TALK BY JACK CARNEY: "A PALLIATIVE-PRIMARY HEALTH CARE DINNER DISCUSSION" I want to speak personally yet abstractly here on our topic of Palliative-Primary Health Care. Personally because I have been a recent giver and receiver of palliative care. I nursed my wife in our home to her death of terminal cancer just before Christmas of this last year and I was greatly helped in this by the Mt Olivet Home Care and Hospice and the Blue Nursing Service. And abstractly, because I am a philosopher interested in understanding the human condition as I live it. Many authors of antiquity when addressing the problem of human suffering expressed it as a state of being "cut off". This being cut off from others - whether as the family, tribe, City-State, or one's God - was seen as the ultimate disaster that could befall an individual. Worse than death is separation from our source of meaning - from ourselves as human relationship. As Spinoza said, Man is a God to Man. Or Seneca put it, "You must live for another if you are to live for yourself." What we fear as death is what we fear in life: disconnection from others. We do not want to admit the obvious, that being separate we must connect to others to ease our separative pain. Life is a series of connections and disconnections which we must learn to be responsible for. Loss of connection - human relationships - is the species' disease of humans. How to connect and remain connected as individuals has been and always will be our central problem. To me there is no cure for this separative human condition which ends in death other than to connect as care. Yet today's independence obsessed individuals tend to be careless of their human connections. We are increasingly isolated from one another by the continued loss of commonly binding social structures. We've gone from being a messy hierarchical community collective of individual cells to self-contained billard balls bouncing off each other upon the level playing table of the social welfare state. As we head for our holes to end the game not a few of us along the way wonder how we got caught in mainly entertaining ourselves to death as a way of life. Thus I don't think we have to be unduly confused or mystified by our current state of social dis-ease and our out of control public health systems. We are reaping the whirlwind of a massive social disconnection brought on by our expanding human consciousness of science and technology and loss of human communal meaning. To quote the American sociologist Aaron Wildavsky, "If most people are healthier today than have ever been, and if access to medical care now is more evenly distributed among the rich and poor, why is there said to be a crisis in medical care? Why are we doing better but feeling worse? More medical care does not equal better health. "Most of the bad things that happen to people are at present beyond the reach of medicine. If medical care does not equal health, access to medical care is largely

irrelevant to health - unless, of course, health is not the real goal but merely a cover for something more fundamental, which might be called 'mental health' (reverently), or 'shamanism' (irreverently), or 'caring' (most accurately)." Caring is - accurately - what we desperately need rather than newer technology or more efficient institutional management. For we must stop deluding ourselves that we can be cured of the human condition by substituting technical means for human ends. For as one of my favorite writers, the American longshoreman philosopher Eric Hoffer wrote in an essay titled Compassion, "A most startling and fateful fact of our age is the non-fulfillment of the prophecy that a triumphant technology would make man superfluous. It is evident that impersonal factors do not shape and direct affairs in post-industrial society. Instead, we have entered a psychological age. "In the alchemy of man's soul almost all noble attributes can be transmuted into ruthlessness. Compassion alone stands apart from the continuous traffic between good and evil within us. The survival of the species may well depend on the ability to foster a boundless capacity for compassion. It could well be that the adoption of a certain view of life would be fruitful of benevolence and compassion. "We draw together when we are aware that night must close in on all living things; that we are condemned to death at birth, and that life is a bus ride to the place of execution. All our squabbling and vying are about seats in the bus, and the ride is over before we know it." That "certain view of life" Hoffer wrote about is the human condition which we can not be cured of no matter how good our technology and management gets. We finally and always come back to connective care as what we really are left with when we face the facts of life which include separation, loss and death. As leaders of the community we need to personally come to be guided by connective care as both our proper human end and our best means to achieve that end. Only in personally feeling the pain of separation and in hearing the cry for care will we come to acknowledge the need to connect. And only then will we find the right motivation and criteria by which to create and evaluate the social structures we need. incurable human condition by attentively and tenderly attending to it as the need for human connection. That is what each of us must do for one another. While I understand what the modern poet Auden meant when he wrote in his poem the Age of Anxiety, "we must love one another or die". It is more accurate to say, "we must love one another because we must die". When you consciously act out of the knowledge you must die and that you are separate and therefore must care to connect to other while living, then you are re-membering who you are as a member of humanity and acting to join again your separate part to all those other separate parts next to you. Only then you are being cured as in maturing or ripening rather then seeking to be cured as in remaining adolescently careless and rotting alone and lonely. Choose.