“I will utter things which have been kept secret from the foundation of the world” — Matthew 13:35 and the epigraph to Jordan Peterson’s 1999 book Maps of Meaning: The Architecture of Belief

On Friday, May 18 a 17 year old walked into his high school in Southeast Texas with a shotgun and a .38 revolver. He shot at least ten people dead, including his ex-girlfriend.

In April, a young man in Toronto drove his van into a crowd, killing ten people and wounding fourteen. Most of the dead were women, and the driver has been connected to an ideology that demeans women as less than human and advocates for forced sex as the right of males. The killer took his inspiration from another killer who shot and stabbed six people to death in Isla Vista, California, in 2014. Yet another young man killed twenty-six parishioners at First Baptist Church in Sutherland Springs, Texas last year. The killer wanted revenge on a spurning lover.

Easy gun access and a welling radicalization of disaffected and hate-filled young men is not a new phenomenon—but school shootings are. They are also a phenomenon with a strong foundation in U.S. culture.

When I began this column in October, 2013, the purpose was clear: to draw attention to the quote-unquote religious views weaponized (for political, social and plain old discriminatory reasons) to thwart by any means possible the full access and provision of health care to all Americans. Or the reverse: the use of medical science to confront and demean religious beliefs. (I’ve likely been more successful at the former than the latter.) With some few exceptions, this column has focused on the U.S. simply because of the research I was working on and the endless examples of where friction exists between religion and medicine.

The issues have been inexhaustible, from women’s reproductive rights to elders’ access to end of life care, from organ donation to drug regulation. The column has covered a wide range of issues—but continues, perhaps because of my own proclivities as much as the ongoing U.S. culture wars—to tend toward the subject of both overt and covert violence against women.

When this column began, some of us could blissfully take comfort in that old and noble saw, the arc of justice bending upwards. And then, of course, came President Trump and the license he gave to hatred, discrimination, and misogyny. It’s always been there, seething beneath our social fabric. But the mainstreaming of retrograde and gratuitous ideas that reinforce our spiral into violence against minority groups and women has had direct and horrifying results. What death and violence this mainstreaming has brought is supported by a growing and popular host of pseudo-intellectuals, lawmakers, and tastemakers who are willing to justify it. If there is an arc of justice, our current moment is left out of its long average.

Being a woman in the United States is dangerous to your health. Women have always been profoundly harmed by sexual violence at a greater rate than men, their bodies too long considered their rights and property. Coverture, the status of a married woman and all her possessions as the property of her husband, was common law for centuries. It is derived from the “legal fiction” that a man and wife were one entity: the husband. But the consideration of women’s bodies as the property of men didn’t end with coverture. As recently as seven years ago it was reported that a Virginia legislator, Dick Black, said that marital rape shouldn’t be a crime. In fact, marital rape wasn’t a crime until 1979.

Women’s sexuality has been used to justify white male violence for most of the nation’s history. The post-Civil War South employed ideas of (white) female sexual purity, national purity, and safety to justify slavery, lynchings, and white male violence. Even economic vitality was considered the reward for women’s sexual purity. As Ellen Ann Fentress recently wrote at The Baffler (where I’m web editor):

The myth of the threat of the black male rapist gave the white male an enhanced role as the necessary protector of white women and Southern society. He had a responsibility to make the community safe. An added plus was that the rape-threat claim was possibly the sole premise for deflection of Northern and British censure as the white South reestablished its power.

This violent history and treatment of women as male property has visceral ramifications for women today. Every minute, twenty people experience sexual violence, a vast majority of them women according to the National Coalition Against Domestic Violence. One in five women have been raped. One in three women have been a victim of some form of violence. One in seven have been stalked. One hundred and forty two women were killed at work by an abuser between the years of 2003 and 2008. When you intersect this data with race, poverty, maternity, education, language barriers, and fear of deportation, the prevalence of violence is compounded.

But what is becoming clear in the endless horror that is our regular news cycle is that misogyny, defined by philosopher Kate Manne as “social systems or environments where women face hostility and hatred because they’re women in a man’s world — a historical patriarchy,” is a defining factor in these mass killings. They are most often committed by young white men who are compelled to punish women for challenging male dominance, men who feel they are vulnerable to women’s challenges. As Jared Keller writes (citing the work of sociologist Michael Kimmel), a “complicated tension between homophobia and the developing masculinity of adolescent American men” characterized school shootings in the country between 1982 and 2001. This male, he writes, is a “clinical category.”

Crosses stand in a field on the edge of town to honor the 26 victims killed at the First Baptist Church on November 6th, 2017, in Sutherland Springs, Texas.
(Photo: Scott Olson/Getty Images)

There have been twenty-two school shootings since the beginning of 2018, for an average of more than one every week. After the May 18 shooting in Texas, Mark Allan Bovair posted on Twitter “The destabilization of the sexual marketplace has hit young men hard and any [attempt] to discuss the issue is labeled misogyny.” To men like this, female company and sex are considered a commodity that men are being cheated out of as women push for greater equality in society.

This subculture of male resentment has no shortage of adherents—and a new scion, Jordan Peterson, has recently achieved market saturation with the publication of a book that provides a pseudo-scientific, -intellectual, and -religious justification for anger among men and violence against women.

In a Nellie Bowles’ profile of Peterson in the New York Times, he encapsulated his ideology about the erosion of historical sexual norms and the inherent rights of men in a reference to the Toronto killer, saying, “He was angry at God because women were rejecting him. The cure for that is enforced monogamy. That’s actually why monogamy emerges.”

The modern world, according to Peterson, is rife not just with gun violence but also its cause, social and cultural chaos. Traditional family structures have been upended, genders are no longer binary, freedom of speech is increasingly restricted, identity politics are marring governance and social order, the old hierarchies have been dismantled, and ethics has strayed from the ancient moral teachings of the Bible. “The masculine spirit is under assault. It’s obvious,” Peterson further explained to the Times.

Peterson, a clinical psychologist at the University of Toronto and a mega-best selling author, has a solution to this “chaos”: return to earlier times when women knew their place, teach young men to toughen up, violently restore the patriarchy, and things will settle down. Peterson’s worldview is clearly popular. His quotes are internet-clogging memes. Videos of his talks on YouTube have millions of views. His adherents wear T-shirts with lobsters on them, lobsters being Peterson’s impossible-to-follow “scientific” proof that hierarchies are very, very old and therefore good. He’s selling out five thousand seat auditoriums and has amassed a devoted and noted following. Malcolm Gladwell has hailed him as a brilliant psychologist. At the New York Times, columnist David Brooks has called him the new William F. Buckley, Jr. and Ross Douthat parroted Peterson-like ideas in a recent column that argued for “the redistribution of sex” as “entirely responsive to the logic of late-modern sexual life,” by which he means a time in which women have a tenuous enough equality to choose who to have sex with.

Jordan Peterson (Photograph: Phil Fisk for the Observer)

A combination of particular characteristics makes Peterson attractive to nostalgics in search of a great thinker. According to Nathan J. Robinson at Current Affairs, “Peterson appears very profound and has convinced many people to take him seriously. Yet he has almost nothing of value to say.” He’s vague and hard to follow but his work contains shreds of inherent truth. He’s commanding, somber and over-the-top confident. And he brooks no challenge; a class-A Alphamale doesn’t.

Lord knows the right needs a new intellectual foundation. And that’s precisely why Peterson appeals to adherents of a mythologized past, young men who can’t get laid, anti-feminists, nationalists, the religion-y folk who see the world in a hand basket, conservatives too eager to exercise their brutal “might makes right” cosmology.

Celebrated as a great mind that must be heeded, praised, believed, Peterson has found an audience in search of, not so much a new message, but a brazen, white, credentialed, aggressive male authority who will widely evangelize an old message: male dominance by any means necessary. Peterson’s popularity as an elite mind coarsely splays the right on its own anti-intellectual petard. As journalist Josh Marshall wrote in a series of tweets after Bowles’ Times profile of Peterson was published:

She captures in the lede the role as validator, all those things you felt were true. You were right all along. I’ve actually become fascinated by these Peterson types and their role in the backlash against gender equality in this case but other MAGAist revanchist in other cases. They place themselves as something akin to the bodhisattvas of inceldom, men who have achieved transcendence or alphadom but are so filled with compassion for incels trapped in the illusion of modernity and sexual liberation that they have remained behind to …help usher these rage filled virgins toward gorilla mindset enlightenment.

A smart man, after all, is the man one agrees with. In addition to a misogyny-sympathetic narrative and the posturing of an intellectual man’s man, Peterson employs various other tools of the authenticity-generating variety: science, history, and religion. “I’m a scientist but I’m also a religious person, I’m a deeply religious person,” Peterson has stated, “Genuine religious truth tells you how to act.” In this age-old construction, religion (however vaguely defined in Peterson’s case) helps justify violence toward others as a means of obtaining and maintaining an ordered, hierarchical and peaceful society. The sanctity and purity of the nation requires white men to define, police, and “protect” female sexuality. Physically and violently enforced monogamy is then the best means of maintaining a pure and ordered nation.

Peterson’s ideas, as Bowles writes, “stem from a gnawing anxiety around gender.” Despite speaking, teaching and writing in relative obscurity for decades, he burst on the media scene in 2016 by loudly opposing a Canadian bill that made it possible for students to use their preferred pronouns. Peterson claimed that the gender-neutral pronouns violated his academic freedom and free speech. In a video viewed by more than 3 million people, Peterson is shown engaging with transgendered young students. As recounted in an article by Tom Bartlett for The Chronicle of Higher Education, when one student asks Peterson what gives him “the authority to determine which pronouns he uses when referring to someone else,” Peterson angrily responds, “Why do I have the authority to determine what I say? What kind of question is that?” (A man shot and killed nearly 50 people at a gay nightclub in Orlando, Florida that same year.)

Such arguments, which assert the unquestionable rights of a privileged and exclusive subset of the population over others—and insist that this dominance is historically, scientifically, legally and religiously justifiable—are the parlance of the moment.

As well, these arguments, by Peterson and others, are made by a demographic of American society that fears the end of longstanding violent, nativist, and misogynist norms and laws that have kept them on top to the detriment of others. This movement has turned rights and freedoms language on its head, applying them to a narrowing subset of society. Our president is, after all, an admitted sexual aggressor, hell bent on demeaning, dehumanizing, torturing and deporting those he finds socially, sexually or economically expendable. He is abetted by a coterie of officials, leaders, and voters who are drunk on their own control and eager for violent opportunities to “defend” it. Women and particularly women of color continue to pay the price of their health, independence and lives for this drunken orgy of political male dominance.

This is a culture war and the young white men with weapons are the crusading heroes. Peterson’s endorsement of violence is proving to empower and radicalize followers who are armed and out to take revenge on the health and safety of the rest of us, particularly autonomous women.

School is out now. We can pray for a quiet season, after the year’s record number of shootings. As midterm elections approach and the country reassesses its losses, women have focused their attention on running for office, on uncovering sexual harassment, on becoming activists against deportations and human rights abuses. “To everything there is a season and a time to every purpose under heaven.” I close out this long run of columns with muted hope, but with a great deal of satisfaction in the subjects its many installments have allowed me to explore with you.

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Ann Neumann is author of The Good Death: An Exploration of Dying in America (Beacon, 2016) and a visiting scholar at The Center for Religion and Media, NYU.

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This is the final installment of Ann Neumann’s column, “The Patient Body,” which began in October 2013 and has appeared in almost every issue of The Revealer since.  It has been an enormous pleasure to work with Ann each month — her insights and analysis have been vital to our work and we will miss her and them. But don’t fret, you can still see Ann’s wit and verve in full force over at The Baffler where she is now Web Editor. And if you’ve missed an installment of “The Patient Body” we invite you to check out the full archive, here. — Kali Handelman, Editor

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Published with support from the Henry R. Luce Initiative on Religion in International Affairs.

The post Unearned Positions appeared first on The Revealer.

When the King James Bible was first published in the early 1600s, a small fraction of women lived long enough to reach menopause, their lives ended by age 35 or 40 by famine, disease, war, poor nutrition, untreatable illnesses, contaminated water and food, and, of course, childbirth. If female pleasure was considered at all in the Bible, it was the pleasure of fertility. Or sin. Today, women have a life expectancy that is nearly double what it was 500 years ago. The ensuing centuries have added another 40 years to the female lifespan. Many of those additional years are spent in peri-menopause, the period of time when fertility fades, or menopause, defined as when a woman has ceased to menstruate for a period of 12 months. Barrenness, whether by choice, reproductive incapacity, or age—at least in so-called “developed” countries—is for an increasing number of women, the new normal.

Ève maudite par Dieu (Eve Incurs God’s Displeasure) by Marc Chagall

Not that many faith traditions, medicine, or even our culture have caught up to this new female normal. Fertility, then and now, is often the defining characteristic of womanhood. (In a recent review of the current revival of Edward Albees “Three Tall Women,” Hilton Als writes that mother is “the greatest roll onstage and off.”) A woman’s purpose is so universally reduced to reproduction—through pregnancy, motherhood, and their accompanying traits: nurturing of others, caregiving, patience, self-sacrifice (of time, self-care, and even life), tending to a home, and the fostering of community—that we’ve struggled for centuries to acknowledge that beyond the baby, she also has value to society. Women are the village that childrearing requires. Every other ambition she may have is superfluous.

My own return to normal began with hot flashes last year, a few weeks after having my ovaries laparoscopically removed. The estrogen they were producing caused palpable endometrial masses to form in my abdomen. For the course of my adult life, it was my unwavering choice to not have children and remaining childless was a luxury that cost me great effort and expense—a luxury, I acknowledge, few women can afford. The irony of my over-active ovaries was not lost on me. They were now finding alternative purposes. At long last, surgery, and of course age, had taken choice out of it. The plumbing was no longer intact.

