What comes to mind when you think of being nourished? Perhaps it is a memory of sharing a meal with loved ones or sipping a cup of tea with a close friend. Maybe it is being sick as a child and having a caregiver offer a blanket and a comforting touch. It may have even been the glimpse of a smile offered by a stranger in passing earlier today. The details of the experience itself are far less relevant than the felt sense of what you remember here and now. But during that exchange of laughter, tears, or whatever else may have arisen, there was likely a mutual experience of feeling seen and heard – an awareness of, “I belong here.” Few moments can substitute the nourishment, safety, and stability that accompanies the essence of confident belonging.
Next, bring to mind a memory of not belonging – one in which you felt insecure, unsafe, or had a sense of uneasiness as a response to your environment or the people around you. It is quite possible you felt out of sorts or anxious. Maybe you were worried about how you might be treated or received. To not belong is to be overlooked and silenced. To not belong is to suffer in fearful isolation. And, on an existential level, to not belong may be akin to dying a death of rejection again and again.
Oh – to belong! How easy it is to take this for granted. And how easy it can be to nourish it for a fellow human being.
In the rush to respond to the increased global social discourse regarding diversity, equity, inclusion, and justice, many organizations have overlooked the foundational need to nourish experiences of belonging for those they serve. Many historically excluded populations, including LGBTQ+ persons and their families of choice, often confront discrimination, violence, criminalization, homophobia, transphobia, and disenfranchised grief as barriers to palliative care. Many LGBTQ+ identified people may feel their sense of belonging has been eroded by deliberate mistreatment. COVID-19 has further compromised the health and wellbeing of LGBTQ+ individuals, leading to advocacy for improved policy protections and an emphasis on inclusive clinical practices. In a context of exclusion and systematic marginalization, few moments are as life-giving as one in which we feel that we fully, wholly, and undoubtedly belong.
In many parts of the world, healthcare workers can legally refuse to care for LGBTQ+ individuals and harassment of these communities is often protected or enforced by governmental authorities. As palliative specialists, we hold a commitment to preserving, promoting, and protecting human dignity as a foundational ethic. In addition, we must take informed individual and collective action to dismantle structural discrimination wherever it may interfere with the quality of human-centered care throughout the serious illness continuum. This may mean speaking up to address discriminatory behaviors of a colleague, or acknowledging where we, ourselves, are wielding bias in our decision-making, engagement, or care delivery.
We must also remember that caregiving support comes in many forms, and for some of our LGBTQ+ patients, relationships with their families of origin may be distant or volatile. In these cases, we must honor whomever the patient identifies as their “family of choice.” Doing so may require a humbling reflection on our own implicit or unconscious biases and assumptions. This can be uncomfortable. And – yet – none of us signed up for “comfortable.” We signed up to be of service to the greater good.
Researcher Brené Brown says, “Belonging is the innate human desire to be part of something larger than us… True belonging doesn’t require you to change who you are; it requires you to be who you are.” Although Brown calls for all people to cultivate their own self-sufficiency and the courage to be authentic and vulnerable in their own skin, we must also play our part in forging palliative care environments that are ripe for belonging and for the full expression of humanity before us. Procuring spaces of belonging inherently reflects the core values of palliative care – compassion, kindness, respect, and nurturance for all people regardless of sexual orientation, gender identity, race, ethnicity, culture, or other restrictive categorical denominators. It calls us to nourish through our practice – to nourish belonging for our fellow humans.
Individuals and families in need of palliative care often come to the table with suffering that is yearning for attention and for relief. Unmanaged symptoms, complicated social dynamics, distress of spirit, of mind, or of existence… each burden coming forward with a need to be known and acknowledged. The histories and hurts of our patients – the pain of being excluded or harmed – may be an intricate part of who they are and how they see the world. In my mind, one of the highest aspirations of the palliative specialist is to co-create care environments alongside colleagues, individuals with serious illness, their families of choice, and their communities that are conducive to healing and wholeness. In fostering these environments of deep care and concern, we prioritize and honor the room every human being needs to openly share their own truth of self without the fear of judgment or rejection.
It is here – in this very sacred encounter – that we are invited to nourish belonging.