Sweet Charity Or Solidarity?

IMG_0678Or something in between?

When we are moved by compassion and empathy to do something to help people in need, what ethical principles should guide our actions? What should we as teachers be modeling for our students? Is it enough to have good intentions when what we do can have negative unintended (although many times predictable) consequences? The road to hell is paved with good intentions and all of that.

Of course, I have in mind here the latest large-scale natural disaster in our world, that of Typhoon Haiyan in the Philippines. But closer to home (at least closer to my home) I was thinking about these questions yesterday while helping with a university health science interprofessional service-learning project called Teeth and Toes. I work with colleagues in the Schools of Medicine (Dr. Frederica Overstreet) and Dentistry (Dr. Bea Gandera) to train and precept groups of health science students in the provision of basic foot and dental care to Seattle’s homeless populations. We build on long-standing relationships with quality homeless service providers (such as the ROOTS Young Adult Shelter, Mary’s Place, and Downtown Emergency Service Center) to provide this ‘charity care‘ throughout the academic year. We try to build into the student training some element of upstream systems-level thinking about health and homelessness and student self-reflection, but we could do more (given more time and resources, of course!). Despite its current shortcomings, the Teeth and Toes clinics are one of the most rewarding parts of my job.

Charity care is feel-good care for the giver much more so than for the receiver of care. Charity care can reinforce the status quo, including the pervasive belief that individuals are the sole cause of their own problems. But charity care can also be a starting point to a widening world view and to greater civic engagement and involvement in systems-level change. Charity can be a political act. Charity and solidarity can both be sweet.

Good resources on this topic (or closely related topics):

  • Sweet Charity: Emergency Food and the End of Entitlement by Janet Poppendieck (Viking, 1998).
  • Crossing Boundaries–Violation or Obligation (excellent short article!) by Gordon Schiff, MD. In JAMA 310(12): 1233-1234. September 25, 2013.
  • From Charity to Justice: The Potential of University-Community Collaboration for Social Change by Sarah Marcello and Bob Edwards. American Behavioral Scientist, vol 43) 895-912. February 2000.
  • When Healers Get Too Friendly, by Abigail Zuger, MD. NYT, November 11, 2013.

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