Transforming Care: A Christian Vision of Nursing Practice (6 page)

MARY ELIZABETH O'BRIEN

When the nurse clinician ... stands
before a patient .... God is also
present.... For it is here, in the act
of serving a brother or sister in
need, that the nurse truly encounters God.

MARY ELIZABETH O'BRIEN

Jesus himself modeled how we are to engage appropriately with "the
least of these" as image-bearers of God. In Luke 7:11-17 we are told a story
of Jesus' response to a woman's
paralyzing grief. Jesus encountered a funeral procession at the
gate of the town of Nain. He
learned that the man who had
died was his mother's only son
and that she was a widow. The author of Luke tells us that Jesus
"had compassion for her," and so
he raised the son from the dead.
Jesus recognized the particular
grief that this woman experienced: she had previously lost her husband
and now her only son. This would be a devastating set of losses for anyone,
but especially for a woman in an ancient society. Jesus felt compassion for
her in her fragile and vulnerable state. Likewise, Christ's empathy permeated and literally touched the multitudes of other suffering, vulnerable,
and outcast persons that he healed. Jesus often identified himself with social outcasts. He ate and drank with sinners and tax collectors. He considered women to be worthwhile conversation partners. He treated with respect those who were considered beneath contempt. In short, he upset
social expectations about respectability, righteousness, and purity, and he
calls us to do the same. When nurses, mindful of the grace that has been
extended to them in their unworthiness, model themselves on Christ, they
approach the vulnerable as mediators of the divine, they respect the dignity of those whom our society would cast aside, and they treat with respect even those, especially those, whom they consider to be sinners.

Because we recognize God's presence in the vulnerable and weak, both
reverence and awe are appropriate attitudes for the Christian nurse as well.
To treat clients with reverence is to honor them as image-bearers of God
who escort us into the presence of what Rudolf Otto was fond of calling
the "mysterium tremendum," the overwhelming mystery of the Holy One
who binds all of reality together (Otto 1950). Just as we quake in wonder
before the majesty of God, so we ought to hold in reverence those who
bear God's image. This means that the task of nursing must be approached
with fear and trembling, for the ones the nurse cares for are the fragile vessels of the God who weaves a meaningful cosmos out of the chaos of nothing. This is cause for awe, for we are participants in God's creative work as
we engage others in the task of seeking meaning. Nurses undertake this
wondrous and awe-full task as they promote the health and welfare of
their clients, enabling them to pursue their life's plans and purposes.

The web of relationships that call for us to reflect reverence, awe, and
respect includes not only the nurse and the client but also the nurse's colleagues, health care institutions, and the health care delivery "system" such
as it is. The nurse works together with lab technicians, nurse's aides, physicians, social workers, chaplains, clients' families, and administrators. In all
of these relationships, the nurse seeks the presence of God and cultivates
reverence, awe, and respect.

It is important to note that the nurse herself or himself likewise deserves to be treated as one who belongs to the God whom we approach
with reverence, awe, and respect. Consciousness of the sacredness of human life and awareness of the way we encounter Christ in those around us
generate a commitment to create, maintain, and preserve structures that
ensure that everyone is treated with concern and respect. This consciousness will be important in Chapter Four when we consider the ways in
which Christian faith shapes the values and principles that guide ethical
action in nursing practice.

If the majesty of God shines through the created order, evoking in the
nurse gratitude and a sense of well-being, then that same light, as it strikes
the objects of creation, also casts a long shadow over the nurse's experience. We cannot be honest about the human relationship with God if we fail to acknowledge this "shadow side" of religious experience. The experience of God as it is found in nursing practice prompts an awareness of the
goodness of creation that takes priority in the nurse's consciousness, but
this awareness does not eclipse the experience of brokenness and tragedy.
This other side of the nurse's double consciousness, the shadow side of religious experience, includes two aspects pertinent to our discussion of
Christian nursing practice. The first is the experience of self-deception; the
second is the experience of tragedy. The first of these is rooted in our sinfulness, the second in our finitude.

