ETHICS MADE REAL

Gordon Self

March 26, 2012

Constantly I am reminded of the ordinariness of ethics. Some might think the largest Catholic health care organization in Canada would be confronted everyday by sensational ethical dilemmas.

Sorry (and thankfully) to disappoint, but the ethical issues we see at Covenant Health have less to do with embryonic stem cells or conjoined twins, but the seemingly mundane dilemmas like parking or smoking.

Do not misunderstand me - the mundane can be taxing. Take confidentiality, for example. It is not as if our culture has mastered the art of keeping confidences, and I can assure you we can damage the lives, reputations and integrity of the people we work with or serve by simply failing to heed this basic ethical obligation.

Privacy breaches are no laughing matter, despite the cavalier attitude in our addictive social-network culture where people post anything to their personal home page. There is still a place for discretion, please.

Another seemingly mundane but no less trivial moral obligation comes to mind - hand hygiene. Despite countless peer-reviewed scientific studies, there is continued resistance within some pockets of the health care community to comply with good hand washing technique.

To my surprise, there is even lingering denial within highly educated professional ranks including non-clinical folks accepting that such basic practices can compromise patient and resident health.

Covenant Health and our various funding and regulatory bodies take seriously the issue of hospital acquired infections. Aside from the quality and safety implications, it is a moral violation of the Hippocratic Oath "to do no harm."

WASH THOSE HANDS

Still, hand hygiene audits would suggest we have work to do convincing people that washing hands saves lives. Soap and water are admittedly not as sexy as the latest technological device, but can nevertheless have far-reaching positive effects on the well-being of those we serve.

The ethical issue at question really amounts to our willingness to be inconvenienced: taking the necessary time to wash my hands to spare a greater inconvenience or burden to the vulnerable person in the bed.

Assuming people have been thoroughly engaged in the policy development and specific clinical circumstances identified that would make 100 per cent compliance in those settings possible, it is hard to cite inconvenience as an excuse from changing our behaviour.

But we are reminded the liturgical season of Lent is about metanoia - turning our lives around to serve Christ and our fellow human beings more closely.

To reassure the reader that hand hygiene is not just an issue for health care workers, all of us, family and visitors alike, have a moral responsibility to do the thing Mom taught us - wash our hands. Yet, how often have we skipped washing our hands when preparing meals, or after sneezing into our hands?

Even our public worship bears scrutiny. Have we gone to Mass when we probably shouldn't have? Drank from the chalice when it would have been better to receive the Eucharist under the species of bread only? Shook hands during the Rite of Peace when a reverential nod would have been preferred?

We also have the right and responsibility, as members of the public, to expect those who treat us to wash their hands. A good quality and safety culture makes the patient a partner and active participant in their care, and we have a right to speak up.

GIVE IT UP

We often quip about what we will give up during Lent to bring us closer to God. Sometimes turning around our lives requires not so much a giving up but rather a taking on. Do not dismiss hand hygiene or respiratory etiquette as a good almsgiving practice to commit to during Lent.

But if you feel you must give something up, then why not sacrifice a few precious minutes each day to wash your hands to ensure the precious health of others?

At a deeper level, it is good for all us to think about giving up some of the filters in our lives that prevent us from seeing the needs of others. Our capacity to select information that advances our ego versus that which demands self-sacrifice plays out in many aspects of our lives.

I would challenge that sometimes our fixation on the big moral issues of our day - abortion, threat of legalizing euthanasia and assisted suicide, for example - may distract us from changing our lives and attitudes around the more ordinary and everyday issues, like truth telling, honesty, keeping confidences, and yes, even washing our hands.

These are equally "pro-life" practices. Think about it.

(Gordon Self is vice president, mission, ethics and spirituality for Covenant Health and can be reached at mes@covenanthealth.ca.)