Counteracting Throwaway Culture in Daily Clinical Practice

Abstract

Since his election in March 2013, Pope Francis has brought significant attention to the concept of “throwaway culture.” This moral paradigm—which has been defined by Francis in various speeches and the encyclical Laudato si’—characterizes a present-day culture in which food, disposable objects, and even human beings themselves are “discarded as ‘unnecessary.’” As Catholic physicians, it is our duty to ensure that we are working to counteract throwaway culture in our daily clinical practice by embracing and exhibiting a culture of encounter. When throwaway culture is discussed within the context of medical practice, it is easy to think of major life and systemic issues including abortion, assistive reproductive technology, physician assisted suicide, and so on. However, rejection of throwaway culture has much broader implications for Catholic physicians. We are called to resist this perverse culture whenever we experience a situation that requires special attention to the respect of human dignity. In this article, we present two common situations encountered in clinical practice in which it is essential to counteract throwaway culture and embrace a culture of encounter: in working with patients who are isolation settings and those who require translation services. Various studies are cited which demonstrate a lack of respect for human dignity that can be seen when working with these patient populations, and recommendations are provided which illustrate how to embrace a culture of encounter in each scenario. The authors conclude that through adoption of a culture of encounter, Catholic physicians as a community can be role models for coworkers, trainees, and students, promoting a culture in which we validate human dignity and ensure the quality and just care of even our most vulnerable patients.

Summary:

Pope Francis had defined a “throwaway culture” in which “Human life, the person, are no longer seen as a primary value to be respected and safeguarded.” In this article we present two common situations encountered in clinical practice in which it is essential to counteract throwaway culture and embrace a culture of encounter: in working with patients who are isolation settings and those who require translation services. We conclude that, as Catholic physicians, it is our duty to ensure that we are working to counteract throwaway culture in our daily clinical practice by embracing and exhibiting a culture of encounter.

In his first public speeches shortly after his election in March 2013, Pope Francis began to both define and bring significant attention to the concept of “throwaway culture” in Catholic moral thinking. Initially described as a “culture of waste” in a General Audience for World Environmental Day (Francis 2013c) and at an Address to the International Federation of Catholic Medical Associations (Francis 2013a) in the same year of his election, Francis suggests that we are at risk of being infected by a common mentality in which “Human life, the person, are no longer seen as a primary value to be respected and safeguarded” (Francis 2013c).

The phrase “throwaway culture” itself first received public attention when it was discussed by Pope Francis in a January 2014 address to members of the Diplomatic Corps accredited to the Holy See (Francis 2014). In this speech, he defined this idea as a mindset in which food, disposable objects, and even human beings themselves are “discarded as ‘unnecessary’” (Francis 2014). He then gives examples of this present-day culture including abortion, the use of children as soldiers, and human trafficking.

The concept of throwaway culture was further solidified as a moral paradigm in the 2015 encyclical Laudato si’ (Francis 2015c). The encyclical critiques the excesses of consumerism and power derived from technology, which has profoundly negative and lasting effects on all God’s creation, including both the natural environment and human life. Although largely focused on attitudes toward the degradation of our natural environment and promotion of a greater respect for nature as God’s creation, Laudato si’ also acknowledges the undeniable connection between respect for the natural world and the dignity of the human person. Francis makes this clear in writing, “A sense of deep communion with the rest of nature cannot be real if our hearts lack tenderness, compassion and concern for our fellow human beings” (Francis 2015c). In the same way that we must counteract the consumerist culture that generates so much waste (i.e., resisting the throwaway culture) so must we also counteract a culture that fails to uphold the dignity of every person.

While acknowledging that large scale structural changes including an “integral ecology” are needed to solve this “…one complex crisis which is both social and environmental,” Francis states that an important component in creating societal and cultural responses begins with the individual person, writing “[a] change in lifestyle could bring healthy pressure to bear on those who wield political, economic and social power” (Francis 2015c). He emphasizes that “If we can overcome individualism, we will truly be able to develop a different lifestyle and bring about significant changes in society” (Francis 2015c). We must note, however, that “social problems must be addressed by community networks” as greater societal change “…will make such tremendous demands of man that he could never achieve is by individual initiative,” as described by Father Romano Guardini in his work The End of the Modern World (Francis 2015c; Guardini 1950, 65–66). Although individual works are essential for cultural shift, individuals must unite in common purpose to make true societal change.

Since the original introduction of throwaway culture as a “culture of waste” and the more formal definition provided in the context of concern for God’s creation through the publication of Laudato si”, Pope Francis has continued to utilize throwaway culture in many instances to draw attention to the importance of various social justice issues including economic policy, religious fundamentalist terrorism, war, and immigration policies (Francis 2015a, 2015b). The concept of throwaway culture is a key metaphor in Pope Francis’s Catholic social teaching and is an overarching model for understanding the importance of resisting this societal mindset in order to promote respect for God’s creation and the dignity of all human beings.

