11 May 2013

Liverpool Care Pathway: A Homily

Three or four times a year, a group of fellow Catholics and friends meet to discuss a matter of current social, public or ecclesiastical interest. At the preceding celebration of Mass, I try to find in the Scripture readings of the day something that will reflect on the subject of the discussion.

On Thursday, the matter concerned was the controversial Liverpool Care Pathway. Intended to provide the framework for the best nursing and medical care for the dying, in the hands of some practitioners it is used as the basis for proactive judgments that determine the course resulting in the ending of life. It seems that withdrawal of sustenance or life-saving intervention can be decided, without the consultation of family or respect for a patient's faith or wishes, on a pragmatic (or economic) assessment that takes into account such considerations as the average likelihood of recovery, age, social demography and so on. As it has manifested itself in England – following a series of terrible instances of not only negligent but harmful nursing practice – it looks like the pressure of a “culture of death” from a medical establishment that steers people, either through persuasion or as a result of the ethic applied to the way the care programme is being applied, to a non-illegalised version of euthanasia.

Without getting into the technicalities, my homily sought to stress that human mortality can never be seen as “end of life” but as the setting of its resurrection. The dying person is thus not an animal being managed out of existence, but an integral member of the creation which has been and is being restored in Christ, all humanity in it, and him.

6th May 2013
Thursday of the Sixth Week of Easter
The Frame of Risen Humanity and its Care
Acts 18.1-8
John 16.16-20
Through the readings, today we have witnessed that moment that so incensed St Paul that he turned his attention from revealing the true significance of Christ’s passion and resurrection just to the members of the Jewish diaspora, and oriented it to the rest of the world too. And we almost missed it, but we also saw the moment when St Paul baptised and thus admitted to the Church not just personal converts, but a whole family household. In other words, the resurrection to new life is not just for those who believe in it, or for those who form a religious group or, as we might relativise ourselves nowadays, a “world faith”, but for the whole world. Indeed it has happened TO the whole world, and it has re-created the nature of ALL humanity.
Similarly, we have stood before Jesus on the verge of his taking leave of us in this world, only to be told that his going away is nothing other than his constant returning. In other words, just as his death was not the end but the means to a new creation, so his new life, which cannot be contained within this world, is by no means restricted to the next.
If there is a weakness in the way we proclaim the Gospel of the Resurrection in the Christian West it is that we seem to be locked into the philosophy that heaven is an after-life, that life after death is a realm for the body’s leftover spirit, that rest eternal is inertia, that resurrection is a scientific conundrum to be explained away spiritually, or even denied materially. It is as though we more truly believe that this life here and now is what matters, that here is where we find the concrete reality.
In truth, however, as C S Lewis pointed out in The Great Divorce, here is the world of shadows, false impressions and soft authenticity – heaven is the hard and vivid reality, at first too hard and vivid to be bearable. Thus famously he also said that the suffering now is part of the glory then – the two are not only connected, they are the same thing as they impinge, the first in the fallen world, the second in the life that is to come and is already upon us. St Paul, with his massive impression of the way in which everything is integral to Christ who fills the universe, put it another way – “your life is hid with Christ in God”; and again, “it is not I who live, but Christ who lives within me”. Thus it is the great intuition of the Christian East that the resurrection is not some far off and distant result, still less a merely spiritual phenomenon appropriated now only through faith and grace, but it is the true, harsh, vivid, pointed reality of existence as it stands now, since Christ burst the tomb and ascended the heavens, and to which those who are baptised in the Spirit are – we trust – acutely attuned.
The resurrection is not then; it is now. Heaven is not hereafter; it is the present Kingdom that we pray may “come on earth - as it is … “.
All humanity is of one piece before it – not in one group, or nation, or religion; still less in one individual’s mind for faith. Just as we all belong to each other in this world, so this world belongs to heaven and in heaven. By the same token, there is no difference of separation now to the humanity that fell from grace, and the humanity in which Christ redeemed it from loss and endued it with the everlasting life, which is the quality of the Kingdom of Heaven. As St Paul also said, “it was sown a material body; it is raised a spiritual body”. Christ is risen – we are risen: “As in Adam all die, even so in Christ all are made alive”. The living of the resurrection in the body is not something from which this life and the barrier of death insulate us – this resurrection is the truth of who we are with the nature of human beings. And it is now. More vivid, harder, more blindingly apparent for all we believe we cannot see it. This is not a mere opinion of how Christians regard themselves. It is how Christians understand the created, fallen, forgiven and resurrected order in which we find ourselves, because this is where we see that Christ, who went “beyond” in his act of constantly being present again and again in it. This is what his going to the Father means: for ever being seen “on earth, as it is in heaven”.
This evening we turn our attention to the ethical questions surrounding end of life care, and the response of the Catholic Church, in its members, to those whose bodies decline, fade and falter, as well as to those who attend to their needs. For us, the first response must arise from our faith. And that is to profess the faith of St Paul that, despite appearances to the contrary in the physical changes that affect and challenge our living through this world, the body is not a manifestation of a person’s death and dying:  always it belongs to a person whose humanity is raised from mortality and restored to the Kingdom. The body is integral to their living within the resurrection, the “beyond” that has not departed, but still fills the universe. It is the frame of suffering now that is inseparable from the glory then. It is not the advent of decline, but of ascension.
The care of the end of any human being’s course through this world should hardly be marked by an attitude that looks upon it as loss, decline, ending and closure. Truly these are realities in the flesh that Christ our God went through too. But our eye is set at the same time on “the things that are above” them - a restoration after sin and suffering, and the working of a new creation as it is coming to pass in them. Thus, as the Prayer over the Gifts we are about to offer says,  even now we are being “conformed to the mysteries of … mighty love”.