Who is this person with COVID-19, admitted to a busy acute care emergency department with no human accompaniment and scant paperwork to describe her background? It becomes apparent, many hours later, that ‘Gladys’, aged 96, has advanced Alzheimer’s disease and has lived in a nursing home for the past two years. Apart from a list of her several co-morbidities little information is given about her pre-hospital life.
There is nothing in her notes to inform staff of her likes and dislikes, her closest companion, her food preferences, her fear of loud noises. No narrative of her unique life, her love of flowers, and certainly no mention of her seventy-year ministry as a ‘religious sister’. Her hospital carers were unaware that her sometimes aggressive behaviour and loud speech would be quietened by the chaplain’s presence, someone with whom she could, even at this late stage of her dementia, recite ‘Hail Mary’ and ‘The Lord’s Prayer’.
None of these details would of course, be considered important while intensive care strategies were applied to save her from death. But who would know her when she woke from her deeply unconscious state? Who would reassure her that she was safe, albeit in an alien environment? No one from the nursing home had thought (or had time) to enquire about her condition and she was allowed no visitors. Notwithstanding the strict isolation rules pertaining to the pandemic, an insightful nurse sought permission to take Gladys to the chapel when she became restless and noisy. The familiar ambience and the placing of rosary beads in her hands produced an immediate, calming response.
So, who is this person? Gladys is more than ‘another COVID case’, or ‘one more individual to add to the statistics’. Nor is Gladys merely a person or an individual alone: she is a person within community. In some countries, as an individual, labelled by this disease, her life would be considered expendable; less valuable and therefore less deserving of care than a much younger patient with COVID-19. As a mere individual, her relationship in community with others would not be acknowledged; her life therefore would not be worth saving.
The Universal Declaration of Human Rights avoids the term individual in favour of person. The link is then clearly made from person to community; implying that persons are not individuals alone, but persons engaged with other persons. Hence, the focus here on the nature of persons in community and, in Novak’s terms, persons with a spiritual dimension.
A cat or a dog, or even a tree, can be an individual, but only a human being (or God and the angels) can be a person. Person is far more specific to the human race; it is a far more humanistic term. What makes a person a person, rather more than merely an individual, is a spiritual capacity: the capacity to reflect and choose, to be imaginative and creative, to be an originating source of action. . . Persons are social beings before they are aware of having their own distinctive personalities. Persons come to fulfilment only in community, and communities have as their end and purpose the raising of persons worthy of their inherent dignity (Novak, 1999, p. 41).
In sharp contrast to Novak’s description of person, is the contemporary propensity to speak of the individual. Ageing in the 21st century reveals how the ‘cult of the individual’ is given supremacy over ‘persons-in-relation’, posing a challenge for the development of communities in which frail, dependent older people can thrive.
The COVID-19 pandemic has, unfortunately, given rise to descriptions of persons not merely as individuals but as ‘cases.’ Neither are persons regarded as inherently relational, or bound together by communities; they are described by the intensity of their infection. With such a concentration on issues other than the person, many families of nursing home residents have been left distraught, ignorant of their relative’s whereabouts or whether, in fact, they are alive or dead. Strict infection control protocols have left no room for risk-taking: the comforting presence of close family (appropriately protected) at the bedside of a dying person, in a nursing home or hospital, is (in most instances) strictly forbidden. What spiritual care accompanies the dying person in these circumstances? The bywords of Meaningful Ageing Australia — meaning, purpose, connectedness — have no place in the COVID-19 world so described; giving way to words such as ‘protection’, ‘management’, ‘containment’. Our ‘inherent dignity’ as persons is not conveyed through such words; neither is it constrained by a clinical diagnosis and prognosis: we know who we are through our human community.
Whether impeded by advancing dementia and/or by serious viral infection, Gladys remains a person. Swinton’s description is apt:
. . . human beings can be persons for 60, 70, 80 years, and live under the protection of this particular notion of personhood, only to find themselves living out their final years as non-persons who suddenly (or gradually) become less worthy of moral attention and protection (Swinton, 2008, p. 25).
Gladys, and other persons of all ages who are affected by this lethal virus, have deeply human needs: spiritual as well as physiological. Without minimising the seriousness of the COVID-19 pandemic, we are reminded of the persons behind the statistics.
References
Novak, M. (1999). Human dignity, human rights. First Things, 97(November), 39-42.
Swinton, J. (2008). Remembering the person: Theological reflections on God, personhood and dementia. In E. MacKinlay (Ed.), Ageing, disability and spirituality: Addressing the challenge of disability in later life (pp. 22–35). London, England: Jessica Kingsley.
Dr Rosalie Hudson
Consultant/nurse educator in aged care, palliative care, dementia care and ethics. She holds an honorary associate professorship at the University of Melbourne (school of nursing) and adjunct associate professorship at Charles Sturt University.