A Palliative Care Approach to our Collective Crisis

Sharon October 5th, 2009

There was nothing in the Washington Post article (three essays back) that I didn’t know.  There was nothing in the Washington Post article that shocked me.  The fact that we aren’t on track to address climate change is not news.  The fact that we probably won’t address climate change successfully is not news.  I still don’t enjoy hearing it.  Nor can I respond as my climate-change skeptic readers will - I understand the science well enough to know that it simply isn’t sufficient to say that we don’t have perfect models, or that the climate is always changing.  Both are true, and neither is sufficient - no, we don’t have perfect models, but waiting until we do is not a viable choice.  Yes, the climate has changed in the past - but of course - and the consequences of those changes make it imperative that we not encourage the process, as we are now. 

The reality is this - the odds are extremely poor that we are going to prevent massive climate change precipitated by human emissions.  We’re unwilling to endure short term suffering in order to prevent much deeper long term suffering - as I’ve said several times, part of the reason we’ve failed is that climate activists have chosen to come at this as an easy sell - we’ve been told that green jobs will keep us rich, that our lifestyle can continue powered by new technologies, that all will be well, when the language of sacrifice was the only one available to us.  Now that it is becoming blazingly evident that only the most draconian measures will possibly give us a chance of having a climate like the one we’ve had for most of human history, we’re stuck with all those old false promises.

I do not believe we are free to stop working on preventing unchecked climate change until the deal is done. Why not?  Because what’s at stake are the people and things we love, and you don’t give up on those until they are dead and you’ve seen the corpse.  Imagine your loved one facing death from an illness - and you know there’s a 50% chance he or she will die.  Do you stop trying for life?  What about 20%?  What about 10%?  5%?  2%?  As far as I can tell, you go on fighting as long as there’s hope, however faint.

But extending the illness metaphor, it is important to note that when someone is facing a severe or even fatal illess, there’s a too pronged approach you can take that may work better than a single-minded focus on fixing the problem - this involves integrating curative medicine with palliative care.  And this, I think, is what’s most necessary at this moment.

Palliative care is medical care that focuses on the relief of symptoms and the maintenence of quality of life.  Unlike hospice care, which focuses on cases where loss is inevitable, palliative care has the same basic focus on relief of suffering, but can exist simultaneously with curative medicine.  In some cases the patient will be cured.  In some cases, the patient will die.  Either way, the relief of pain and the improvement of quality of life is one central focus.

Our approach to climate change, to energy depletion and to our financial crisis could learn something from this medical analysis - that it is not sufficient to focus only on the cure.  It is, of course, tempting to do so, to say that we can’t afford to divert resources from solutions that might save us.  But the problem with this is that it leaves us nothing but mourning if our work fails.  I should be clear here - I don’t really believe that most of our problems can be “cured” in any sense - that is, I don’t think we can stop depletion.  But we could render them radically less severe, perhaps shift from acute to chronic in some cases.

What would palliative care for a dying industrial civilization, for an unstable climate, increasingly depleted resources and an economic crisis look like?  Like medical palliative care, it would focus on relieving pain and improving quality of life - on enabling people to do well with much less, on investment in the commons and public resources available to those who no longer have access to private ones.  It would involve accepting that the areas most vulnerable to climate change might have to have massive population relocations - and beginning them now.  It would involve focusing on caring for people’s needs, and enabling them to live their lives as they will have to.  Making sure that we prioritize food, shelter and water, basic safety and the comfort and emotional needs of people in difficult situations may be less shiny and exciting than building a giant dome to block out the sun or whatever, but it is more necessary.

This need not be in conflict with the project of trying to fix some of our most pressing projects - in fact, there’s a compelling case that in a world with too much to do and not enough resources, that the most important acts are the ones that provide both curative and palliative measures - for example moving people rapidly to a lower level of consumption of resources both reduces emissions and helps people get ready for their new lifestyle.  But both prongs are essential.