When we considered the ethic of consent earlier, we noted that it is
grounded in a sense of rightness and well-being that reflects a recognition
and enjoyment of God's sovereign power over all creation. But this recognition of God's sovereign power, which allows us to discern some of God's
purposes from the patterning of creation, also brings forth a different set
of affections: bewilderment rather than awe, anger rather than gratitude,
lament rather than enjoyment. Consenting to the divine ordering of the
world requires an honest assessment of our place in it, and that assessment
does not always prompt joy.

Imagine the whole creation bound together the way the points of a
cobweb are related to one another. Every point derives its existence and
significance from its relationship to the central point, and each point relates to other points on the web on the basis of their relationship to the
central point. If we think of God as occupying that central point, then we
have the image of a theocentric creation - that is, a creation focused on
and oriented toward the glory of God. Each creature comes into existence
and derives its meaning and purpose for being through its relationship to
its Creator. All things exist for the glory of God. Creatures may serve each
other's purposes, too, but this is not their primary identity. No creature is
merely a means to another creature's end. Every creature is intrinsically
valuable. The exacting client who makes constant, inconsequential demands on an overworked nurse and treats her as nothing but a servant has
probably forgotten this important truth. The efficient nurse who moves
through her client assessments as though those individuals were widgets
on an assembly line has also forgotten it.

One of the things that happens when we forget that we are to "relate to
all things in a manner appropriate to their relations to God" is that we become self-deceived. Rather than living our lives out of a theocentric orientation, we become anthropocentric or egocentric in our orientation. We think, in other words, of the human species and its good, or of ourselves as
individuals, as the central purpose for the creation. In that perspective, all
things exist to serve our purposes; all things derive their meaning and
value from our priorities. Plants, animals, even other people are seen as
valuable only if they suit our plans. Even God is moved to the periphery
and given a minor role that serves our good - God becomes the heavenly
sugar-daddy who doles out blessings at our prayerful request and who ultimately exists to save our immortal souls and provide them with a happy
afterlife. In short, we put ourselves in the place of God.

But this is all an elaborate self-deception rooted in our unwillingness
to acknowledge that we are not God and that all things do not exist for our
sake. This can happen in subtle ways. Nursing is a practice oriented toward
the preservation of life, and this is a good thing; but it is not an absolute
end in itself. If, for example, Janet can find her work meaningful and
worthwhile only when its goal is the preservation of life at all costs, then
she cannot care effectively for Ann because she is fundamentally deceived
about the nature and limitations of human life. Such a view of health care
demonstrates a refusal to accept the reality of death and to acknowledge
that we will not live indefinitely. At bottom this refusal, this self-deception,
is an effort to transfer divine infinitude to the finite and fragile human
frame. It is a form of self-deification wherein the continuation of physical
existence becomes the highest good. And if we operate with such a distorted picture of human life as the absolute good, we cause destruction to
the very lives we should be treating with care and respect. There comes a
time in some lives when death is a gracious relief from inconceivable suffering, and if we arrogantly insist on using every resource to stave off
death, which ultimately only prolongs suffering, we do so out of a mistaken desire to pretend that human life is not finite.

To preclude misunderstanding, it is worth noting that this is not intended to be an argument for active euthanasia. It is, instead, an argument
for recognizing that the attempt to use interventions to stave off death
should come to an end at some point, in recognition that human lives, on
this side of the general resurrection, do not continue indefinitely. We are
finite creatures, and respect for that finitude includes the recognition that
at some point we should no longer attempt to prolong life at whatever cost.
The unbounded fight to prevent physical death represents an idolatry of
physical human life that is generated by self-deception about our place in
creation.

One of the great strengths of the Christian faith is that it takes our capacity for self-deception - our ability to confuse ourselves with God - as
a central theme for theology. Christianity acknowledges that even religion
can be associated with self-deception and self-deification. Because of this,
Christians must always be self-critical. We must always seek out the hidden
idolatries in all of our activities. When we begin to assume that all things
exist for our sake, we also begin to feel the weight and responsibility of being God. Suddenly the salvation of individuals falls to us! But this is an illusion, for salvation is a gift from God. God claims us before we are ever
capable of claiming God.

