Pagan Medical Ethics

http://www.bbc.co.uk/news/health-10899275

The concept of Pagan ethics is getting a good airing; as a community we’re ready to think about our responsibilities as well as our rights. But I do wonder how, or even if, we approach medical issues that other religions struggle with, things like fertility, quality of human life and the artificial manipulation of genes. Individual choice is part of the post-modern mindset which Paganism has most effectively embraced and of course no matter what any religious authorities decide on most individual religious people go their own way, choosing to have or not have assisted conception, abortions, genetic treatments for conditions such as spinal muscular atrophy and so on. Their religious leaders and societies have the debate, understandings are generated but followers generally ignore them. Beyond vegitarianism and in the US, the abortion debate (based in politics much more than religion) we're yet to really get going.

News of Ciaran Finn-Lynch and his life-saving trachea transplant grown from his own stem cells reminds us that medical science is both exciting and moving at a speed that may often be beyond what we can keep up with. New guidelines around the use of genetic tests for children demonstrates that philosophy may not move as fast as science or the free market but is profoundly necessary to protect the individual, family, society and the most vulnerable from the excesses of both.  Freedom of choice for the parent has, in this situation and others, overwhelmed the rights of the child. Post modernism and raw capitalism are ironically close relatives.

So where might Paganisms start with a deasophy of assisted conception? Do we start with ‘An it harm none . . .” or the damage that is being done to the Earth by the unsustainable numbers of humans draining the basic resource of water? We already use medical technologies like surgery, chemotherapy and antibiotics so why not AI and IVF? Where do our responsibilities as a human community intersect with our individual human rights? Might we embrace infertility not only as part of the natural world that is as worthy of respect as other aspects of fertility, as much a demonstration of balance in nature as flood and fire but now also a much needed natural gift to the Earth? Might we forgo or limit reproduction as part of a sustainable relationship with the planet? This might be the most pointed definition of ‘Bioethics.’

Vegans have long experience of coping with the ethics of animal-derived medicines and treatments born from vivisection but what about the ethics of human research? Are Pagans who put themselves forward for medical research honouring animals or dishonouring their own bodies? How does being paid for the risk effect the ethics?

And since we don’t consider our children Pagan how do we make decisions about our children’s health? Is there a uniquely Pagan way or do we just tag along with our friends?

There are often no answers to these kinds of questions but in attempting to answer them we discover what is fundamentally important to us and why, not just viscerally but materially. Speaking about inter-relatedness and earth consciousness is one thing; but how do we relate to the realities of disability, poverty, mental illness?

Obstetric and neonatal care and life expectancy has improved so radically that there are already a greater number of people with learning disabilities than there were a decade ago and this number is expected to rise.

In the UK most people who have learning disabilites live with their families and 40,000 live in institutions. Although a tiny minority of these institutions are excellent (measured by the kinds of relationships you would want for yourself rather than a managerial tick box exercise) most people in institutions are not treated as well as they might be.  Here are some cheery statistics:

•    Four times as many people with learning disabilities die of preventable causes as people in the general population.

•     People with learning disabilities are 58 times more likely to die before the age of 50 than the general population

•     Almost one in three people with learning disabilities say they do not have any contact with friends.  One in twenty have no friends and do not see anyone from their family

•     40 per cent of people say they would like more say in what goes on in their everyday life

•    Nearly one in three people say they did not feel safe using public transport

•     Nearly one in three people with learning disabilities said someone had been rude or offensive to them in the last year. In most cases, the person who bullied them was a stranger

•     Only one in four women have ever had a cervical smear

•    More than one in ten people with learning disabilities say they never feel confident.

People with learning disabilities have a right to life. They can have rich and fulfilled lives and improve the lives of people without learning difficulties simply by being present in them. The reality is that most will die young and live as second-class citizens. Like the elderly and mentally ill they are too often used as a form of employment scheme for people who would not be able to work in an environment where clients can make use of a meaningful complaints process.

How might a Pagan ethic approach this situation? People who detest the meat industry can become vegan and have an economic effect, but how do we respond to a reality that is located between ethics and economics, between total expediency (involuntary euthanasia) and a total social revolution that values fire-fighters, teachers and people with disabilities as much as CEO’s and celebrities? We know it’s wrong to euthanize people with disabilities (Why? Just because Nazi’s did it? Is there a Pagan take on right to life, voluntary and involuntary euthanasia, quality of life?) but we are, in truth, killing them off through direct and indirect neglect and many will live lives filled with casual, catastrophic and everyday abuse.