16 Responses to “A Palliative Care Approach to our Collective Crisis”

  1. Grandma Misi says:

    Excellent! Sometimes I wonder with the very busy life you lead how you can have the time and wherewithall to see things so clearly… I give thanks every day that my addled brain has you and other clear-thinking folks to keep me focused on what is really important in life. Thank you Sharon!

  2. Julie says:

    Grandma Misi has nailed how I feel about Sharon. “Seeing things so clearly” (and with such speed.) I may given time come to some of the same conclusions as Sharon but it would take me a year or two.

  3. Anonymous says:

    Excellent post. We’ll never live in a sustainable steady state economy of any color. But if anyone is to live in one we will be the ones to begin the transition to it. It’s up to us to begin honestly addressing the pain and discomfort at both the social and personal levels. If we don’t do it, who will?

  4. Andrew says:

    Another excellent post.

    Perhaps what we are witnessing is in fact hospice care (bank bailouts, concessions to oil to coal, agribusiness tax breaks) - but only for a small, wealthy segment in the Western world. The segment to which I do not belong - maybe we were triaged long ago.

  5. Raye says:

    I`m in, Sharon. Time for me to start implementing some of the “good ideas” I have been considering (such as a local transition skills institute). Here goes.

  6. Robyn M. says:

    Nothing, and I do mean nothing, makes me as angry as the “But it could be false!!!!” whine/response to human-caused climate change. Could we be wrong? OF COURSE WE COULD! WELL DUH!! We could, and probably are, wrong about all kinds of things. What, do people need *proof* of the truth of any claim before they believe it? That’s a joke. We don’t demand proof that, for example, the chair one is about to sit in won’t collapse under his weight, or that the car one is about to turn on won’t explode, or that igniting the burner on one’s stove will work, etc. Further, we don’t demand *proof* that the new decongestant on the market won’t make you grow a third arm, or that the traffic lights will all work flawlessly. Evidence, yes. Proof, no. It’s just silly to think that we can have proof or certainty for any of these things. And yet we roll around to climate change, and all of a sudden it’s “But but but it could be wrong! But but but we don’t have proof!” *headesk*

    No we don’t have proof, and no we won’t ever have proof, because you can’t get proof of claims like this (similarly, there’s no proof that AGW *isn’t* true, either-don’t hear people harping about that). Science doesn’t give us proof. It gives us evidence. And the *evidence* (one helluva lot of it, too) indicates that we are SOL, or worse, and it’s mostly our fault.

    But I’m guessing there will be people sitting in their desert shacks (in Des Moines) in 70 years declaiming loudly about how its all just cyclical.

  7. dewey says:

    I wouldn’t agree that it makes sense for a person with a life-threatening disease to pursue a 2% chance of a cure no matter what financial burden and physical suffering that will involve; there’s a point at which I’d rather accept the likely facts than waste my loved one’s last months playing the medical lottery. The difference is, though, that death is part of the human condition - if you survive cancer now, it will only mean you die of Alzheimer’s or something a few years down the road, not that you’ll live forever - whereas your argument seems to imply that the ecological destruction and civilizational collapse foreseen could be permanently avoided. The metaphor is therefore elegant but not exact.

    OTOH, Greer, Tainter, etc. might say that civilizations will inevitably “die” at some point, and I suspect that’s true, because, humans being what they are (apes with thumbs), sooner or later a future generation will get itself into the same pickle. If that is so, the nonhuman world will be better off the faster the global society collapses. I’m not rooting for a human dieoff, let me make that clear - but if I were a parrot or a dolphin, I sure would be, and I do think their interests are just as legitimate as ours.

  8. MarkyMark says:


    While climate change may be happening, I don’t know if one can say for certain that it’s human induced. One, the Earth has been through climactic cycles through the centuries; what we’re seeing now is no different. Climate changes depending on what the sunspots do (decrease or increase). Secondly, what impact does a massive volcanic eruption have on our atmosphere? Doesn’t an eruption dump TONS of soot, ash, smoke, and rock particles into the atmosphere? Would this not have an effect on our climate? Does this have anything to do with man?