I don’t miss my ovaries, of course. Most of the romance of motherhood was long ago lost on me. But surgery gave me a new understanding of what it means to be a post-reproductive woman in American society—or as an older friend says, I began having “crone insights.” Almost overnight, the incredible skill, shame, coercion and resources that society employs to perpetuate the human reproductive project was laid bare to me—and eventually became the best solace a menopausal woman could ever have: the embodiment of the knowledge that my value as a human being could be deemed by something other than my physical desirability. I could just be a human. And that could be enough.

Agar dans le Désert (Hagar in the Desert) by Marc Chagall

While little about my appearance changed in the immediate period after surgery, at least to an outsider, I was a new being, released from the responsibility of catering first to men’s attention and then to family’s. Survival of the human species was no longer on my shoulders. In its absence was the liberation to please not others but myself. I could dress for myself, spend my time on my own work, keep house (or not) as I chose. To be clear, I’ve been single for a decade so my domestic obligations haven’t changed. But what has changed is the pressure to have a certain kind of more—a man and children. I was also relieved of the imposed apology (as in the cocktail qualification: “no, I’m single, no, I have no children.”) I was no longer defined by the absence of something. I could just be myself. All the pressure to be something in addition to an independent person became, at last, unimportant to me.

The cultural cache afforded to mothering—rather than being a woman—is explicit in our language. Female writers birth books, ones that we are often paid less for than men because, of course, our real labors reside elsewhere. Our bodies have never been our own; they belong to the state (which tells us what to do with them), to our husbands (who are free to do with them what they wish), to our children (who need every form of our attention for survival), and to our bosses (who have long put a price on us according to our appearance—think: rampant sexual assault—or our supposed outside obligations to family).

Until barrenness was physiological, I was still tethered to the pervasive and persistent construction of what a good woman must be, if not for myself, for the comfort of others. The conflicting attributes are recognizable to us all: sexy, but not too sexy; young; passive, or if a tiger, a tiger mom; if deviant, in the service of sexy; emotionally accessible, but not too emotional; independent, but not outspoken; ambitious, but not too ambitious. Snip-snip and suddenly I was not beholden to anyone.

Women, I understood at my surgically altered core, spend their early decades focused on how and when and if to have babies; once menopause arrives to undermine all our prized ideas of youth and beauty, compatibility and deference, we acknowledge why such attributes are prized in the first place. Quite often the answer is: for our own subjugation.

For decades, studies have shown that women live longer, earn more, and obtain higher levels of education if they control their fertility or remain childless. Still, most studies (including those linked above) approach the question of women’s improved circumstances from the other way around. For instance, does enrollment in graduate school decrease childbearing? The assumption is that childbearing and rearing are an unquestionable good prevented (hindered, thwarted) by other types of “achievement.”

The message of this frame has been loud and clear since the early days of modern medicine, when Margaret Sanger struck fear in the heart of our Godly nation by founding the American Birth Control League: women without children are a problem to be solved, regulated, controlled, and cured. Which explains why childlessness is either something that must be medically fixed (if you have the money) or the secret shame, the thing that must not be discussed.

Esther (Esther) by Marc Chagall

Dominant faith groups in the US have been the gatekeepers of this limited idea of woman. By systematically keeping women from leadership roles, by preaching female submission from the pulpit, by failing to acknowledge the trials of women’s domestic lives and child birthing, the loudest denominations and leaders, with both feet in the culture wars, have worked to prevent any kind of male-female equality (beyond the false “separate but equal”). Purity culture, male headship, and rules for Godly women (and the men looking for them) have all entrenched female inequality.

Our faith traditions have emboldened legislators who continue to ignore the inequality of women’s lives. The rub here of course is that even when we fulfill our wifely and motherly duties, we’re still second class citizens. Consider the epidemic of neglect of women’s medical needs, including the inadequate treatment or mistreatment of female pain, the failure to test new drugs on women, particularly pregnant women, anemic research about ailments that predominantly afflict women, and, of course, the paucity of attention to menopause.

“Despite the fact that for millions of women their menopausal symptoms are intolerable so many are suffering in silence because it is a taboo subject and treatment options are limited,” Dr. Julia Prague told Science Daily last year about her study on a new drug treatment for hot flashes, one of the many physical challenges menopausal women face. Attention deficit and lack of concentration, vaginal dryness, hair loss, drying and thinning skin, fatigue, muscle soreness, mood swings, weight gain: these are only a few of the 34 symptoms of menopause. (Many suffering women, I think, would conclude that this list is abbreviated.) Each symptom is like a strategic attack on what our society has deemed the most becoming characteristics of femininity. Still, for instance, medicine has not isolated the cause of hot flashes, the ostensible first step in alleviating hot flashes.

In a 2011 article for The Atlantic, Sandra Tsing Loh wrote about embracing her menopause—the anger, frustration, mood swings, crying, and the throwing off of the caretaking mantle women are forced to wear. The piece is titled, “The Bitch is Back,” and challenges women to see their menopausal years as the normal years, consistent with our pre-menstrual lives. The fertile, child bearing years are the abnormality, she writes:

A sudden influx of hormones is not what causes 50-year-old Aunt Carol to throw the leg of lamb out the window. Improperly balanced hormones were probably the culprit. Fertility’s amped-up reproductive hormones helped Aunt Carol 30 years ago to begin her mysterious automatic weekly ritual of roasting lamb just so and laying out 12 settings of silverware with an OCD-like attention to detail while cheerfully washing and folding and ironing the family laundry. No normal person would do that—look at the rest of the family: they are reading the paper and lazing about like rational, sensible people. And now that Aunt Carol’s hormonal cloud is finally wearing off, it’s not a tragedy, or an abnormality, or her going crazy—it just means she can rejoin the rest of the human race: she can be the same selfish, non-nurturing, non-bonding type of person everyone else is.

“Rejoin[ing] the rest of the human race” is exactly right, in my assessment. I may have been a fist-raising feminist before surgery, but now my body has caught up to my beliefs.

These beliefs undercut religious and medical prescriptions to conform with behaviors that serve the patriarchal project of motherhood and all her attendant behaviors. Now I finally have the body chemistry to back these beliefs up.

Women may not yet be represented in scientific studies; treatments for menopause and every other female ailment under the sun may not yet be in development. But as women live longer, enter male-dominated fields (including medicine) in greater numbers and contest inequality—#metoo, #unequalpay, #girlslikeus, #rapecultureiswhen, #intersectionality, #everydaysexism, #effyourbeautystandards—a new post-reproductive idea of woman that doesn’t predicate femininity on fertility is emerging. By continuing to reimagine our roles in society, we can catch up with our bodies: independent, capable, beyond the confines of domesticated motherhood, perfectly enough on our own, thank you, normal.

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Ann Neumann is author of The Good Death: An Exploration of Dying in America (Beacon, 2016) and a visiting scholar at The Center for Religion and Media, NYU.

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Published with support from the Henry R. Luce Initiative on Religion in International Affairs.

The post A Normal Woman appeared first on The Revealer.

Gilbert is a registered nurse and director of the Parish Nursing/Community Outreach Department of Sacred Heart Health Services, a Catholic hospital founded in 1912 by a monsignor and the Missionary Sisters of the Most Sacred Heart. Gilbert meets with patients in this coat-filled basement room every week to practice her version of holistic medicine, which is part first aid, part prayer, and part close listening. She is not Catholic, she tells me, so she is able to refer patients to whatever denominational services they desire. “The first question I ask,” Gilbert says of her approach to patients, “is ‘Tell me about your spiritual journey.’”

Parish Nursing is a movement nestled squarely within the Christian tradition of caring for the ill, a commitment that reaches back to Catholic “hospices” during the Crusades of the Middle Ages. This mission has led Christians of all denominations to the institutionalized operation of hospitals, care facilities, elder homes, and hospices across the country and the globe. It is impossible to understand modern medicine, its development, prejudices, practices and the complicated relationship between faith and science, without examining this history.

Parish Nursing is an international organization that employs RNs “concerned not only with the body and mind but also with the spirit,” according to the Evangelical Lutheran Church of America’s website. Nurses of any (Judeo-Christian) denomination are encouraged to act as counselors and educators to their congregation and community, helping individuals to connect with local health resources, create support groups, train volunteers for outreach, and “clarify issues and or reinforce the strong tie between faith and health.” While parish nurse training programs exist across the country, the number of acting parish nurses is hard to estimate; some sources count them in the thousands. They are employed by their local churches, by hospitals’ community outreach programs, or by faith-based foundations.

The heart of the movement, however, is the life and teachings of Granger Westberg, who wrote the 1961 Minister and Doctor Meet, and the 1971 Good Grief: A Constructive Approach to the Problem of Loss, which sold more than two million copies. A 50th anniversary edition was published in 2010. Westberg served on both the medical and theological faculties of the University of Chicago.

He was the first hospital chaplain to formalize the role by emphasizing both clinical and theological training and is often wrongly credited with founding the College of Chaplains (today known as the Association of Professional Chaplains) in 1971, although the organization has existed since 1946. Westberg did, however, establish clear guidelines and accreditation for hospital chaplains through the College while serving as director.

At the time of her father’s death in 1999, Granger Westberg’s daughter Jane said, “Dad challenged the prevailing didactic model of theological education and proposed that theological education be a blend of theory and practice.” She continued, “Starting in their first year of seminary, Dad said that students should have clinical community-based educational experiences in churches, hospitals and other settings.” Granger Westberg’s legacy has been championed and expanded by Jane and his other daughter, Jill Westberg McNamara, who in 1990 coauthored The Parish Nurse: Providing a Minister of Health for Your Congregation with her father.

The Westberg Institute, located in Memphis, Tennessee has also continued his work training parish nurses. “Throughout scripture, God calls people of faith to healing,” the Westberg Institute’s website reads, “As an integral part of a healing ministry, faith community nursing is one of the best ways a congregation can promote health and wholeness.” After Westberg’s death, the Chicago Daily Herald estimated that more than 3,000 US nurses had been trained in parish nursing.

Today, the Parish Nursing movement provides a key to understanding the failures and achievements of the health care delivery system. Health care policy, as the current president quickly discovered, is complicated. Particularly when appropriate efforts must cross various service providers, like Medicare, Medicaid and other government entities, and attempt to simultaneously provide preventative care. When affordable housing, employment, accessible healthy food, and effective mental and drug addiction treatments are all necessary approaches to improving health care, institutions with limited resources and good intentions are most often left to make interventions that feel good, that sound good, but that do little to improve long-term health outcomes.

It’s not that the parish nursing movement is misguided, it’s that it lacks the muscle – or perhaps the will – to change policies that produce, for instance, homelessness, or unemployment, or any of the root problems faced by communities. The result can look a lot like the craven “prayer for porridge” programs of old. Prayer can be uplifting, but it won’t cure liver failure. And because parish nurses can lack a broader understanding of just how complex social service systems are, their efforts are limited to hearty prayer, warm coats, and immediate interventions that won’t cure longstanding and profound medical issues.

Furthermore, parish nursing is hindered by another structural flaw: the belief that charitable efforts can improve national health outcomes. Indeed, charity seems to be the go-to answer to today’s escalating poverty and all its attendant vagaries. Republican legislators like Paul Ryan, who ascribes to a Randian “you get what you deserve” philosophy that denies systemic inequality, have long harped on how community and faith-based charity are the answer to poverty, including health care inequality. He even penned an op-ed, with Wisconsin Republican Ron Jonson, for USA Today in 2016, that praises a charitable program, the Joseph Project, for bussing workers to their jobs, writing:

This is how you fight poverty: person to person. The Joseph Project is an example of what community leaders are doing across Wisconsin and America. They are developing homegrown solutions based on their neighbors’ unique needs — in this case, after noticing a shortage of workers in one place, a shortage of work in another. But to expand opportunity, the federal government needs to stop competing with these social entrepreneurs.

Notice what’s not mentioned in the op-ed: the federal policies—or lack thereof—that contribute to economic inequality. Instead Ryan prefers to consider the government as a benevolent business, charged with protecting its profit generators, businesses, and keeping its “competing” hands out of social services. Rather than address the root causes of poverty, legislators like Ryan emphasize local interventions that serves their laissez-faire ideology. (Of course no such local interventions regarding, say reproductive rights, would ever meet Ryan’s approval.) In this way, Ryan and his colleagues are able to simulate compassion for the ill without ever having to legislatively and meaningful address the policies and deregulation that have put so many Americans in crisis.

At the same time, Sessions-esque legislators are using their emphasis on charity as a cover for overt discrimination against minority groups defined by race, class, gender, sexual identity, or any other characteristic, like drug use, deemed politically expedient.

The crutch of charity is by no means used only by the right. Even left-leaning, tech-funded philanthropists, like Bill Gates, who buys immediate and limited relief for populations suffering from rising housing prices, for instance, lack the will or imagination to address political dysfunction. Government is seen as either too cumbersome or too dysfunctional to care for its people. By throwing bundles of cash at quick fixes rather than mass political and institutional change, they too are abetting a system predicated on feel-good works rather than lasting solutions.

Inadequately filling this compassionless maw are faith-groups, like parish nurses, left to rally whatever minimal resources they can from their generous congregations (and the government’s treacly faith-based condescension).

Today, Parish nursing is a “growing specialty” and it’s easy to understand why. On the demand-side of the equation, healthcare is increasingly becoming less affordable and less accessible at the same time that our elder population is rapidly increasing. And on the supply side, there aren’t enough doctors^[1] to go around—and nurses’ salaries are much lower than doctors’, making their employment more desirable to financially-strapped institutions.

What nurses are able to do, and do well, is get close to patients, something doctors can rarely offer with their high case loads and regulated billing hours. Nurses, particularly those embedded in grass-roots organizations like a church, can meet the needs of communities who lack health care (and the insurance or out-of-pocket wealth to access it), have minor health needs, and are on the front lines of medical access. Parish nursing makes a lot of sense in today’s medical landscape.

