Status and limitations

Have a look at this article by two medical ethicists clearly declaring that hospital chaplains should not have automatic access to every patient or ever to patient notes. I acknowledged the part of my psyche that objected: “Bah! This is just another way of keeping religion in its lowly place.” But it isn’t. We know that there are individual chaplains who feel the need to impose their religion – they’re likely to perceive it as offering a very important service to vulnerable people. Indeed, we probably know of Pagan friends who found a Christian chaplain at the end of their bed offering their services, and how inappropriate that was. That’s an abuse of power.

I remember being fairly pushy myself when it came to having Paganism recognized in hospitals and I’m grateful for the other Pagan individuals and groups who’ve also made it their responsibility. Wherever there are institutions who have a chaplaincy service and who’re likely to have Pagans amongst them then Paganism should be officially represented on the chaplaincy panel, that’s pretty straightforward. That whole debate is about status, primarily the status of Paganism, but also about the status of chaplaincy.

If this is the case then we need to think hard about what chaplaincy is about and what our role is. Chaplaincy seems to me to be about perceiving a person as unique and as part of their own ‘ecosystem’ – relationships, history, hopes and dreams, fears, desires, abilities, the whole kit and caboodle - rather than simply as their diagnosis, and serving individuals and groups so that they can find meaning and purpose for themselves. I really like this quote

Helping, fixing, and serving represent three different ways of seeing life. When you help, you see life as weak. When you fix, you see life as broken. When you serve, you see life as whole. Fixing and helping may be the work of the ego, and service the work of the soul.

Chaplains are not part of the medical team. Although spirituality has a role in wellbeing and health this doesn’t mean that chaplains have the same role as doctors, nurses and radiotherapists. This is no threat to our status: we wouldn’t expect doctors, nurses and radiotherapists to be experts in spiritual care. I know that if I read a patients notes I will form a certain set of beliefs and expectations around those written words, it’s why notes are so confidential and the writing of them always under review. ‘Witty’ shorthand such as ‘FLK’ (Funny Looking Kid) is now recognized as reducing the humanity of the individual and being unethical and unacceptable. So it is that the chaplain – and every other person who isn’t directly concerned with the symptoms and cure of the patient – has no need to know anything about them other than what they see in front of them.

I’d say that the strict adherence to limiting who has access to patient notes is a measure of the quality of care patients receive. I know a very ethical, professional complimentary therapist working in a local mental health hospital who is given access to patient notes. She doesn’t take it but it’s not too surprising that the hospital is well known for the number of patients who abscond.

Certainly, doctors have a godlike status. Nurses are, of course, angels. I’m not sure where in the heavenly hierarchy radiographers might fall but as far as pay and conditions are concerned it’s somewhere above ward cleaners and canteen workers. That’s just the way it is, that’s a matter of society deciding that junior doctors and professional football players should be paid more than experienced nurses and firefighters. Chaplains, well we’re strange altogether, with Deity as our employer and the general public feeling both that they respect us and feel weird around us. For me, that’s just a symptom of our liminality and whilst that’s not always the most comfortable place to be it’s also entirely appropriate. This is not to say that chaplains should be content to creep around being thankful to be allowed into a hospital: that’s to get status and role confused.

Paganism should be given the same status as any other religion. Pagan chaplains should be treated with the same respect that other chaplains are offered, and all chaplains should be treated with the same respect as any other member of the healthcare team. But our role is not to tell people what’s best for them. Neither is it to do things at or to a patient. Although chaplains of all faiths have a responsibility to our gods and the culture of our religions we have a greater responsibility to offer something that other people who work in healthcare cannot: we offer love. We are with patients in a unique manner; we bring the empathy of the professional psychotherapist, the communication skills of mediators, and leadership functions of senior staff. We add a thorough, boundaried and flexible knowledge and understanding of our religion and, on top of it all, the wisdom that whatever a persons religion, spirituality or atheism they are equally worthy of our attention.

High status is lovely but the role of the chaplain is not to compete, it is to Be With people who have requested spiritual input. As long as that is facilitated in a quality manner and chaplains of all faiths are treated respectfully what more do we need, and why?