    The other problem I have with recent climate change treaties is this: other nations would not be held to the same standards as we would. For example, in the Kyoto Accords, nations such as China & India were permitted the same pollution levels as they’d had previously, while we were to decrease ours. That would not only have a deleterious effect on our economy; it would place us at a severe, competitive disadvantage. IOW, it’s not in our BEST INTERESTS to sign agreements like that!

    Those are my thoughts. With that, I need to do dishes and eat.


  9. MarkyMark says:

    Oh, and one more thing: meteorologists can hardly predict the weather two DAYS from now with any accuracy! WTF makes anyone think that they can tell us with any certainty of what will happen two decades from now? Yeah, that’s what I thought…

  10. Sharon says:

    Dewey, I realized after posting this that the analogy wasn’t precise - but I think there’s another distinction that’s sort of relevant, if maybe stretching it. If your loved one has a 2% chance of survival, they certainly can say (or you can say if you have been formally deputized to make their decisions) that they would choose not to pursue treatment - but you can’t say that they *must* make that choice, given any viable possibility (yeah, yeah, we could go all death panel here… ;-) ). That is, this is a decision for the person involved - but I don’t think we’d like to see other people making that judgement - and that’s how climate change works - we choose death for other people.

    MarkyMark, which volcano are you referring to? Of course volcanoes can change the climate - but what does that have to do with AGW. As for sunspots, my husband has a Ph.d in astrophysics, is a professor of astronomy, and teaches environmental physics, and we know that it isn’t sunspots - in the simplest terms (and there are other reasons we know it isn’t sunspots), among other things if this were solar radiation, we would expect the upper atmosphere to be getting warmer too - but it isn’t. It is actually cooler than before, which suggests that the problem is trapped heat that would come from the planet to the upper atmosphere were it not for heat retention, rather than heat being transmitted. The sun cycle does matter, but of course, the models include the sun cycle.

    As for the last point, I have to say, I don’t find it compelling. Does this mean that if you were diagnosed with diabetes, you wouldn’t take insulin, because, after all, we can’t cure the common cold? My six year old can explain the difference between weather and climate.


  11. Brad K. says:

    I think of a culture as the combination of definitions of right and wrong, of social values, of traditions that one chooses to define their life. Often similar cultures are nurtured and preserved in families, in communities, and in nations.

    I would argue that inner cities and elite city dwellers don’t share cultures in a meaningful way with each other, or with rural dwellers.

    And though the US Constitution does *not* guarantee to preserve one’s culture - I believe the expectation was that every citizen would participate in a common, national culture - I think pulling people out of a culture to relocate them is a form of death. One defines security, social position, and one’s identity with respect to the prevailing culture.

    We know that everyone experiences a period of depression when beginning a new job, at least depression at some level. We experience buyers remorse when purchasing a car or home - which purchase usually affects our culture. Most of the time we recover, and often grow from the experience.

    The US Navy counts on that culture shock, builds the expectation of disorientation and loss of identity into the training program at Boot Camp. We send our kids to visit relatives, or to summer camp, to give them a taste of dislocation and finding themselves again when marooned (homesick).

    Two scenarios seem likely, to me, to bring about meaningful relocation of people from threatened urban centers to viable land where homesteads could be built. First is the disaster - say, another Katrina, get everyone evacuated - then tell people to start digging in. The other is to establish some kind of homestead plan that you can interest significant numbers of people in partaking, providing reasonable plans or at least concepts, and making success likely enough that early adopters keep the momentum going as they relate their success to the undecided.

    Possible disasters range from natural disasters to military or vigilante attack, to massive government foreclosures and evictions, to turning off city services such as food, water, electricity, gasoline, natural gas, etc.

