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Finite Care in a World of Infinite Need
Abstract
I joined the faculty of the Divinity School at Duke University in 1984. I arrived just in time to witness a debate in the Duke Medical Center that centered around questions of organ transplants. The medical center was to begin liver transplants which were projected to cost $140,000 an operation. Dr. Harvey Estes, chair of Duke's department of community and family medicine, questioned whether the money spent on organ transplants could not be better spent in other ways. In response Clark Havighurst, a professor in Duke law school, observed "It is very hard for society to face the death of someone who could be saved but we will have to face this more and more." 1 I call attention to this brief scrimmage at Duke in 1984 because I think the issues remain with us, but contrary to Havighurst we still have not faced them. Indeed if anything the problems have gotten worse. Every center dedicated to high tech medicine knows it must compete with other centers if it is to command research funds requiring the development of more exotic forms of care. Just as anyone who is facing surgery wants to believe that they have the best surgeon available so it seems every medical school and center must give the impression that they represent the "cutting edge" of research medicine. The result, as Estes suggested, creates a bizarre world. Why should we develop extraordinary forms of therapy when we are increasingly unable to give even the most minimal medical care to the poor? The result is a multi-tiered system for the delivery of medical care—one for people with plastic and the other for those without plastic. Faced 1 Durham Herald Sun, (November 11, 1984), p. 11D.
... This unhappy reality must also be kept in view as we consider how to allocate personal and societal time, talents and energies to both treatment and prevention. Elsewhere, Christians have elaborated on how longstanding problems of disproportionate access to resources (whether in psychology, healthcare, or any facets of life) ought to be unacceptable to the Christian believer (see Canning, Case & Kruse, 2001;Canning, Pozzi, McNeil & McMinn, 2000;Hauerwas, 2009;and Wolterstorff 1983;; for respective examples). ...
... This emphasis has left many individuals and groups systematically underserved and done little to prevent problems (and suffering) before they occur (Canning, Case & Kruse, 2001). Hauerwas (2009) has argued that this emphasis also reflects a cultural attempt to cheat death. Still, the enormous difficulty of these choices must be appreciated. ...
From the beginning, community psychologists made many of the assumptions behind their theories and methodologies explicit, openly articulating values at the core of their discipline. As a result, community psychology's foundational principles may be readily appraised by any who wish to seriously reflect upon them. This article introduces a set of assumptions and values commonly agreed upon within communi-ty psychology: (1) the ecological perspective as a lens for viewing human behavior, (2) adaptation as the means of development and change, (3) wellness as a focus over psychopathology, (4) prevention and pro-motion as priorities over treatment (5) collaborative, empowering helping relationships, (6) justice as a prominent goal of action, (7) research as wedded to action, and (8) human diversity reflected theories and methods. These core values and assumptions are examined from an integrative perspective and illus-trated in practice through an example taken from the author's work as a consultant.
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