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THE PATIENT AND THE DISEASE AS “OTHER”: RESPONSE TO SULMASY
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53 THE PATIENT AND THE DISEASE AS “OTHER” RESPONSE TO SULMASY Mary Hroscikoski, O.S.F., M.D. I am going to use the lens of culture today to try to open up this notion of the patient as sister and brother from yet another perspective. In one sense, I believe this symposium on “Franciscans and Healthcare” is about developing a greater understanding of our shared Franciscan culture. I am hopeful this perspective will help us better understand what it means to serve and to be served in the context of Franciscan healthcare ministry. Culture may be thought of as having four components: 1) a realm of knowledge and beliefs, 2) a system of values with ideals of behavior, 3) an organized means for teaching the culture, and 4) a setting where the beliefs, values, and ideals are lived out. 1 From this perspective, we each belong to a variety of cultures—religious cultures, work cultures, ethnic cultures, family cultures, and so on. These many cultures are related in complex ways. Tensions arise as they intersect and compete for dominance. Developing cross-cultural relationships that are respectful and effective can be challenging in particular ways for healthcare providers and patients. The tensions are often fueled by one key feature of culture—its rules and meanings are hidden and implicit. But by naming what “the patient as brother and sister” means, as Sulmasy and Howe have begun doing, we make our own Franciscan culture more explicit. Doing this is valuable, for it helps us to reexamine , to understand, to reaffirm, and to recommit ourselves to our Franciscan values. Most importantly, it enables us to enact them more effectively. In asking “What is the future of Franciscan healthcare?” we begin by focusing on two central cultural values—the value of the person and the value of relationship. Our Franciscan system of 1 R. A. Hahn, Sickness and Healing: An Anthropological Perspective (New Haven: Yale University Press, 1995), 132. 54 MARY HROSCIKOSKI, O.S.F., M.D. values and our ideals of behavior center on the belief that all of creation exists in relationship as sister and brother. But it is no easy task to live as sister and brother, and our healthcare ministry holds particular challenges for doing so. We will look at the challenges facing our leadership and healthcare institutions as they strive to implement these beliefs and values. No culture is isolated from its larger world, Franciscan culture included. To understand the challenge of caring for patients as sisters and brothers, it is important to look at the culture of American medicine in which Franciscan healthcare is embedded. The “what” of Franciscan healthcare’s future relies, in part, on our responding to the ways that American culture is at odds with Franciscan culture. I propose to develop further our cultural knowledge by contrasting Franciscan culture with American medicine’s dominant paradigm, the biomedical model. Biomedicine offers us powerful disease explanation and treatment. Admittedly, American medicine is larger than the construction of biomedicine that I am about to give. But I present this picture in stark relief to emphasize that we need to recognize biomedicine’s limits, particularly the limits it places on Franciscan models of healthcare. I will focus on the ways biomedicine promotes viewing the patient and the disease as “other” rather than as sister or brother and how it promotes exclusion of all that is viewed as “other.” Later, I’ll return to the Franciscan call to relationship, a call that leads us to embrace the other. To embrace the other means to transform the patient and the disease from other into sister and brother. It means to transform death into life, which is the eucharistic movement at the center of our Christian, Catholic, Franciscan life. It is this embracing of patient and disease and this call to relationship in healthcare that can lead us to living, as Francis did, from a place of abundance rather than one of scarcity. The Biomedical Model Throughout the twentieth century, the biomedical model has been so dominant that we are generally unaware it is but one conceptual model of medicine, rather than medical reality itself. Its dominance is evident in The New Merriam-Webster Dictionary (1989), which [44.203.219.117] Project MUSE (2024-03-28 15:45 GMT) PATIENT AND DISEASE AS “OTHER” 55 defines medicine as “a science or art dealing with the prevention or cure of disease.” In other words, medicine is focused on disease, rather than on...