What we can learn from the ancient Greek Asklepian roots of medicine.
Nearly 30 years ago I was drawn into the world of palliative care. Its nature and essence spoke to my innate existential world view. I found an approach to caring that held the scientific rigor and understanding of humanity that made perfect sense to me.
The paradigm of care understood that my relationship with the person/family as well as the health care intervention I delivered was important to the family. Indeed, it was usually the quality of the relationship that stayed in the memory of the bereaved not the complexity of the intervention! It was WHO I was as well as HOW I did WHAT I did which was therapeutic and healing.
I acknowledge that kind, tender care exists in pockets of all care settings- from homeless hostels, hospitals to hospices. But should we expect more ‘depth’ of care from those of us who choose to work primarily in palliative and end of life care?
I am now beginning to question if palliative care nursing has somehow lost its way, lost its essence and identity. As the ‘science’ of palliative care nursing has grown exponentially, where has the ‘art of caring’ gone? Has it gone underground through lack of organisational vision and guidance? Or has it faded on the branch due to pressures and conflicting priorities of increasing bureaucratisation of palliative care settings?
Re-imagining palliative care nursing: incorporation of the Asklepian tenets of care
I want to make a plea for the sake of our profession but more especially those we serve; a plea that palliative care nursing refocuses on both traditions of care that informed Cecily Saunders vision of end of life care: the well-known Hippocratic and lesser known Asklepian paradigms of care. She understood the need for science and rigor of informed Hippocratic care. But unlike many medical colleagues at the time, she also respected the essence of the professionally marginalised Asklepian Tradition; that is the spirit; the ‘art of care and caring’ and relationship in which care is delivered.
Modern medicine and health care draws from two main strands of Greek medicine. The dominant strand emerges from the rational and observable explanations of health and illness; these ideas stemmed from Greek doctors, Hippocrates being the most famous.
The Asklepian tradition stemmed from the ancient Greeks strong belief in the supernatural and metaphysical aspects of life and is associated with Asclepius, the god of medicine and healing.
Above: The Askepian symbol is a snake wrapped around a staff. This symbol is part of the Who and BMA logo
I believe that 21st century palliative care nursing has much to learn from the Asklepian tradition. This approach is necessary to counterbalance the dominance of the Hippocratic approach which has even pushed forward into hospices and the care of people in the last days and hours of life. The increasing imbalance of the palliative paradigm is to the detriment of care needed by people in the last phase of life and, I posit, leads to confusion and loss of identity of the nurses drawn like I was to work within the speciality.
Essential elements of an Asklepian Approach to care
- Authentic Presence: Frightened, vulnerable people need more than informed robots. The most sophisticated A.I. creations don’t touch the suffering of a human being.
- Authentic Relationships: People are really touched when we care ABOUT them as well as care FOR them. Our patients and families need to feel known and loved to enable them to find their own inner strength.
- Engaged and concentrated attention: The Asklepian moment of concentrated attention, and the quietness that flows, comes from the nurse’s own humanity not from externally imposed guidelines and pathways.
- Personal growth for professional purposes: The personhood of the nurse is key. Are Palliative Care nurses willing to embark on the personal development that would enable this mode of care? The nurse needs to create some opportunity for inner growth and reflection to enable themselves to be able to work in this way.
In other words, at key points of care, it’s the personhood of the nurse meeting the personhood of the patient that matters most – be that walking someone to the toilet, washing their body, setting up a syringe driver or having an important conversation (I do wish we would stop calling conversations ‘difficult!).
It would be easy to say that these tenets of care are too demanding, too difficult on busy chaotic settings; or not ‘professional’ enough to protect the nurse or gain them esteem in the MDT hierarchy; or even too ‘fluffy’ to be relevant within specialist Palliative care.
And it is true to say, that not all patients desire this level of intimate interaction.
But many dying people and those close to them need to be met in this real human to human way; much more than the posh fancy care environments we professional get so hung up on. Its ‘the face, not the place’ that’s important as I heard from recent research into the needs of homeless people at the end of their life.
It is to our detriment we have not elevated the essence of the Asklepian tradition of care.
Have we lacked courage, wisdom or vision leading us to follow the paradigm shift in palliative medicine that seeks to fragment and objectify the body and mind?
In face of their mortality our patients and those who love them, need more than our drug formulas and outcome measures. They need our very essence to be alongside them in the fullness and richness of the last phase of life as well as the suffering and terror.
Have nurses got the courage and wisdom to stand up for the dying (which is all of us one day) and support and articulate a concurrent Hippocratic and Asklepian Care Model?
Siobhan Horton is a nurse who believes that death and loss is a natural human and relational experience with clinical components, not a clinical experience with relational components.
She has a deep passion for the acceptance and pursuit of appropriate palliative care for all.