Note Keeping

Because of audits and keeping track of who is where with whom chaplains have to keep some notes. It’s worth remembering the intent of these notes, what they’re not intended for and how they may be used.

The written word has such enormous authority and at the same time can be so ambiguous as to be used and misused by people with very varying purposes.
There’s an art to note keeping, you need to record the fact that you and a particular patient met at a certain date and time and that’s it. There’s a temptation to go into detail and things can begin to unravel quickly, sometimes years after the event.

“X seemed excited today” can be read as “X was sexually aroused.” “X was agitated:” was that generally or specifically around you? Did that agitation have any connection to his behaviour later in the evening, and who did you inform about his agitation? If X goes on to offend or if a clinician or a barrister wants to make a point about X or about your relationship with X or with your way of practicing you can see how your own words can be used to prove something that you did not intend. If we use words that we don’t really know the full meaning of – like ‘manic’ or ‘depressed’ or ‘labile’ – then those words can come back to bite us, used both to prove something about a patient or to demonstrate our own lack of knowledge. You can imagine in a court being asked: “Can you describe what you understand the meaning of ‘manic’ to be? And can you tell the court what your professional qualifications are?”

I get a bit weary when overly anxious people start making noises about the desperate threat of litigation and how we must protect ourselves by messing everyone else about. Personally, as long as the patient, the ward staff and I are happy for something to happen, like taking a patient off the ward, then off we go. It would be so much more safe if we remained in a glass box with audio and videotaping but there are implications for the quality of our relationship. But. The written word supersedes memory in importance. Notes are, not unreasonably, assumed to be an accurate, contemporaneous record of events.

I write notes as if the patient is going to read them which helps me stay focused on what I’m communicating and how it may be read. It’s easy to forget that whilst we are afforded the same respect as other professionals in a clinical setting we are not serving the hospital but the patient. It’s tempting to try and match specialist language or to demonstrate to a putative professional reader that we function at the same level as they do; a paradoxical temptation since the less confident and settled we feel in the role of chaplain the more likely we may be to fall into this style of writing. In the very unlikely event that you’re asked to write anything more than the fact you met then you really should ask for written guidelines about how to write notes for that hospital, then discuss them in depth with the lead chaplain and write those notes under their guidance at the same time as keeping your highest ideal very clear in your own mind.

Perhaps the most fragile and important aspect of the relationship between chaplain and patient is trust and every attempt must be made not to break it. Patient confidentiality should be the basis from which anything is written. If you have a doubt about their safety or the safety of people around them, your notes are not the place to record this in the first instance, you should seek immediate and appropriate support, almost certainly from the lead chaplain. Before you discuss a patient with anyone else it’s an article of faith that you discuss it first with the patient themselves. Saying “I’d like to talk to my boss about this,” creates a space for meaningful communication, you’re demonstrating that you know your limitations, that you’re confident in discussing your limitations with the patient – because it’s not a matter of weakness to know when things are going beyond your remit, quite the opposite. And it models the normality and safety of knowing that we can’t deal with everything on our own, that discussing a difficult matter with someone trustworthy is worthwhile.

When you’ve talked with the lead chaplain and come to a decision, put that in the notes. A patient told me he was going to try to abscond. We talked about why and what this might achieve and so on and still, he declared he was going to try to escape. I didn’t actually believe that this was the case at all, but an expression of despair, a desire for boundaries and attention which would be achieved when I told the staff, which I was obliged to do. But first I told the patient that this was the case (as he knew it was) and that I would have to talk to my boss. I made a verbal contract with the patient that they would not abscond and not make a final decision about absconding until I’d spoken with my boss. Then I asked for an urgent meeting with my boss which primarily served to help me feel better about talking to the ward staff, 15 minutes later. My notes remained very short, about 2 sentences more than normal and limited to absolute fact. Life in hospitals is dramatic and gossipy enough: there’s no need to add to it or get caught up in it.

Confidentiality is entirely breached if you are summonsed by a court, which may happen if your patient does something unlawful or accuses the hospital of something unlawful. In my private psychotherapy practice I simply don’t keep client notes any more which simplifies matters no end and I shred my personal reflections, which are about me rather than clients, around a year after we finish meeting. But hospitals keep notes for a minimum of 5 years and particularly in psychiatric care they can be kept a lot longer and have the potential to be incendiary.

