The doctrine of creatio ex nihilo stands as the foundational tenet undergirding subsequent theological reflections on creaturely finitude and embodiment. Rooted in the notion that the created order is continually sustained by its divine source, the doctrine of creation testifies to the relational dependence that is characteristic of finite being. Creatures participate in God (whose essence, as ipsum esse, is simply ‘to be’Footnote 1), from whom they receive their existence and their particular qualities. In this essay, I take these foundational insights of the doctrine of creation as they bear on the particular context of palliative care, and the practice of being with one who is dying. Specifically, I hope to consider how the practices of silence and touch, central but perhaps under-discussed by theologians, can be understood as embodied acts in which creatures finitely participate in, and thus manifest, God's own faithful presence to creation. Situated within the broader framework of creatio ex nihilo, these practices of being with affirm a central principle of what it is to be finite: namely, that the ‘beginning of love for [others] is learning to listen to them’.Footnote 2
I begin with a brief reflection on the doctrines of creation and redemption, located within the ongoing, relational dependence of creatures on God. This lays the foundation for my subsequent reflection on silence and touch as embodied participations in the love of God, which graciously wills, sustains and fulfils the finite other. In particular, the practice of silence at the bedside shares in God's own ‘silence’ as a unique mode of listening and love. These embodied acts between persons thus become, I argue, a concrete reflection of ‘[the] love that is God's own life’,Footnote 3 affirming the validity of embodied modes of healing beyond the paradigm of ‘control’ or ‘cure’. I frame the theological analysis of silence and touch within the broader notion of presence, a category that is central to the theoretical and practical frameworks of palliative care. Indeed, Elisabeth Kübler-Ross observes that communication with a dying person ‘[may become] more nonverbal than verbal … the patient may just make a gesture of the hand to invite us to sit down for a while [or] may just hold our hand and ask us to sit in silence’.Footnote 4 Situating these practices within a theological context, the acts of affirmative touch and sitting in silence, as modes of being present to the person, share in the divine attentiveness to creatures, revealing ‘something of the nature of the God who inspires and indeed inhabits such practices’.Footnote 5
Creation and redemption: divine–human relationality
Central to the doctrine of creatio ex nihilo is the notion that God creates the world through no compulsion or to serve a need of any kind: rather, God wills to ‘make real something wholly other than the divine life and to endow it with beauty, rationality and liberty’.Footnote 6 In an act of gracious love, the God who is intrinsically ‘complete’ in the relations of the triune life ‘determines also to [create and thus enter into loving relation with] that which is not divine’.Footnote 7 The creature is always and only sustained in its relation to God in an ongoing dependence: creatures share in the being that God alone is. This relationality is, then, the essence of what it means to participate in being as gift. To understand oneself as held in the love of God is to know that ‘there is an act that draws us into being and affirms our being’.Footnote 8 If the creative intent of God thus freely wills the other, the final fulfilment of creation must also sustain this other, in a faithful affirmation of the divine love.