But what was made clear to me during my time in Deb’s little room is that no number of parish nurses can fill the void left in communities where gross inequality is created by a health care industry that has either abnegated its responsibility or been prevented by a callous government from fulfilling it. Deb may be efficient but she doesn’t have the resources the homeless around her suffer without—jobs, mental health care, rents that can be covered by unskilled (or even skilled) labor.

Healing a soul that has only a broken body for housing is a tall order. Our god may be awesome, but his mission to heal the sick is not getting through to Washington’s leaders, the only men (and a handful of women) too removed from the parish or the street to recognize their dire obligation.

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^[1]Although, some claim that the problem is not a shortage of physicians but their poor distribution.

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Ann Neumann is author of The Good Death: An Exploration of Dying in America (Beacon, 2016) and a visiting scholar at The Center for Religion and Media, NYU.

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Published with support from the Henry R. Luce Initiative on Religion in International Affairs.

The post Health and Salvation appeared first on The Revealer.

The Adorers of the Blood of Christ Chapel at Dawn.
Photograph by Anne Sensenig

“Praise be to you, my Lord, through our Sister, Mother Earth, who sustains and governs us, and who produces various fruit with colored flowers and herbs.” —Canticle of the Creatures, Francis of Assisi^[1] 

On November 16th, at a press conference held in Albany, NY by a group called the Sheridan Hollow Alliance for Renewable Energy, Reverence McKinley Johnson told attendees, “It’s a shame that we always, in our communities, seem to be the acceptable casualties, meaning that we don’t matter, it don’t make any difference because [it’s] what’s best for other people.” Johnson was condemning Governor Andrew Cuomo’s proposal to convert an existing energy plant in Sheridan Hollow, a low-income community of color in a ravine north of downtown Albany, to fracked gas.

The energy from the factory conversion would be used to power Empire State Plaza, the site of several of the state government’s administrative buildings. It would also make use of fracked gas, a controversial and polluting fossil fuel piped in from other states. Fracking is currently banned in New York. Johnson, who is the president of the Albany African American Clergy United for Empowerment, a collective of 26 predominantly African American churches in New York’s state capital, called out to the press conference gathering, “It’s not right, it’s not right.” The crowd responded in unison, “Amen.”

Throughout the 1980s, the plant incinerated garbage, raining black ash down on Sheridan Hollow residents, until Mario Cuomo, the current governor’s father, closed it in 1994. Speakers at the conference speculated that more than a decade of pollution from the plant has caused high rates of cancer and other illnesses in the community.^[2]

As the Trump administration continues to strike climate change from one agency agenda after another, Christian faith leaders from various denominations are stepping up to denounce the effects of industrial pollution and energy generation on their communities, the country, and the world.^[3] From Pope Francis’s Laudato Si’ encyclical to Reverend Johnson’s press conference statements, church leaders have decried the injustices of our current energy policies on the health of the human population, often noting the role that capitalism (the Pope) and racism (Johnson) play in energy infrastructure and generation.

These faith leaders are bringing a new moral weight to the conversation—if we could indeed say it’s a conversation in this highly politicized era—on the inequities of climate change. Rather than allow issues of pollution and energy infrastructure to be framed by corporate profit, faith leaders are identifying our current practices as immoral, unethical and detrimental to the most vulnerable.

This movement has proven to be nimble, able to partner with existing green or “outdoors” organizations and industries. As well, it has built on prominent themes that came out of the 2016 election campaign—namely racial and economic injustice—to identify and make personal the hazards of continuing current methods of energy consumption and production.

***

Last fall, CBS Religion & Culture produced a 30-minute series on the role of faith in combatting climate change, Protecting the Sacred: Water, the Environment, and Climate Change. Producer Liz Kineke interviewed scientists, theologians, and activists to examine how faith leaders have begun to address climate change. The documentary highlighted how Native faith guided tribes during the Standing Rock protests, when hundreds of people were assaulted and mistreated. Kineke also visited a group in Lancaster, Pennsylvania, that is fighting the construction of a pipeline that will transport fracked gas to the Chesapeake Bay for export.

Lancaster Against the Pipeline Nonviolent Mass Action Training
(Photograph by Becky Gardner)

Lancaster Against Pipelines (LAP) was founded to prevent an Oklahoma-based corporation, Williams Partners, from seizing their private property for construction of a pipeline, cheerfully named the Atlantic Sunrise. Emboldened by lax energy policies, the easy co-optation of local and municipal resources, and the complicity of courts—Williams swept into the county relatively unchecked. Lancastrians who were unaware of the company’s methods, who had limited resources, and were intimidated by the company’s agents, were no match for the multibillion corporation. (See my full disclaimer in the footnote^[4] below.)

In Lancaster, one of the properties crossed by the Atlantic Sunrise is owned by a Catholic order of women religious, the Adorers of the Blood of Christ. They have lived on that land for more than 100 years.

The sisters have opposed the pipeline from the beginning, but their story highlights the ways in which corporations use complicated processes and eminent domain to get their way. Because the US government has favored increased fracked gas production, corporations, claiming public utility status, have been able to use eminent domain to override residents’ property rights. The sisters, like hundreds of other Lancastrians, thought that the pipeline couldn’t be built without their consent. They were wrong. The company has argued that the Sister’s lack of response to early requests for information was the same as consenting to the project.

Last fall, LAP and the Adorers built a prayer chapel in the path of the pipeline, which led to protests, dozens of arrests, and national media coverage.

The Adorers also filed a federal lawsuit, stating that the Federal Energy Regulatory Commission violated their religious freedom by approving the construction of the pipeline across their property. Williams responded by beginning construction on the Adorers’ property first; if it’s already in the ground, what good is a pending lawsuit?

A Pennsylvania district judge, Jeffrey L. Schmehl, the same judge who approved Williams Corporations’s use of eminent domain to seize property for the pipeline, dismissed the Adorers’ lawsuit. They immediately appealed.

Oral arguments in their case were heard on Friday, January 19 in Philadelphia. “The Sisters are challenging the use of eminent domain for the Atlantic Sunrise fracked gas pipeline, since it’s forcing them to use their own land in direct violation of their deeply held religious convictions regarding the Earth,” read a statement on LAP’s Facebook page. The judges seemed, according to LAP members in attendance, unsympathetic to the Sisters’ religious convictions. One stated that he felt the Sisters should have opposed construction sooner—an acknowledgement on the court’s part that they do not understand the coercion and opacity of the pipeline corporation’s manipulation of the “permission” process. A decision on the case is still pending as of publication.

***

Pipeline construction continues, in Lancaster County and all across the country. Still, the addition of faith leaders to the ecological movement has significantly raised the visibility of such projects and made the immoral and unethical actions of such corporations’ starkly clear. The prominence of faith leaders’ voices undermines the Republican Party’s seeming cooptation of American religion for it’s own political purpose, thus eroding the party’s unfounded or overblown claims of progress, job creation, and safety. Faith voices also expose the human costs of the industry’s ruthless advancement.

Another effect of national religious efforts to stop pipelines, like the one in Lancaster, is the attention they’ve brought to the racially unjust practices and placement of the country’s energy infrastructure. As Mark Clatterbuck, one of the founders of LAP has pointed out, pipelines must travel from A to B and in doing so, they are not contained in minority communities but cross through neighborhoods both tawny and working class, white and minority, urban, suburban and rural. Opponents of these projects are forced to face the injustice of energy infrastructure in less privileged communities, and work with others outside their immediate racial or economic group, making economic and racial disparity starkly evident.

Like the plant in Sheridan Hollow, a low-income, minority community where opposition is hard to muster among residents who are already encumbered by the difficulties of daily living, and the Dakota Access Pipeline, which was rerouted through Native lands so that any spills, explosions or leaks would not affect the city of Bismark, the story of energy corporations’ absurdly enormous profits and decimating pollution is the story of systemic corporate and governmental injustice. When faith leaders proclaim such injustice as immoral, they tap into a grass-roots network already in existence, they make visible the devastating practices of the fossil fuel industry, and they highlight our country’s devastating complicity with unscrupulous corporations. They also undermine the current religious power dynamics in government.

At the same time, the Adorers and faith leaders like Johnson have made it harder for corporations (and their allies) to denigrate project opponents as crusty, granola-eating hippies of yore. And the credibility, rightly or wrongly, that they bring to the conversation about the industry’s practices have changed the dynamic in communities large and small.

Those effected by new projects are learning from LAP, making creative alliances, and employing more effective techniques to gather communities together to stop proposals before they start. But as we become increasingly aware of the ecological and safety hazards of wholesale destruction for corporate profit, we also realize how very entrenched political and corporate power are, unrestrained by our laws and regulations, making the “higher” power of religious communities one of the few sources of hope.

***

^[1] From Early Documents, vol. 1, New York-London-Manila, 1999, 113-114. Quoted in the opening paragraph of Pope Francis’s 2015 encyclical Laudato Si’: On Care For Our Common Home,

^[2] For more information, you can call Cuomo’s office at 877-235-6537, a hotline set up by Sheridan Hollow Alliance for Renewable Energy (SHARE)

^[3] I’m specifically referring to Christian denominations for the purposes of this piece, but many other faith groups across the country are focusing on the dangers of climate change, like DC Green Muslims (http://dcgreenmuslims.blogspot.com), and the Buddhist organization The Earth Sangha (http://fore.yale.edu/religion/buddhism/projects/earth_sangha/).

^[4] Malinda and Mark Clatterbuck, two of the founders of Lancaster Against Pipelines, are my sister and brother in law. I spent much of last year working with LAP. Lancaster, Pennsylvania is my hometown.

***

Past “The Patient Body” columns can be found here.

***

Ann Neumann is author of The Good Death: An Exploration of Dying in America (Beacon, 2016) and a visiting scholar at The Center for Religion and Media, NYU.

***

Published with support from the Henry R. Luce Initiative on Religion in International Affairs.

The post Industrial Strength Moral Compass appeared first on The Revealer.

The two councils sent their decrees to the Apostolic See and the decrees quickly came back. The cause is finished; would that the error were as quickly finished.—Augustine, early 5th century, Sermon 131:10, at the time of the Pelagian Heresy

The Catholic Church’s enormous global influence over healthcare is currently under threat due to, of all things, a dispute with board members of a civil corporation in Belgium.

If I sound overly dramatic, it’s for a good – and hopeful – reason.

The Brothers of Charity is a global order of Catholic men that sponsors 15 psychiatric hospitals in Belgium. The Brothers of Charity Group, not to be confused with the order of Catholic men, runs the hospitals, but only three of its fifteen board members are actual Brothers.

When the hospitals’ board declared last spring that it would permit euthanasia in its facilities, the three Brothers of Charity members asked their colleagues to reverse the decision. The board refused, and the Brothers appealed to the Vatican’s Congregation for the Doctrine of Faith, which declared the board’s decision a violation of Catholic doctrine and, in October, summoned the board to the Vatican.

For years I’ve been an alarmist—justifiably, I still believe—about the role of the Catholic Church in the delivery of health care. More than 600 hospitals and hundreds more elder or assisted living facilities in the US are sponsored by the Church. Although the majority of patients served at these facilities are not Catholic, Church sponsorship of hospitals influences everything from access to women’s reproductive health services like abortion, tubal ligations, and access to the morning after pill for rape victims. Several lawsuits attacking the Affordable Care Act have permitted Catholic organizations (and private evangelical corporations) to deny women contraceptive coverage. And the most vocal opponents of aid in dying movements in states across the US are Catholic institutions and organizations. Patients seeking access to aid in dying will not find it at Catholic hospitals.

For just as long I’ve been trying to call attention to the fact that aid in dying has the potential to define, and re-define, the Church’s role in the delivery of health care.

Women’s health care rights will not do so; they continue to be eroded by the bulwarks of misogyny that render women’s needs secondary and egregious. But patients’ access to aid in dying, a service requested by both men and women, has successfully addressed patient suffering more broadly and has won some momentous victories in the past decade, providing necessary social and medical protections for patient autonomy.

This advancement of legal aid in dying has the potential to put Catholic facilities in a bind.

***

Catholic sponsorship of a hospital can mean anything from name-only to bishops’ direct oversight, depending on a facility’s history. In the US, Catholic hospitals receive, on average, only about 3 percent of their funding from Catholic sources, yet their services can still be the purview of the local deacon. The challenge for Catholic hospitals—and the Church—comes when laws require their participation in legal medical practices that are considered problematic by the Church. Which is exactly what is happening in Belgium. The Catholic Church has consistently opposed the legalization of aid in dying, even as eight countries, largely in Europe and South America, and seven US states have legalized it in some form.^[1] Belgium and the Netherlands are the only two countries where non-terminal and mentally ill patients may use euthanasia to end their lives. If the board does not give in to the Vatican, the Church may withdraw the Brothers of Charity’s sponsorship of the hospital.

The visit of the Brothers of Charity Group’s board to the Vatican has not yet been scheduled, but reporting about the case has highlighted greater conflicts within the Church. Not all of these conflicts are substantial or even real, but the media’s partisan portrayal treats them like they are. As US media has polarized over the past decade, so has Catholic media.

America magazine, for instance, reported that, “A Belgian religious congregation is defying Pope Francis’ order to stop allowing euthanasia in its psychiatric hospitals, saying that its decision to do so is fully consistent with Catholic doctrine.” Such stories make it sound as though it was the order that defied the Vatican when, in fact, it was the 12 non-Catholic hospital group board members who were defiant. Stories like this wrongly throw the Orders’ board members under the wheels of the conservative Catholic bus along with the lay members.

Before issuing its summons, the Vatican ordered the board to return to compliance with Church law, prompting Herman Van Rompuy, the former Belgian prime minister, former president of the European Council, a devout Catholic, and member of the hospitals’ board, to tweet: “The time of ‘Roma locuta causa finita’ [Rome has spoken, the cause is finished] is long past.” In response, Conservative Catholic publications chose headlines declaring things like: “Pope Attacked on Twitter about Euthanasia.”

