Last Updated: Friday - 09/24/2010
March 22, 2010
Ethical issues demand understanding, clarity
Covenant health ethicist realizes the public needs to understand ethical issues involved in health care
Ethics Made Real
I invite readers to join me in reflecting on ethical issues we face everyday in Catholic health care. As the largest provider of faith-based health care in Canada, Covenant Health has a unique role and responsibility to offer a critical moral lens regarding issues many of us will face at some point in our lives.
Decisions whether to pursue or forgo treatment, for example, or enacting a personal directive or inserting a feeding tube are never easy matters and require knowing the clinical facts of each case. They also involve working together with patients, residents, family and clinicians to make an informed choice that support the goals of care.
This column is entitled Ethics Made Real for three important reasons.
First, in my experience, sometimes we ethicists use language that is accessible to only a few. While we may know what we are saying, ultimately it is the persons we serve who are dealing with difficult clinical or organizational decisions who need a moral lens to weigh their options.
It is important to make ethics real and accessible so it can be of practical help. Sometimes we can camouflage the ethical by the language we use. When it comes to what health care workers' responsibilities are during a pandemic like H1N1, for example, both our clinicians and the public should know whether the duty to care or the greatest good for the greatest number is what ultimately matters.
Second, I want to focus on ethical issues that are real to most people on most days. Yes, there are highly publicized cases occasionally about withdrawing or withholding treatment that I will certainly speak to in future columns. But the vast majority of time the ethical issues in Catholic health care are much broader and mundane.
To illustrate, I ask you to think for a moment of the choices you made today. Did you commit to eating the right foods you promised to do?
Did you allow the person in that car ahead signaling their intentions to move into your lane?
Did you speak up when you accidentally got more change back when buying your coffee?
Did you speak directly to the person you were upset with or just go around behind their back?
These are not insignificant moral issues. How we treat one another will have a noticeable impact on the culture of an organization. With over 9,000 employees, there are plenty of opportunities each day in Covenant Health for creating the desired ethical culture in which patients and residents will want to come to for care.
Not many of us want to do business with a company when it is obvious the staff does not get along, and you can feel animosity in the air. Health care is even more dependent upon many people working closely together to ensure safe, quality care and attending to the needs of the whole person - body, mind and soul.
So while there are - and will be no doubt in the future sensational ethical issues to explore - I also want to help readers reflect on the ordinary scenarios we face everyday. One by one, each decision we make deepens the moral capacity of the organization to deal with ambiguity, conflict, and the proverbial "grey areas."
It is these issues that are closer to home that actually provide the lens and confidence to weigh the more serious ethical dilemmas.
Finally, I want to be clear that my reflections will be rooted in an authentic moral framework and Christian understanding of the human person. As a Catholic health care organization, we have to be real and honest about our own moral boundaries, knowing at the same time those we treat within a publicly funded system that Covenant Health operates, as well as our diverse staff and physician group may have a different moral lens.
Ethics made real is being able to stay engaged with others, honouring diverse opinion, while also being faithful to our own moral boundaries. I suggest this is what ethics is all about and which the various orders of sisters faithfully modelled in their care for all those they served.
I look forward to exceeding good conversation about the real ethical issues we face in health care - the sensational and the ordinary.
(Gordon Self is vice president, mission, ethics and spirituality for Covenant Health and can be reached at firstname.lastname@example.org)
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