Recently, various aspects of throwaway culture have been analyzed by Charles Camosy in his book Resisting Throwaway Culture: How a Consistent Life Ethic Can Unite a Fractured People. In this book, Camosy takes on a diverse set of issues that are demonstrative of modern throwaway culture, including reproductive biotechnology, state-sponsored violence, and ecological issues, to name a few. In each discussion, the book calls readers to resist the throwaway culture by cultivating Pope Francis’s “culture of encounter.” In contrast to throwaway culture, “…if we do good to others, if we meet there, doing good…we will make that culture of encounter” (Francis 2013d). In his work, Camosy describes the culture of encounter as a way of life “…whereby we meet the vulnerable and marginalized personally by disrupting our routines and going to the peripheries of our familiar communities” (Camosy 2019, 23–24). Pope Francis’s call to culture of encounter ensures personal outreach and meeting between individuals in a rejection of the societal mindset which often treats human beings as discardable. As Catholic physicians, it is our duty to ensure that we are working to counteract throwaway culture in our daily clinical practice by embracing and exhibiting a culture of encounter.

When throwaway culture is discussed within the context of medical practice, it is easy to think about major life and systemic issues including abortion, assistive reproductive technology, physician assisted suicide, care for the elderly, provision of health care, and so on. Although important in its own right and worthy of attention, for the average physician, working to counteract throwaway culture can seem wholly overwhelming. We may think this to be the work of large organizations, hospital administrators, or politicians, not of an individual physician caring for an individual patient.

While these interventions are necessary for systemic and cultural changes, and are worthy pursuits for us to undertake as a society, these actions begin with individual “change[s] in lifestyle” as noted in Laudato si’. Additionally, it has been noted that “…a culture of encounter implies a collective approach…shared by people who facilitate encounter by cultivating dispositions, which become habits, which become normative practices for community life” (Mescher 2020, 8). Therefore, Catholic physicians as a community embracing the personal encounter and refuting throwaway culture is the starting point for shaping a societal embrace of encounter.

Rejection of throwaway culture has broad implications for Catholic physicians. We are called to resist this perverse culture whenever we experience a situation that requires special focus on the respect of human dignity. Here, we present two common situations encountered in clinical practice in which it is essential to counteract throwaway culture and embrace a culture of encounter: in working with patients who are in isolation settings and those who require interpreter services.

It is common for patients in hospital setting to be under isolation precautions with the goal of preventing the spread of harmful and potentially drug resistant pathogens such as Clostridium dificile and Methicillin-resistant Staphylococcus aureus. While these precautions have been found to reduce the transmission of pathogens and their morbidity, it has also been shown that isolation has a negative impact on patient care (Sydnor and Perl 2011).

It has been demonstrated that health-care workers are half as likely to enter the room of a patient in contact isolation and patients are significantly less likely to see an attending physician (Kirkland and Weinstein 1999; Saint et al. 2003). Unfortunately, these trends have been consistent with more recent studies demonstrating that patients in isolation precautions have longer hospital stays and are associated with greater risk of other adverse events such as falls and IV fluid infiltration as well (Tran et al. 2017; Spence and McQuaid 2011, 155). Furthermore, patients in pathogen-related isolation are more likely to experience social isolation with a study finding patients in isolation have 23 percent less contact from visitors compared to patients not under these precautions (Morgan et al. 2013, 71).

These studies demonstrate how patients under isolation precautions are at risk for both adverse medical outcomes and social isolation from visitors and their care providers. This deviation from the standard of care is a clear demonstration of throwaway culture, as patients who require more effort to provide care, even a task as simple as donning isolation gowns and gloves, lead to disregard of their inherent worth and dignity. The relational aspect of care of these patients is ignored and the value of human interaction with these patients is forgotten. These patients under isolation then become the “disposables of society,” just as happens to the elderly, poor, and disabled.

The treatment of patients under isolation precautions becomes reminiscent of the lepers we encounter in both the Old and New Testaments; these individuals are often cast away as unclean. Mark’s Gospel describes Christ’s encounter with a leper in which “A leper came to him [and kneeling down] begged him and said, ‘If you wish, you can make me clean.’ Moved with pity, he stretched out his hand, touched him, and said to him, ‘I do will it. Be made clean’” (Mark 1:40-41 The New American Bible, Revised Edition). Catholic physicians should be drawn toward the leper reaching out for help and healing. In a rebuke to throwaway culture, we must ensure that, like the leper in Mark’s Gospel, we are reaching out to patients under isolation precautions, who are often isolated both physically and socially.

