February 14, 2020
Dear Interested Readers,
Charity, Empathy, and Equity, How Are They Related?
Before launching into the main thoughts of this letter, let me clarify some of my sharp comments about Florida. One of my family members, a Floridian, pushed me on the subject. I will not give ground on the fact that I have mixed feelings about the state. I will agree with my critic that much of what disturbs me in terms of ostentatious wealth comes from other places, and some of those places are other countries. My concerned relative pointed out that many expensive Florida properties are owned by people from out of state. Floridians are hard at work, and the ostentatious displays are also attributable to outsiders like me. I will concur with that observation, but will defend my sense of discomfort from Florida’s stark presentation of economic inequity. I love the natural beauty of Florida’s seashore and wetlands. Everyone I meet is friendly. The warm weather this time of year is delightful, but it is hard to look past the fact that there are many people who are excluded from the party.
As I said in my Tuesday letter, my wife and I are here because of the annual Grandparent’s Day at my granddaughter’s school. I am delighted that she is able to attend one of the most academically excellent secondary schools in the state. The campus and facilities would be the envy of many colleges. Many of the faculty of the school have doctorates in their fields. The curriculum that is offered is a great preparation for college, and its graduates go on to many of our finest universities.
The day began with a welcoming assembly for the grandparents. The grandparents were a distinctly international collection of personalities. After we enjoyed an excellent student jazz combo, the “head of school” welcomed us with apologies for the inconvenience of the construction of the the new “STEM” and arts center, and then continued on to describe the wonderful new humanities center that is soon to follow. After the head of school finished her presentation, we heard from the Chairman of the Board of Trustees. He has a well known South Florida surname, and graduated from the school when his father was Chairman of the Board. Now his children attend the school. He divulged a lot of personal history in his presentation, and it was easy to fill in the rest from Wikipedia using the clues he provided about himself and his four grandparents. In essence his grandfather moved to Florida from Massachusetts in the forties after building a successful shoe manufacturing business in Central Massachusetts. Once he arrived in Florida he started buying property and later the father of the Chairman got into owning television stations. The father is still alive and is now a philanthropic billionaire. The school boasts a multimillion dollar aquatic center that bears the family’s name.
What came next surprised me. He said one of his objectives as the Chairman of the Board was that the students learn “charity and empathy.” He went on to talk about the political diversity within his own family. He never divulged his own political preferences, but I did learn that he has progressive relatives from Massachusetts to balance his business oriented relatives who are also from Massachusetts. I was really surprised by all that reference to family and then to charity and empathy. What I was expecting to hear from him was more about the importance of having our grandchildren be well founded in the arts to complement their proficiencies in science and math. That the Chairman of the Board and one of the most prominent members of the business community was pushing “charity and empathy” surprised me, and got me thinking. Is not the real goal of any educational institution to get people thinking?
The word “charity” always brings to my mind the King James translation of the famous 13th chapter of St. Paul’s first letter to the Corinthians. You have heard I Corinthians 13 read at weddings and funerals. Most of the time the version that is read is from a more contemporary translation and “love” replaces “charity.” Here is the King James Version. It is poetry.
Though I speak with the tongues of men and of angels, and have not charity, I am become as sounding brass, or a tinkling cymbal.
2 And though I have the gift of prophecy, and understand all mysteries, and all knowledge; and though I have all faith, so that I could remove mountains, and have not charity, I am nothing.
3 And though I bestow all my goods to feed the poor, and though I give my body to be burned, and have not charity, it profiteth me nothing.
4 Charity suffereth long, and is kind; charity envieth not; charity vaunteth not itself, is not puffed up,
5 Doth not behave itself unseemly, seeketh not her own, is not easily provoked, thinketh no evil;
6 Rejoiceth not in iniquity, but rejoiceth in the truth;
7 Beareth all things, believeth all things, hopeth all things, endureth all things.
8 Charity never faileth: but whether there be prophecies, they shall fail; whether there be tongues, they shall cease; whether there be knowledge, it shall vanish away.
