ETHICS MADE REAL

Gordon Self

August 27, 2012

Planning is underway for the fifth and final year of the Nothing More Beautiful initiative in the Edmonton Archdiocese. Time and again, catechists and witnesses have reminded us of Pope Benedict's words that "there is nothing more beautiful than to be surprised by the Gospel, by the encounter with Christ."

The New Evangelization is about a personal encounter with the living Christ, entering more deeply in relationship with Jesus, and not merely an intellectual exercise about philosophical principles.

Such personal encounter invites conversion and a new way of life. We encounter the height, depth and breadth of Christ's love for us, which in turn we are called to share freely with others as disciples of the Lord.

In like fashion, our response to our brother and sister in the face of difficult ethical conundrums must also be personal. We cannot hide behind mere principles or directives.

Moral principles and ethical directives can certainly guide and inform our response to another, but they are meaningless if applied in isolation from the real person standing (or laying) before us. We can never lose sight of the pastoral dimension of ethics, especially in health care. No person can be simply reduced to an "ethics case."

During the next few months the newly-approved 2012 edition of the Health Ethics Guide will be available for circulation to all Catholic health care institutions in Canada, including Covenant Health. As a member of the core team commissioned to revise the new edition, I am very aware of the many articles and ethical principles contained in the text.

For example, the new guide will speak about the need to respect the right of conscience, arguing that no person should be asked or expected to participate in an activity they consider immoral. At Covenant Health the right of conscientious objection is respected.

However, the Health Ethics Guide adds this caveat - "the exercise of conscientious objection must not put the person receiving care at risk of harm or abandonment." Imagine then this scenario and how these statements of the guide apply:

A pregnant woman at 19 weeks gestation is admitted with spontaneous rupture to her uterine sac. There is leaking of amniotic fluid but no clinical evidence presently of imminent infection that could seriously threaten both her life and the life she carries.

Thus a wait-and-see approach is taken but she is told that her condition could change at any moment, and advised to prepare for the possibility that she may lose her baby.

ANGER FLARES

The patient is angry, asking to induce the baby now "to get it over with." The physician explains that as a Catholic hospital it would be immoral to remove non-infected membranes containing her baby when there currently is no proportionate grave risk to her own life.

The patient vehemently states that she is not Catholic and does not care about the policies of the hospital, but adds, "If you can't do it, then transfer me to another hospital where they can."

The physician is a practising Catholic and his conscience is divided. He questions if by picking up the phone to arrange safe transfer when there is no imminent risk, if he is aiding and abetting in a direct abortion?

But he searches his conscience and also asks whether by refusing to transfer her he is abandoning her and risks putting her in harm's way, especially if delaying too long risks her delivering while en route to another hospital.

No matter how clearly the new Health Ethics Guide is written, informed by the moral tradition of the Church and the clinical experience of many respected Catholic ethicists, an answer to every possible scenario will not be conveniently found on page X.

GUIDED BY WISDOM

Still, a decision has to be made, upholding the conscientious beliefs of the physician, the institution and the person in our care. Resolving such dilemmas requires more than a well-written guide. We must be guided by good conversation, having the ability to listen to some of the other unspoken needs that may lay behind the urgent request "to do something."

Perhaps it is anticipated grief that fuels this woman's insistence in the hope to ease her pain. Perhaps not. This is the art of ethics. Like marriage, ethics can be aided by a guide, but no marriage manual will resolve every marital issue. It takes good listening, keen judgment and an open heart.

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