Depreciating human life: a year-end market report

The cold currency of trading hostages repels George Pitcher, who explores the casual acceptance that some lives are biddable against lives of intrinsically higher value.

George Pitcher

George is a visiting fellow at the London School of Economics and an Anglican priest.

Three men huddle around a laptop and talk animatedly.

Israel's Prime Minister monitors the recent hostage exhchange.

Prime Minister's Office, Israeli Government.

There is something peculiarly horrific about the barter of Israeli hostages held in Gaza by Hamas for Palestinian prisoners in Israel. And it isn’t only the unimaginable suffering these innocent civilians have to endure somewhere on an unknown scale between life and death.

It’s also that their lives are reduced to their commodity value. Hostages are assets to be traded in the market for peace, not human beings. It’s difficult to write this, but it’s almost as if three dead hostages, including a 10-month-old baby, said to have been killed in an Israeli airstrike, have lost their asset value. These ones are no good – they don’t work anymore.

Negotiating the release of hostages for peace terms is as old as the Hebron Hills. An Egyptian pharaoh once released his enslaved Israelites to Moses in return for the lifting of the plagues being inflicted on his people. But there is something of the neo-liberal free market in the way that post-modern conflict resolution uses human life as a currency of exchange.

Ryan Gilfeather wrote excellently here how this material valuation offends against the human dignity in which the divine invests. The imago dei that humanity bears, if you like, is not to be reduced to a bounty, a financial liability or an asset value.

As a consequence, human life is tradeable. Yes, it has value, but its share price can fall as well as rise.

I’d want to take that a step further, to ask how that depreciation has come about with such ready acceptance and to note a couple of instances where the mentality of the trade in human existence has become a natural process of marketing.

The attitude, I think, has its roots in the Enlightenment of the 17th and 18th centuries. Don’t get me wrong: This is no censure of progressivism. Universal literacy, healthcare, scientific endeavour and the birth and growth of democracy are all very good ideas indeed. But the Enlightenment also brought the capitalist mindset to almost every area of human existence. Our lives, in many contexts, became actuarial.

This is not my idea. The great, perhaps the greatest, Christian mind of the 20th century, C.S. Lewis, railed against how Fascism and genocide were the bastard offspring of our common-law marriage to progressive thinking, in that traditional values of human existence were now only there to be debunked.

I am indebted to Lewis’s biographer, A.N. Wilson, for this. In Lewis’s book, The Abolition of Man, he writes of “The belief that we can invent ‘ideologies’ at pleasure, and the consequent treatment of mankind as mere specimens… begins to affect our very language.’

Lewis was no white-knuckled reactionary, but he did recognise that the values and virtues of ancient religious thought were binned at humanity’s peril. We had begun to understand the price of human life, rather the the value of it.

This is not to suggest for a moment that the ancient world was a nirvana (or even a Narnia). The Garden of Eden was lost at the beginning of time, not at the Enlightenment. Brutality, slavery and cruelty are part of our post-lapsarian world.

It’s just that religious virtue used to be a bulwark against such things. As a consequence, human life is tradeable. Yes, it has value, but its share price can fall as well as rise. By the 21st century, we can look behind us to see how that has played out. Allow me to elucidate a couple of examples of how casual is our acceptance that some lives are biddable against lives of intrinsically higher value.

The first is the almost clownishly implemented government policy proposal to redeploy migrants to the UK to Rwanda. Almost clownishly, because it would be funny if it didn’t involve a trade in human misery, the idea that desperate people endangering their lives and those of their families in small boats can be made someone else’s problem to sort out, simply by looking away. These people are worthless, you see, because they are not us and only we belong here (whoever “we” may be). The idea is that we pay Rwanda per capita to take them, rather as we might send our plastic refuse to China for landfill.

A second example of merchandising human life I would cite are the repeated attempts to have assisted suicide, or voluntary euthanasia, legalised in the UK, rather than enhancing palliative end-of-life care. These proposals depend entirely on the state legislature endorsing that some human lives aren’t worth living and are disposable.

At base, it’s the same principle as the Rwanda policy, other than we’d be killing them, or assisting them to kill themselves, rather than disposing of them in a central African waste-bin.

These are the “anythings” that humans believe in when they stop recognising the sanctity of human life. The value equation used for Gazan hostages is on the same continuum as the human trafficker and the politician who tries to stop him, or the calculation of the cost to the state and their family of a terminally ill patient offered an alternative way out.

It’s just that these equations have become invisible to the naked eye. We don’t see them anymore. But, I’d suggest, for Christ’s sake we’d better start looking.

Article

Care

Change

26 July 2024

6 min read

Are we forgetting how to care?

The profound act at the heart of nursing.

Helen Cowan

Helen is a registered nurse and freelance writer, writing for audiences ranging from the general public to practitioners and scientists.

A nurse bends beside a bed and talks to a patient

Marie Curie.

Recently, at a nursing leadership programme in Oxford, attendees focused on the fundamentals of care. Have we forgotten how to care? What can we re-learn from those who pioneered an ordinary yet profound act that affects millions?

Anam Cara is an old Gaelic term for ‘soul friend’, a person with whom you can share your innermost self, your mind and your heart. It is a term that Tom Hill, former chief executive at Helen House Hospice in Oxford, used to describe the relationship between his staff and the thousands of children and their families who passed through their ‘big red door’ in its first twenty-five years. The hospice (or ‘loving respice’ as it became known) had been founded by Sister Frances Dominica in 1982.

