Whose Soul? Which Limits? Reimagining Medicine via Paul Farmer’s Praxis of Accompaniment
Alexandre Martins, PhD, Assistant Professor, Marquette University; M. Therese Lysaught, Loyola University Chicago; Julie. Gunby, PhD Student, Saint Louis University; Patrick T. Smith, PhD, Associate Research Professor, Duke University; and D. Brendan Johnson, Medical Student, University of Minnesota Medical School
Paul Farmer, MD, PhD—physician, medical anthropologist, and indefatigable companion of the poor across continents who tragically died in February 2022—famously did not believe in limits. Or rather, he did not believe in the arbitrary limits that reserved effective, high-quality healthcare for those on one side of “the great epi-divide”—that mappable boundary separating those who die primarily from diseases typically associated with old age from those who die overwhelmingly from violence, hunger, and preventable communicable diseases.[1]
Such limits and boundaries are in significant part the product of medicine as a social imaginary. In this imaginary, some lives are worth more than others. Only some lives—and, thus, only some ‘souls’—are worth the ‘scarce’ resources (technologies, beds, pharmaceuticals, physician time) and care of modern medicine.
Farmer challenged this imaginary and, in so doing, transformed the field of global health. A key catalyst of Farmer’s unique and powerful vision was the Catholic social tradition, particularly in its incarnation as liberation theology. As his unfailing hermeneutic, liberation theology provided an incisive theoretical lens by which he inverted standard assumptions within global health, medical anthropology, and international policy, reimagined the practice of health care (both globally and in the US), and achieved extraordinary outcomes. Through his work, the seed of liberation theology was sown in new fields and produced one hundred-fold. His (secular) organization Partners In Health adopted as its mission statement a line from liberation theology, promising to relentlessly embody “a preferential option for the poor in healthcare.” In addition to “visiting the sick,” PIH self-consciously pursued the other works of mercy, including visiting the prisoners (treating TB in post-Soviet Russia) and burying the dead (ceremonially reinterring victims of Central American paramilitary killings).
At the heart of Farmer’s challenge to the imaginary of contemporary medicine was what one could describe as medicine as a practice of “care of souls.” But here, again, he challenged and reimagined the traditional framing of that concept. For Farmer did not care, dualistically, for eventually dis-embodiable “souls”—he cared for people, primarily poor people, and he did this by accompanying them.
This panel will discuss key characteristics of Farmer’s praxis of accompaniment that challenges traditional ways of conceptualizing the “care of souls”—listening to the poor/patients, being open to learning from them, letting them challenge standard medical practices, treating not only for people’s diseases, but working and walking alongside them to rescue a sense of hope and justice (historical and eschatological)—in short, befriending them. In so doing, he cared not only for their “soul”; he recognized and restored the dignity of the destitute sick and their agency—and often restored them to health as well. To do so, the panelists—an interdisciplinary group of theologians, ethicists, and medical practitioners—will draw on a forthcoming edited volume on Farmer’s legacy for theological ethics [title anonymized, February 2023] to highlight the theological and practical dimensions of this praxis of accompaniment and to complicate the conference theme.
The panel moderator, a theologian, ethicist, and co-editor of the book, will provide an overview of the book and pose key theological questions regarding the tradition and framing of ‘the care of souls.’
The second speaker, a professor of bioethics and theology and co-editor of the book, will speak about the intersection of liberation theology and public health ethics preceding Farmer that provided the foundation for his praxis of accompaniment.
The third speaker, a medical student with training in liberation theology and social medicine and a contributor to the book, will offer comments about drawn from his literature review of religious themes throughout Farmer’s written works.
The fourth speaker, an African American philosopher and bioethicist, will offer a critical response to the book.
The fifth speaker, a nurse midwife and bioethics graduate student who works with un- and under-insured patients, will offer a second critical response to the book.
