assume that what is technically possible is always morally right.”

Conversely, assistive function machines and artificial nutrition for severely debilitated patients who are unable to consent are mandatory: a stark contrast to the suggested extreme case scenario, where “an insistence on useless or burdensome technology even when a patient may legitimately wish to forgo it” is seen as being as morally reprehensible as “the withdrawal of technology with the intention of causing death.”

Yet while the ERDs promise that there is no moral penalty for voluntary withdrawal from life-prolonging procedure, the Declaration on Euthanasia is less nuanced, stating that:

Euthanasia is used in a more particular sense to mean “mercy killing,” for the purpose of putting an end to extreme suffering … from the prolongation, perhaps for many years of a miserable life, which could impose too heavy a burden on their families or on society. …Furthermore, no one is permitted to ask for this act of killing, either for himself or herself or for another person entrusted to his or her care, nor can he or she consent to it, either explicitly or implicitly … The pleas of gravely ill people who sometimes ask for death are not to be understood as implying a true desire for euthanasia; in fact, it is almost always a case of an anguished plea for help and love. (II)

The word ‘burden,’ here, of course carries connotations married to the non-Catholic idea of ‘dignity’ by being its polar opposite. In no short terms: if you are a burden, then you are void of dignity. Problem solved. However, the Declaration approaches this word from a Catholic vernacular as well, prefacing that “It is also permissible to make do with the normal means that medicine can offer.”

Therefore one cannot impose on anyone the obligation to have recourse to a technique which is already in use but which carries a risk or is burdensome. Such a refusal is not the equivalent of suicide; on the contrary, it should be considered as an acceptance of the human condition, or a wish to avoid the application of a medical procedure disproportionate to the results that can be expected, or a desire not to impose excessive expense on the family or the community. – When inevitable death is imminent in spite of the means used, it is permitted in conscience to take the decision to refuse forms of treatment that would only secure a precarious and burdensome prolongation of life, so long as the normal care due to the sick person in similar cases is not interrupted. (IV)

Here lies the logic connecting the context of ‘burden’ to the definitive understanding of what renders an assistive technology as overreaching, as in the case of the reproductive aids.

It doesn’t take more than cursory analysis to recognize that this logic isn’t perfect. It’s not even agreeable to me. It’s most certainly not agreeable to Chaplain P. I think back to our interview,”Not all other chaplains agree with me on this… ” she forewarned before she described a vacationer who suffered a sudden accident and signalled to be cut off from life support. “Remember how I said that I believe that we die the way we live? I strongly feel that just because we can do something doesn’t mean we should.”

I think back to how that language is used so differently in the ERD. I think about Catholic vernacular and its moral integrity. I think about how the promise of life eternal is a lens to comprehend the mainstream dialogue of mortality and the key to immortality.

The apparent contradictions and the blocked intersections to my living experience aren’t as perturbing as they may have been in another life, or even so much as they might become in my continued course of study. My life and my shifting sense of identity has always been at the crosshairs of these intersections.

Maybe that’s what Chaplain P sensed in me when she prefaced her email to me the next day with “Ariel, I am confident you will do just as well as previously.”

Had I decided to interview at the Seventh Day Adventist Hospital, instead, I probably would have had a much more straightforward experience that would have lined up with the goalposts of the outline assignment. I would have been able to ask my questions and receive predictable, perfunctory, sometimes profound (in all the right places) answers. I would have made a pleasant connection. I would have meditated on the synergy between the health care field and the spiritual care field and mused on surface social problems.

I’m so glad I didn’t.

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