Some of these issues are addressed directly in Starhawks' Truth or Dare whose understanding of power dynamics have been taken up by academics and practitioners. If Paganisms are more than Reclaiming what are the other Pagan ways of approaching modern medical ethics?

The temptation is to look for ultimate answers where there may only be fragmentary ones if any exist at all.  But engaging with the questions, examining reality as it is rather than as we wish it was; developing new and decidedly Pagan understandings of what, why and how we value the Apparent world (as opposed and in relation to our colossal valuing of the Otherworlds) and the people in it (as opposed and in relation to the concepts of animals, Land and Nature) demonstrates a readiness to be taken seriously as part of that world.

Start here with a feminist, relationship ethic and please feel free to contribute your own favourite
 Pagan medical ethic pages and sources.

Spirituality in Cancer Care

Facebook is a wonderful thing. Thanks to William for  bringing this to my and all his FB friends attention.


Spirituality in Cancer Care: comprehensive, peer-reviewed information for health professionals about religious and spiritual coping in cancer care. This summary is reviewed regularly and updated as necessary by the PDQ Supportive and Palliative Care Editorial Board. 

I don't know why the PDQ link won't work, please cut and paste this:

http://www.cancer.gov/cancerinfo/pdq/supportive-care-board

Sacred Dying

Megory Anderson of the Sacred Dying Foundation brought the following piece from the New York Times to the attention of her Facebook friends: Making Sure Patients Don’t Die Alone. The article demonstrates how enlightened young doctors can be but it also throws light onto the way we perceive death and dying: a failure to cure, an opportunity for litigation, perhaps something rather shameful. It is extraordinary that something as basic as someone being around when a person dies makes the news.

Paganism has an uneasy relationship with death. We talk about life, death and rebirth, celebrate Samhain, honour deities Who deal out death as well as Those from Whom life flows knowing that They’re often one and the same. But when it comes to the reality of the end of life we are, unsurprisingly, products of our societies. Fragmented, isolated, we can perform endless ritual and still find ourselves helpless in the determinedly real and unromantic event of death.

So many of our rites of passage are organised to be performed at seasonal gatherings but of course when we begin actively dying we’re unlikely to be able to travel, to be away from the things that make living and sleeping less uncomfortable, to have time between medical appointments or simply to have enough energy. The Pagan dying, like everyone else’s dying, disappear.

It doesn’t help that, like giving birth, dying happens in its own time. I like the analogy of midwifery for both birth and death but there are important differences: if a labouring woman encounters difficulties the midwife needs to be technically skilled because things can go very wrong very quickly. There is nothing to go wrong in the physical processes of death. Many physical symptoms can be relieved, many psychological processes can be facilitated but the outcome will always and inevitably be the same. It can even be (whisper it low) tedious to be with a person who is dying when they just don't die. Birth midwives learn to sit on their hands, be attentive and act swiftly when it's needed. People attending the dying learn to be attentive and do very little, actively.

Dying is a high energy event, it draws people to it, we all want to be in some way connected to this ultimate drama. Being involved with death brings out the worst as well as the best in people perhaps because there’s no set way to ‘do’ it. As the dying person becomes less connected to the everyday world there's a risk that they become a means for others to take a little limelight. All that  unfocused energy around death and dying has to ground somewhere, and when doing nothing is the most important thing to do we can all get frustrated.

You’ll know by now that I trip up over the word ‘Healing’. I don’t like it because it’s routinely abused, particularly so around the dying. The only healing for death is death itself and it’s self evident that this hasn’t been thought through or even thought about by a great majority. People offering candle lighting, prayers, ritual and so on for the ‘healing’ of a person who is actively dying would be horrified to think they were actively working towards someone death, or conversely that they were holding a person unnaturally in a life that is finished.

The Sacred Dying Foundation is one of the premier resources around death and dying, offering ways in which to focus some of that instinctive anxiety and interest, to be helpfully involved. The following is reproduced with kind permission.