Some of the patients I see are likely to reoffend when they leave hospital and it’s possible that some years into the future I may be asked to give evidence in court. What are my responsibilities? Who am I serving? My answer is that I am serving the cause of truth, that I am not a judge or a jury and that justice will be served by them, not me. The relationships that are co-created with the people I see are delicate, part of the healing process is served by offering and being able to sustain deep trust. If they are then accused of something grave I have to just answer questions as faithfully as I can and put a great deal of trust in the Goddess. I fervently hope it never happens.

Note keeping is a vague subject at the best of times and there are differences between US and UK practice. In the US the Health Insurance and Portability Act appears to cover this minefield. (In an avalanche of impenitrable information, Wikipedia seems to have the best coverage. But my keyboard doesn't have a hash key and the link requires it.)

http://en.wikipedia.org/wiki/Health_Insurance_Portability_and_Accountability_Act#Privacy_Rule

Here is something less fuzzy for US chaplains that is also of interest to UK chaplains.

Frankly, I have little idea what the Data Protection Act has to say on the matter but believe in keeping it really simple: I keep no chaplaincy notes on my own computer. I used to send my notes by email, but now write them at home, print them out, hand them over to the Chaplaincy Office at my next visit, and keep one copy in a file in a locked filing cabinet. If I know my next visit is going to be longer than a week I’ll write the notes at the end of the day in the hospital itself and take them to the office.

Wherever you practice your chaplaincy notes should be kept separate from the clinical notes. Although spirituality has a proven positive contribution to wellbeing and health, chaplains are not part of the clinical team for excellent reasons. We are not primarily concerned about cure or illness or insurance, it’s not our role to be involved in diagnosis or medication or anything other than the wellbeing of that persons essential being that exists beyond their body or their mind. It’s impossible to capture that relationship on paper and so lets not attempt to. Keep it simple: 'Met with X. Spirituality discussed'

Missed Sessions

From time to time patients don’t want to come to sessions. At first I used to worry about this and tended to take it personally – what had I done to cause someone not to want to see me? This question remains part of my reflection on missed sessions but I’ve learned that frankly, it’s not all about me!

I don’t subscribe to the theory that there is no such thing as a meaningless occurrence: sometimes a missed meeting is just a missed meeting. And sometimes there is a greater pattern to events. It can be a test, to see if the discussion of returning as much personal authority to a patient as possible has any real meaning; to test that boundary and the boundary of continued relationship. If I am rejected, how will I respond? This has implications too for modelling how rejection might be managed in other relationships.

The therapeutic literature offers different understandings of missed sessions. My own experience suggests that if a client is serious about addressing their distress they will make the effort not to miss sessions. For some clients, therapy is the equivalent for them of buying a new handbag or doing yoga, it’s primarily a statement about who they believe themselves to be and how they want to portray themselves, and when something more interesting than therapy turns up they’ll give up therapy. Some clients are told to go to therapy, very often to gain access to their children or to mime their desire to change, and these clients too are very unlikely to really engage in the relationship. Why should they? They haven’t chosen to, they’ve been ordered to.

When a person finds themselves in an institution where conformity is given high value and behavioural modalities are to the fore they - we, you, I - will seek ways of not conforming at the same time as not being punished for non-conformity. Many of the people I see do this by saying they’re Pagan, which is also a way of demonstrating that the institution cannot fulfil their individual rights. Instead, they manifest me. I’m not part of the medical team and I’m not a mainstream representative. I’m not an employee of the hospital and I don’t have any institutional power. The first question they ask me is if I will do a spell to change their situation. Who can blame them for wanting to know where my boundaries are? I make contractual safety boundaries clear from the beginning “I don’t hurt you, you don’t hurt me,” and very early on in our meetings we talk about the importance of relationship and the uses and abuses of power.

For me, missed sessions can be part of that discourse. One or two missed sessions now and again, well, that’s life. Any apparent pattern can be interesting. A missed session with no reason given is worth talking about, several missed sessions in a row are definitely worth talking about, particularly if this happens around the same time that a client told me something that might result in shame for them, or if they’re also pushing other people away.