9 For we know in part, and we prophesy in part.
10 But when that which is perfect is come, then that which is in part shall be done away.
11 When I was a child, I spake as a child, I understood as a child, I thought as a child: but when I became a man, I put away childish things.
12 For now we see through a glass, darkly; but then face to face: now I know in part; but then shall I know even as also I am known.
13 And now abideth faith, hope, charity, these three; but the greatest of these is charity.
Modern English does not have the nuance to give to “love” that Greek, the language in which St. Paul wrote, provides. I am told that the Greeks had eight different words to describe the variations in circumstances and focus for the human feelings that we call love. Click here for a quick review of the eight Greek words for love. St. Paul used “agape” which we translate as “charity” or “love.” If you did not click on the link, here is what it says about agape.
Agape – the love of humanity
This is an unconditional love that sees beyond the outer surface and accepts the recipient for whom he/she is, regardless of their flaws, shortcomings or faults. It’s the type of love that everyone strives to have for their fellow human beings. Although you may not like someone, you decide to love them just as a human being. This kind of love is all about sacrifice as well as giving and expecting nothing in return. The translation of the word agape is love in the verb – form: it is the love demonstrated by your behavior towards another person. It is a committed and chosen love.
Perhaps the authors of the explanation are going a bit too far when they say that agape is:
…the type of love that everyone strives to have for their fellow human beings.
I would argue that we all sense, or at least suspect, that there is a relative shortage of agape these days. When our divisions become very deep, agape becomes a hard orientation for most of us to maintain.
As I thought more about what the very earnest Chairman of the Board was saying, I moved on to considering “empathy.” What a twentieth century term. It even sounds a little quaint, sort of like Bill Clinton’s, “I feel your pain.” It’s also presumptive. Empathy implies an “…ability to understand and share the feelings of another.” In an excellent brief discussion of sympathy versus empathy we learn that sympathy is the older term. It’s been in our language since the 1500s.
…sympathy is largely used to convey commiseration, pity, or feelings of sorrow for someone else who is experiencing misfortune.
We learn that empathy is the new kid on the block. It evolved from psychological writings in the 1800s. Empathy has evolved from “…the concept that a person could project their own feelings onto a viewed object.” it is presumptive because now:
…empathy …is…most often used to refer to the capacity or ability to imagine oneself in the situation of another, experiencing the emotions, ideas, or opinions of that person.
The question that we must ask ourselves is whether we can ever really understand an experience that some person has had that we have not. I can be sympathetic to my wife’s pain in childbirth, but can I be empathetic? If I have enjoyed the benefits of family wealth and position all my life, can I ever really empathize with a very poor father who is an illegal alien who is try to support his family as a low paid agricultural worker in California who suddenly has a sick child, but has no money and no health coverage?
I agree with the chairman of the board about the importance of having charity. St. Paul is also right to imply that we are lost without charity. I would extend that reality to all of society. A society without charity that is defined as a care for others is a dreary place and probably is sustainable only by oppressive force. If we don’t have charity, or “the type of love that everyone strives to have for their fellow human beings,” we sooner or later don’t have anything. Without charity we are just a lot of noise. We are metaphorically like the cacophony generated by banging on brass and tinkling cymbals. Without charity we don’t attend to much other than our individual concerns, and our efforts to protect ourselves are wasted, or ineffective. As St. Paul says, “…it profiteth me nothing.”
I am impressed that most healthcare professionals have an abundance of charity. I am also convinced that many suffer from what Barbara Brown Taylor calls “compassion fatigue”, and that we call an epidemic of “burnout.” I am increasingly convinced that the answer to “burnout” or “compassion fatigue” is not more “touchy feely sessions” or even time away from practice with family and friends. I do believe that we can engineer our healthcare systems to be more efficient, and that will help a bit, but the real problem that causes our patients to suffer is that collectively our society has turned away from its conversations about “we” that were becoming more frequent 20 years ago, and we are more and more focused on “me.” History teaches us that a focus on “me” does not lead to sustainability. A focus on “we” is not a guarantee of success, but whenever “we” becomes the dominant philosophy good things can happen. How often do high school coaches say, “There is no “I” in team”?