    In the past, gold rushes and pioneering treks resulted in awful death rates. I cannot see much change in mortality rates with mass exoduses in the near future. If one were to attempt an orderly transition and relocation - to where? Parcel out federal parks and forests? Condemn and attach existing farm land?

    In previous times, families raised children so that one or more would be available and ready to care for the injured or elderly. We haven’t been raising children with that kind of expectation or skill, not recently, at least, most American families haven’t. Farm life used to be based on establishing a farm for subsistence survival, and raising kids for enough energy and labor to make the farm successful. We haven’t been used to thinking of working with our children, of teaching them our skills, of expecting them to participate in enriching the family as they essentially apprentice for their life’s work. Instead we debate whether the schools should tell our kids about sex and drugs.

    I applaud the sentiment of dismantling the cultures of the inner city rich and poor, of the suburban consumer, and even the agribusiness farmer. I just have trouble envisioning what they would transition to, how that kind of relocation could be motivated in a humane fashion, so that the result would be a thriving people secure in their person, their shelter, and their food.

    Sharon, you demonstrate daily what a family can choose to do, given interest, time, and opportunity. When discussing significant population shifts, the interest and opportunity have to be arranged on a grand scale. The opportunities to learn to adapt to less heating, for instance, requires re-thinking such mundane things as plumbing facilities, wood stoves and wood or charcoal sources.

    The discussions about adapting in place made certain assumptions about security of person, shelter, and food, that may or may not be warranted. But that is something that could spread to nearly everyone, regardless of culture and circumstance. Relocation presumes there is a place to relocate to, that there are resources to sustain one and one’s family - community? - at the destination. That skills will be available at the destination to use the resources in a sufficiently rational manner to make the transition achievable, at some rate of success.

    I cannot imagine that such a mass relocation from Everly, IA (44 in my graduating High School class in 1970, we were consolidated with Moneta, IA) being 100% successful. The success rate of cooperative and productive gardening and agriculture for anyone coming from an affluent or gang-affected culture boggles the mind.

    I happen to agree with you, that mass relocation will be needed to achieve a dispersed and thus sustainable solution. That consumerism has to be diverted to agriculture and horticulture as a livelihood for most people, to provide a healthy family environment and food and shelter security.

    I further believe we cannot allow too much wealth to languish, we cannot afford to lose productivity of too many people. Because we live in a dangerous world, and our military will need to be sustained at nearly the current level into the future, to be able to establish and maintain security from lawless and aggressive outsiders. Effective security will remain expensive in terms of gross national product, and will require research and support industries.

    But the first couple of steps still elude me. Where will people be relocated to, and what will make them eager and willing to start anew in a new culture?

  12. EcoYogini says:

    This was timely, as I’ve just attended a lecture by Dr. Andrew Weaver (excellent lecture btw). It was striking and I was shocked that people actually believe that climate change may be caused by sun spots (sun spots??? lol). What I found most interesting about his lecture, was his analysis of how the popular media as well as scientists both have played a part in confusing the public with global warming. It was interesting to listen as he outlined peer reviewed qualitative studies that show how 0% of all peer reviewed quantitative studies have any debate on human causation of climate change…. whereas only 6% of media reports have no debate…. As each media report is required to print some sense of ‘balance’- unqualified ‘experts’ or non-experts are quoted stating climate change is not human caused. No wonder the general public is so confused when it comes to climate change.

    As a health professional, I would take a more balanced approach to your theory- palliative care is used for patients who have no hope- the name itself implies dying. No hope at all. Therefore, as I have gleaned implications of hope from your post, I would assume that you do not necessarily mean palliative (as the world will end and die within the following generation or two) but more a holistic approach. This term- holistic, implies a more broad sense of care, where the patient (or our planet) is cared for using a variety of therapies, managing pain, easing suffering while continuing to search and treat for a ‘cure’. I guess I’m being picky on the term palliative simply because as a health professional it has extremely negative implications. Perhaps that is what you meant.
    However, I would hope that we would continue to fight for a cure (as you stated) until the very last moment, which would in fact be something entirely different than a palliative approach.