Authenticity is central to being Pagan, central to being a properly functioning human being and entirely peripheral to life in an institution. Institutions demand Approved Behaviour rather than authenticity. Just the right amount of crying, but no self-pity; being positive but not manic; sufficient sorrow for past deeds, perhaps even a little panic, but don’t get stuck there. In some US institutions it’s wise to become a very practiced, repenting Christian. For people with anything like psychosis this is terrifically dangerous. Knowing that you will be rewarded if you just consistently appear one way rather than another is very unhealthy. (Which is exactly how we are all expected to behave.) For people who then become dangerous to the people they’ve charmed, this has implications. As a Chaplain I don’t get told and have a positive disinterest in a patients past, but I’d be foolish to ignore the implications of our setting.

There’s an institutional significance to the notion of missed sessions for Chaplains. If a patient doesn’t want to meet with a psychologist or doctor or nutritionist or any other professional it’s too bad, they have to get to the meeting or the meeting comes to them. This is reflected in their notes, a judgement about them and their behaviour is made, formally and informally. If a patient doesn’t want to see the Chaplain, he doesn’t have to, and he doesn’t have to give a reason. This offers religious freedom, protection from religious abuse and is useful in other ways too. But the difference in response between any other professional service and the Chaplaincy service reflects the importance that spirituality – all of them, not just Paganism - is afforded by institutions. That’s not the end of the world. “Professionalism” is the last refuge of many things.

The liminality around the role of chaplains and spirituality offers more space in which to practice, and that’s a double-edged sword. We have to be very clear about our boundaries and behaviours. Once more, I am thrown back on the importance of authenticity: I need to be aware of my own responses. Am I annoyed, interested, bored, upset, sad, glad to be getting off early when a patient doesn’t want to see me? What does that tell me about the relationship, about my role, about my way of being? Once I have that clear-ish, I can bring my authentic self to the relationship. What happens when I say, “I felt dismissed when you wouldn’t meet with me last week. And I still care for you”? Possibilities, sometimes in the form of terrifying chasms, can open up.

Chaplains can offer a model of relationship which is caring, boundaried, deals with power with a clarity and complexity that may never have been encountered before. That’s a heady responsibility and a wonderful opportunity.

pic by Terry Border "Bent Objects"

Is there a Pagan thealogy of assisted suicide?

All 5 Law Lords agreed that a clarification of the law on assisted suicide is required following by Debbie Purdy’s successful challenge in the House of Lords today. The Director of Public Prosecutions made some very clear and very compassionate statements on the issue taking into account people who will wish to die between now and September when there will be a public consultation. It’s not a change in the law, it’s an understanding that the law is unclear and needs clarity.

Off on a slight tangent my friend Jane in intensive care is in a pitiful state. When we last visited I had a dreadful memory of the Little Brown Dog, a mongrel in 1903 who was passed illegally from vivisector to vivisector and eventually killed, again illegally, in front of a room full of medical students. The suffragists, Louise Lind-af-Hageby, and Leisa K. Schartau, were there too, the only women allowed into the vivisection lab and the only people who objected. Riots occured, statues were erected.

We were with Jane less than 5 minutes when a team of people in scrubs arrived and ‘asked’ us to leave. 4 of those people, all women, none of whom had any ID or name badge, didn’t meet our eyes and seemed entirely disinterested in our existence. The one that spoke to us smiled, but her smile didn’t reach her eyes. Jane, meanwhile . . . well who knows, she can’t speak or move anything apart from her head, and she’s under light sedation so that she doesn’t remove all the lines and tubes. What I felt from her was profound disgust and sorrow. They may be my feelings. Knowing that Jane has consistently discharged herself from hospital whenever she’s been able it’s very hard for both of us to observe the activity of whomever the scrub-clad people might be, and increasingly maddening to watch her other visitors maniacally bounce around talking about getting better and coming home and going on holiday and all the other fantasy.

I know they’re fearful and I’m losing respect for their feelings. Their feelings have always taken precedence over what Jane might want. I don’t know what Jane wants and no one seems very interested in finding out. 7 years ago Jane was given months to live, the will to live through a shocking childhood now seemed to preserve her and I’m sure the medics find her very interesting and a fascinating challenge. I asked what their plan for her might be: “When she comes off the ventilator she’ll be moved to a medical ward.”

