Thanks Angela on Catholica for pointing me to the following reflection. It’s a cracker. At first I thought I’d post excerpts and point you to the link but, for my record if nothing else, I’m posting the lot.
The patient art of dying
By Scott Stephens
The draft report of the Productivity Commission’s call for urgent reform of aged-care is an extraordinary and long-overdue document that, if implemented, will go a long way toward rectifying the myriad injustices and forms of institutional and economic abuse to which our elderly are subjected in the final years of their lives.
And yet it would be mistake, I believe, simply to limit our focus to the institutional and economic dimensions of aged-care, thereby keeping this problem at arm’s length. There is an equally important moral or personal dimension to the ongoing catastrophe of aged-care in Australia that demands a reform of our moral imaginations as well.
But whereas budgetary constraints and sheer political will are the impediments to the implementation of the Productivity Commission’s draft report, our impediment is that we have grown far too adept at suppressing our obligations to the elderly.
Anyone who has had any experience of working or volunteering in aged-care facilities knows the conditions in which our elderly so often live: their clothes drenched with either excrement or the property-less mush served to them as food; cavernous hallways echoing with howls and plaintive cries for assistance; under-resourced, overworked and frequently untrained staff rushing frenetically from task to task; the ambient disdain for these frail, barely existing hominoids who are not treated as though they were alive, but simply “not yet dead”.
With some noble but all too rare exceptions, this is the ubiquitous experience of residential aged care in the West. But perhaps this is the way it has always been. Perhaps there is something unnatural about the outsourcing of the care of our elderly to a disinterested third party, as if it ruptured the proper order of things.
Just take Elizabeth Jennings’s haunting poem “Old People’s Nursing Home”, written in the middle of last century (with thanks to Kim Fabricius for the reference).
The faces differentiate themselves,
The men half-women, the women half-men
And each entirely children
Except in anger, except in ignorance.
These wrinkled faces know too much, these gnarled
Hands have touched the pulse of love, have known
The family increase and birth’s harvesting.
But that was the past and this house has shut out the past
And it dare not face the future:
So it lives in a perilous present that could be cracked
By a broken cup or a laugh.
Cups are unbreakable here,
Jokes are in print too small
And the noisy future, the passionate past are dammed
Partly by deafness, partly
By doctors’ decisions and nurses’
Hiding the stuff of life and death away –
Tear-heavy handkerchiefs, the whiff of pain.
Jennings captured the unreality – and indeed, the hellish immorality – of the nursing home as a place where past and future, memory and hope, are somehow eradicated and all that is left is the nightmare of an immutable, insipid present in which not even cups can break.
But how can it be otherwise when it is one’s family and immediate community that safeguards memory and embodies hope, and while the expressed purpose of residential aged care is to separate the elderly from their families and communities?
And although it is inevitable that residents would look to the staff to function as an ersatz family, the staff are themselves ill-equipped and incapable of meeting the residents most basic material needs, much less provide the kind of emotional succour so necessary in old age.
The tragedy of residential aged care is that there is no way of simply dividing the different actors into the victims and the perpetrators, the indigent and the sadistic. Instead, the staff and the residents are bound, as it were, back-to-back in an institution that makes human affection and mutuality well-nigh impossible, and that is cruel in its very indifference.
One of the more worrying aspects of the Productivity Commission’s draft report is the worsening of two trends identified in the Commission’s 2008 report.
The first is the continued increase in the number of large residential aged care facilities – that is, those with more than 100 beds – run both by not-for-profit and by private for-profit operators, such as the Moran Health Care Group, TriCare and Macquarie Capital Alliance Group.
The effect of this expansion on smaller not-for-profit facilities – those with 40 or fewer beds – has been devastating, forcing them to contract from over 50 per cent of the total number of residential aged care facilities in 1998 to less than 30 per cent in 2010.
But the second, more disturbing trend identified by the Productivity Commission is the sharp reduction in the willingness of family members and communities to care for their elderly. As David de Vaus observed (and is cited in both reports), “The more the obligation has a direct impact on people’s lives the more reluctant they are to accept responsibility”.
