Katherine Pettus
Priorities of the global health narrative are saving and prolonging lives, preventing premature or avoidable death from epidemics and infectious and noncommunicable diseases and promoting maternal and child health, healthy aging, and so on. The World Health Organization (WHO) and most health-focused nongovernmental organizations absorb and promote this narrative unquestioningly. Successful global health interventions that increase life expectancy and decrease premature mortality are funded and implemented. According to health economists, these provide the “best buy”—the biggest bang for the global health investment buck.
Global health champions rarely discuss the fact that the increased life expectancy achieved does not translate into better quality of life for many beneficiaries of these policies, especially those who are older and poorer, and that no matter how advanced, the health sciences have yet to put an end to dying itself.
It is not news to public health scholars and geriatricians that increased life expectancy results in more disease, disability, dementia, and accelerated aging. The acute suffering these conditions produce in increasing numbers of individuals and families, and the costly burdens of this “success” on health and social budgets, which public health experts now have the tools to measure, expose the shortcomings of any global health narrative that excludes palliative care. The global health king parades with no clothes when public health systems lack universal access to quality palliative care.
Kairos and Chronos
Palliative care gently extends global health’s mortality prevention telos into new waters. The definition of palliative cares stipulates that it neither postpones nor hastens death. This positions palliative care at the nexus of chronological and deep time—chronos and kairos, the life course and the mystery. The latter, a thin place that makes space for grace, gives practitioners and patients access to epistemological and spiritual resources to transform and integrate serious health-related suffering. It reaches in where scientific knowledge accumulated over the life course cannot tread.
Palliative care’s acceptance of the chronology of a modern human life while simultaneously entering open-heartedly into the mysteries of living and dying, completes and strengthens the currently foreshortened global health narrative that is powerless in the face of nonpreventable death.
Advocacy’s Kairos Deficit
An existential challenge of global palliative care advocacy—a challenge similar to the one faced by advocates for climate health, also a newbie in the global health agenda—is that it requires policymakers to project into the future, to an experience few have ever encountered up close and personal. Palliative care’s practitioners, supporters, and advocates tend to be called through a personal encounter with death, usually of a loved one. The quality of that experience, or lack thereof, more often than not confers the palliateur vocation. In the absence of such a personal experience, it is difficult for the “death naïve,” including key policymakers, to imagine or understand the urgent need for public health, rather than simply philanthropic or private provision of palliative care.
That peculiarly personal kairos deficit in global health epistemology has exponentially dangerous public policy consequences, as the “dying badly” and climate crises are both already upon us. Soon everyone will be affected personally, but the question is, will policymakers be prepared to meet the acute population level health needs associated with both? The answer is clearly no, unless policymakers and voters are prepared to think long term about caring for aging populations (themselves) with chronic diseases, as well as attending to short term epidemics and health security. The rational alternatives for those whose deaths can no longer be prevented are abandonment, euthanasia, and overtreatment, whose costs have both direct and knock-on effects on household wealth and development.
Palliative care is the ethical fourth way between abandonment, overtreatment, and euthanasia. It is an interdisciplinary response to nonpreventable death that reduces suffering in both quantifiable and nonquantifiable ways. Palliative care practitioners can relieve severe pain and symptoms and support “good,” as opposed to “bad,” dying in the ICU, at home in the center of a stressed-out family, in a prison, or in a refugee camp. Rather than the death sentence it is usually portrayed as, palliative care is a way to make life, and nonpreventable death, as untraumatic as possible by reducing suffering wherever possible. Publicly provided palliative care can help in the effort to build civic trust and resilient communities, the foundation of the United Nation’s 2030 Agenda for Sustainable Development.
Katherine Pettus is the senior advocacy and partnerships director for the International Association for Hospice and Palliative Care.
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