Worth noting too is the social media flame war the election of Donald Trump has caused between conservative Catholics who allied with evangelicals to give Trump the White House and traditional Catholics who found Trump to be an abominable violation of Church morality.^[2]

However repugnant Ross Douthat, the hyper-conservative New York Times columnist, may be, he provided us with this adroit summation of Vatican politics in 2015, in the aftermath of the Pope’s second synod on the family:

The entire situation abounds with ironies. Aging progressives are seizing a moment they thought had slipped away, trying to outmaneuver younger conservatives who recently thought they owned the Catholic future. The African bishops are defending the faith of the European past against Germans and Italians weary of their own patrimony. A Jesuit pope is effectively at war with his own Congregation for the Doctrine of the Faith, the erstwhile Inquisition — a situation that would make 16th century heads spin.

Douthat’s right to point out the way social media has compounded and fortified largely false notions of the Pope’s liberal effects.^[3] But what are facts in today’s polarized media climate, where Douthat’s juvenile expressions of exasperation will garner more than 600 comments in The New York Times?

The Vatican’s rifts are also evident in the endless scrapping over changes at the Pontifical Academy for Life, casting them as a tragic turn away from morality. Three months into his appointment, Archbishop Vicenzio Paglia ended the lifetime tenure of the academy’s 172 members, all John Paul II appointees and resoundingly, politically “pro-life.” Paglia also removed a loyalty pledge that was inaugurated by John Paul II with the Academy’s formation. Luke Gormally, a former member of the academy, told the National Catholic Register that Paglia’s removal of a fidelity pledge “means the academy would no longer have a ‘useful role” in providing an umbrella for the Catholic pro-life movement, which takes the ‘church’s authoritative teaching on contraception as foundational.’”^[4]

And just last month, an event organized by the Pontifical Academy for Life again highlighted discontent in the Church. It was timed to coincide with the first ever World Day of the Poor. The World Medical Association descended on the Vatican to discuss end of life issues with the Pope.

Conservative Catholic outlets covering the event focused on the pope’s condemnation of “overzealous treatment” of patients whose lives are ebbing. “It is morally licit to discontinue therapeutic measures when disproportionate,” he stated. (The Pope’s entire letter is here.) Not all conservatives are comfortable with such explicit support for removing dying or brain dead^[5] patients’ physiological support—certainly not after powerful conservatives in the US and around the world have invested so much over the past few decades into embedding their efforts in Church dogma and questionable but emotionally compelling cases—like that of Terri Schiavo or the child Charlie Gard.

But what non-Catholic and “secular” publications emphasized from the event last month was the Pope’s call for more equality in health care delivery around the world, at a time when US lawmakers are using every resource, including their hideous tax plan, to end any accessible form of insurance. “Pope denounces health care inequality in rich countries,” wrote Reuters. And, “Pope to lawmakers: protect all people with health care laws,” wrote the Washington Post

***

The board that runs the fifteen Brothers of Charity hospitals decided to permit euthanasia in the wake of a 2016 lawsuit in Belgium that fined the St. Augustine rest home for preventing a woman from being euthanized. The Brothers of Charity order have already said that they may cease sponsorship of the hospitals if the board does not reverse its decision.

And this is why I am hopeful that Catholic sponsorship of hospitals may be vulnerable.

Undoubtedly, the political, medical, and religious climate in Belgium, where euthanasia has been legal since 2002, is very different from here in the US. But those watching the Brothers of Charity case have long seen a moment of reckoning coming over the divergence in general medical practice and Catholic health care provision.

In the US, the majority Catholic Supreme Court (with its new resident expert on euthanasia, Neil Gorsuch) and a bevy of evangelical and Catholic Republican legislators (who employ a “pro-life” litmus test to prop up their legitimacy) protect Catholic sponsored hospitals from providing all medical services. Under the guise of “religious freedom” certain Christian entities, like Catholic hospitals, continue to operate in ways that harm or challenge those who have different views, lifestyles or beliefs. And yet, the Brother’s case could establish a new model for this longstanding relationship—one that may translate to our US climate.

It’s a hope. After watching patients’ rights suffer for decades because of our failure to separate a particular kind of Christian ideology from humane medical practice, any such hope is worth celebrating.

***

^[1] Aid in dying, euthanasia, and assisted suicide have definitionally and politically complicated uses around the world. Both opponents and the practice’s most strident supporters tend to use the terms interchangeably. While aid in dying (predominantly used by supporters in the US) refers to the legal ability of a doctor to prescribe lethal medication to a terminal patient, laws here require that the patient ingest the medication themselves. US opponents prefer the term assisted suicide because it best associates their understanding of the practice with suicide. Euthanasia is the predominant term used elsewhere in the world. It often implies that doctors may administer the lethal medication.

^[2] I am playing with the use of “traditional” here in an attempt to remind us of a time, some 60 or so years ago, when a significant number of Catholic adherents and leaders sought to modernize the faith and employ its social justice teachings for the betterment of all.

^[3] Don’t miss Douthat’s August column, “The Vatican’s America Problem,” for yet more explicit doomsaying.

^[4] According to Paglia, the pledge was always optional.

^[5] Since the early 1980s brain death has been the definition of death in the world medical community. Patients and families have, since the time of the court decision on Nancy Cruzan’s case, been legally able to remove or deny physiological support. Yet Catholic and evangelical conservatives have fought to remove patient autonomy by arguing that physiological support is largely therapeutic, “comfort care” and have used the emotional power of some prominent cases to erode medical ethics.

***

Past “The Patient Body” columns can be found here.

*** 

Ann Neumann is author of The Good Death: An Exploration of Dying in America (Beacon, 2016) and a visiting scholar at The Center for Religion and Media, NYU.

***

Published with support from the Henry R. Luce Initiative on Religion in International Affairs.

The post The Patient Body: “Rome has spoken, the cause is finished” appeared first on The Revealer.

“What does spirituality or morality or a good feeling toward others have to do with addiction? Zero. Addiction isn’t about that. Addiction is a psychological symptom to help you get through feelings of being overwhelmed.” —Dr. Lance Dodes, Boston Psychoanalytic Institute^[1]

Heroin, hydrocodone, OxyContin, morphine, fentanyl. “Everyone keeps talking about awareness. We’re aware there is an opiate epidemic,” Jessica Hall, Director of Judicial Programs at The McShin Foundation, an addiction and recovery program in Henricho County, Virginia, told AOL News in July. There are more women in Henricho County’s jail than there have ever been.^[2] “Where’s recovery at in this?” Hall asked.

Yes, we’re aware of the opioid epidemic. It’s been hard to miss in the media—or our personal lives—for the past decade. But there’s a kind of conundrum effect to our current reactions to the opioid crisis. Wade into studies and articles about the unprecedented rate of opioid overdoses in the country and you’re likely to come away confused about how drug epidemics happen and about how to stop what is killing so many right now across the nation.

Yes, people are dying in mass numbers; our prison, health care, education, financial, social support systems—and every other system you can think of—are overwhelmed. And no, nothing is being done. “There’s been a lack of policy action to end the opioid epidemic,” German Lopez wrote at Vox in August, “The only major bill passed by Congress on the crisis appropriated $1 billion to drug treatment over two years — far from the tens of billions a year that studies suggest the crisis actually costs.”

Trump stated on August 10 that he would address opioid addiction, but waited until the end of October to take any action. Trumps declaration of a public health emergency, rather than a national emergency, prevents the necessary funding and resources—trained people on the ground—from being committed to the epidemic.

“What we need is for the president to seek an appropriation from Congress, I believe in the billions, so that we can rapidly expand access for effective outpatient opioid addiction treatments,” Andrew Kolodny, the co-director of opioid policy research at the Heller School for Social Policy and Management at Brandeis University, told the New York Times after the president’s announcement. “Until those treatments are easier to access than heroin or fentanyl, overdose deaths will remain at record-high levels.”

What is clear from endless reporting is the horrifying starkness of the numbers. If nothing is done, half a million more people will die over the next decade. Morgues in Ohio are full. So are prisons in Virginia. Scores of people are dying of opioid withdrawal in jail. Distraught parents are using their children’s obituaries to speak out about opioid use. Children are flooding foster homes.

All of which also makes it clear that opioid addiction is a moral crisis. The moral part in this moral crisis, however, isn’t the habits and behaviors of those addicted or the sellers or makers of those drugs. It is our lack of moral action – our immoral inaction. It is the failure of our legislators to do the right thing, it is our misplaced moral judgment. It’s the application of the entrenched moralizing frame we use to talk about mass addiction: The frame which says that addicts have made bad decisions, have failed to get help, have failed to love themselves, to love God. The dominant perspective which claims that addicts have put their drug before all things, they have robbed their mother blind, they have lost their job, their wife, their kids and their dignity. The fact is, it is precisely because we have characterized addicts as immoral actors enslaved to evil substances—for, like, ever — that we’ve failed to prevent the destructive cycle of drug epidemics, past and present

***

When we do bother to address this moral crisis, we address it as a problem of national purity. I have written before about how our country uses laws regulating sexual purity to express anxieties about the condition of our nation-state, conflating them into stories we tell ourselves about national purity. To preserve the nation, we must be “pure” in all respects. It is especially important to mind the ways in which ideas about national purity carry a particular racially charged weight when applied to public health. Health care and other social support programs are under attack—not least because they serve minorities. The “Us and Them” narrative Trump—and his predecessors—have employed regarding “entitlements,” education, and immigration show that a growing faction of “us” define “American” by an ever-decreasing number of demographic traits: white, Christian, suburban or rural, in a hetero-nuclear family, gainfully employed, gun owning, healthy.

The number of “us” fitting this profile is vastly smaller than we imagine or publicly acknowledge. Yet, a nation can dream. So the American dream has been winnowed to the sole task of maintaining systemic white supremacy in our politics and our government. When Obamacare reasserted the government’s role in health care, efforts to redefine deserving Americans were reinvigorated.

Even those of “us” who live in (blue) cities are getting pushed out of the national family. Throughout the campaign, Trump used the term “inner city” to dogwhistle to MAGA Americans his racial, economic, political and religious exclusions.

Trump is no saint but his personal foibles are forgiven because he continues to pursue the religious right’s unforgiving agenda. The Trump administration and party are stacked with constituents who see poor health as a moral failing. Just last month, Betty Price, a Georgia State Representative and the wife of the former Secretary of Health and Human Services, Tom Price, felt comfortable enough to ask on videotape if quarantining people who are HIV positive was an option to address Atlanta’s high number of predominantly young, African American HIV patients. “It seems to me it’s almost frightening the number of people who are living that are potentially carriers, well they are carriers, with the potential to spread, whereas in the past they died more readily and then at that point they are not posing a risk,” she said.

Later, under national criticism, she walked back her comments. But the point remains clear: those who fall outside a strict definition of America are not worthy of protection or even basic human rights. (It’s worth noting, while we’re on the subject of morality, that Tom Price resigned from HHS after he was criticized for his exorbitant use of private jets for government work. Tax dollars are, apparently, only for the deserving, like Price.)

Our white Christian nation is under threat, so the narrative goes, from those brown, needy, gay drug users in the inner city. Price’s construction of Americanness is clear. She’s not asking how we care for ourselves and our public health, but how we protect “ourselves” from “them.” Yet, we should know from the past what happens when we let a nationalistic politics of purity and prejudice determine public health policy.

Race clearly played a role in the 1980s, when the term “crack baby” was coined. Vann R. Newkirk II wrote in the Atlantic in July, “‘Crack baby’ brings to mind hopeless, damaged children with birth defects and intellectual disabilities who would inevitably grow into criminals… unthinking black mothers who’d knowingly exposed their children to the ravages of cocaine.” Blame the addict, science and our politicians told us. “The term made brutes out of people of color who were living through wave after wave of what were then the deadliest drug epidemics in history,” Newkirk writes.

As On the Media’s Brooke Gladstone has noted, you can fix the date of the nation’s modern war on drugs to Nixon’s declaration in 1971, when he designated drug abuse as America’s enemy number one. The Nixon administration set the tone for future epidemics by using addiction to target and “disrupt” communities the administration saw as opponents.

As Nixon’s chief of domestic policy, John Erlichman, told writer Dan Baum, “We knew we couldn’t make it illegal to be either against the [Vietnam] war or black [sic], but by getting the public to associate the hippies with marijuana and blacks with heroin. And then criminalizing both heavily, we could disrupt those communities,” Ehrlichman said. “We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.”

Gladstone notes that subsequent administrations have all consistently spent more on enforcement than treatment. As a result, wrote the Chicago Tribune’s Dahleen Glanton in August, during the 1980’s crack epidemic, “Hundreds of thousands of African-Americans across the country ended up with prison records because of minor drug violations… a legacy that continues to contribute to the decay of poor, urban communities.”

Today, with the opioid epidemic, we see a stark contrast to the racialized and sexualized reactions during the crack and AIDS epidemics. According to a 2015 Kaiser Family Foundation study, 27,000 of the 33,000 who died from opioid overdose were white.

What’s different about today’s opioid epidemic is that, instead of blaming white people the way we blamed black people in the past, we’ve found ourselves a new devil: big Pharma. It took an epidemic striking the white Christian heartland for the dominant narrative to redirect blame and turn against, of all Republican-heralded things, profitable corporations.

In a recent blockbuster for Esquire magazine, Christopher Glazek went after the Sackler family, who amassed billions of dollars by manufacturing and selling OxyContin. In the piece, Glazek writes, attacking what he calls “the chronic pain movement”:

As the decade wore on, these organizations, which critics have characterized as front groups for the pharmaceutical industry, began pressuring health regulators to make pain “the fifth vital sign”—a number, measured on a subjective ten-point scale, to be asked and recorded at every doctor’s visit. As an internal strategy document put it, Purdue’s ambition was to “attach an emotional aspect to noncancer pain” so that doctors would feel pressure to “treat it more seriously and aggressively.” The company rebranded pain relief as a sacred right: a universal narcotic entitlement available not only to the terminally ill but to every American.