10 Tips for Vigiling and Establishing Sacred Presence

Megory Anderson

Reclaim Grace and Dignity for Your Dying Loved One
10 ideas to engage family and friends in “Spiritual Presence” for your loved-one.

1: De-clutter the bedside area. 
  Set the space apart using candles, music, etc., to create a calm, peaceful atmosphere.  This will be the “sacred space” around your dying loved-one.


2: Within this physical sacred space, keep the focus of any conversation on the dying person.   
   Allow intentional conversation with or about the person, but no idle chatter among visitors: keep that outside.

3: Take cues from your loved-one regarding practical matters.
    If there is no indication that s/he would like to discuss or handle practical things, keep these things well away from the sacred space.  If you know the person’s wishes regarding privacy, make sure they are respected.


4: Take turns or assign someone as “door keeper” to shepherd the transition from the outside hubbub to the sacred space.
It can often be helpful to establish a daily or weekly schedule with family members.

5: Take cues from your loved-one regarding not only physical needs, but emotional and spiritual as well.
Don’t take center stage with your own emotions.  While your own needs are certainly valid, if all eyes are on you and the comfort you need, consider stepping outside the sacred space to allow the focus to re-shift to the loved-one.

6: When s/he begins actively dying, the most important element of vigiling is your calm presence.  It is a solemn gift.
To hold this quiet space so your loved-one can transition as easily as possible, use tools that you have already gathered in a “vigiling toolkit”.  Items to include: special objects to hold that have personal or religious meaning (a prayer shawl, a favorite scarf, a rosary), reflective readings or books or prayers, music, candles (flame or battery).  Traditional prayers are often used, but other favorite readings can be appropriate, too.  The idea is to personalize these items for your loved-one.


7: If you are at home, don’t be surprised if family pets want to participate. 
If possible, let them behave naturally: on the bed or on your lap, etc. 


8: Friends/family who can’t physically be there during this time can still be involved from afar.
For example, someone long-distance could be in charge of mass communications, informational emails, etc.  There are many online choices such as candle-lighting websites, creating a Facebook page with updates, and other internet options.


9: Ask absent friends/family to vigil with you at a designated time once or twice daily.
They could do this from anywhere in the world, simply taking a few minutes in shared thought/prayer, listening to music, lighting a candle, etc.

10: Don’t worry about making practical calls immediately after s/he passes.
Spending some time in silence can be profound and meaningful.  Then, consider designating one person to go do practical things while one continues to sit quietly for as long as possible.

© Megory Anderson 2010
www.SacredDying.org  

Tribal Care?

Walking back from the post office this morning I met my very elderly neighbour. We stopped and talked for a little while and I noticed how frail she’s suddenly become. “I want to fly away,” she said making a gesture skywards, like an aeroplane taking off.

6 months ago her middle aged son and only child had a fit and died in her living room leaving her alone in the world for the first time in her life. Her companion animals have predeceased her and although she has a number of friends who happily help life is changing too quickly around her. Our estate is on the verge of demolition and whilst being forced to move is stressful enough for anyone, for elderly people it can prove fatal. The anecdotal evidence for this is strong enough and it’s backed up in a metastudy which demonstrates that the elderly can’t be treated as units to be shuffled about as everyone else’s needs require.

This afternoon another study winged its way into my inbox, this time from the Association of Therapeutic Communities list. From our enlightened Nordic neighbours comes research about an old peoples home as a therapeutic community.

http://www.informaworld.com/smpp/content~db=all~content=a787554730~frm=titlelink

Here’s the final sentence of the abstract:

“The results suggest that in all organizational sub-processes - housing, treatment, administration, team work, know-how -the old people's therapeutic community functioned significantly better than the controls, namely traditional old people's homes.”

Therapeutic communities, although created and run for and by mentally ill people, are basically healthy intentional communities. Here in the UK there was one Pagan intentional community and now it seems to’ve disappeared. Why can’t we manifest what we say we really desire? The word ‘tribe’ is so overused as to become trite, so what’s preventing us from creating tribal life in a modern setting?

The non-religious intentional communities I’ve visited over the years all have money at the centre, root and heart of their being, it’s what’s allowed them to succeed. They are also highly regulated often to the point of exclusion, sometimes to the point of madness, but these boundaries hold everything else together. The religious communities I’ve visited are sustained by money, tradition, benign dictatorship and the individual intent to submit to the communities foundations. Of course, where the community prevents people from leaving abuse occurs but I sometimes wonder if some of what we call abuse might actually be appropriate communal and personal discipline.