No one can see into the future but I think there’s a fairly good chance that Jane will not leave that medical ward and I don’t see what’s been achieved other than the absence of death which will reassert itself in short while, perhaps as soon as Jane becomes able to take some kind of control over the matter herself. She won’t be able to discharge herself now; she’ll not walk again. Is the absence of death a satisfactory result?

I’ve spent some time thinking hard about a theology of a Pagan response to assisted suicide and it seems to me that at the heart of the matter is the use and abuse of power. Jane-the-person disappeared as soon as she was made mute, all of us are projecting our interests on to her. I fear my own loss of power over my own life and death, I fear the clinical interest and the personal disinterest that I saw in the blue-clad ones. I fear that the people I love will not do what I want them to do when I begin to die but will treat the event with terror and denial and in doing so, abuse me.

So I have to relinquish all desire when I visit Jane and visiting has become very difficult. Perhaps the theory is that I will pass through some kind of trial and find resolution after which I will feel relaxed and enlightened. I’ll let you know. But right now I’m watching a woman, mute and paralysed, in a state of terrible physical and emotional distress, and there seems less interest in her as a person than there was in the little brown dog.

Love without need

I visited intensive care today to see a woman who I’ll call Jane. Jane’s life has been a tragedy from the word go. Born into very unromantic misery, brought up by uncaring people in a harsh environment, working full time aged 9. In Britain in the 20th century. Seeing this person in the street – prison and facial tattoos, staggering about and often incomprehensible – you might cross the road, but like many roaring, frightening people she’s very sensitive and exposed and I feel tearful when I think of the life that was wasted by the adults whose only vaguely gracious act was not to forget to feed her.

This person isn’t Pagan and I don’t visit her in a chaplaincy role, she’s part of our community, she’s appallingly ill and so we visit. I spent about 10 minutes there today and was struck by the strangeness of it all, of every individuals’ need, including my own, being focused through this reclining, semi-conscious lens of a person. The excellent, professional nurses yelled at her in that loving, patronising manner than many nurses have: “Hello darling, I’ll just aspirate your tube.” Her lover, Dan, has miraculously and instantly cleaned up his own problems while he spends as much time as he can at her side. He’s terrified of being left alone. Dan has found status and purpose since Jane has been in hospital. People who would not normally give him the time of day are now treating him kindly and with respect.

What are my reasons for visiting? They’re complex and not fully conscious and I hope that my main impulse is compassion. Jane and I are not intimate friends, there’s a limit to how much time we want to spend in each others company and we don’t have a great deal to talk about beyond having a bit of a laugh. Jane hasn’t got a religious bone in her body but my own needs incline me to offer something that isn’t fear or determinedly, superficially, upbeat. My need to make sense of this situation is as present as anyone else’s, but I hope – I really do hope – that my need is not so desperate that I impose it on Jane.

Jane is dying. She’s not physically alone and there’s a great deal of intense feeling in her room. I wonder, through my own clouded lenses of understanding, about peace. Everyone knows she is dying and no one close to her can bear it, it’s just such an unmanageable, fearful prospect for them. They’ve informed the funeral director, a wake at the pub has been arranged, but these are practical matters, the right and proper actions of responsible friends making forthright plans. There’s a mismatch between what’s being planned and what is being felt. There is no peace in the room.

I stood where Jane and I could make eye contact and spoke quietly to her, saying that she was safe, that she was loved. It’s impossible to know absolutely what is ethical or right or wrong when speaking with someone who can’t speak back, who is in extremis and I would, I believe, feel very desperate if a priest came to me as I lay dying and began imposing his view of the world on me. I know I would want quiet, centred people around me who would not want to hold me back or push me on. But I have a developed personal understanding of how I might approach my own dying and the dying of the people I love, I have a foundation for how I approach the dying of people who know what I do and who deliberately want me present. I have little idea what is right and wrong when I’m with Jane.

What I want to do is to shift the focus of practical support onto Dan, to get him some professional, hospital-based emotional sustenance so that he can begin to reduce his desperate need for Jane not to die. I want to find some impossible compromise with the miraculous, brilliant machines that do more than keep Jane alive, they’re making her body comfortable and safe. And they’re so noisy: the technical mattress and covers hiss, the ventilator whispers, alarms blare.