I have no interest in defending the Sacklers or the pharmaceutical industry; but jeopardizing the lives and health of pain sufferers to do so is a dark and immoral path for journalists and politicians. Not least because tighter restrictions on Pharma and doctors won’t solve the problem. In fact it’s already making it worse, and not just for those who legitimately need pain relief. Now that prescription pain medications are becoming scarcer, some addicts are going straight to heroin. Addiction is no more the product of easy-access pills than national impurity is the product of easy-access women.

The government’s crack down on prescription painkillers has dried up the surplus, but now doctors who fear the CDC’s strict new guidelines are cutting off patients with chronic pain. People are suffering. But we continue to turn a deaf ear to pain and suffering because our political system is still committed to the feeling of moral superiority that such judgment gives us. In September of last year I wrote about our nation’s already muted response to pain treatment, particularly in women. Suffering is a part of our national—and Christian—narrative: it makes us great, it teaches us lessons, brings us back to God and moral behavior. Which in turn should make our nation healthy, whole, and great again. Except it doesn’t.

***

Which brings us to last month’s fracas over Trump’s appointee for drug czar, Pennsylvania Representative Tom Marino. A Washington Post/60 Minutes report (subscription) fingered Marino for supporting the Ensuring Patient Access and Effective Drug Enforcement Act, passed under Obama. The report claims that the bill curtailed the DEA’s drug enforcement efforts and therefore “helped pump more painkillers into parts of the country that were already in the middle of the opioid crisis.”

Democrats were left to rail against Marino as soft on drug enforcement, never a good stance for them, however common. “I was horrified when I read the Washington Post piece and cannot believe the last administration did not sound the alarm on how harmful that bill would be for our efforts to effectively fight the opioid epidemic,” Senator Joe Manchin, a Democrat from West Virginia, said. Senator Claire McCaskill, a Democrat from Missouri, has promised to repeal the law, passed in 2016 under president Obama. (To the growing list of lessons the Democratic Party refuses to learn, add the debilitating and ineffectual impact of increased drug enforcement.)

The default, then, on how to address the opioid epidemic is the same as it ever was—with a twist: Increase DEA and drug enforcement power. The only difference this round is where the blame is placed; not on the predominantly white users, as black addicts had been blamed and penalized during the crack epidemic, but on pharmaceutical companies and doctors who manufacture and prescribe opioids. Nicholas Kristof’s recent New York Times column, “Drug Dealers in Lab Coats,” is a perfect case in reactionary point. He writes: “The opioid crisis unfolded because greedy people — Latin drug lords and American pharma executives alike — lost their humanity when they saw the astounding profits that could be made.”

However little sympathy doctors and Pharma deserve, like Manchin and McCaskill, Kristof is barking up the wrong tree. Here’s how Maia Szalavitz, a neuroscience journalist and author of The Unbroken Brain: Why Addiction is a Learning Disorder and Why it Matters, described Pharma’s role in the opioid crisis to me in an email exchange last month: the epidemic was originally driven by the “diversion” of liberally prescribed pain medication. Studies show that “70 percent of those who misuse these drugs were getting them from friends, family, dealers.” Pain patients weren’t misusing their liberally prescribed pain medications, they were letting them get into other peoples’ hands. Think, perhaps, of a grandfather who gets 75 “oxys” after surgery and takes only 3 of them; the rest are left on a shelf where an experimental teenage grandchild could easily find them. The problem isn’t the doctor, the grandfather, anyone’s morals, the pills, or even the company producing and advertising them: the problem is our willful misunderstanding and mistreatment of addiction.

“Most ‘addicted pain patients’ are people with a past or current history of addiction,” Szalavitz told me, “many of whom deliberately sought doctors for the purpose of getting drugs; others got re-addicted after having alcohol or other drug problems in their youth.” Szalavitz added that “90 percent of all addictions start with recreational use in the teens or early 20s.” Addiction will find a drug, whether its alcohol, crack, or opioids. It is a medical condition, one that requires and deserves medical treatment, not punishment, and certainly not self-righteous promises of redemption.

***

Addiction is the cause of opioid use, not personal character, not the drug, and not the drug maker or prescriber. “The real roots of addiction lie in child trauma, mental illness and despair and we’ve done nothing about them,” Maia Szalavitz told me. We’ve been getting this wrong for centuries.

Citing Szalavitz’s work in an article I wrote about Prince’s death for The Guardian in 2016, I wrote:

American history is rife with “drug panics,” from opium in the 1700s to alcohol in the early 1900s, from coke in the 1970s and crack in the late 80s to methamphetamines in the early aughts. From the beginning, the way that users have been viewed has affected drug regulation and treatment, often with disastrous results.

Those disastrous results are continued addiction epidemics. The drugs are ever changing, but the problem, as we address it, sadly remains the same: an issue of misplaced morality. We’d rather blame anything other than our own failure to address the causes of addiction. So we give moral jurisdiction to law enforcement, to drug makers, to Donald Trump, to God.

Church’s across the country are stepping up to support addicts, either by giving over their basements to AA and Al-Anon meetings or by giving over their pews to moral lessons for addicts. ” As Deborah Baker wrote at WBUR in April:

“The issue of spirituality and addiction treatment is complicated and controversial. The vast majority — by some estimates more than 85 percent — of substance use disorder treatment in the U.S. is based on the 12 steps. Among other things, the steps ask adherents to believe that a ‘power greater than ourselves can restore us to sanity.’”

Some faith leaders are realizing that support can’t come from a place of moral judgment. But the shaming of individual choice and the emphasis on “personal responsibility” that has long been applied to addiction often prevails. Baker observes Tom Thelan, a former Catholic priest who now runs a treatment center in Massachusetts, telling a group of recovering addicts, “‘In many of our groups we talk about: What is the purpose of our life? And I know it’s not to suffer and die miserable. Our purpose in life is literally to live a life of purpose. That is, in giving we receive. This addiction is the exact opposite — it’s all about getting for ourselves.’”

Yet, if addiction is a disease, why don’t we treat it as we do other diseases? With science rather than spiritualized self-help? As Szalavitz wrote at Huffington Post in March, there are two reasons: the existing mobilization of law enforcement against use and possession; and the prevalence of a spiritual and moral failing model of treatment and recovery. These are ineffectual approaches, yet we have no better solutions because most of the population still doesn’t see addiction as a medical problem. And thus addiction—wave after wave of heartbreaking drug epidemics—continues.

So, again we ask, just as Hall in Henricho County, Virginia, asked “Where is recovery at in all this?” Nowhere. In past drug epidemic iterations, the white, Christian, hetero powers-that-be had an easier time blaming the vicitms – the evils were starker thanks to differences in race and class. Today we’ve only managed to find a new and false cause. As long as we continue in this way, so too will addiction, regardless of the drug du jour or the race of the person addicted.

***

^[1] http://www.wbur.org/commonhealth/2017/04/20/spirituality-religion-opioid-addiction-recovery

^[2] Incarceration, it’s worth noting here, is not a method of treating addiction.

Past “The Patient Body” columns can be found here.

*** 

Ann Neumann is author of The Good Death: An Exploration of Dying in America (Beacon, 2016) and a visiting scholar at The Center for Religion and Media, NYU.

***

Published with support from the Henry R. Luce Initiative on Religion in International Affairs.

The post The Patient Body: Opioids: A Crisis of Misplaced Morality appeared first on The Revealer.

Artwork by Nathan Green

By Ann Neumann

“But the fruit of the Spirit is love, joy, peace, longsuffering, gentleness, goodness, faith, Meekness, temperance: against such there is no law.” Galatians 5:22

In August of 2013 I wrote to Kali Handelman, the brand-spanking-new editor of The Revealer, to see if she might be interested in a monthly column about all the testy, complicated questions surrounding religion and medicine that riddle the rich folds of our American social fabric.

My pitch was rather loosey-goosey: a placing of two terms in relation to one another, a commitment to question both my definition of those terms and their commonly understood meanings, a mapping of where they overlap and don’t. The title, “The Patient Body,” was both a play on words and an ode to that most dissipated virtue, patience, to endure discomfort without complaint.^[1] Suffering in silence doesn’t get many points on my own personal scale, but suffering is —either on a cross or on a hospital gurney— the core of both religion and medicine. With a patient body, our most immediate media, seemed like a sound place to start.

At the time, I was thick into research for a book that explored the intersection of religion and medicine through the lens of end of life care. I couldn’t think of a better format for that book-bound research than a monthly column, with its regular deadlines and enforced thinking-through of entrenched problems—with an astute editor who could poke holes and ask good questions. We have since put out some 45 installments of the “Patient Body” column—altogether practically a book itself. (You can browse the archives here.)

***

Religion is the bane and bastion of medical ethics (see “How Ethics Saved the Life of Medicine,” August 2015), the tenets of the application of science to bodily health. Like an appendix, both germane and excessive to the body, religion is the shadow and progenitor of ethical practice in medicine.

Often it is the media coverage of the two that muddies our understanding of their historical interdependence: the court controversies, the ethical conflicts, the tensions between personal and public health. Media’s increasing need to tell stories that outrage, incite and ultimately generate sales (of ads, clicks, or anything, really) reduces any issue to two sides, the more closely matched the better the fight, often characterized as science vs. religion or individual vs. the bureaucracy. No one gets to be a complicated human in these matches; no one gets out alive.

The relationship between religious morality and medical ethics is—and we could argue has always been—narrated by the religious (particularly the most politically visible), the medical professions (the farther from the patient body, the more corporatized). Nuance and subtlety, debate and negotiation, have never been the media’s practice— bet that media legacy, new, subscription, or social. Throw in a heap of our country’s religious illiteracy, add a dollop of “capital T” truth dished out by science and medicine—“we own the facts, we’re curing cancer!”—and you have the perfect recipe for our mediated cultural collision course.

Since I made religion and medicine my beat nearly a decade ago, and since we began The Patient Body, the narrowing and calcifying of mediated opinions have most characterized the national climate. Trump’s election, thanks in large part to evangelicals willing to look past most anything for the sake of an ever more conservative US Supreme Court, confirmed that politics today is about winning, not governing. Even if this had been the case for decades, the cravenness of the Democratic party was exposed; the Republican party’s use of moral purpose as a shield for theft was laid bare.

Even if Trump’s election has made our tone more urgent, The Patient Body’s terrain has consistently been the pitfalls—and pratfalls—of these tensions and stories. The November 2013 column addressed kidney donation and medical equity. The opening of “What’s a Kidney Worth?” reads:

If I pay you $10,000, will you give me a kidney? Just one. You have two and you really only need one; you’re healthy, and while I don’t know you, I think you might have an idea of what to do with an extra ten G. I’ll cover your hospital stay, your operation, your recovery*, all you have to do is… let my surgeon cut into your abdomen and take your kidney. You’ll be saving a life. You’ll be richer. You’ll be giving the ultimate gift.

The column asks us to reconsider the emotionally compelling but ultimately false notion that altruism is an unmitigated good. I argued that the international medical industry was patting its own self-righteous back when it declared that organ donors cannot legally be paid for their kidneys; I factored in the astounding shortage of kidney donors and the elaborately inequitable regimes established to collect organs. It’s a piece of humor and dissection that was easier before Trump’s election shifted medical policy from pragmatic recalibration to outright national triage.

Internal Organ Kidney Heart Lungs Liver c. 1850 Heck antique detailed engraving

Patient autonomy and public health can travel in tandem; most often a patient’s medical decisions are not a threat to society. But in the highly publicized and controversial cases when they don’t agree, I have tried to wade in. The most perfect example of how religion and medicine confound patient autonomy—pitting the soul against its pain—is the battle for legal aid in dying in the US. The very first Patient Body, “An Irresistible Force,” looked at the laws surrounding “assisted suicide” and how they were being used by opponents of aid in dying. I examined a highly charged case where a state’s “assisted suicide” laws, being used to confound patients’ end of life choices, caused unnecessary pain and suffering for one family.

Erring on the side of life is an unquestionable principle, perhaps, until you’re standing where Barbara Mancini was on February 7, 2013, in her father’s home outside Philadelphia, Pennsylvania. Joseph Yourshaw asked his daughter, Barbara, a nurse, to hand him a bottle of morphine. Yourshaw was 93, a war veteran with diabetes, end-stage renal disease, heart disease and the effects of a stroke. She gave him the bottle. He took the morphine.

Mancini was arrested; her defense supported by the largest aid in dying organization in the country, Compassion and Choices. Was Yourshaw’s decision to drink the morphine immoral? Illegal? A danger to his soul? His family? Society? Was Mancini’s simple act a threat to anyone? Ultimately the court ruled that Mancini could go free, but her experience no doubt stifled countless families caught in similar horrors of love and pain.

Mancini’s case is of a genre; pain is one of our most potent political currencies. In September 2016’s “Narratives of Women’s Pain,” I wrote about another aspect of medicine’s regard for suffering: the epidemic of women’s pain in the country today. I started with the story of how Phyllis Schlafy, the Religious Right’s grand doyenne of keeping women in their place, once broke her hip at a talk and continued to smile and thank her hosts even while being carried out on a stretcher. “To be female means to bear pain,” I wrote:

Schlafly wielded pain as a moral cudgel, deployed to maintain the narrow roles of behavior she and her political counterparts interpreted as moral. You venture beyond the hearth, the marriage bed, the modesty of appropriate female clothes, the confines of strict gender-sexual alignment and you are punished.

Our enforcement of women’s subservience has fatal consequences—ones that are too often justified as “natural” or noble. This is evident in recent studies that show doctors—both male and female—blatantly ignore or undertreat women’s pain and suffering, disregarding it as the natural state of women. Citing Jessi Klein’s widely-shared, “Get the Epidural,” essay for the New York Times, I wrote:

Women are never allowed to be their natural selves—without make up, unshaven, uncoiffed—unless they’re giving birth. Then the shaming of selfish women who want medication begins. With such disregard for women’s well being, it can be no wonder that the US maternal mortality rate has doubled since 1990.