Finally, Farmer wrote a book, Via Crucis, that featured the artwork of a local (to Columbus) artist who was married to an anthropologist who specialized in Haiti and with whom Farmer maintained a correspondence. The executor of their estate, who is also local and who has connections to the original artwork for the book (currently at a church in Columbus), will contribute a few words about the artwork and arrange for viewing after the panel.
[1] Tracy Kidder, Mountains Beyond Mountains: Paul Farmer, the Man Who Would Cure the World (Random House, 2003), 125.
Such limits and boundaries are in significant part the product of medicine as a social imaginary. In this imaginary, some lives are worth more than others. Only some lives—and, thus, only some ‘souls’—are worth the ‘scarce’ resources (technologies, beds, pharmaceuticals, physician time) and care of modern medicine.
Farmer challenged this imaginary and, in so doing, transformed the field of global health. A key catalyst of Farmer’s unique and powerful vision was the Catholic social tradition, particularly in its incarnation as liberation theology. As his unfailing hermeneutic, liberation theology provided an incisive theoretical lens by which he inverted standard assumptions within global health, medical anthropology, and international policy, reimagined the practice of health care (both globally and in the US), and achieved extraordinary outcomes. Through his work, the seed of liberation theology was sown in new fields and produced one hundred-fold. His (secular) organization Partners In Health adopted as its mission statement a line from liberation theology, promising to relentlessly embody “a preferential option for the poor in healthcare.” In addition to “visiting the sick,” PIH self-consciously pursued the other works of mercy, including visiting the prisoners (treating TB in post-Soviet Russia) and burying the dead (ceremonially reinterring victims of Central American paramilitary killings).
At the heart of Farmer’s challenge to the imaginary of contemporary medicine was what one could describe as medicine as a practice of “care of souls.” But here, again, he challenged and reimagined the traditional framing of that concept. For Farmer did not care, dualistically, for eventually dis-embodiable “souls”—he cared for people, primarily poor people, and he did this by accompanying them.
This panel will discuss key characteristics of Farmer’s praxis of accompaniment that challenges traditional ways of conceptualizing the “care of souls”—listening to the poor/patients, being open to learning from them, letting them challenge standard medical practices, treating not only for people’s diseases, but working and walking alongside them to rescue a sense of hope and justice (historical and eschatological)—in short, befriending them. In so doing, he cared not only for their “soul”; he recognized and restored the dignity of the destitute sick and their agency—and often restored them to health as well. To do so, the panelists—an interdisciplinary group of theologians, ethicists, and medical practitioners—will draw on a forthcoming edited volume on Farmer’s legacy for theological ethics [title anonymized, February 2023] to highlight the theological and practical dimensions of this praxis of accompaniment and to complicate the conference theme.
The panel moderator, a theologian, ethicist, and co-editor of the book, will provide an overview of the book and pose key theological questions regarding the tradition and framing of ‘the care of souls.’
The second speaker, a professor of bioethics and theology and co-editor of the book, will speak about the intersection of liberation theology and public health ethics preceding Farmer that provided the foundation for his praxis of accompaniment.
The third speaker, a medical student with training in liberation theology and social medicine and a contributor to the book, will offer comments about drawn from his literature review of religious themes throughout Farmer’s written works.
The fourth speaker, an African American philosopher and bioethicist, will offer a critical response to the book.
The fifth speaker, a nurse midwife and bioethics graduate student who works with un- and under-insured patients, will offer a second critical response to the book.
Finally, Farmer wrote a book, Via Crucis, that featured the artwork of a local (to Columbus) artist who was married to an anthropologist who specialized in Haiti and with whom Farmer maintained a correspondence. The executor of their estate, who is also local and who has connections to the original artwork for the book (currently at a church in Columbus), will contribute a few words about the artwork and arrange for viewing after the panel.
[1] Tracy Kidder, Mountains Beyond Mountains: Paul Farmer, the Man Who Would Cure the World (Random House, 2003), 125.