With the publication of the most recent Center for Disease Control (2019) Guideline for isolation precautions which replaced the term “nosocomial infections” with “healthcare-associated infections” (p. 8), it is likely that the reach of isolation precautions will affect more patients in healthcare settings. Further, as seen in the SARS-CoV-2 pandemic, extremely contagious pathogens require strict isolation precautions including the inability of patients to receive visitors. While visitation limits are partially influenced by personal protective equipment shortages, it is likely that infectious processes with high basic reproductive numbers (R ₀) will still require significant contact limits. Therefore, given this potential for an increase in the number of patients in isolation precautions and the severity of such precautions, we must be diligent to ensure proper care—both medical and social—is provided and the dignity of these vulnerable patients is respected.

Another unique population of patients for whom clinicians frequently care are those requiring interpreter services. It is estimated that there are 5.3 million households in the United States with limited English proficiency, defined as having no member greater than fourteen years of age who speaks English only or “very well” (US Census Bureau 2015). When members of these households require medical attention, it is necessary that interpreter services are used clinically in order to ensure proper communication between patients and their care providers.

Despite the US federal government’s requirement that recipients of federal funds are “required to take reasonable steps to ensure meaningful access to their programs and activities by [limited English proficiency] persons” per Title VI of the Civil Rights Act of 1964—which includes the majority of hospitals and healthcare services—studies have shown that integration of these services into daily clinical care is not always provided (US Department of Health and Human Services 2013). In one study, it was found that Spanish-speaking parents of children in the neonatal intensive care unit received medical updates in their native language only 39 percent of the time. These parents thought that greater access to in-person and phone interpreter services would have improved their understanding of their child’s condition (Palau et al. 2019). Additional studies have found that physicians often weighed their workload, schedule, and personal determination of the value of the communication with a patient when deciding to utilize interpreter services. Interestingly, the studies also found that the physicians recognized the underuse of interpreter services and subsequent impact on equitable care (Brooks et al. 2016; Diamond et al. 2008).

Although, it may not be possible to obtain interpreter services for persons who speak more rare languages (which is allowable as defined in the Health and Human Services guidance) the literature demonstrates inadequacy of interpreter services being provided to patients speaking common foreign languages. One example comes from a 2017 study which evaluated improvements in informed consent before and after the availability of telephone interpreter services for Spanish and Chinese speaking patients, which was completed at a large academic center. Results of this study found that the percentage of patients who received no interpreter services in the pre- and postintervention groups remained almost unchanged. In this study, 15.5 percent of patients in the preintervention group and 13.2 percent of patients in the postintervention group received no interpreter services (Lee et al. 2017, 866).

These studies make apparent a lack of essential interpreter services for limited English proficiency patients despite legal requirements and knowledge of the benefit of such services. In clinical settings, it may be difficult to obtain an interpreter at the desired time and therefore easier to rely on providers who are somewhat proficient in the language requested. Additionally, it can be tempting to avoid interactions with patients requiring interpreter services in order to “get through” patient interactions and daily tasks as efficiently as possible. However, this fails to recognize the inherent dignity of these individuals simply due to a language barrier.

Catholic physicians are called to care for the whole person in mind, body, and spirit. Therefore, we must take the time and effort necessary in order to provide the proper care for our patients. In order to establish this type of whole-person care, it is essential to have clear and sufficient communication between the physician and patient. Utilizing interpreter services and taking the time to establish mutual understanding ensure the best patient care. Additionally, we are living out the Gospel, which as Pope Francis writes in Evangelii Gaudium calls us to “run the risk of face-to-face encounter with others, with their physical presence which challenges us, with their pain and their pleas, with their joy which infects us in our close and continuous interaction” (Francis 2013b). By ensuring proper interpreter services are used in clinical settings patients are able to receive whole-person care in the model of the Gospel.

Caring for patients in isolation settings and those who require interpreter services are just two examples of the way in which we are called to counteract the present-day throwaway culture. It is essential that we reject the personal, organization, and societal pressures that tempt us to fail to recognize the dignity of each human being. Catholic physicians can lead the charge to fight these societal practices and ensure the best care of all patients. By taking the time to identify examples of throwaway culture in our practices, we can better embrace Pope Francis’s “culture of encounter.” Catholic physicians should embrace individual encounter with their patients and therefore be role models for coworkers, trainees, and students in promoting a culture in which we validate human dignity and ensure the quality and just care of even our most vulnerable patients. As a community that defies throwaway culture, we can collectively begin to shape our surrounding culture into one dedicated to embracing each human as a child of God.

Biographical Notes

Jeffrey W. Fuchs, BS is a fourth-year medical student at the Northwestern University Feinberg School of Medicine. He is a graduate of Marquette University and is a past president of the Catholic Medical Association—Student Section at Northwestern. He is interested in pursuing a career in internal medicine, and his research interests include the role of religion and spirituality in health.

Joseph R. Fuchs, BS is a fourth-year medical student at the University of Colorado School of Medicine. He is a graduate of Marquette University where he received a Bachelor of Science in Biomechanical Engineering. He is the current Technology Officer for the National Catholic Medical Association—Student Section and past president of the Student Section at the University of Colorado. He is interested in pursuing a career in internal medicine with special emphasis in vulnerable populations.