We need to learn from the patient, we need to listen to them, because from the classroom – as Charles G. Vella calls it – of the bedside, we glean an ethical lesson of inestimable value.The patient can help us become more human, and see the truth of our humanity.
The patient may render us more humane while we accompany and care for him, always keeping in mind that despite his weakness and helplessness he remains, nevertheless, a person. And following this path, which Charles G. Vella can speak of with authority by the fact of his internationally recognised expertise and long experience with the sick, we discover that the simple communicative acts of listening, caressing, smiling, stopping by, Staying close to and giving time to the sick, may, in time, become therapeutic for ourselves.
- Enzo Bianchi
This is a beautifully written book that invites its readers to reflect more deeply upon the health care system and those who work within it. Drawing from his own personal experiences of health care as both a patient and a chaplain, Charles Vella gives a deeply humane and mature account of how our health care system should function. Readers get to the heart of the issues very quickly with Vellas examples of how the doctor and patient relationship should be understood and embodied. At all times, he brings his theological reflections into the equation thereby facilitating a very real and sincere style of writing. The suffering Christ emerges as a central motif, as the author explains how bedside ethics can be viewed through the lens of the Christian story. In each and every patients experience, there is an occasion for doctors and all health care professionals to deepen their own self-knowledge; gain greater insight into the lives of suffering patients; and acquire a mature and humble understanding of their own vocation as carers.
Vella lists the essential characteristics which doctors must have. These include faithfulness; benevolence; humility; self knowledge; trust; confidentiality; patience; understanding (at both medical and personal levels); a sense of humour; awareness of the uniqueness of each and every situation as well as the ability to listen. Listening is emphasised throughout the work, as the author maintains that all professionals should have the ability to talk less and to listen more. Thus he argues that `all depends [...] on a doctors decision to be at a patients disposal at all times. He must always be prepared to listen (p. 73).
But Vellas counsel does not stop with health care professionals; he also offers guidelines for the Chaplaincy team. The word team is significant here because Vella believes that the task of spiritual healing, of counsel, and of administering the sacraments is one which should take place in groups. Further, Vella points out that the Chaplains role should be made clear in the hospital so that meetings do not clash with ward rounds or family visits. The need for confidentiality, care and professionalism of the highest order are emphasised by the author, as he seeks to reinstate the Chaplains role in hospitals as one of crucial importance for those of faith and indeed for those who experience a conversion whilst in hospital. Vella argues that elitist attitudes about which roles are most significant in hospitals need to be challenged, and that Chaplains should also be remembered when heads of hospitals are giving praise and showing appreciation for other health care professionals. He explains that post Vatican H vision of `participation founded on the common priesthood of the people could bring about a more just understanding of what care for the sick and dying entails (p. 87).
The final chapters focus upon more controversial issues facing the families of the sick and dying as well as their carers and doctors. Of particular interest is the discussion in chapter 10 about `living wills. The author emphasises the fact that frequently there exists a misunderstanding about how the Catholic Church interprets a `living will. He explains that one is not obliged to keep a person alive by `extraordinary means (p. 146). Vellas explanation of the Catholic position on such matters is clear though it lacks depth and seems to avoid getting into any difficult discussion of how a patient might interpret `extraordinary means. There is no mention of mental health and how this might impact on the patients ability to make a living will. In addition, the discussion on euthanasia does not engage with the difficult issues that face the sick and dying.
The final chapter of Vellas work examines HIV/AIDS patients and the care they receive in the San Raffaelo Hospital in Milan. Drawing upon Timothy Radcliffes phrase `the body of Christ has AIDS, the author explains how the faith community should respond in solidarity to the AIDS epidemic which is rife amongst African and Asian populations. The eradication of myths and fears concerning AIDS comes out strongly in this final chapter, but there is no mention of how Catholic teachings might need to be changed or reinterpreted in order to begin the process of healing and AIDS prevention. The use of condoms is not mentioned, and there is no real engagement with the work of theologians who write from a different perspective than the one adopted by Vella.
Notwithstanding such criticisms, this book deserves to be read widely. The wealth of stories and real experiences that are recounted throughout the work make it real, compelling and relevant to the issues facing health care professionals and patients in the modern world. The main message of the book may be summed up in the words of Enda McDonagh speaking at Kevin Kellys festschrift: when it comes to ethics, we must see ourselves as `guests of God, and hosts to one another. Each of us, therefore, has a responsibility to engage with the health care profession at every level so that when we are faced with tough decisions we will be able to act with integrity and an informed conscience.