Confusion about our role can lead Christian nurses to forget this central affirmation of the faith. They come to believe that they are acting as
Christian nurses only when they are "witnessing" to their clients, when
they are being explicit about their faith and trying to convert the client. Or,
worse, they can think of their vocation as a nurse as merely a pretense to
get at vulnerable clients and convert them. But because we are not God,
and because salvation is the work of God, it is not our responsibility to
save anyone. This is not to say that there is never a time when Christian
nurses should speak of their faith with clients. The spiritual dimensions of
nursing care are central and important, and nurses who are open about
their own faith commitments are better nurses for it. But acknowledging
one's faith and being open to the spiritual needs of the client are not the
same thing as confusing nursing with evangelization. Nursing itself is a
valid Christian ministry, responding to Christ's call to care for the least of
these, and should be treated as such.

Sinful self-deception sometimes operates subtly - for example, when
we value human life as if it were the absolute good or when we are led by
genuine concern to ignore the constraints of respect and manipulate clients' vulnerability in order to feel that we have saved their souls. But we also
need to have a clear vision of the ways in which self-deception operates in
more obvious ways. When we label a client "non-compliant" or ignore the
call light and repeated requests of a demanding client, we probably have
some justification, but we run the risk of justifying too much. When we
simply give the medication ordered by a cantankerous physician, rather
than calling to check on a dosage that looks wrong, we may be choosing not
to see what we should see. Self-deception also plays a deep and abiding role
in the many ways in which we fall short of living a life that brings glory to
God and contributes to the well-being of those we are responsible for. We need to learn to see the workings of this self-deception and self-deification
in our own lives, as we can so often see it in the lives of others.

The awareness of our sinfulness forms one part of the "shadow side"
of the nurse's religious consciousness. But another important dimension is
rooted in the simple fact of our finitude. Even if Janet recognizes that human life comes to an end, her recognition does not cancel out Ann's misery, because the suffering itself is not a result of our self-deception. It is
real. The Gospel accounts of Jesus' life give ample evidence that he understood the reality and full range of human suffering as he took on human
form and appearance for the sake of our salvation. Jesus, the Messiah, was
betrayed, mocked, taunted, spat upon, flogged, and nailed to the cross,
where he endured a slow and tortuous death. Jesus' death likely entailed
some of the same horrible elements of physical suffering that nurses often
see in their dying clients - exhaustion, searing pain, gasping for breath.
Christ's experience with suffering validates the reality of human suffering
in general and offers the assurance that our particular suffering is not foreign to him. Ann suffers as her body is failing, and Janet suffers as she
struggles with a sense of futility that her care cannot reverse Ann's deterioration and pain. Ann is dying, and therefore she needs a different kind of
care than she would if she were suffering from a reversible condition. Even
if Janet acknowledges this fact and comes to enjoy the work of palliative
care as a way of consenting to human finitude, she will still, no doubt, be
confounded by the reality of suffering.

A careful examination of the structure of creation reveals that not all
of God's purposes are to do with us, and not all of them conform to our
immediate good, or at least to our perception of it (Gustafson i98i, 202). It
is far easier for the zebra to consent to the divine ordering as it munches on
the grasses of the savannah than to do so in the mouth of the lion. And we
should expect that, even as the zebra struggles against the lion's jaw, so
Janet will protest the raw evil that decimates Ann's body and unravels her
mind. But we prefer to imagine that there is never a time in the proper ordering of things when we belong in the lion's mouth, or its equivalent in
human experience. This happens in part because we are deceived about
our place in the world, deceived into believing that we are the ultimate reason for its existence and that the rest of creation derives its meaning and
purpose from its relationship to humanity. But there is more to it than
that. We can certainly recognize that there is something wrong with asking
the zebra to take delight in being devoured by the lion even if it is part of how God has ordered the world. We expect the zebra to put up a fight.
Likewise, an ethic of consent could be nothing but perverse if it called for
human beings to submit gleefully to the process of degradation that ultimately ends in our deaths.