I don’t think most of us are capable of empathetic caring for those who are really challenged and live below the median income of our society. We can be sympathetic to their plight, or at a minimum stop making it so hard for them to access the benefits that may lift them and give their children a better chance to thrive. We have stratified poverty. There are those who live below the poverty level, and in about two thirds of our states qualify for Medicaid, but others with equal levels of poverty in another third of states, including Florida, have no coverage. Is that charity? The ACA offers subsidies on the exchanges for individuals and families who are below four times the poverty level. Do other people need help? The ACA was an expression of concern and sympathy. I do not understand the lack of charity or …the type of love that everyone strives to have for their fellow human beings that is manifested in those who would do away with what is left of the ACA. I also don’t think sympathy and empathy are reliable commodities. Both can become patronizing and leave the recipient feeling “less than…”
I wish the chairman of the board of trustees at my granddaughter’s school had said that he was trying to promote charity and commitment to equity as the goal of the school. He could also throw in “sustainability” as a follow up that may be an even high level goal for the talented kids that have gone on from his school in South Florida to be leaders in their community and the nation for more than a hundred years.
I frequently quote scripture and marvel at the ancient wisdom that is presented in our Holy texts, but for healthcare I think that Crossing the Quality Chasm (2001) represents modern day medical prophecy and wisdom, that is a “holy” text. “Quality” is presented as a “system property” and it has six domains that I like to present as patient centered, safe, efficient, effective, timely, and from the perspective of all that is charitable and and humanly important–equitable.
Economic equity is a concept that may consume the best work of several future generations. We are told that we will “always have the poor among us.” There is some debate about whether that has to be true or is just a statement based on the selfish nature of mankind. Equality in access to care, and is something that other nations provide now, and a good place for us to begin to take on the larger issues of economic inequality and the long struggle to improve the social determinants of health for all of our citizens. How short sighted are we to celebrate our stock market successes and turn a blind eye to the lack of equity that we have in healthcare that perpetuates misery for millions? Where is the charity or empathy in that? It may sound cynical, but it is even implied by St. Paul that charity is good “game theory.” He writes:
Charity never faileth: but whether there be prophecies, they shall fail; whether there be tongues, they shall cease; whether there be knowledge, it shall vanish away.
9 For we know in part, and we prophesy in part.
10 But when that which is perfect is come, then that which is in part shall be done away.
You don’t need to be religious to recognize the benefits of caring for others in a meaningful way, as an individual, as part of a community, as part of a nation, or as part of humanity on a small planet. Our individual prospects are best when everyone has a reason to hope. What price will our lack of charity and equity in healthcare eventually cause us?
Moving On Toward President’s Day
We left Key West on Tuesday. The high points for me were visits to the home of Ernest Hemingway, and a tour of Harry Truman’s “little White House.” Those sites alone are worth the trip. On our way to Coconut Grove and Grandparent’s Day we spent a very enjoyable day in Key Largo. I love walking on flat land and flat beaches. The water was wonderful, the kayaking was invigorating, and we loved our visit to the John Pennekamp Coral Reef State Park. You need not get in the water there to have a great experience. Their aquarium is quite an education. It’s much easier to avoid the T-shirt shops and the kitch in Key Largo than in Key West.
I think that our public parks: metropolitan, state and national, are shared resources where we can experience a bit of equity. It is important that we protect them, and the best way to find the will to protect them is to be an avid consumer of all they have to offer. Teddy Roosevelt was a capitalist, an honorable public servant, a progressive, and very political in a way that worked toward his vision of what the public needed. He did not always win, but he was always positively engaged. Beyond his political prowess, he had the wisdom to understand the healing power of nature. He was an important voice for the preservation of our natural resources as parks for the equitable benefit of all of our people. We could use a twenty first century version of just such a man. He was a president worth remembering and emulating, or just thinking about, on our upcoming Monday holiday. On President’s Day I will be headed home, and glad to be back in a simpler world.
Be well, take good care of yourself, let me hear from you often, and don’t let anything keep you from doing the good that you can do every day,
Gene