Shame is so much a part of living with a female body that it works as its own censure on behavior. Women are ashamed to speak of their own pain. The detriment to public health is obvious: women die in childbirth. For July 2015’s column “Impossible Purity,” I looked at the shaming of sex and how failure to teach and discuss individual rights affects public health. With a cue from Sara Moslener’s excellent Virgin Nation: Sexual Purity and American Adolescence about iterations of the purity movement, I wrote:

Calls for abstinence are as old as the Garden of Eden, and for exactly none of that time have they been broadly heeded. Nevertheless, Christian evangelicals persist in their cultural and political emphasis on sexual abstinence. And that persistence continues to have serious consequences.

Those consequences are unwanted pregnancies, STDs, financial and educational inequality, shaming of sex and those who have it, and an entrenched double standard for boys and girls. Moslener’s book sets up the argument that (female) sexual purity has historically been conflated with our nation’s purity. The politics of religion influence the politics of health in such a way that individual rights are pitted against nationalism, I wrote, quoting Moslener:

Public health is always rife with the politics of moral judgment (exactly what makes this column possible!). Public health regulations are often a telling barometer of our country’s moral compass, from vaccination laws to the legal drinking age. And no public health category is more fraught with moral minefields than sexual health. Right now, our moral compass is set on shaming and inhibiting the lives of young people, particularly women, by setting up and devoting wads of money to an ideal that will never be achieved (not least by a majority of those espousing it). “That is the erotic dream of Christian conservatism: a restoration of chivalry, a cleansing of impurity, a nation without sin, an empire of the personal as political.”

With the Trump administration’s embrace of inequalities—racial, financial, gendered—not as tacit unfortunate challenges but as designed and moral structures, public health (and how we talk about both nationalism and the health of the country when we talk about it) becomes a cudgel aimed at the most vulnerable. In this administration, the most vulnerable are re-characterized as unsafe, immoral and dangerous; they are a threat to the nation’s physical and financial health: dangerous Muslims and Mexicans, grifting welfare recipients, lazy poor people. In a dog-eat-dog world where survival goes to the fittest, it takes a pretty self-assured ideology to carry this kind of warped “moral” weight.

The Martyrdom of Saint Cecilia by Stefano Maderno

 Othering, redefining citizenship, privileging of some rights over others, heightening fears of moral and physical danger or infection: these are the tools of power, political and moral. More often than not, these tools pit the rights of minority groups against a glorious retelling of nationhood. They help shift the definition of morality away from health and care and rights to profit and winning and might. With The Patient Body, my goal is to find the moral truths, to ask who is scapegoated or ignored, to point to what’s at stake.

***

Few tasks can be more exciting to a writer than looking back at the accumulation of work diligently amassed over time. As I sat down to mark the passing of our four years by rereading these columns, so many surprised me with their urgency, clarity, and bravery. Much of that freshness is due to Kali’s fine directing, to Angela’s eternal astuteness, and to the history and mission of the Center and The Revealer. Lord, make me a vessel!

There are some true clunkers here too, don’t get me wrong. But the living nature of the column, its unfettered willingness to go into dark corners and to speak up at seemingly inappropriate times has kept the work of the past four years somehow fresh. And—this is an important point—it has continued to engage and motivate me. Not once have I looked across at my Revealer deadline and thought, “what in the world am I going to write about.”

***

^[1] Unless you’re into literal interpretation: longsuffering and forbearance are often used in place of patience. https://www.biblegateway.com/passage/?search=Galatians+5%3A22-5%3A23

***

Past “The Patient Body” columns can be found here.

*** 

Ann Neumann is author of The Good Death: An Exploration of Dying in America (Beacon, 2016) and a visiting scholar at The Center for Religion and Media, NYU.

***

Published with support from the Henry R. Luce Initiative on Religion in International Affairs.

The post Anniversary Edition: Four Years of “The Patient Body” appeared first on The Revealer.

By Ann Neumann

But, fundamentally, choosing against a life-sustaining measure because it is unduly burdensome or futile with the foreseeable consequence of an earlier death is not the same thing as declining or discontinuing care to directly facilitate dying. The former is a choice for a different kind of life, however long it lasts, and the latter is a choice for death. —O. Carter Snead, director of the Center for Ethics and Culture and professor of law at the University of Notre Dame, in an op ed, “Why the Pope is Fighting for Charlie Gard,” for CNN on July 13, 2017

With the death of an 11 month-old child last month, another cycle of life-and-death spectacle left the world stage. They called themselves the “C Team”: Connie Yates, the desperate grieving mother with no flesh between her bones and her draping press conference clothes, a cascade of hair to her unnursed breast, a fair curtain covering one eye; Chris Gard, the crusading father, a dark warrior with a cloth monkey in the breast pocket of his ill-fitting, armor-like suit, protectively leading his wife by the hand into a wad of press or a tangle of London traffic; and Charlie, universal infant, innocent, white, golden haired and bright, “our angel,” our future, our hope—whom we were all asked to bludgeon or protect.

A fantastical tragedy (like so many other tragedies of young women and babies before it, Karen Ann Quinlan, Nancy Cruzan, Terri Schiavo, Jahi McMath, Baby Joseph), the story of Charlie Gard featured warriors, philosophers, saints, kings, charlatans and maids, all illuminated by a robust and perpetual chorus. All displaying the most compelling characteristics of human drama: conviction, pride, bravery, justice, duplicity, grief, frenzy, and compassion. It was a passion play of a new but familiar order, a perfect fleeting little boy onto whom so much could be projected; the ghost-like parents, gaunt, speaking, when they spoke at all, in the clichés of profound emotion.

Charlie’s condition, mitochondrial DNA depletion syndrome (MDDS), was rare, debilitating, and fatal in early childhood. It affected many organs, including the brain and muscles and caused a wasting of his tissues and energy. He was deaf, immobile, epileptic and increasingly unable to see. He was kept alive only by artificial ventilation.^[1]

The Charlie Gard story in three parts: 1. The doctors of Great Ormond Street Hospital in London advised Charlie’s parents to end artificial ventilation. They refused. In April this year the Family Division of the High Court ruled for the hospital. 2. Chris and Connie appealed—to the courts, to the public, to the media, to the pope, to the US president, to Columbia University’s research scholars, to a hospital in Rome, to a hospital in New York, to US “pro-life” evangelicals, to you, me, and every media consumer. 3. Finally, when science proved even too conditional for hope, the Gards relented. Charlie died in hospice on July 28, one week before his first birthday. Donated funds were established as a foundation—little Charlie’s afterlife and legacy—for other children with rare medical conditions so that #charliesfight, #charliesarmy might have everlasting life.

Beginning, middle and end— Aristotle’s protasis, epitasis, and catastrophe–the three stages of plot structure. Our reward for attending to the Gards and their courts is a kind of Aristotelian catharsis. “Aristotle’s somewhat technical understanding of catharsis acquires its overtones of meaning from a double linguistic heritage, in part medical and in part religious,” states the Princeton Encyclopedia of Poetry and Poetics. The medical part harks to the early writings of the Hippocratic School of Medicine, which “refers to the discharge of whatever excess of bodily elements” has made the body sick. Once discharged the body may return “to that state of right proportion, which is health.”

The religious part Aristotle likely picked up from various Plato works, including Phaedo, in which catharsis consists “in separating, so far as possible, the soul from the body, and in teaching the soul the habit of collecting and bringing itself together from all parts of the body, and in living so far as it can both now and hereafter, alone by itself, freed from the body as from fetters.”

The resultant meaning from blending these two philosophical strands is both physical and psychic“A wisdom is distilled from tragic suffering: man is pathei mathos, ‘taught by suffering,’” states Poetry and Poetics, referencing the chorus in the Agamemnon. Richmond Lattimore wrote in his classic 1953 translation and introduction to the Oresteia, of which Agememnon is the first in the trilogy: “What they kill is what they love.”

Grieving mother Lu Spinney wrote in the New York Times on August 11 about the death of her son who had been mentally and physically disabled in a skiing accident. He died of pneumonia four years later when the family decided not to treat him: “protecting my son meant wishing for his death.”

Great Ormond Street Hospital wrote in a June 18 statement: “Our priority has always been, and will always be, the best interests of Charlie Gard.”

The story of modern medicine is so very many Oresteias. The suffering are dead at the hands of those who loved them. The killers, people like you and me, killing what we love. Again and again the story is epic heartbreak and tragedy. We blame whatever we can, we ascribe the eternal pain to fate, we give it order, outline it in three parts. We contrive meaning and lesson out of the cold body, the blood on our hands, the shattered lives, the cacophony of the chorus, the memories of the dead. It is what we do.

***

The four horsemen of the tragedy of Charlie Gard are same as they ever were and will be: the medicine; the media; the politics; and the faith, hope and charity.

The medicine was bitter. There was no cure for the child’s disease. The experimental treatments waved wildly before the courts’ and the family’s eyes were rudimentary, untested, and prescribed from afar. On July 7, New York Presbyterian Hospital and Columbia University Irving Medical Center offered to accept the child if the UK courts cleared him to leave the country. Dr. Michio Hirano offered an experimental treatment with a 10 percent efficacy, if he could get the FDA to approve his treatment of the child or his mailing of the special drug to London. Hirano was immediately and roundly criticized by other doctors and ethicists for not having examined the child before offering medical treatment. And for, rightly or wrongly, having a financial stake in the experimental treatment he intended to use. Hirano’s commitment to Hippocrates’ “do no harm” was strongly questioned.

The media spent three months voraciously vying for every angle, opinion, development and counter narrative of the Charlie Gard story. Every opinion piece, every article pumped more anguish into the exposition and rising action of Charlie’s narrative—attracting support from global luminaries like Pope Francis, who cagily tweeted on June 30:

“To defend human life, above all when it is wounded by illness, is a duty of love that God entrusts to all.” Cagey because Vicenzo Paglia, the president of the Vatican’s Pontifical Academy for Life wisely weighed the nuances of the case and released a statement which read in part: “we must also accept the limits of medicine and […] avoid aggressive medical procedures that are disproportionate to any expected results or excessively burdensome to the patient or the family.” Factions claimed the Pope’s words for themselves; practically, the Holy diagnosis was inconclusive.

Yet a hospital near the Vatican tweeted that it would take the child in. On Twitter the hashtag #jesuisCharlieGard proliferated, accompanied by adorable photos of the infant, enormous doe eyes seeming to stare imploringly at the camera. The Gards also had an active crowdfunding website, charliesfight.org, and Facebook and Twitter accounts that amplified every shudder, heartstring, statement, or report. After Charlie’s death on July 28th, #iamcharliegard, used by the ubiquitous and consistently “pro-life” website, LifeNews.com, kept Charlie’s legacy alive by playing on the “I am Sparticus” meme to highlight other infants in supposedly similar straights as Charlie.

All this swirl, engaging general readers, infecting primed demographic groups—religious and political, particularly—did important financial work: driving traffic to media outlets and charity dollars to the family’s GoFundMe page which raised nearly $2 million dollars in the blink of an eye. What the funding did was remove any question of how Connie, a caregiver, and Chris, a postman, would pay for their child’s treatment—an important point for American supporters who apparently believe—grotesquely, inconsistently, immorally—that care really only should go to those who can afford it. The funds also exempted the Gards from British national health care, a devilish and corrupting form of socialism according to those bootstrapping conservatives across the pond.

The political chips were stirred. They fell for or against as they may: UK Prime Minister Theresa May and muppet-like UK Foreign Secretary Boris Johnson stated their support for Great Ormond hospital. US President Donald Trump, however—having just run through the repeal and replace gauntlet but nonetheless unwilling to admit anything like defeat—came out for Charlie’s charity-funded experimental treatments. He tweeted, “If we can help little #CharlieGard, as per our friends in the U.K. and the Pope, we would be delighted to do so.” @fight4charlie, the C Team’s Twitter account, retweeted, “Thanks @realdonaldtrump for your support – @theresa_may do the right thing and #savecharliegard!”

Unintentional comic, Trump pal, and former UK politician Nigel Farage stated on his radio show, “Should we live in a society where parents, providing they’re of sound mind, can make the ultimate choice about their children’s future. Or does the state have that power? What this case has shown, sadly, is the state has that power. I don’t like it. I want this changed.”

***

Why Farage wanted “it” changed was best articulated by Bobby Schindler, brother of Terri Schiavo, founder of the Terri Schiavo Life and Hope Network, self-proclaimed disability rights activist, and Chris, Connie, and Charlie visitor a few weeks before the latter’s death. Schindler wrote in a June 30 statement,

The central issue of the Charlie Gard struggle is not about rationing, limited resources, or even life support. At issue is whether universal healthcare means that bureaucrats and judges will determine appropriate treatment, or whether parents like Charlie’s with the energy, finances, and physicians to care for their child will be allowed to do so.

Schindler here and elsewhere condemns “universal” healthcare (read: blood thirsty bureaucrats) for making the hard decisions when those decisions should be up to the “consumer”—but only those consumers who have the “energy, finances, and physicians” to make their own decisions. And only if those decisions are ones Schindler and his radical “pro life” allies agree with. It’s an argument for privilege when you examine the costs to community that futile care, like what was required to keep little Charlie “alive,” are considered.

Keeping Charlie alive was an all court press conference for the specialness of some patients (the pretty young ones) at the expense of all other less meme-ready, emotionally engaging patients. If you dramatically get the audience’s attention, you get the special drug, the pope’s tweets, the moral justification.^[2] The hospital’s concerns regarding Charlie’s suffering and the misuse of resources were grotesquely re-narrated as proof of the “culture of death.”^[3] No nuance. No moral ambiguity. The world consists of the immoral killers (feminists, government, hospital ethics boards…) and the moral killed (innocent babies, the most vulnerable for whom miracles may occur).