The promise of this redemption takes shape in Christ's resurrection, an act of divine grace that brings finite existence to its destined wholeness in communion with God. Thus, the fulfilment of the creature lies squarely in the hope of a ‘newness that is not of our own making’.Footnote 9 God's abiding love assures us that ‘“who we are” is preserved, even taken to God’ beyond the fact of bodily death.Footnote 10 The notion that we are thus ‘taken up into the life of God as the very mortal creatures we are’,Footnote 11 is affirmed in the example of Christ's own resurrection: his wounds are not erased from his resurrected body, rather it is his crucified body that is raised in glorification. It is the particular creature that is redeemed, such that the final fulfilment of the created order is neither a ‘reversal’ of the old nor the instantiation of what is completely new: the sanctification of human existence is the fulfilment of that act of creative love wherein God wills finite particularity. If our creaturely and individual particularity is thus sustained beyond the fact of death, the promise of a renewed existence does not indicate an ‘absorption’ of that creaturely difference instantiated in creation – for the love of God, in creating and redeeming, is a desire precisely for the ‘joy of another’.Footnote 12
Human participation in divine love
The doctrine of creatio ex nihilo, in affirming that creatures do not exist apart from relation to God, further sets forth the particular, finite perfections of creaturely existence as reflections of and participations in the divine properties. In other words, those attributes which are contained in one essence in God are refracted in multiple and diverse ways by creatures – who reflect God in their particular, contingent modalities. Thus, the divine perfection of presence, for instance, is ‘imaged’ by the creaturely property of existing in a particular temporal and spatial place:Footnote 13 in enabling relations between beings (a possibility which itself mirrors the relationality that is the triune life), the fact of being in a place necessarily limits that relational presence to some beings and not others (unlike God, who is present at once and eternally to all of creation). Given that creatures receive all that they have from God, it is a characteristic of creatures that they share in the divine qualities, manifesting in a finite way something of ‘God's infinite goodness’.Footnote 14
More significantly for our purposes, the question of the creaturely vocation to thus (finitely) reflect the divine qualities centres on the specific mode of human love as a participation in God's own love. The divine love, as outlined earlier, intends relation with finite creatures – a love that attentively turns to the world and affirms, as Josef Pieper puts it, ‘it's good that you exist; it's good that you are in this world’.Footnote 15 Pieper highlights therefore that God's love ultimately centres on the ontological goodness of created existence: a love that this creature exists. This is crucial for the context of palliative care: for even if the experience of terminal illness means that the patient can no longer ‘do’ the things he or she once did, the Christian ethic of creation testifies that he or she is still held in the divine love which thus bestows an objective ‘affirmability’ to all persons. Inasmuch as everything is ‘willed … [and] loved by the Creator … [we know that all creatures] are really [i.e. objectively] good and therefore susceptible to, but also worthy of, being loved by us’.Footnote 16
Drawing together this notion of God's love and creaturely participation in the divine qualities, we might ask: if it belongs to creatures, as outlined above, to reflect the divine perfections in ways mediated by their own modes of contingency, what can it mean for human love to align with the character of God's love? Here, the nature of God's creative love becomes significant in two ways: first, if the doctrine of creatio ex nihilo tells us that it is only in relation to God's loving grace that creatures are sustained in being, this means crucially that ‘before anyone or anything is in relation with anything or anyone else, it is in relation to God’.Footnote 17 There is, then, always something about the person that ‘I cannot simply master or own or treat as an object like other objects’.Footnote 18 In practical terms, this sets forth modes of presence, of being with another, that transcend the paradigm of ‘controlling’ or definitively ‘grasping’ another person.
Secondly, if God's love is fundamentally a love that grounds and affirms creaturely ontology, a love that this person exists, our love properly participates in the divine love when it attends to the being (and thus the particularity) of the person. If the fact of another's abiding relation to a ‘non-worldly, non-historical, everlasting attention and love’Footnote 19 (i.e. God) means that the person does not, finally, ‘belong’ to me, we reflect the character of God's love (which in creation takes the form of a willing instantiation of another) when we seek modes of being with that person that attend to the other as other – thus resisting a ‘mastery’ of the person, reflecting in limited ways the non-competitive nature of God's own love. In the context of palliative care, to accompany one who is dying is to partake in the creative affirmation of God, which is a love for the person in their being (even just that they are). Specifically, the practices of silence and touch, as practices of being with another, actualise a form of presence that decisively transcends the model of control, partaking in, and thus echoing, the creative and redemptive love of God in virtue of which all things are.
