The politics of being.

In the year in which our association reached its Biblical allotment of three score and ten, we seem unable to escape the message of the old Anglican churchman who, on hearing the sounds of a distant funeral procession, reflected that "No man is an island entire of itself ... any man's death diminishes me, because I am involved in mankind, and therefore never send to know for whom the bell tolls; it tolls for thee." In this year, we could not afford the pretense of being just a "professional association" without ties to political realities and social issues. We accepted that we are involved in humankind, and that means more than parochial interest and isolated political acts.

For better or worse, the die was cast when the Association leadership moved the Combined Sections Meeting from Phoenix because Arizona voters chose not to have a statewide paid holiday honoring Dr Martin Luther King Jr. Some members decried this as a blatant political act unworthy of an organization composed of health professionals. John Donne, the poet-churchman who heard the distant bells, I believe, would offer another interpretation. Perhaps he would have observed that we recognized we were part of the world and could not escape involvement when the issue arose among our members.

As members of a caring profession, we, though our organization, now face the imperative of asking not who will right all the wrongs of the world, but rather: What issues become so vital to our roles as citizens and caregivers that we have no choice but to become involved? The answer is not a simple one. For example, it was a political but relatively noncontroversial act when we honored the veterans of Desert Storm at our 1991 Annual Conference. We could have chosen to honor those who protested the war at the risk of personal harm or social ostracism, but we did not. We could have done nothing, but we did not.

Through selective deeds and through selective inaction, we make political statements all the time. We cannot function as island unto ourselves; we must become involved with all of humankind. If we simply channel our political activities into battles for reimbursement, turf fights, and licensing efforts, we will have abrogated our responsibilities to care for the health and well-being of our patients, our planet, and ourselves.

There are many issues worthy of our consideration. How can we as health care professionals argue for funding of neonatal care without having a view on other budgetary issues? How can we view patients with parkinsonism and diabetes and not consider the issue of fetal tissue research, which has been banned at a time when it offers promise for both of these conditions? How can we face the growing legions of gunshot victims without participating in the debate on gun control as a health issue? The list goes on.

In view of our profession's historical origins and because of what we do every day, we have a special obligation. We rose like a modern-day phoenix from the ashes of war. Our pioneers followed in the wake of the political debacles that led to World War I and attempted to rehabilitate those injured as the result of political decisions. But for 70 years we have assured ourselves that we are not political and that political activity beyond the narrow confines of selected issues would doom our professional association. Our experiences of this past year should dispel that myth.

Are we to relegate our activities to after-the-fact efforts? We often talk of prevention, but that means more than back schools, work hardening, and athletic screening clinics. We cannot only consider the health of our patients after they have been injured in accidents or in urban crime or when they have suffered poor neonatal care. We face the frightening spectacle of health care rationing and a fight for diminished resources in the coming decades. Is this not the time to accept our special responsibility in prevention through political action on a variety of fronts? Or shall we passively accept the role of witnesses who, in the end, will pick up the pieces using whatever resources others have doled out to us? All too often we who care for people disconnect the political from the personal. They are not separable. Flying back home from APTA headquarters in the weeks after the Gulf War, I was reminded of the link. I saw a female Air Force lieutenant approach the desk at the air terminal. She sought permission to meet a plane at the gate. Her husband, she said, was returning from the Gulf. A special pass was issued for her and her three children, three little girls who appeared to range in age from 3 to 7 years. Two were blonde, one was brunette, but each had a Buster Brown haircut that ended in bangs just above her wide and eager eyes. Each of the little girls had a yellow ribbon conspicuously tied on her left wrist.

When the door to the jetway opened, the little girls, as if propelled by rockets, flew into their father's arms, eagerly hugging and kissing him. Even minutes later, the mother had difficulty squeezing between the girls to deposit her own "welcome home" kiss. Then the little girls eagerly asked about their neighbor, a pilot whom they had seen on television, apparently because he was shot down. They wanted to know if their neighbor was all right, and their dad assured them that all was well. But all was not well. In that waiting room not a dry eye was visible. We had witnessed one of the oldest human rituals--the warrior returning home. My mind wandered to images of the thousands of Iraqi children who would have no such moments with their fathers, and I thought about the American and coalition households where there would be no celebrations.

I speak neither for nor against the war in observing that it was political decisions that brought us to the day of combat and to the day when our troops came home. Today physical therapists are treating patients because of those decisions. When we arbitrarily and completely dissociate ourselves as a professional association from "political issues," we leave a vacuum into which may move those who neither comprehend nor care about the results of "political decisions." As health care professionals we are constantly reminded of the consequences of "political decisions." We have a right to participate in political dialogue. In fact, we have more than a right--we have an obligation. Although we have recognized that obligation, we often avoid the reality of our association's political commitments. It is as though we fear potential involvements, as though we do not trust ourselves and our professional association's judgments.

We banned smoking at APTA meetings in the name of good health. But this was in reality a political act taken by professionals on behalf of our members and our society. We recycle paper at our national headquarters and conduct meetings at hotels that recycle and use leftover food to feed the homeless. We seek adherence to the Americans with Disabilities Act and foster cultural diversity in our association and in our profession. We recognize discrimination against women and have long sought to correct this social ill. If we have been apolitical, it has been in name only. Our failure to admit to our political involvements has served us poorly because it has allowed us to occasionally dismiss issues and acts and to stifle debate in the name of avoiding political issues. To argue that the taint of politics is reason enough for inaction is to avoid substantive discussions and consideration of moral issues.

The difficulty in crossing the great divide between professional isolation and involvement in political issues is that you need to know when and where to take the leaps. We should not and cannot become involved in every form of political redress, but I know of no simple rule that will tell us when there is such urgency that we must act. The problem for us, in our 70th year, is that we have seen a new obligation but are not yet comportable with our task. Like any new freedom, political involvement places burdens of choice upon the liberated. We will need thoughful leadership, widespread membership participation, restraint, and self-discipline. We also must be willing to engage in respectfull participants in a world society and in which no one need ever ask us for whom the bell tolls.