    Very interesting post- thank you.

  13. Sharon says:

    EcoYogini - I’m afraid you are mistaken - *hospice* care is used by patients who have no hope. Palliative care as a specialty is used by any patient suffering from chronic pain or fatigue, regardless of their prognosis - hospice is palliative care, but all palliative care is not hospice. Palliative means “pain relieving” not “gonna die” ;-) . It is worth googling - it is a common misconception that palliative care means giving up.


  14. dewey says:

    MarkyMark - has the rate of volcanic activity changed enormously over the past 40 years, enough to result in observed climate and ocean changes according to any published model? Can any of your sources of denialist rhetoric cite a paper in a reputable journal that claims it has? If not, they are simply lying to you. You are not to blame for the falsity of the argument; you’re not a geologist and you can’t and shouldn’t have to independently research everything you see on a website. But those who put themselves up as sources of “unbiased” information for people like us had better know more, so if they use an argument that’s already been disproven, they do so deliberately. You ought to be offended to be on the receiving end.

    Sharon - I wouldn’t make the decision for a loved one. You originally used the example of a sick third party, which is harder for Americans to approach rationally: many of us who would let ourselves die when it was time turn around and stick Grandma on a machine. The reasonable question to ask is whether Grandma will ever get off that machine. JMG’s argument, of course, is that the “patient” (our globalized industrial civilization) is dying and cannot be saved, and that attempting to save him only limits the opportunity to provide palliative care that would make the death easier. I don’t know if he’s right, but he makes a good case.

    If you see climate change as being humans’ only crisis, then since Western societies have burned the vast majority of fossil fuels on their way to global dominance (note, Marky Mark, that’s why India is still poor), we would be solely responsible for collapse. However, it’s not that simple. Many societies that use very little fossil fuel are grossly in overshoot, as many others (that later collapsed) were long before the industrial era. Some future famine, war, etc. will therefore happen because people outbred their carrying capacity and destroyed their own habitat. You don’t want to make the West responsible for preventing this.

  15. EcoYogini says:

    A quick survey in the clinic followed by a google search (as you suggested) clarified the situation. It would seem that I assumed (as you did) that the medical terms used in one country applied to another. As a health professional that has worked across Canada I should have realized that terminology would differ.

    In Canada, Palliative care is synonymous with end of life or hospice care. Please view the Government of Canada’s site for further details.


    This also explains my negative reaction to the term palliative (which is used much more commonly in Canada as it is felt to have more positive connotations than the traditional term “hospice” care).

    I should not have been surprised as medical terms can differ immensely between provinces (as I’m sure they do between each state).

  16. Sharon says:

    EY, thanks for clarifying that.

    Dewey, JMG also sees climate change is a second-order priority - we have a pretty deep difference of opinion there, although we agree on a lot of other things. And I think that constitutes a fairly important distinction - catabolic collapse depends on a vision of decline that isn’t overarchingly rapid and radical - Greer is offering a prognosis served over the course of a century or more, climate change is offering a prognosis that is extremely short term for many people.

    As for making the west responsible - I’m reminded of a comment made by a professor of mine when showing (in a cultural criticism class) the then-popular movie, _The Lion King_ - it has a long Disneyish song about the circle of life, and goes on to have the wise lion father talk about how everyone is part of the cycle…the gazelles eat the grass, the lions eat the gazelles, eventually the lions die of old age and fertilize the grass. My professor simply pointed out the deep speciousness of this analysis - as though there is no difference between a gazelle whose flesh is being ripped from them and the lion dying of old age ;-) . I don’t disagree that many non-western societies are probably in overshoot, and headed for collapse - but the primacy of climate change means that we’re facing a really different collapse - if the monsoons fail in asia and africa gets 50% dryer, as predicted, we get to the difference between the gazelle’s end and the lion’s - and that is our fault.


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