Palliative care and the centrality of presence
Having discussed the theological foundations of my approach, I now consider how the doctrines of creation and redemption thus elaborated bear on the embodied context of being present to the dying. Following Pieper, if to love another is to declare the fundamental goodness of that person's existence, the practices of silence and touch demonstrate that this love can take shape in a silent, attentive presence that affirms the being of the other as they are known and held ‘in God’. The importance of non-verbal communication attests to the centrality of presence, a practice that is foundational in embodied practices of palliative care. The domain of palliative care can be understood not simply as an institution or a ‘place’ of care, but rather an entire ‘philosophy’ that attends to the multi-faceted needs of the whole person.Footnote 20 This includes providing relief from physical pain and other symptoms of the disease, as well as attending to the social, psychological and spiritual needs of the patient. In this way, the aim is to provide holistic care for one with a life-shortening illness, and to thus improve the quality of life for both the patient and his or her family.
Cicely Saunders, who founded the modern hospice movement, foregrounded the dynamic of ‘what it means to care about as well as to care for patients’ as a distinctive mode of relational presence.Footnote 21 Rooted in her Christian faith, Saunders set forth a vision of care for the dying founded not only on medical expertise but also on a deeply attentive listening and silence – above all, a being there. She cites Christ's words in the garden of Gethsemane, ‘watch with me’, as the expression of the hospice ethos: as she explains, these words do not ask for an understanding or an explanation of what is happening, but ask simply for a gentle accompaniment.Footnote 22 The practice of presence further points towards the centrality of embodiment: to truly ‘be with’ another is to be present bodily, as one shares time and space with the dying person. Palliative care thus emphasises the significance of dying as an embodied experience, shaped as much by the aesthetic landscape of the hospiceFootnote 23 as by the more intimate, bodily practices of care that affirm the patient's non-instrumental, ontological value (and thus, theologically speaking, impart something of the divine love). If we experience the process of dying in and through our bodies, so too do we experience the love and presence of another in and through our bodies. On this understanding, the practices of silence and touch can be theologically framed as particular embodied expressions of love, instantiating the words of Cicely Saunders: ‘even when we feel that we can do absolutely nothing, we will still have to be prepared to stay’.Footnote 24
Silence: divine and human dispossession
Our starting point for reflecting on human silence as an embodied expression of love is a consideration of what it means for God to be silent. Rachel Muers, in her seminal work, Keeping God's Silence: Towards a Theological Ethics of Communication, situates the divine silence within the doctrine of creatio ex nihilo highlighted earlier: the silence of God is the silence by which God wills the other into existence in an abundance of grace, forming the ‘determinative context for human freedom and finitude’.Footnote 25 God's silence thus wills a certain created freedom such that the other might truly be other; as Karl Rahner affirms, ‘the creature is a genuine reality different from God, and not a mere appearance behind which God and his own reality hide’.Footnote 26
However, in the divine–human relation, this freedom is never divorced from one's essential relationality to God: for dependence on the divine is not comparable to dependence on any worldly agency, and is thus, paradoxically, the very basis of human autonomy. God's silence, therefore, does not imply a distance from creatures – indeed, the doctrine of creation tells us that God creates precisely because God's abundant love seeks another with whom to enter into relation. For this reason, as Muers highlights, the primordial silence of God is above all, a ‘listening silence, the silence in which God hears the world’.Footnote 27 God's hearing of the world is an expression of God's intimate love and proximity to creatures, in a particular, non-competitive relation that graciously holds the creature in being at all moments in time.
Turning now to human silence, it is necessary first to point out that the paradigm of non-competitive relation cannot straightforwardly apply between creatures in the same way as between God and creatures. The doctrine of creatio ex nihilo affirms that God does not compete with creaturely autonomy precisely because God is not a thing among worldly things, and cannot be said to occupy (and thus compete for) the same logical ‘space’ as creatures. This ontological difference does not apply to inter-creaturely relationality. However, following the notion of human qualities as finite participations in the divine perfections, our focus here is on how human silence can limitedly reflect something of the divine silence precisely in and through its created difference from God. As highlighted earlier, human love is most properly fulfilled when it seeks to ‘echo’ God's own love: a love that can be reflected as we silently bear witness to, and affirm, that which we cannot control, setting forth alternative modes of presence to another.