Is Paganism ready for this kind of surrender and engagement?

Modern Paganisms began as a way for each individual to become her own priestess and in the best of worlds there would be no need for chaplains at all. Our companions would, as they sometimes do now, support us when we’re admitted to hospital; we would be personally prepared to manage our own deaths if we were involved in some kind of lethal event; we would have our chronically ill and dying close at hand, as part of everyday life and the manifestation of our beliefs. I’m worried that in our concern to compete with other religions on their terms we lose sight of what’s important to us. I long to offer my neighbour more than I do now and I long for that to be offered to my family too. Being part of a tribe, a community, isn’t a retreat from life but a deep engagement with it and for Pagans, a bottomless reciprocal engagement with all life. Can we manage it? Have we the individual and collective will?

Cherry Hill Seminary

A guest post from Cherry Hill’s Executive Director, Holli Emore.

Here in the United States we have an interesting legacy connected with the term “professional” as applied to chaplaincy and other religious service. The same spirit which drove many of our early European settlers to make that daring leap across the ocean into the unknown also inspired a new way of looking at religious clergy. At the same time that new Americans rejected the hierarchies of monarchy, they often embraced self-taught clergy. The similarities between institutional religion and institutional government must have been all-too-obvious in the atmosphere which birthed democracy. Also, trained educated clergy were not always available (this is sometimes the case in rural areas even today). Protestantism is nothing if not democratic, though like democracy, it is no stronger than the weakest link, which is often a well-meaning but uneducated minister/leader. We so strongly hold to the value of individual inspiration and vision that we too easily overlook what may be gained by educating our clergy.

At Cherry Hill Seminary we find ourselves in an ongoing examination of what it means to serve the spiritual needs of a community, what skills and education are beneficial, or even essential, to such service, and where we should either forge new ground or look at the successful models developed by other religions. Certainly, we could spend all of our time negotiating the maze of professional standards put out there by professional associations, standards for pastoral counselors, therapists, chaplains, prison chaplains, hospital chaplains, and more. The U.S. military has been very rigid about the education it requires of its chaplains, but then relaxed those standards when the Middle East conflict exceeded the numbers the armed forces were prepared to serve spiritually. Part of the CHS push for future accreditation has been to satisfy requirements which may now be negotiable.

Nevertheless, setting a high bar for those who serve, and, therefore, lead us, is a good idea. One need not look far to encounter spiritual leaders who have ranged from mediocre to pathological and even murderous. One of the first courses all CHS students must take is Ethics and Boundaries. Most people think that ethics is an intuitive exercise, and trust that the Rede or the Golden Rule will get them through a rough patch. Our course challenges a student in every way possible, and by the end of the course each student has produced their own detailed code of ethics. More importantly, those students are better prepared to face the real world, with its unpredictable, ever-changing barrage of issues, predicaments and gray areas.

And then there is the reality that hospitals, prisons and other institutional settings simply must establish some kind of standards for the people they allow to have access to their clients. Ultimately, they are held responsible for the standard of care, including spiritual, and so it is only fair that they ask us to demonstrate that we are up to the task. There are worlds of issues that the average individual has no way of knowing about operating in such an environment. We will be far better able to deliver something of value to those clients if we have had the proper preparation.

To some people, the word “professional” implies that they are paid a salary for the work. Salaried Pagan clergy are not likely to abound in my lifetime. Rather, we propose that “professional” in this context signals a level of excellence perhaps not found among the rank and file volunteers. Most of us have a healthy respect for the training and apprentice-ship required of a goldsmith or accountant or social worker. But we resist the idea that a spiritual worker may need specialized training, too. I look forward to a day, in my lifetime, when Pagan clergy command respect for their expertise, not just from the mundane world, but from our own.



ps - M. Macha Nightmare's interview with TWPT offers further background on CHS.