It is not hard to imagine the future that awaits our elderly as these trends continue to converge: ever increasing numbers of the frail and infirm herded into an ever-decreasing number of sterile profit-based mega-facilities, and there left to vanish in anonymous isolation.
To be sure, there are family members that agonise over having to leave their loved ones in such a degrading environment but simply cannot see any other option. But for far too many Australians, the ability to go on living in our consumerist nirvana is predicated on the capacity to forget our obligations to the elderly.
And here there is a rather distressing correlation between our failure to honour our obligations to the unborn and to the elderly. In this respect, what Peter Hitchens says about the “strange popularity of abortion” applies to our haste to consign the elderly to third-party care:
“I have often thought that the strange popularity of abortion among people who ought to know better has much to do with this sensation of lost control, of being pulled down into a world of servitude, into becoming our own parents. It is not the doomed baby that the unwilling parents hate … It is the life they might have to live if the baby is born.”
And so it seems that the elderly, like unwanted pregnancies, have become a kind of ritual sacrifice that we as a society offer to the most implacable of our modern idols: what Herve Juvin has described as a kind of lived immortality sustained by unlimited choice, a freedom from obligation to others, and the delusion that we can somehow indefinitely defer our deaths.
So what might be a moral response to this intolerable and mutually demeaning situation? Alongside any reform and increase in funding for the provision of supported accommodation and community-based care, there must necessarily also be a change in what can only be described as our cultural ailment, our moral amnesia.
Perhaps a first step might be to remember that morality itself is neither bound by convenience nor enacted from a distance, but rather, as Gilbert Meilaender nicely puts it, “consists in large part in learning to deal with the unwanted and unexpected interruptions to our plans” – which the demands of the elderly undoubtedly are.
But there is a second facet of such a reform of our moral imaginations that is far more demanding, and requires the strength of an entire community to sustain. It is the patience to help the elderly die.
Residential aged care, paradoxically, does not let its wards die, but rather consigns them to an interminably aseptic life. Again, Elizabeth Jennings captured this with grim accuracy.
But there was no smell, not even the deathly sick
Odour of death. And then I realised:
Death is shut from this house, the language of death,
The accoutrements of dying.
A ghost would be lively. Ghosts are not allowed here
And neither is talk of birth.
We forget that the ars moriendi or the “art of dying” – of which Langland’s Piers Plowman is perhaps the best literary example – was cultivated in the mediaeval Christian tradition as an indispensable part of living well. But it was never understood as an individual virtue. It was instead a communal effort, whereby the community gathers to listen with patient gratitude to lives that have finally learned to tell the truth about themselves.
Dying, in other words, was deemed the last theatre of virtue and courage, the manifestation of the bond between the living and the dead whereby what it might mean to die well is exemplified.
One of the more surprising advocates of the Christian tradition of the ars moriendi is also one of the most notorious modern atheists. In the final volume of the His Dark Materials trilogy, Philip Pullman tells the story of Lyra and Will, two children who have made a perilous journey to the world of the dead so that Lyra may apologise to a friend she inadvertently betrayed, and for whose death she was responsible.
But once there, it becomes clear that their destiny is to destroy death itself by, quite literally, cutting a hole in the other side, thereby permitting the ghosts of the dead to disperse into the benign indifference of the universe.
When one of the harpies – whose role it is to torment the dead by spitting venomous reminders of their failed lives – complains that releasing the dead would negate the very reason for the harpies’ existence, the children’s travelling companion makes a touching suggestion:
“‘Then’, said Tialys, ‘let’s make a bargain with you. Instead of seeing only the wickedness and cruelty and greed of the ghosts that come down here, from now on you will have the right to ask every ghost to tell you the story of their lives, and they will have to tell the truth about what they’ve seen and touched and heard and loved and known in the world. Every one of these ghosts has a story; every single one that comes down in the future will have true things to tell you about the world. And you’ll have the right to hear them, and they will have to tell you.'”
If we don’t recover this patient art of dying, whereby we learn to tell the truth about ourselves, and if we don’t allow our lives to be formed by our obligations, it is not simply our elderly that will continue to suffer. We will find ourselves, and our moral imaginations, immeasurably poorer.