I want, for my own comfort, to speak to the part of Jane that is not a devastated human being, which is nevertheless intimately joined with every part of her human experience, to remind that most vital part of her that everything is as it should be, that it is safe, that there is nothing to fear. And so on. I want to make it familiar so that I no longer feel helpless.

My husband is so much better at this. He visits more than I do and Jane knows him better. He feels no need to do anything other than hold her hand for 10 minutes a day, to talk about the mundane which is precisely what Jane would wish to talk about most of the time, at the same time as bringing transcendent love with him. In the room he’s not as grounded as I am but he has much more capacity to simply bring Jane love without need. What a journey this is, what learning.

For pity's sake, get involved.

Last week the House of Lords rejected an attempt to relax the law on assisted suicide so that people who accompany their loved ones to the Dignitas clinic don’t have to face 14 years in prison. Britain is pretty good at fudging and it may be that this is one of those situations where fudge is uncomfortable but useful. 120 British people have gone to Dignitas so far and not one of the people who went with them has been prosecuted, there’s a tacit understanding between the police, the Crown Prosecution Service and the courts that people who go to the trouble of arranging a Dignitas ending are not likely to be murderers. Lord Faulkner who sponsored the most recent application to the Lords noted that there was a ‘legal no-mans land’ around the subject, which indeed can be dangerous. It means that the police are choosing what they will and won’t prosecute. As it is the situation is being allowed to evolve, the law following public debate rather than public debate being forced to change the law. I foresee a time in the next 5 or so years when an individual is put on trial as a way of testing public opinion. It would be a very blunt, shortsighted move to put the Downes children on trial today when public debate is raging.

A century ago, a policeman would turn up to arrest someone who had attempted suicide. Never mind the circumstances, the law was the law and a person who was actually dying from their attempt would be put in a cell and treated as a criminal. British society, which was fairly universally Christian, eventually found this intolerable and the law was changed so that the suicidal person was viewed as mad rather than bad. But still, suicide was perceived as something that must be prevented at all costs. This remains the case today. I remember babysitting a depressed elderly man who had cut his own throat so extensively that he severed his trachea. He was caught, pounced on, dragged to surgery and spent the rest of his time folded up in a chair. Nurses weren’t there to care for him, we were there to make sure he didn’t attempt to kill himself again.

Chaplains and counselors are very mindful of a clients right to confidentiality, but should the professional believe the client to be at serious risk of suicide we are bound to break that confidentiality. Other times when confidentiality must be broken are when a child is at risk and when a client is planning or admits to terrorism.

I find it absolutely extraordinary that finding ones own life intolerable is judged to be the same as raping a child or blowing up a train full of people. This is solely a religious hangover and it’s worth noting that the 3 most powerful religious leaders led the Lords rejection to a change in the law. Individual religious people may feel that their suffering demonstrates trust in their god but there’s a dangerous madness in the monotheist approach to end of life suffering. Modern hospices were set up by religious people who recognised that palliative care was not, is not, good enough; sadly, religious people don’t contribute anywhere near the sums required to maintain existing hospices, let alone building enough for everyone. When they do, I’ll be more inclined to take their anti-suicide debate seriously.

So the situation we’re left with is delicate. I heard a man tell the story of his dying mother today, in hospital, suffering, exhausted. Her family asked for a meeting with the doctor who said that surgery would extend their mothers life by two weeks. The family said they didn’t want their mother to suffer any more. “You know what you’re saying?” said the doctor, the family nodded and a morphine drip was set up to run rather more quickly than it should have done. Everyone’s heard a similar story. Nothing is said, everyone knows. It seems to me that this is no bad thing when it comes to illegally killing a person in unalterable extremis.

Doctors and nurses hold enormous power over the lives, deaths and suffering of the people in their care and the anti-assisted suicide theory is that they are there to save lives rather than kill people. But they do no harm, which is very different from not killing. It is very harmful to slice someone open or give them drugs that will kill parts of their body, and that’s what we expect surgeons and oncologists to do. When they do kill people as a criminal act they are generally caught, as Beverly Allitt and Harold Shipman were. Shipman is the only British doctor convicted of murdering patients and 23 nurses worldwide have been convicted, so it’s not something that health professionals tend to get up to. Anti-voluntary euthanasia campaigners make a lot of noise about the likelihood of abuse should VE become law, which is a disgraceful insult to the health care professionals and the people who create the safeguards around such a procedure.