Other care in this country can also trace its religious roots. Between 1048 and 1070 in Jerusalem, the Order of St. John was founded for the purpose of helping pilgrims (“our Lords, The Sick”) who had become lost, weary, or beset by other difficulties while on their way to the Holy Land. Today, in the United Kingdom, the British Association of the Order has extended care to older people first in almshouses and later in care homes. A trustee for ten years was John Monckton, a man of ‘considerable talent, enormous integrity and deep religious conviction’; his tragic murder in 2004 led to the creation of the John Monckton Memorial Prize, which recognised and rightly celebrated commitment to care by care workers.

Today, across the world, seen and unseen, nurses, carers and families continue to provide compassionate care. “Assisting individuals, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge” is the very essence of nursing, captured by ‘architect of nursing’, researcher and author Virginia Henderson in 1966. Meeting more than basic needs such as breathing, eating, drinking and eliminating bodily waste (which are of essential importance), Henderson recognised the role of the nurse in enabling humans to communicate with others, worship according to their faith, satisfy curiosity and sense accomplishment.

In the desire for modernisation and professionalisation, have we lost sight of the core values and activities central to patient care?

An uncomfortable truth brought out in healthcare reports such as the Final Report of the Special Commission of Inquiry (The Garling Report) 2008, and the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (The Francis Report) 2013 is though that this type of nursing is too often done badly or even missed, leading to pressure injury, medication errors, hospital-acquired infection, falls, unplanned readmission, critical incidents and mortality. According to nurse scientist and scholar Professor Debra Jackson, “missed care occurs much more frequently than we might think”. She cites a systematic review in which ‘care left undone’ on the last shift ranged from 75 per cent in England, to 93 per cent in Germany, with an overall estimate of 88 per cent across 12 European countries’.

In one offensively-titled paper, “Shitty nursing - the new normal?” (in which the authors apologise for the title but not the questions raised), real-life pen portraits are drawn of patients lying for hours on hospital trolleys, immobile through infection or injury, ignored by staff. Whilst acknowledging contextual factors for poor care, such as a shortage of nurses and resources, the authors argue that circumstances cannot be the sole cause of missed nursing care.

A report published by the University of Adelaide, School of Nursing, has called for nurses to ‘reclaim and redefine’ the fundamentals of care. It asks whether the cause of the problem (of missed nursing care) lies “deep in the psyche of the nursing profession itself?” “Has something happened to the way modern nursing views and values caring?” it continues. “Indeed, is nursing in danger of losing its claim to care? In the desire for modernisation and professionalisation, have we lost sight of the core values and activities central to patient care? Or is this a broader social pattern where individuals are less inclined to show kindness, compassion, and care for others even if it is a necessary requirement of the job?”

Compassion, he emphasises, is more than empathy - and way "less fluffy" but much more measurable than kindness.

Writing in the British Medical Journal, Professor of critical care medicine Peter Brindley and Consultant in intensive care Matt Morgan wonder whether doctors also “too often default to high-tech and low-touch” when patients are dying – a time “when community and connection matter most”. They powerfully begin with a mother’s comment: “Humans are gardens to tend – not machines to fix.”

Professor Sir Al Aynsley-Green, the first National Clinical Director for Children in Government and former Children’s Commissioner for England, and past president of the British Medical Association, suggests that we as a society need a “momentum for compassion”. Struck by the extremes of compassion witnessed during his wife’s treatment in the last years of her life, Sir Al wants to see a cultural transformation in healthcare: for compassion to be a key operating principle in NHS and care settings, led by the Chief Nurse’s Office; for every organisation to promote the importance of compassion at the professional level; for the views of patients and families to be sought regularly; for much earlier and better focus on compassion in undergraduate and postgraduate teaching programmes for all staff; for compassion to be inspected against by the Care Quality Commission; and for a willingness to encourage staff at all levels to expose poor practice as well as celebrating excellent care.

Compassion, he emphasises, is more than empathy - and way "less fluffy" but much more measurable than kindness. “It’s putting yourself into somebody else’s shoes – and doing something about it.” Recently appointed the UK’s first Visiting Professor in Compassionate Care at Northampton University, at the age of 80, Sir Al certainly is doing something about it. He has made it his new purpose in life to “embed compassion into every aspect of care”.

Like Sir Al, Queen Elizabeth II, the UK’s longest serving monarch, espoused compassion, in word and deed. Living a life of compassionate service, the Queen made clear that her Christian faith was her guiding principle. She speaks of Jesus Christ as ‘an inspiration,’ a ‘role model’ and ‘an anchor’. “Many will have been inspired by Jesus’ simple but powerful teaching,” she said in her Christmas Broadcast, 2000. “Love God and love thy neighbour as thyself – in other words, treat others as you would like them to treat you. His great emphasis was to give spirituality a practical purpose.”

When nurses do unto others as they would have done unto themselves, and act as role model to colleagues, not only do patient experiences of care and their outcomes improve – but so does job satisfaction for nurses: a critical factor in nurse recruitment and retention – the biggest workforce challenge faced by healthcare organisations. Across the UK, there are currently more than 40,000 nursing vacancies, and thousands of burnt-out nurses are leaving the profession early. Whether nurses decide to stay or go is driven in part by their daily experience at work. The late Kate Granger, Consultant in medicine for older people, inspired Compassionate Care Awards in her name, envisioning that such a legacy would drive up standards in care - and surely also help retain nurses, through restoring a sense of pride, achievement and fulfilment to the nursing workforce.