Historically, bioethics began centuries ago as both a pastoral and theological enterprise within religious traditions. It was pastoral in the sense that clergy would address the questions of right and wrong, good and evil, in relation to questions of uncertainty among the faithful. It was a theological enterprise in the sense that the theologians would bring philosophical and theological method to bear upon those questions to provide general guidance that reflected the extension of the tradition’s norms. For example, guidance regarding hastening the death of goses, ( גּוֹסֵס) that is, persons thought to be within three days of death, is discussed in the Shulchan Aruch, which dates from the 1500s.
One in a dying condition is considered a living being in all respects. We may not tie up his jaws, nor may we anoint him with oil, nor wash him, nor stop off his organs of the extremities, nor may we remove the pillow from under him, nor may we place him on sand, clay-ground or earth, nor may we place on his stomach a dish, a shovel, a flask of water or a globule of salt, nor may we summon the towns on his behalf, nor may we hire pipers and lamenting women, nor may we close his eyes before his soul departs. And whosoever closes [the dying person’s] eyes before death is regarded as one who sheds blood. One may not rend garments, nor bare the shoulder in mourning, nor make a lamentation for him, nor bring a coffin into the house in his presence before he dies, nor may we begin the recital of Ẓidduk Haddin before his soul departs.
This is guidance for how one is to treat a dying person at the very end of life, as a living person whose life is to be celebrated and not mourned before death, whose dying is not to be accelerated, nor made uncomfortable.
Bioethical questions have always been day-to-day fodder of religious persons and their leaders and, indeed, as bioethics arose in the mid-to-late 1960s the field was initially developed by theologians such as Paul Ramsey, James Gustafson, and others. As philosophers entered the field, those theological voices were silenced or code-switched and, in the process, a now secular bioethics suffered (and suffers) a great loss of resources and clarity around ethical thinking in general as well as the applied field of bioethics. One of those areas is in the understanding of forgiveness.
Forgiveness has not been of great interest to bioethics. There is some discussion of forgiveness in the nursing literature, though it is scarce and poorly developed. More recently there has been more frequent mention of forgiveness, specifically in relation to racial reconciliation. The concept of forgiveness, and its relationship to reconciliation in that literature is thin; this is where drawing upon millenia of theological discourse could sharpen nursing’s understanding of what is needful for any efforts at racial reproachment toward reconciliation.
Recent discussions on racial reconciliation in nursing have bandied-about the concept of forgiveness in ways that neglect the essential elements of the process of forgiveness. Based upon six millennia of longitudinal observation and n of approximately 117 billion pre and human subjects, forgiveness is a process, the individual elements are essential, and the steps are sequential. Domestic abuse is a classic example of problematic forgiveness that has parallels in discussions of racial reconciliation. In domestic abuse the perpetrator inflicts harm upon a partner then begs forgiveness. The person abused indicates that forgiveness is granted, which tacitly grants the abuser permission to continue the abuse. Here, the forgiveness is premature in that the abuser has not engaged with all the steps toward reconciliation. Racial reconciliation is not possible, and should not proceed, until each of the steps of the process of forgiveness have been authentically and fully engaged with both on an individual and collective basis. Though the steps are framed to apply to an individual they must also be read as applying to one’s own group. The steps can, and perhaps must be, used to examine where attempts to further racial reconciliation have erred.
Elements of Forgiveness as Process
Forgiveness is a process containing several essential and sequential elements: contrition, confession, penitence, repentance, forgiveness, then reconciliation, meaning, to grieve, to acknowledge, to regret, to turn around, to let go/my sins let go, to be restored. This is the movement that is forgiveness.
Contrition: Contrition is to grieve one’s sin ; to feel its weight; to feel our own complicity and uncleanness (“dirty hands”). Contrition comes from the Latin to rub or to bruise; we are bruised by our own sin. Contrition is the beginning of the journey. Contrition is for one’s own act or participation, not for having been found out. It is an inward examination by a group or individual, and inward acknowledgement and grieving for one’s moral failure. The adequacy and fullness of the confession reflects the genuineness of the contrition: shallow or incomplete confession indicates a lack of contrition.