It is, of course, probable that abuses of the system will very occasionally occur. Emergency services are allowed to run red lights and exceed the speed limit and very occasionally a pedestrian is killed. Does this mean that the emergency services should wait for a red light to change and tootle along at 30mph? No system is perfect, there will always be an individual who feels above the law but, as with organ transplantation, policy safeguards and transparency will prevent the vast majority of abuse and catch it when it occurs.

Practice already embraces voluntary euthanasia and assisted suicide, precedent is being set, assisted suicide is presented to the Lords every couple of years. Those people who are firm in the knowledge that any positive change in the law will open the door to euthanasia on the grounds of economics seem blind to the fact that it already occurs in catastrophic numbers. If you’re poor you’re much more likely to die miserable, alone or in a crap human storage facility. Private elder and disabled care is already a goldmine and abuse is commonplace.

I haven’t spoken with one Pagan who has a theology around keeping themselves or their loved ones alive in pain. But we haven’t begun to realistically discuss the alternatives. Some of us know about advance directives and that’s about as far as we go. A small number of us will have an idea about hoarding up a store of drugs or leaping from Beachy Head, but these thoughts are hesitant, fearful or more bravura than realistic. We really do need an open debate about the Pagan approach to what will certainly become law within the next 20 years. Judy Harrow began the debate in 1997 ‘Coup de Grace: Neo-Pagan Ethics and Assisted Suicide’ an extended version of which can be found in the Pagan Book of Living and Dying

Take a look here for some different views and opinions.

What is the British Pagan approach to suicide, voluntary euthanasia and assisted suicide? If Boudicca killed herself to avoid dishonour, is suicide OK? In which case, is butchering children and destroying Colchester OK? We need a coherent, intelligent debate based on 2 things: our theology, and what we as individuals are prepared to live with in order to balance our lives as Pagans living in a non-Pagan world. The vast majority of us are recreational Pagans, we take up the cosmetic bits of it and use it when we want some recognition but really we’re like the rest of the country in which we live: culturally Christian and just trying to get on. There’s nothing wrong with that, but it’s not a conscious decision, it’s a default position. That’s just about OK if it helps us make choices about whether to eat meat or not and nowhere near good enough when we know people who are in psychological or physical agony and we have no tools to help; not safe when practice is moving, along with the law, towards voluntary euthanasia and we find ourselves just mooching along with it.

Discuss.

Taking ownership of our last great adventure.

Lady Joan Downes and her husband Sir Edward Downes are in the news today for their joint assisted suicide at Dignitas. He was 85, going deaf and blind and she, at 74, had cancer. They’d been married for 54 years. The clerics are rolling out their doleful moaning about how very, very sad and sinister it all is

(please cut and paste this addy, I don't have a hash key!)
http://bcreepy-coverage-of-sir-edward-and-lady-downess-joint-suicide/#commentslogs.telegraph.co.uk/news/damianthompson/100003190/the-bbcs-


I know nothing at all about the Downes’ but my fantasy is that they took their time getting their affairs in order and being with their families, then got on a plane for their next-to-last great adventure. I hope they were with people they loved before going to Dignitas to peacefully, quickly and painlessly die together.

Also today Labour are announcing a vauge ideaish kind of thing about care for the elderly. They’re calling the present system of care ‘a cruel lottery’ which it most certainly is. Unless you are a unspeakably rich with a devotedly loving family you’re very likely to end up sitting in a circle of high backed chairs lining the walls of a room where the telly is permanently on, having been forced to sell your home for the privilege. Which is perhaps better than being maintained, alone in your own home by people who have so little time that they will feed you while you’re on the toilet.

Suicide rates are high in the elderly population. Although people older than 65 years comprise only 13% of the US population in 2000 18% of all suicides are in this age group . . . The elderly generally have a stronger intent to die, plan their suicide more carefully and are more likely to use lethal means of killing themselves than are younger persons.

