It has taken me some time to digest this book and so commend it to others for both reflection and action.
Laurie Green has established a well-deserved reputation for his ministry amongst the poor and voiceless but also for his ability to think theologically. The book took me backwards into my story but also catapulted me forwards ainto imagining what kind of society we are building. Within the tension between history and the future lies the key element in Greens persuasive, compelling and radical arguments in these nine chapters. I shall say more about that in a moment but one point at the outset is worth making. There is a quality to this narrative that is borne out of a life well lived and a text written in ‘retirement’ which leads me to feel that older people reflecting on their experience should have a much more honoured place and voice in our spiritual economy. There is some maturation and deep wisdom present in the way in which Green listens to the cry of the poor. Valuing Age might also mean moving older people voices into the forefront of social action.
Why should such a text take me backwards? Well, in the mid-1980s and after theological education in London and Cambridge I was ordained in the Diocese of Durham to serve my curacy in Consett. You may remember that it one stage in our economic history (1985)Winchester was regarded as the wealthiest place in the country and Consett the poorest – this was the case because of the closure of the steelworks and the catastrophic consequences for thousands of workers across the area. By the time I had arrived many of the more entrepreneurial families had taken their redundancy money and relocated either in different parts of the country or across the north-east in new jobs. Some had resolutely stayed in the town that they were born in and felt inextricably connected with and thereby presenting a real picture of economic, social, cultural and spiritual poverty. It was a cold and bleak place and a living or dying reminder of the results of political policy that devastated huge sections of the industrial north. An example, quite simply, of the power and persuasiveness of economics over individuals and families. Money talks – people should listen!
Green reflects on this and takes us inside many stories of hardship and dismay. Green acts as an advocate for the forgotten residents of Britain’s housing estates and their devaluing marginalisation. At the centre of all of this are the experience and stories of poor people.
And what of the future trajectory? The advantage of having this book on my desk for so long before I dispatch it to the library for wider readership and use is that it has seen and experienced the decision of this country to remove itself as a member of the European Union. We live in uncertain times and it remains to be seen which parts of the community will bear the inevitable (perhaps?) consequences of our post Brexit world. I suspect that it will be the poor again who will pay some of the price of the economic and social uncertainty that faces this democratic position. We are faced again with Greens plea outlined in chapter 5 about how we challenge the present culture by seeking to lead a kingdom orientated life together. This book demands that we explore what are kingdom values might look like and how we challenge those things that contradict and undermine equality, justice, decency, faithfulness and goodness.
This book draws upon what Laurie Green has learnt – in a kind of long meditation on the beatitude ‘bless are you who are poor’. It stands in a noble tradition of Anglican antagonists who long to develop a new tradition that seeks to learn from the poor and so offer a new theology that might enable the merging our past and our future into a more sustainable present. It is nothing short of a tragedy that we continue to tolerate such significant levels of poverty in our country today. While there are churches involved in social action and care of the marginalised and vulnerable we continue to live with an economic system that forces some people to live in the most appalling conditions. Not to keep on articulating the contradictions and paradoxes of this reality is, to return to an earlier analogy, to move Greens book from desk to library. Put another : way what is to be done now? Are we listening to the voices of the Poor? Are they to be our teachers? Perhaps it is the case that as long as we ignore these complex realities we ourselves become poorer as individuals and as communities.
Green is at his most creative in showing his reader how to be confident in theology and how, above all, to put it to work. It should become a core textbook for all those interested in enabling individuals and groups to become reflective practitioners.
I have recently seen at close hand the work a busy acute hospital having to deal with an older person suffering multiple challenges to well-being caused in the main by intense confusion as a result of the Alzheimer’s disease. The result was shocking and frustrating. Although,of course, a one-off situation which was intensified by my own sense of powerlessness and pain at the way this person was treated – I suspect that this experience may well be replicated across the UK. We keep on being told that the NHS is in crisis principally for financial reasons but the central organising question this book suggests that there challenges are also moral : it asks is how we care for vulnerable people in such a way as to deepen compassion and alleviate suffering.
Fo me, this book came at the right time and Andrew Sloane deserves gratitude and praise for a powerful narrative that asked this question: can the focus of modern medicine change? The implication is that if it does not its very soul is in jeopardy. In the light of my own experience the reader will understand why this plea resonated so deeply and profoundly in my soul.
To return to the anecdotal – I remember during my time teaching at the Birmingham University medical school exploring with groups of students how far their ethical teaching and curriculum help them make decisions. Since those teaching days a great deal of attention has been given to public and academic debate about medical and bioethical issues. Those groups of students and young doctors taught me that they relied as much on intuition (I need to respond quickly and so do what I feel is right) as much as the body of knowledge oclassified as medical ethics. Sloane takes one step back from the issue of the relationship between theory and practice and asks his reader to explore the nature of medicine and its role in human community.
The nine chapters seek to put theology to work by offering a framework of Christian philosophical and theological thinking which might enable us to understand the nature and purposes of medicine and its role in a Christian understanding of human society.
So what does the book do?
First it presents a description of the contexts in which medicine is practiced in the early 21st century, identifying key problems and challenges that medicine must address. It then turns to issues in contemporary bioethics, demonstrating how the debate is rooted in conflicting visions of the nature of medicine (and so human existence). This leads to a discussion of some of the philosophical and theological resources currently available for those who would reflect ‘Christianly’ on medicine.
The core of the text attempts to articulate a Christian view of medicine as a moral practice which might be shaped by a Christian social vision and a number of key theological commitments.
The book concludes with some powerful pedagogical reflections (pp 178 ff ). First Sloane asks that if it is the case that medicine is an expression of a community solidarity with those whose vulnerability is exposed and if its goal is to express appropriate forms of care for the frail then we should rethink how we train doctors. In terms of medical epistemology, the internal goods of medicine and their relationship to other goals always threaten to distort or corrupt the practice of medicine. And in this we all need to take responsibility in relation to our wildly unrealistic expectations about what medicine can deliver.
A final theme, and possibly to be developed in his future writing lies, in the embodied nature of medicine. If we are ‘knowing bodies’ then doctors in partnership with their patients need to understand what is going on in the body: to listen carefully to the story of our bodies as to discern both what matters and how we might embrace frailty and nurture wholeness. The undue focus on investigations, the obsession with tasks and performance both detract from the human element of the clinical encounter and (in Sloane’s view) wrongly understand the nature and goals of medical knowledge. This reflects an ongoing interest in a number of public bodies in the UK concerning the medical humanities and how these might be built into a more holistic approach of nurturing both medicine and the medical profession. Medical paternalism and powerful self protecting professionalism needs to be challenged if the world of medicine is to be re-engaged and transformed. However this will require from us that we reconfigure what medicine can and cannot do for us.
This is a stimulating and enriching book. It is inevitably stronger on theory rather than practice but its call and argument is clear and convincing.It deserves to be picked up and developed by those of us who seek wholeness and all those professional groups that are tasked to care for those in need.
I hope to use some of this work in our future learning at Sarum College (www.sarum.ac.uk ) and particularly in the Sarum Centre for Human Flourishing.
Principal Sarum College