Schindler explained to Glenn Beck in July the seemingly senseless reason the hospital both refused to treat Charlie and prevented him from getting treatment elsewhere: “But it makes sense to me. And also, think about it this way, Glenn. If they are wrong and Charlie does improve from treatment out there, think about all the other families now that are being cared for in that hospital.” Fear of being found out as fallible. He continued:

I mean, if you’re looking at it from a purely financial point of view, the hospital’s best interest is to say, “Okay. Listen, this person’s life is going to cost a lot of money. He’s not going to get much better anyway.” So then they go in and tell the parents. They give them this poor diagnosis. And they say, “Look, you don’t want to end up like a Terry [sic] Schiavo, so to speak. You know, why don’t you do what’s best for this person. Put him out of his suffering and end his life.” And they have the legal means now to do this.

What Schiavo brought to the Gards’ fight was language, media savvy, and a well-established frame for how to hope beyond all hope (a suffering for the sake of suffering). The Life and Hope Network was called TerrisFight.org long before little Charlie was born. Everything Schiavo knows about media sensation he learned from circus barker extraordinaire, Randall Terry, who staged protesters outside Terri Schiavo’s hospice and called in legislators, from local to the president, to prevent Schiavo’s feeding tube from being removed. Schiavo also gave the Gard’s access to a fundraising network and a long-cultivated list of allies in the medical industry.^[6]

Schindler also brought the Gard cause an indisputable, if misdirected, mantra: killing the disabled is wrong. Aid in dying—euthanasia—is always immoral. And denying or removing treatment, as the courts ordered for Terri Schiavo’s feeding tube, is murder. Charles C. Cosey, a professor at Fordham University, rallied to this mantra in an article for FirstThings:

They reached this judgment on the basis of [Charlie’s] expected mental disability. They denied him treatment, and ordered his ventilator removed, not because of the burden of the treatment, but because of the burden of his life. In a cruel act proposed by doctors, approved by courts, cheered by the press, and blessed by certain high clerics, Charlie Gard was euthanized. It was euthanasia by omission, but it was euthanasia all the same.”

Many saw through the ill-conceived categorization of little Charlie as disabled, as the stopping of his ventilator as murder. They were having none of the Schiavo-like tragic framing and fashioning their own lessons from suffering. Michael Redinger, psychiatrist and medical ethicist at the Western Michigan University Homer Stryker MD School of Medicine, wrote at America magazine:

One category includes those treatments that are termed futile or, more accurately, “nonbeneficial,” and it has been an increasing focus of both secular and Catholic medical ethics. Physicians are not obligated to offer treatments that, in their medical expertise, have no reasonable chance of success or in which the harms so far exceed the potential benefits that it becomes inhumane to provide them. To do so violates the ancient maxim to “first, do no harm.”

Redinger’s tone, like that of the Vatican’s Vicenzo Paglia, is the tone the Mother Church uses to smack down undisciplined and upstart “pro-life” politicians and advocates who try to speak for them. Redinger shakes a finger at the “well-intentioned members of the pro-life community” who “reflexively leapt to the defense of the Gard family”: “In doing so, they unfortunately failed to recognize the nuances of Catholic teaching on end-of-life care. When life is valued so highly relative to other goods, its pursuit becomes detrimental. In effect, life itself becomes an idol.”

***

The faith, hope, and charity of Charlie Gard’s tragedy are eternal. Early on, when they first engaged the courts, Gard’s parents believed that he was strong enough, special enough, to be among the few 10 percent of patients for whom the experimental drug could be efficacious. How could they? And yet, how could they not? The day little Charlie died, they wrote, “We are struggling to find any comfort or peace with all this but one thing that does give us the slightest bit of comfort, is that we truly believe that Charlie may have been too special for this cruel world.” When there was no hope for their son’s survival, they fabricated it out of noise and light and social media posts and small-increment charity.

As to Charlie’s suffering, he was their fighter. They could see no pain on his face, despite the court’s constant concern for his suffering. Of if they could see his pain, it meant he was still theirs, still alive; his pain now paying forward his heavenly reward.

Most of the comments on Lu Spinney’s essay, “Protecting my son meant wishing for his death,” about her disabled son’s death by pneumonia, are encouraging and supportive. She had done the brave, right, counterintuitive thing: she cared for him by letting him die. But one voice stands out in the affirming chorus, one that stays with her son’s suffering rather than raising up Spinney’s grief. Cynthia Starks of Zionsville, Indiana wrote two days after the piece was published:

Yet none of the comments I have read considers that we are all called to suffer as Christ suffered. No one escapes. Not even beautiful and brilliant young men. With a belief in God, we know that our suffering is united with Christs [sic] in service to the world. My own brother, died of a particularly painful and aggressive form of cancer. Our priest said that he felt sure his suffering was his purgatory on earth. Mother Angelica, founder of the EWTN Network, once said, in her final difficult illness, that she prayed each night for one more day of life so her suffering could be offered up for another soul in purgatory. I know these beliefs are out-of-fashion, but some of us still hold to them, as they are still taught by the Catholic Church.

It’s an ancient sentiment, one that, even before Jesus hanged by nails, compelled Greek choruses to extoll pain’s great lessons. What was Charlie’s lesson? Christ too suffered? “No one escapes?” And yet, through death, Charlie Gard did.

***

^[1] I take this description of MDDS and Charlie Gard from an essay by British physician Phil Whitaker, which appeared at the New Statesman on July 11, 2017: http://www.newstatesman.com/politics/health/2017/07/decision-over-charlie-gard-comes-down-matter-belief

^[2] See also the Right to Try movement, which successfully has sought to circumvent FDA drug approval processes (big government!) to allow boisterous parents to request experimental drugs directly from pharmaceutical companies, thus jeopardizing existing testing procedures for treatments needed by the rest of us. Because: they’re special. https://therevealer.org/2015/12/21/the-patient-body-accusing-the-fda-of-playing-god/

^[3] The phrase comes from Pope John Paul II and is most often used to refer to abortion and “euthanasia” but is increasingly applied to confrontations over removal of physiological support. For more on the “culture of death,” see Wesley J. Smith, a self-appointed bioethicist of this wing of the “pro life” movement. https://www.firstthings.com/web-exclusives/2017/06/three-culture-of-death-tipping-points

^[4] See also the Right to Try movement, which successfully has sought to circumvent FDA drug approval processes (big government!) to allow boisterous parents to request experimental drugs directly from pharmaceutical companies, thus jeopardizing existing testing procedures for treatments needed by the rest of us. Because: they’re special. https://therevealer.org/2015/12/21/the-patient-body-accusing-the-fda-of-playing-god/

^[5] The phrase comes from Pope John Paul II and is most often used to refer to abortion and “euthanasia” but is increasingly applied to confrontations over removal of physiological support. For more on the “culture of death,” see Wesley J. Smith, a self-appointed bioethicist of this wing of the “pro life” movement. https://www.firstthings.com/web-exclusives/2017/06/three-culture-of-death-tipping-points

^[6] The Life and Hope Network has a long established “Lifeline” that is supported by donors and staffed by likeminded doctors, ethicists, nurses, facility and hospital directors and lawyers. In the past half dozen years, the Life and Hope Network has been involved in many of the high profile “futile care” cases that have garnered national and international attention: https://donorbox.org/lifeandhope?recurring=true

***

Ann Neumann is author of The Good Death: An Exploration of Dying in America (Beacon, 2016) and a visiting scholar at the Center for Religion and Media at NYU.

The post “A Different Kind of Life”: The Tragedy of Charlie Gard appeared first on The Revealer.

Like most family stories, the one told to explain why my Mennonite grandparents chose to switch churches in the 1950s has a few variations. As one version goes, the pastor of Byerland Church, where many of our relatives were active members (and where several generations are buried), asked that my grandmother reconsider the length of the strings on her covering. They were a little too short for the pastor’s modesty. She declined; my grandparents found a new congregation, Willow Street Mennonite Church.

The second version of the story involves my grandfather who, they say, was inclined to purchase health insurance for his young family, a violation of Byerland’s ordinances. While health insurance was popularized in the 1950s (see here for more on the history of health insurance in the US) Mennonites traditionally did not participate in the growing program. Many Anabaptists—a category of Christians that includes both the Amish and Mennonites—have, because of their history of persecution in Switzerland and subsequent countries after the Reformation, refrained from participating in corporate, legal, and government practices or institutions such as: health insurance, lawsuits, military conscription, or public schools. Even today, very few Amish vote.^[1]

While churches like Byerland and Willow Street no longer require that members dress plainly or go without health insurance, many Anabaptists continue to cover medical costs without insurance.^[2] The Amish, for instance, pool their congregation’s money to meet the medical needs that members accrue.^[3] The practices of Mennonite churches are hard to generalize. Their worldly engagement has both drastically changed and not changed at all in the past several decades, depending on the congregation and the conference. Still, the Anabaptist population remains relatively small: about 1.4 million global church members.

Health insurance has changed radically in the past half century because of the increasing rate of self-employment (and unemployment), the decline of affordable job benefits (and salaries against cost of living), the increasing age of the population, the radical rise of medical costs, and the greater availability of medical treatments. When the Obama administration broached health care reform, it was not a minute too soon and about 30 years too late. But ideological and political differences warped the conversation about quality national health care provision into the spectacle of a national World Wrestling Entertainment, Inc., match.

In January 2010, when the policies and provisions of the Affordable Care Act were just taking shape, I wrote a piece for the web publication, Killing the Buddha, about right-wing commenters who got wind that Anabaptists would be exempt from the law’s mandate. “We’re all Amish now,” the likes of Michelle Malkin and Don Surber claimed. “I’d say the Amish have about 16 million people who might want to become Amish and be conscientious objectors to being drafted into Obamacare,” Surber wrote at the time, callously managing to demean both the religious convictions of an entire Christian denomination and to mock the desperate need for equitable care coverage for the rest of the country. (Why 16 million? Perhaps that was Surber’s sad reach for a critical mass?) Malkin’s point that “some faiths are more exempt from government intrusion than others,” I wrote at the time, “is further explained by Raymond Arroyo, [a blogger on Laura Ingram’s website]:

So get this straight: the Amish, Old Order Mennonites and possibly Christian Scientists can opt out of the health care plan, with no penalty, while Catholics and other Christians are bound to pay premiums that fund abortion. How is that fair? Hundreds of Christian, pro-life hospitals, doctors and nurses may soon be forced to violate their consciences and offer or perform procedures they consider morally objectionable.

The conflation of health care providers (hospitals) who serve a pluralistic society with individuals (doctors, nurses, and folks like Surber) who might oppose certain constitutional medical treatments, is not an error. Conservatives have been successful at claiming that institutions and businesses have consciences just like individuals.^[4]

As it turns out, right-wing, anti-Obamacare conservatives were onto something. First came a wave of “religious exemption” haggles between the Obama administration and the Catholic Church. Then evangelical Christian corporations won the right to flout the law.^[5]

Catholic and evangelical families have also found a way around the Affordable Care Act (ACA) mandate in increasing numbers through health sharing ministries, which look a lot like mutual aid societies, a relic of the pre-insurance days. Health sharing ministries have had a revival in the wake of Obamacare’s passage. Last month, Buzzfeed’s Laura Turner wrote a long exposé of Samaritan Ministries, “one of a number of Christian health care sharing ministries in the US that take the place of traditional health insurance by pooling and redistributing members’ money each month.” Samaritan is a nonprofit based in Peoria, Illinois with revenue of more than $34 million in 2015 (up from $6.6 million in 2013). Its members are asked to send their prayers and monthly checks (enrollment costs are based on family size) to those in need and can then submit copies of their medical receipts to the organization for reimbursement.

How many are enrolled in such cost sharing “ministries”? Turner writes that the three largest ministries, Samaritan, Medi-Share, and Christian Healthcare have just under 900,000 individuals. That includes nearly 400,000 new enrollees since February, 2016. Even smaller ministries are experiencing incredible growth, some at the rate of 200% since last year.

Many other health share ministries exist in the country, but they are much smaller, like the Mennonite organization Liberty HealthShare, based in Florida. Another, according to Turner, is Solidarity HealthShare, which is Catholic but partnered with a Mennonite organization to meet Obamacare’s stipulation that qualifying health sharing ministries existed before 1999.

Several factors are attracting evangelicals and Catholics to health care ministries like Samaritan: members appreciate the low overhead costs, aided by the fact that CEOs tend to earn a fraction of what corporate insurance companies do (Samaritan’s CEO took home $184,000 in 2014; in 2015 Aetna and Cigna’s CEOs earned $17.3 million each).^[6] “I haven’t felt like I’ve been throwing my money away to grease some CEO’s pocket,” a ministry member named Jennifer told US News’s Kimberly Leonard last year.

Members also like the sense of community created by sharing financial needs and prayers. But the big draw for many of the Catholics and evangelicals who have rushed to enroll since the passage of the ACA is the ministries’ anti-government and “pro-life” practices, an ideological mix that is as political as it is religious.

At reason.org, Jim Epstein wrote last year that Samaritan protected members from paying for others’ bad behavior. He quotes: “Do you support abortion, sexual immorality, drug & alcohol abuse with your health insurance?” from the cover of one Samaritan pamphlet which, he writes, later warns that “Joining with ‘unbelievers’ to cover the ‘health consequences of sinful living is not a way of showing the love of Jesus Christ.’”

However one might wish to interpret and institutionalize Jesus’s prejudices (on Epstein’s claims of what Jesus would do, I beg to differ), the new iteration of health care ministries pose serious problems for patients. While they satisfy the Obamacare mandate, they bypass most of the consumer protections that Obamacare made law, like inclusion of those with preexisting conditions. As Turner finds, “there are serious drawbacks lurking below the surface” for many members. Samaritan, for instance, has a lifetime cap “between $125,000 and $250,000.” Chronic illness, addiction, mental illness? You’re on your own.