Mary Ann Boyd, Psychiatric Nursing p260

Many apparently very sophisticated philosophical and clinical treaties have been written about the terrible isolation and psychological pain that leads many people to kill themselves. It is always considered irrational, an aberration of mind, a madness that one can take some kind of pill or psychological treatment for. This is because they are all written by Christians or people acculturated to a Christian society. Most Pagans perceive suicide through a Christian lens too.

But life will end. Usually, the weeks, months or years leading up to death will be filled with misery and pain. Most of us don’t know that because our infirm disappear. It’s all very well for domineering Christians and people who are culturally Christian to insist that voluntary euthanasia can be avoided if only we put more money into palliative and elder care, but beyond wishful thinking is the fact that the very best palliative care often cannot deal with terminal pain; that palliative cocktails are often little more than heavy sedatives, so we can’t tell anyone we’re in pain. Ultimately, it’s the economy, stupid. There are too many elderly people and not enough money to even warehouse them let alone care for them. We voters have no social will to change this state of affairs and it is going to get worse.

Suicide can be an honourable act, as sepuku is, as it was for some periods of Classical Greece and Rome and as it was for the Jews trapped at Masada. It can be a perfectly accepted cultural practice, such as when an elderly person acknowledges that they can’t manage the usual winter river crossing and so stops on the bank, watching their tribe cross to the winter grounds, waiting to die of hypothermia. This has been called quasi-voluntary suicide, the implication being that the youngsters no longer want to care for their elders and so the elder has no choice. I wonder how those tribal people would view our more civilized stockroom approach.

Is there a Pagan theology of suicide? What we have so far seems to’ve come about as a result of our own reactions rather than in considered response to any understanding of Paganism. At the heart of all Pagan practice are two concepts: an immanent Deity, and the implications of our choices.

Deity is part of us rather than some external judge and that immanent part of our Selves cannot be harmed if our corporeal form drops away. If we have a theory of reincarnation – and many of us do not – then how does this affect a proposed journey of the soul? Too many Pagans just echo their dominant culture, somehow suggesting that suicide will mean that the person will just have to go back to the beginning like a naughty child or a sinful follower of a vengeful (but curiously undefined) god. If life is a process of gathering experience then the experience of taking ones own life is simply that.

Ending ones own life certainly can have a devastating impact on those who’re left behind but how much of this is to do with our cultures’ attitude to suicide in the first place? Shock rises from the secrecy and shame surrounding the act, secrecy and shame grows from its illegality. People who kill themselves often leave angry people behind, usually because there are so many pieces left to pick up, and that’s because most suicidal people who start putting their affairs in order are prevented from killing themselves. There’s also a lot of self-righteous gossiping, often in the guise of deep concern, which fuels the anger. A parent who adores their children can find the weight of sorrow greater than their love. They may indeed be psychiatrically ill, and for many depressed people psychiatric services do not help them, it just preserves them in pain. More often, they are alone in their suffering. Life is not perfect.

Many of the people I see in a chaplaincy role are in mental states so enduring and so dreadful that they will never be allowed out of an institution. They will have 50 years or more of living with other enduringly unhappy people, no control over what they eat, when they go to bed, when they wake. Most of them function in barely controlled panic and I’ve been asked a number of times to do a spell that will put them into another world or a picture in a book or back in time so that they can avoid certain behaviours that got them institutionalised. They’re diagnosed as having diminished responsibility – they’re not necessarily bad in the sense that an ordinary criminal is – and they have a life sentence in the absolute meaning of the term. They are in as much pain as the person enduring physical anguish.

Imagine a world where people who were in a permanent state of torment were treated with a compassion that suited them rather than those who have control over them. Imagine if they were given the option – by intelligent people without a budget in mind – to forgo the performance of being a good patient. This alone, paradoxically, might give them the freedom to live as a fully integrated human being for a period of time, something they will never experience on a locked ward, in a locked-down life or a locked-up body.

How much more wonderful would Joan and Edwards final days been if they could have their loved ones around them in their own home and garden, holding hands as they took the drugs that would peacefully and swiftly take away their age, infirmities, fears and pains. What an honour, what a privilege to be with these people in a moment of what could be ecstasy, peace and satisfied completion.