- Ann Marie Mealey, The Furrow, Nov 2010
Before my mother died six years ago she spent some respite time in a nursing home. When she was admitted to the nursing home, which was a lovely place to look at, my sister and I were asked by a nurse what medications, if any, my mother was allergic to. We explained in detail all the tablets my mother must not have.
When we visited my mother every day she appeared to be heavily sedated and one night a nurse phoned to tell us that my mother had been given the forbidden medication (sleeping tablets) by mistake and had got two very bad falls. She had to be admitted to hospital from which she never came out and died three months later. Clearly she had not received the proper care she deserved.
I mention this personal story to introduce Monsignor Charles G Vella and his wonderful book, Ethics in the Service of the Sick. This inspirational book is the result of working for many years with the sick at the San Raffaele Hospital, Milan. He feels that hospitals can often be inhuman and frightening places where the unfortunate patient is sometimes seen as just a number devoid of human dignity and rights.
He writes: "Human values, strengthened by a fervent belief in spiritual values, allow carers to share in each patients sufferings and hope for survival. Patients long to be treated with love and compassion. The Capuchin Saint Pio of Pietrelcina often urged doctors who worked in the Home for the Relief of Suffering to give a great dose of love together with their medicine. The ability to treat the sick not only with medication, but also with love is only possible if carers believe in spiritual values."
Charles Vella quotes Carl Rogers quite a lot to the effect that the treatment must be centred on the sick individual. Rogers insists that we must look into our own hearts and develop compassion and sensitivity and learn to know ourselves before we can really care for others. In other words, nurses and doctors must essentially be people of deep compassion and concern.
The author quotes from a speech of Pope a- John Paul II to Catholic doctors: "The humanisation of medicine is a proclamation of human dignity, respect for the body, for the spirit and the culture of each patient. In concrete terms, none of you re can limit yourselves to being doctors who cure only the body but must care for the person as a whole and, even more than that, must foster relationships with each of your patients in order to make a valuable contribution to their well-being."
Monsignor Vella says: "I simply wish to emphasise that I was called to the San Raffaele to `teach and heal by Providence. It was from the San Raffaele foundations philosophy that I learned that each patient is, before all else, a human being and that every person is Jesus Deus Patiens (Christ, the suffering God)".I found this a deeply moving and encouraging book and it should be compulsory reading for every nurse, doctor and carer.
- Anthony Redmond, The Irish Catholic, July 9th 2009
Those of us who visit hospitals on a frequent basis are only too well aware that the vocation of healing is being severely tested at every level in our healthcare system at present. Despite the efforts of many dedicated people in the health service insufficient or misapplied resources, stifling bureaucracy and the diminishing regard for the individual patient as a child of God but rather as a client or customer all add to the unease which many of us now feel at the prospect of hospital care for ourselves or those that we love.
For those reasons and more a new publication entitled Ethics: In the Service of the Sick by Charles Vella, who at 81 has a lifetime of experience in hospital care, brings an invaluable perspective to the ongoing discussion about the treatment of the sick. Guided by the teaching of Carl Rogers, Charles Vella advocates that all treatment should be centred round the sick individual. This may sound like a statement of the blindingly obvious yet anyone who has spent any length of time in a hospital or nursing home can testify how frequently the individual patients needs slips down the agenda.
He also emphasises the crucial role of the family and the wider community in the process of healing. Over the eleven chapters of Ethics the author blends personal anecdotes, biblical reflection and numerous medical, philosophical and spiritual resources into a narrative that should enlighten and guide all who are concerned with the welfare of sick people. He does not avoid the difficult personal and ethical dilemmas faced by those with terminal illness as well as the tensions between the purely secular and Christian Catholic ethics and offers many practical examples of both from his own experience which provide ample food for reflection. Included are appendices in the form of a living will which a person may sign before undergoing management of a serious illness as well as exhaustive lists of saints for illnesses of all kinds as well as patrons of medical professionals.
Monsignor Vella puts forward a truly holistic approach to patient care which deserves to be carefully reflected upon and fully embraced by the Irish medical profession at this particular moment in our history of patient care.
- Fr Paul Clayton-Lea Clogherhead, Co Louth, Intercom, January 2010