Other restrictions, as noted by health care blogger Sean Parnell, involve members’ demonstrated religious conviction. Parnell writes about Solidarity, which launched last year:

The requirements for membership in the ministry are fairly consistent with those of other ministries, for example no drug or alcohol abuse. Regular church attendance is also expected. Not surprisingly for a Catholic entity, there are also prohibitions on contraceptive use (Protestants tend not to have objections to married couples using contraception) and an expectation that members “[r]eceive the Sacraments regularly” and “[c]onsult with our priests over matters of moral conscience.”

The questions that the current ministry boom raises are many. While the pre-ACA methods and size of health care sharing ministries were apportioned to a small minority religious group (Anabaptists), the increasing inclusion of Catholics and evangelicals signifies something new, primarily because this group’s newfound use of ministries appears to be significantly politically motivated. Where once these ministries sheltered unique religious convictions, centuries old—Anabaptists largely live sequestered from general public life—the new and growing membership of Catholics and evangelicals has begun to transform ministries from havens of protection into organizations that enforce exclusion and even jeopardize member’s health and financial well being.

The articles I’ve linked to above often chronicle cases of ministry members whose health care bills were denied or whose membership was terminated because of coverage restrictions. Turner’s article is framed around a couple whose adopted child was ultimately not covered. Lifetime cost caps, denial of those with existing conditions, and lifestyle requirements further embed discriminating practices.

Ministries like Samaritan have raised concern across the country. As Kimberly Leonard writes at US News (linked above):

Commissioners or judges in Washington, Kentucky and Oklahoma tried to shut health sharing ministries down in recent years, but state lawmakers stepped in, allowing them to run without the same regulations insurance companies face. According to the Alliance of Health Care Sharing Ministries, 30 states have such exemptions.

As the status of health care hangs in Trump’s balance, many leaders in the Catholic Church have come around to the health care provision, urging congress to not repeal the law. Many of the ACA’s protections have proven beneficial to millions.

While the ACA is deeply flawed (a recent article by Helaine Olen at The Atlantic goes a long way in reminding us that our current system is not even close to meeting our health needs), Republican’s opaque and diabolical plan to un-insure 20 to 24 million Americans—while simultaneously relegating elders, the disabled, the chronically and terminally ill, the mentally ill and pretty much anyone who doesn’t have a full time, salaried job to the not very metaphorical curb outside the emergency room door—the politicization of affordable and comprehensive care in the country is likely only to increase.

***

^[1] Although that hasn’t stopped Republican’s from focusing efforts on this “often forgotten block of voters”: http://www.aljazeera.com/indepth/features/2016/09/elections-america-amish-voters-160915122802283.html

^[2] You can learn more about plain dress here: https://en.wikipedia.org/wiki/Plain_dress

^[3] The Amish do not have physical churches, they meet in families’ homes; the bishop, deacon and ministers work together to define the level of worldly engagement the group will have, from clothing styles to telephone use.

^[4] For more on the history and evolution of institutional conscience (for instance, hospitals) see here: http://scholarship.law.nd.edu/cgi/viewcontent.cgi?article=1086&context=ndlr

^[5] http://www.npr.org/2012/02/07/146511839/weekly-standard-obamacare-vs-the-catholics; see also Little Sister’s of the Poor, https://www.theatlantic.com/politics/archive/2015/07/obama-beats-the-nuns-on-contraception/398519/

^[6] Although the cost savings for families enrolled in health ministries is disputed: http://www.healthline.com/health-news/christian-health-cost-sharing-programs-growing-in-wake-of-obamacare

***

The post The Politics of Healthcare Sharing Ministries appeared first on The Revealer.

Mark and Malinda Clatterbuck, members of Community Mennonite Church and founders of Lancaster Against Pipelines, participate in Easter Sunday service. (EmmaKate Martin)

By Ann Neumann

The field of bioethics—and the important social and policy contributions it makes to our democracy—will be profoundly affected if authoritarian populism displaces constitutional democracy. —Mildred Z. Solomon, Bruce Jennings, “Bioethics and Populism: How Should Our Field Respond?” The Hastings Report, March 16, 2017

As the sun came up on Easter Sunday, I was standing in a sprouting, dew-wet cornfield in Lancaster County with 60 others who had gathered to celebrate the resurrection and spring. The crowd was a hodge-podge, made up of members of my family, members of the nearby Community Mennonite Church, members of a neighboring, sprawling Amish family, and a smattering of activists (local and national) who have been camping on the site for several weeks, their objective to stop the Atlantic Sunrise pipeline which will slice through the county, jeopardizing the lives and health of everything in its path.

Since the election of Donald Trump, questions about health and safety are no longer rhetorical. All around us, individuals have been making rich, ramshackle communities and loudly parsing the difference between partisanship and morality: non-believing people (like me) are joining churches of all stripes, tapping into existing communities of all types to raise a louder voice.^[1] Alarmed mothers are marching and running for office, millennials and minority groups are gathering to protest and make friends, students and teachers are walking out of classrooms. Within disciplines, too, vocal debates are taking place about members’ responsibilities for what many have qualified as the rise of authoritarian populism and the endangerment of public health.

Recently, contributors to a listserv I read, a heap of otherwise non-religious political scientists, policy wonks and journalists, waxed on about their renewed participation in local churches and synagogues, their need for community heightened by the election. Like our Easter Sunrise service in the path of a pipeline, resistance to unhealthy policies is making rich and diverse new communities in which moral actions are the collective purpose, an embrace of the longstanding but often muted morality of the liberal American church.

Churches embody community by, at the most local level, providing social support to those who will most benefit from it: housing, food, child care, care for the disabled, and even health care. The voices of activist groups like Lancaster Against Pipelines and inclusive churches like Community Mennonite are made more relevant and necessary in the current political environment when they work together. Such disparate groups are increasingly finding themselves as allies. Which is only natural; we are all members of more than one group in our communities and professions.

***

A recent debate in the field of bioethics, a discipline predicated on balancing the health needs of individuals with those of the public, highlights the ways in which discourse about moral obligation to community has bloomed since the election. In the March-April issue of The Hastings Center Report, Mildred Z. Solomon, a professor at Harvard Medical School and president of The Hastings Center, and Bruce Jennings, a professor at Vanderbilt University and a senior advisor at The Hastings Center, co-wrote an essay that’s garnered a host of telling commentary. Their essay, “Bioethics and Populism: How Should Our Discipline Respond?,” is a kind of rallying cry for bioethicists to see the centrality of their role, as members of an interdisciplinary field long predicated on the study of justice and equity in public health, in this political moment.

Solomon and Jennings spend the first third of the essay defining America’s current form of populism. They argue that “In the discourse of constitutional democracies, ‘the people’ is an inclusive, egalitarian, and culturally and religiously diverse conception, while in today’s populist discourse, the people are defined as an exceedingly selective and antipluralistic entity.” This redefining of “We, the people” has further marginalized the concerns of all but an elite group of people, threatening the health and well being of vast demographic categories of residents.

The rest of the essay answers the question, “Why and How Should Bioethics Respond?” Bioethics, they explain, embodies the very same “values and norms of discourse” as constitutional democracy because bioethics “has been concerned with the age-old communitarian question, how should we live together?” Who should have access to new and expensive medical technologies and drugs? What health resources are we all entitled to? How can the costs and benefits of public health best be distributed? What health services violate human morality or medical ethics? How can the autonomy of individual patients be protected and defined within supportive communities?

Science, like the Church, has taught us that we are all in this together, that “We, the people” must mean everyone. The health of all, as medical science tells us, is determined by the health of individuals, and vice versa. Herd immunity, for instance, provides health safety to individuals who are not inoculated against deadly viruses, thus demonstrating the reliance of all on community. While protecting the health of the nation may involve politics, our collective obligation to do so should not be a partisan debate.

Solomon and Jennings make the case that the interdisciplinarity of bioethics, its moral weight in discussion of health justice, and its process of debating equitable structures and distribution, put bioethicists squarely at the forefront of the debate about the politics of health. The authors broadly (and rightly) include issues of the environment, the justice system, immigration, education, and food and drug safety in the realm of bioethicists’ concerns. And while they acknowledge that they are engaging in politics (it’s absurd but frequently claimed that the profession – any profession – is apolitical) they deny any partisanship. The equitable distribution of health care and resources protects and elevates the health of all Americans. What’s controversial about that? Yet, history tells us that disciplines and organizations of all types have been complicit in atrocities.

Chillingly, the essay notes how the medical industry had, in the past, been “coopted for state purposes”:

Academic medicine and practicing health care professionals played key roles in the early twentieth-century eugenics movement, assisted the U.S. government with human radiation experiments during the Cold War, and most recently were involved in the support of torture.

Complicity in immoral state actions, they warn, lies in ignoring democratic values and failing to publicly work for them. Indeed, bioethics in part grew out of this history of state-sponsored eugenics (as well as the ethical challenges created by rapid development of medical technologies).^[2] The authors are warning that the field should remember its roots.

Yet, Solomon and Jennings have received ample criticism which falls into two categories: polite admonitions that everyone should please calm down (‘cause, you know, Trump’s not so bad); and hand-wringing warnings that bioethics, the discipline, will be damaged by taking a moral stand. As Franklin G. Miller, a professor at Cornell Weill Medical College, writes in his response (also published in The Hastings Center Report):

Solomon and Jennings give the impression that bioethicists all do, or should, subscribe to a stance of liberal progressivism. Evidence for this view is the way that they advocate for “a greater focus on justice” as one of the ways in which bioethics should respond to populism. The section of their essay devoted to this position gives no attention to competing conceptions of justice; rather, their discussion of distributional and “structural” dimensions of justice provides a liberal progressive perspective, as filtered through a communitarian lens.

I stifled a giggle when reading Miller’s response. “Justice,” as he would have it, is a kind of dirty word, a dog whistle for leftists, a concept and objective that cannot be defended without partisan leanings. Trump’s administration—and his supporters—have long been on a campaign of making “justice for all” the enemy. As this conversation plays out in bioethics, it more clearly and accurately represents the health discrimination Americans have long struggled with. That Miller so publicly concedes this is stunning. Michelle Bayefsky’s response, also a criticism of Solomon and Jennings, drives Miller’s point home:

While Solomon and Jennings may have intended to appeal to fundamental democratic values upon which all civic-minded people can agree, their emphasis on human interdependence and structural and distributional injustices, as Miller points out, would likely appeal more to those with a progressive, communitarian approach.

Bayefsky worries that when bioethicists advocate for justice it could convince “those who disagree with those views” that they “do not belong in the field of bioethics.”

With new emphasis on community and justice, it’s gratifying to imagine that Trump’s election has renewed the power and persuasion of community, not only in the professions, like bioethics, but in the nation’s moral and organizing bedrock, the church. For decades, the power of liberal churches has been usurped and out-shined by the prosperity and political dominance—the partisanship—of the religious right, their purpose maligned as a relic of organized religion’s past. It is bewildering that some would try to rewrite the history of bioethics to erase its foundational purpose of health equity.

Religion has forever granted authority to moral positions on health equity (its own prejudices notwithstanding); it is seen as the keeper and legitimizer of right behavior toward one another. The role that liberal churches are playing today —and the backdrop they provide for local and national organizing—is that of moral authority. If the liberal church—with its embedded community infrastructure both physical (here is the church, here is the steeple) and social (look inside and see all the people)—can demonstrate ways to include those Trump and his henchmen have singled out, the moral conviction and license of like-minded activist groups are made stronger. The religious right has long influenced unjust moral, legal and scientific laws. But an opportunity now exists for a renewed moral voice to usurp that influence.

Mark and Malinda Clatterbuck, members of Community Mennonite Church and founders of Lancaster Against Pipelines, participate in Easter Sunday service. (EmmaKate Martin)

That the religious left is experiencing new authority in political and social America has been the topic of much discussion in the past several weeks. Daniel Schultz (pastor and, in the past, contributor to this publication) was joined by a host of conservative voices in denouncing the liberal church’s influence—on anything, let alone the health sciences. Schultz writes:

Most people on the left aren’t hostile to faith, but they’re only willing to cede it so much authority. That’s not because liberal clergy deal away the moral (or even revealed) content of their faith, as the stereotype often has it. In fact, I and many colleagues across denominations struggle mightily to know God and to understand where our faith is leading us. But we take pluralism seriously, and we are painfully aware of how faith has been used to control, hurt, and oppress the vulnerable.

I’m not denying Schultz’s well-made points—that the left is a plurality of voices whose power is affected by its acceptance of a multitude of faiths and nonfaiths. My point is more pragmatic and along the lines of Solomon and Jennings’s distinction between politics and partisanship. The religious left in the US cannot alone counter the greed and individualism that this administration is hell bent on enacting, but its voice, when amplified by activist movements and disciplines in need of moral authority and organization, perhaps can.

A multitude of positions then is not a weakness but a strength, contributing what it can to the cause of equity. I have only these slim evidences: members of a non-religious listserv extolling the benefits of right-minded, inclusive churches; and a motley but righteous Sunday Sunrise service in a Pennsylvania cornfield. The call within bioethics for a unified voice for public health makes bedfellows of the American religious left and the scientific community—and a driven smattering of movements across the country. That’s more than the recent American past can boast. And given the vagaries of the near future, enough to place one’s hopes on.

***

^[1] Community is itself in need of some bit of reclamation. As Kate Reed Petty recently wrote at the Los Angeles Review of Books, “community is overused by nonprofits and has been co-opted by corporations, used as a synonym for ‘consumers.’ What hasn’t capitalism yet coopted?” (Petty directs us to this helpful discussion of the use of community in technology.) But as the word is used among burgeoning anti-Trump movements today, so has it also long been used to identify not only affinity (senior and youth centers) or proximity (the 400 block of Main Street), but a group’s organization around the practice of identifying and caring for people in jeopardy. This is where churches, the more inclusive the better, have prevailed in leveraging moral voices against injustice.

^[2] For more on the history of bioethics, read here, here and here.

***

Past “The Patient Body” columns can be found here.

***

Ann Neumann is author of The Good Death: An Exploration of Dying in America (Beacon, 2016) and a visiting scholar at the Center for Religion and Media, NYU.

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