Notably, we already find a particular modality of dispossession (i.e. being confronted by that which cannot be mastered) at the heart of what human silence conveys. Referring to those moments where silence ‘imposes’ itself on us,Footnote 28 Rowan Williams cites the example of the silence that accompanies the end of a good play: the silence that affirms, ‘I mustn't wrap this up too quickly. Let's give that little bit of extra space to allow it to be what it is.’Footnote 29 In ‘imposing’ itself in moments that cannot be readily absorbed into the self, the experience of silence testifies that there is no way of rendering this situation ‘domestic’.Footnote 30 This is exemplified particularly in the silence that often accompanies devotional prayer, as we allow ourselves to ‘be silenced by the mystery of God’ – a silence that gestures ultimately towards that encounter that constitutes our very being but that can never be ‘contained’.Footnote 31 Silence thus calls us to recognise a certain lack of power that is at the heart of what it is to be a finite creature existing in and for God, as a gentle attentiveness to that which is ‘utterly unmanageable’.Footnote 32
By thus encountering and relating to what cannot finally be mastered, ‘our most fully aware and deliberate silences, where the speaker's agenda is most manifestly suspended [become] moments where truthfulness is most evident’.Footnote 33 It is important, then, not to perceive silence as a blank negation of meaning (a sheer ‘absence or passivity’Footnote 34): inasmuch as silence conveys something about our shared humanity (which is at all moments grasped in relation to God but can never exhaustively grasp its environment), silence bears witness to and communicates that which cannot be rendered under my control. Silence thus invites us to inhabit more meaningful relations with those moments in our lives that preclude any final ‘grasping’.
In the context of palliative care then, the question might be framed thus: how can our practices of being with the dying, whilst still reflecting a deeply personal attentiveness and love, move beyond the agenda of the self to partake in the primordial creative love of God who graciously allows the other to be? The act of sharing silence is central to the approach of palliative care, as a practice that testifies to the healing potential of human presence.Footnote 35 Indeed, Kübler-Ross describes the silence that accompanies the final moments of a patient's life: there comes a time when the dying person's ‘mind slips off into a dreamless state, when the need for food becomes minimal and the awareness of the environment all but disappears into the darkness’.Footnote 36 Though it can often be difficult for caregivers and family members to sit alongside the patient in this non-responsive state, Kübler-Ross emphasises that to do so is above all, an act of love: ‘our presence may just confirm that we are going to be around until the end’.Footnote 37
To sit alongside a dying person is to assure them that they will not be ‘forgotten’ even when nothing (in a medical/curative capacity) can be done for them. This demonstrates that silence is not about mere passivity, but is an active commitment that the other will not be abandoned even when he or she cannot relate to me in any ‘overt’ sense. As Parker J. Palmer puts, ‘it is at such a bedside where we finally learn that we have no “fix” or “save” to offer those who suffer deeply. Yet we [can always offer] our gift of self in the form of personal presence and attention.’Footnote 38 The act of being fully present in silence, therefore, embodies a radical subversion of the ‘consumerist [values of] productivity, efficiency and acquisition’,Footnote 39 as we learn to suspend modes of relation oriented towards discernible ‘results’ or achievable outcomes. Such a practice thus partakes in the creative love of God – a love that is gratuitous of its very nature, creating not as a means to an end but for the sheer delight of the other.