Finding Support

Speaking as an outsider, there seems to be a paradox at work in the American psyche. European people escaping religious persecution gave up homes, land and long generations of national identity to begin an entirely new life thousands of miles from all they knew for the sake of religious freedom. Almost as soon as the first principals of that freedom were enacted they were challenged to prevent Catholics from openly practicing, and so the struggle to limit religious freedom has continued right up to the present day. Despite the separation of church and state religion is absolutely central to every aspect of every American persons life, whatever their belief or lack of it.

It means that there’s is an instinctive neighbourliness in many American communities, people tend to pull together and put their money where their mouth is, willing to support charities and services in a way that we don’t here in the UK. The founding optimism and work ethic means that where people can, they tend to. And atheists are the most mistrusted group in America. (1)

40% of respondents characterized atheists as a group that "does not at all agree with my vision of American society", putting atheists well ahead of every other group, with the next highest being Muslims (26%) and homosexuals (23%).

So religion is a powder keg and a fundamental feature of American identity. Where Paganism is mildly mocked in the UK it (along with every other non-Christian philosophy) is perceived by too many Americans as some kind of threat to the soul of the nation. Personally, I believe it would be wonderful if American Pagans were able to sidestep the religious Olympics, to not enter into litigious, strident, corporate-speak that seems to characterise so much religious discourse, but with the stakes set so high I’m not sure that’s realistic. I emailed a US hospital chaplaincy organisation to ask how many Pagan members they had. The receptionist replied: “None. Paganism is not a religion.” Pagan pals sorted this out within the hour, but when a receptionist feels so strongly about what is and is not a religion, and safe enough to announce her opinion on behalf of a national organisation, that’s an indication of how febrile the subject is.

In which case, Pagan chaplains need all the support they can get, and this is where I hope that the professionalization of chaplaincy can be most useful. To be in contact with a group of people who are in a similar situation, facing similar problems and opportunities is a blessing. This is what good supervision can offer. A confidential space, run on similar but different foundations from a magical working group, where the focus is not the client but the practitioners’ relationship with the client.

Being able to make use of chaplaincy supervision depends on a background competency in chaplaincy skills. A solid, thought-through understanding of Pagan theology, counselling skills, boundaries and ethics are a foundation from which all else flows. The most brilliant ritualist, skilled in surfing magical realms is going to run into trouble as soon as they step foot into a hospital if they don’t have an understanding of what it means to enter a hospital.

Because of the centrality of religion in the US there are already a good number of Pagan chaplains functioning in a skilled and effective way. This is how most new vocations grow, from people just getting on with the job, wanting to learn more, to share their skills so that others can avoid pitfalls and offer the service more widely. Paganism has reached a level of maturity where it can (just about) support a virtual seminary, a place where Pagan ideals are supported.

Providing an extensive education in diverse aspects of Pagan philosophy, practice, and skilled ministry;

Supplementing existing ritual and magical skills with training for professional ministry and counseling;

Serving as an ongoing resource for individual continuing education; and

Providing a forum for scholarship and community

If you haven’t already looked at Cherry Hill Seminary, take the opportunity now! This is the premier gathering and resource for people serious about the vocation of Pagan Chaplaincy. They offer Masters degrees that are required by many hospitals before they recongise a religious visitor as a chaplain.

Perhaps most importantly, they offer fellowship. You will suddenly gain access to many other Pagan people doing the same thing as you, some of whom have been doing it for a very long time. Connections are made, friendships struck up, knowledgeable peer support is available. Formal supervision isn’t yet available but this is close to the next best thing.





1 ^ Penny Edgell; Joseph Gerteis, and Douglas Hartmann (April 2006). "Atheists As “Other”: Moral Boundaries and Cultural Membership in American Society". American Sociological Review 71 (2). http://www2.asanet.org/journals/asr/2006/toc050.html.

Managing the Urge to Professionalise

The urge towards professionalism builds up a rigid bureaucracy. Bureaucratic rules become a substitute for sound judgment.

Carl Rogers

When I was a student nurse on night duty there was an elderly man who was blind and hallucinating. He was distressed and spent much of the night yelling “Hold me tight, for Gawds sake!” We would go over and hold his hand and it wouldn’t make much difference, he’d just up the noise, begging for reassurance and containment. In the end he was prescribed sedation which brought him much closer to death but kept him quiet. One night, the registrar came on to the ward as the sedation was wearing off and the elderly man began his painful wailing. The Registrar went over to him, held his hand and asked, “What can I do for you?” “Hold me tight!” said the old man. So the registrar pulled back the covers, got into bed and shifted the old man to recline between his legs, back to chest, and held him tight. A good nights sleep was had by all. Now of course, he’d never consider doing something like this and would be disciplined if he did.