Confession: Confession means to make a statement or to bear witness and, in this sense, give utterance that fully, honestly, and openly names and declares my sin (both in an individual and a collective sense). My confession is a refusal to hide my darkness from myself (ourselves), or from others. Sin may be understood as: to trespass or transgress against another (person or group), to perpetrate a wrong or harm or offence against another; a breach of duty not to harm others; a wrongdoing (direct or indirect; individual or collective; ongoing), a refusal of proper relations with others. I can be, and am, blind to my own complicity in, or perpetration of, sin against others, so I must engage with those whom I have harmed in order to see through my blindness, and then in order to fully bear witness to my transgressions and the harm I have caused. The adequacy and fullness of the confession reflects the genuineness of the contrition: shallow or incomplete confession indicates a lack of contrition.
Penitence: Penitence moves us a bit farther yet, for to be penitent is to be sorry, that is, to regret our sins. Regret requires an immersion into the depths of the way in which my wrongfulness has harmed (continues to harm) others and has “benefitted” or privileged, (and continues to privilege), myself; and to come to a deep sense of the injustice, unfairness and harm that I perpetrate and perpetuate. Penitence is an inward response that is inextricably tied to an outward response, metanoia.
Repentance: Repentance, (from the Greek metanoia, μετάνοια) means to turn around as in turning back toward God; or to turn from, as in turning away from one’s sin so as not to repeat it. It is a reversal of direction. Metanoia is a significant point of failure in the process – asking for forgiveness without change, asking for forgiveness for the past without changing the present or future. False repentance asks the slate to be wiped clean to start all over again; that is not metanoia. False repentance seeks cheap forgiveness, no-cost forgiveness.
Forgiveness: Forgiveness finds its root in the Greek verb aphíēmi (ἀφίημι) meaning to let go, or to leave. Only those harmed or offended, not the offender, can let go. Though sometimes used in a secular sense, it generally means forgiveness in a religious sense, of sins, trespasses, iniquities, and intent of the heart. Forgiveness cannot be demanded of another, and cannot be asked of another, that is, those who perpetrate harm against others have no claim upon their forgiveness. It is the other person’s choice to forgive and, even if forgiven, the offenders still retain responsibility for harms that have been inflicted or participated in. Egregious wrongs hold a peculiar relationship to forgiveness and generally require remembrance held in tension with forgiveness. Forgiveness is not a get-out-of-jail-free card. The wrong-doer has further responsibility for participating in the amelioration of the consequences of the harm, and for preventing their continuance.
Reconciliation: Reconciliation comes directly from the Latin reconcilare meaning to bring together again; regain; win over again, conciliate. Reconciliation requires a transformation, a change. That change is toward justice, fairness, healing, and health, but only takes place built upon the prior elements en toto. Reconciliation overcomes estrangement; it is a process of winning-back another into relationship, that is, it must be merited to be engaged. Reconciliation is not one moment in time but is, itself, and ongoing process that requires fidelity and trust.
While this is called the process of forgiveness it is a process with a telos of reconciliation. Yet I focus here on forgiveness, as what I see in the literature fails to demonstrate that forgiveness is not an act, but a process, not a static act, and shows no recognition of the essential precursors to either forgiveness or reconciliation. My great fear is that nursing is stumbling along, attempting to secure forgiveness that is not fulsome and thus not authentic, but is instead looking for cheap forgiveness, which can only produce a fragile, temporary reconciliation that will not hold or, worse, will lead to heightened mistrust and enmity.
The community of nursing would be well served to pause, engage in self- reflection, and seek to more fully uncover where it has failed, or is failing, or in danger of failing, in the process of forgiveness. A community of moral discourse must, first, be a community in its fullest sense, willing to explore and expose that for which it needs forgiveness.