To observe silence, or as Rowan Williams puts it, to have silence impose itself on us, is to encounter that which bears within itself a ‘certain intrinsic resistance to being subordinated to a particular end’,Footnote 40 and in the context of being with the dying, silence thus testifies to the other's relation to God – that ontological ‘encounter’ that places the other fundamentally in a context outside my own needs or agenda. Relinquishing one's agenda is not to deny the prospect of meaningful, personal relation with the dying person. Indeed, by transcending the model of relation oriented towards control or ‘graspability’, the potential arises for a more wholesome and genuine being-with the person: rooted in God's own dispossession, as God ‘[opens up] space for the world’.Footnote 41 As we saw above, to accompany the dying in silence testifies that he or she will not be abandoned even though they cannot respond or ‘give’ anything to me in any straightforward sense: thus fulfilling the divine creative intent which loves the fact of the creature's being itself. To thus partake in or (in Muers’ words) ‘keep’ God's own silence is ultimately to listen to (or affirm) another person, echoing the creative intent of God in a particular act of embodied presence and love.Footnote 42
The particularity of the other: touch as an embodied act of love
The attention to one's embodied particularity becomes especially significant in the practice of touch as an affirmative participation in the divine love.Footnote 43 The faculty of touch is central in the practices of palliative care, emphasised for instance by Kübler-Ross who speaks of the stage of preparatory grief (wherein a patient begins to mourn the impending loss of his or her life, and all the goods associated with it: family, friends, etc.), as often requiring ‘little or no need for words … [rather], it is a feeling that can be mutually expressed … with a touch of the hand, a stroking of the hair or just a silent sitting together’.Footnote 44 In the words of Thelma Fayle, a hospice volunteer and reflexologist, there is something about the human touch that affirms the particularity of the other: ‘offering reflexology gives me a chance to unobtrusively bear witness to a life's end … I listen, and learn that the feet in my hands have travelled far and carried an accomplished fashion designer, artist, and mother of two beautiful children’.Footnote 45 Inasmuch as our bodies convey the stories of where we have been and the paths we have taken, the human touch affirms the value of those particular narratives.
Indeed, from a theological perspective, Paul Griffiths notes that it is in the giving and receiving of touch that flesh is constituted and sustained as flesh.Footnote 46 Defining flesh as that which is en-souled, Griffiths echoes the Aristotelian notion that the soul or form of the body ‘makes matter be the kind of matter it is’.Footnote 47 To be flesh is then to be a certain kind of thing, and in the case of human beings, it is to be a person, and this person, rather than any other. Insofar as touch ‘establishes’ us as flesh, and thus as the particular persons that we are, the touch becomes a finite participation in the divine willing of creaturely contingency – the divine creation of the particular other. Indeed, it is central to the theological notion of the human that God takes an interest in individuals; as Janet Soskice affirms, ‘with the emphasis on God as Creator of all, [Christians] understand their god to be a God who cares about everything in particular’.Footnote 48 In affirming the contingency and the particular patterns of an individual's life, the human touch becomes a mode of attending to the person in the whole context of their unique narratives and relationships, an act of love that therefore intends and sustains the other as ‘flesh’.Footnote 49
The touch also, crucially, ‘locates’ the dying person as a creature: inasmuch as, if it is a property of creatures to exist in a particular place (as outlined earlier), the touch affirms the embodied situated-ness of the person. To be here is not to be there, enabling a certain mode of full, relational presence within the given moment. If the touch thus situates the ‘created-ness’ of the person, it attends to the particularity of this human life – for it is this flesh, this person, that we hope is to be raised in the final glorification of creatures to eternal life with God.Footnote 50 Inasmuch as the touch thus centres on the particularity of the person, we might frame the touch as a loving act of remembrance: partaking fundamentally in God's own redemptive ‘remembering’ of creatures. As we saw earlier, the final promise of redemption is not the imposition of an absolutely new creation, utterly discontinuous with the old, but is the act whereby God faithfully raises us, as the particular creatures that we are, to renewed life in God. We trust that, although the physical body dies, ‘its form is held in God's hand’ – that is, that the particular contingencies of our lives, the soul or form that constitutes us as particular individuals, is preserved in God as it moves into the divine presence.Footnote 51