When I first began working with young girls who had been subjected to dreadful abuse and were considered dangerous, one or two of them needed to negotiate physical contact. The rooms we met in had beanbags and some of them sat on the floor cuddled up to me as we lay back, experiencing safe intimacy and basic human connection without which we all go mad. Now of course, I’d never consider doing something like this and would be disciplined if I did.

Chaplaincy is undergoing a process of professionalisation that will result in very well qualified chaplains and no certainty of high-quality work. The only positive result of professionalisation is that it’s easier to fire someone when they work outside of professional boundaries.

Time and again, history demonstrates that when a vocational group enters into the process of professionalisation what actually happens is gross standardisation and a parallel requirement for the individual to stop thinking for themselves. Employers, who may know and care nothing about the internal dialogue within a group of people sharing the same job title, begin to demand that employees have professional qualifications and a very vicious cycle is set up. Creativity is stunted, peer review becomes meaningless, relationship becomes defunct in preference to saying the right thing.

Here in the UK, this means that the most qualified, experienced but not accredited on principle psychotherapist is not as attractive to an employer as someone who has been qualified for 3 years if they are accredited. The less experienced psychotherapist has ticked some boxes, written the right words, perhaps made a few up and paid her money to the British Association of Counsellors and Psychotherapists. Sound research demonstrates that BACP accredited therapists are more likely to have complaints made and upheld against them (1) but employers don’t care and neither do therapists who correctly perceive accreditation to be what employers (rather than clients) want. Two issues become plain here: employers want to reduce their feelings of risk of liability and people who feel strongly about being part of a professional group are likely to be status-led rather than client-led.

Chaplaincy is deep into the process of becoming professionalised. US hospital chaplains are required to have a Masters of Theology which demonstrates that they at least have an interest and background in their own belief systems. This requirement equips the chaplain with the theology she needs to serve her clients in terms of the relationship between deity and person. But a theology qualification doesn’t cover the ethics of the relationship between the chaplain and the patient, or the patient and chaplain with the institution. Various chaplaincy professional bodies are beginning to address these situations as an aside to the process of gaining professional recognition. To me, that phrase ‘gaining professional recognition’ is very telling: we want to be seen rather than ignored by important people. We want to join those important people as peers.

The model we have to guide us is a Christian one, and I have a lot of time for it. Christ was a very ordinary person who chose not to be a priest or to join the Jewish hierarchy or to work for the Roman hierarchy where he could have gained a great deal of power and influence. He visited the sick to bring them comfort rather than to offer an integrated holistic approach to healthcare and related to people as people rather than the relationship being dependent on which social group they were part of.

Meeting with administrators and chief executives is part of the work of the chaplain, as is report writing and collecting statistics. Studying the experience of other chaplains is vital, so that we can learn from their mistakes without having to repeat them and build on their successes. But desiring professional recognition - not because it allows us to deepen relationships, but because it highlights status – moves us away from humility, away from the position of liminality that is central to being a chaplain, and away from empathising with the vulnerable in preference to empathising with shareholders who need prestige to advertise their hospital.

The professionalisation of chaplaincy is inevitable. As we move through it, we would be well served to maintain a private store of cynicism, a way of being that isn’t fashionably sweetness- filled but which protects us from believing everything we’re told, in this case about how important professional status is. ‘Professional’ is very different from ‘accountable’ and the more professionally qualified a person is the more they are trusted to be left alone with vulnerable people: that equation alone should give us pause. The sad cliché of the pedophile masquerading as a Scout Master demonstrates that processes which bestow status facilitate people who want to abuse power.


ps - looking for a picture to illustrate this post I searched 'professional priest' and 'professional'. Google for yourself what comes up for 'professional': young, arms folded, mildly sexually alluring but essentially challenging. It's what we expect from the title, and aspire to.

1 Khele.S, Symons.C, &Wheeler. S. An analysis of complaints to the British Association for Counselling and Psychotherapy 1996-2006. Counselling and psychotherapy research CPR) 8 (2) 2008: p127