This ‘remembering’ of the particular other is lovingly enacted, indeed manifested, in the act of human touch – particularly at the end of life, through which we affirm that this particular person will not be forgotten.Footnote 52 Following Griffiths, inasmuch as touch sustains as ‘flesh’ (i.e. particular creatures with particular life histories), the practice of touch in the context of palliative care partakes in the primordial love of God, which creates and redeems us as the particular bodily and finite persons that we are.Footnote 53 In this way, accompanying a dying person with physical presence and a gentle touch, is, like silence, a loving, embodied willing of the person: through the touch, the dying person can recognise that he or she is loved and held in memory (beyond the fact of death) by others, much as he or she is loved and ‘remembered’, finally, by God.Footnote 54
Crucially, in accompanying a dying person, we are confronted most profoundly by that which we cannot finally reverse or ‘master’ – the physical death of another. This echoes a central implication of creatio ex nihilo highlighted earlier, namely that a person's relation to God means that I cannot finally ‘grasp’ them. Just as human silence can finitely reflect something of the divine silence, human touch too, as a specific mode of non-grasping, can echo God's own ‘touch’. Notably, Thomas Aquinas employs the metaphor of God's touch to articulate the divine causal presence to creatures: if an agent ‘must be joined to that wherein it acts immediately and touch it by its power’ (sua virtute illud contingere), it follows that ‘God is in all things, and innermostly’.Footnote 55 We might emphasise here the fact that God does not grasp, but touches, all things. God is present to or ‘touches’ creatures in such a way that does not deny their finite particularity.
Although the human touch remains distinct in important ways from God's own touch (as noted earlier, God's ‘non-competition’ with creatures logically follows from the ontological distinction between God and finite being), human persons can nonetheless echo the divine proximity to creatures in being fully present to the dying person – without finally ‘controlling’ the other but lovingly attesting to this life that is coming to an end. By being present with and to one who is dying, we are reminded especially of the finitude of human life; in this way, a gentle touch can speak silently of one's willingness to let the dying person go – an embodied attestation to the central truth of creatio ex nihilo: in life and in death, we belong wholly to God.
Conclusion
In attending to the multi-faceted needs of patients, the domain of palliative care foregrounds the centrality of the whole person as the recipient of care. By situating these themes theologically, within the framework of the doctrine of creation, I have sought to demonstrate that embodied practices acquire a renewed significance as participating in the creative love of God. The practices of silence and touch, as they affirm the particularity of the person in an embodied act of love, become finite refractions of God's creative and sustaining love of each creature. The doctrine of creatio ex nihilo asserts that the value of the human being lies fundamentally beyond any dynamic of control imposed by the self – rather, the other is always oriented to that Good that cannot finally be grasped. To observe silence with another is to relinquish any attempts at human finality, affirming the other's ‘belonging’ to God in creative, sustaining relation. In this way, silence is not a blank ‘absence’ but becomes an embodied practice of loving intention of the other, confirming the other's identity in and for God. To thus participate in silence as a practice of caregiving is to share in the primordial divine silence that is the very ground of created otherness in all its multiplicity and particularity.
Although in the context of care for the dying, there may be nothing left to ‘do’ in the material/curative sense, the practices of silence and touch realise a possibility of human relation that transcends the paradigm of control and ownership. In ‘relating to the [other] as [the other] is related to God’,Footnote 56 one enacts a ‘voluntary displacement … and a willingness to tangibly practice hospitality, presence and listening’.Footnote 57 In the case of touch, the creative affirmation of the other becomes a concrete recognition of the other's particularity, inasmuch as touch constitutes and sustains us as flesh – as the distinctive, embodied persons that we are. Touch can thus be understood theologically as a bodily act of remembering, partaking in the final divine restoration of creatures, in their particularity, to eternal communion with God. Just as God's creative and redemptive acts flow forth from the abundance of divine love, so too do our own ‘re-creative’, caregiving practices intentionally affirm the other as he or she is held in God and, beyond death, remembered by us. Such embodied practices, then, set forth ‘concrete, if imperfect, ways in which [we] bear witness to the divine love through which [all] is called into being and sustained’.Footnote 58
