Last Updated: Thursday - 09/23/2010

Listen and hear what another is saying

Hearing other's needs, wants and building consensus allows for comfort - if not a cure

Ethics Made Real

Gordon Self

In last month's column I wrote how mistaken assumptions can trigger conflict. I reminded readers to check our assumptions first to prevent unnecessary conflict. The old adage regarding assumptions and "making a you-know-what out of you-and-me" comes to mind.

One of my ethics mentors taught me we should not assume anything in health care, making sure what we hear a patient or resident telling us is what they are actually saying.

That is good advice for everyday life. We live in a busy culture that values expediency and efficiency, sometimes prompting us to put words in people's mouths to hurry a conversation along. We can filter someone's story, neatly fitting them into our preconceived notions of what they should be because we don't have time, or capacity, to listen.

In health care, we must always remember that the person before us is an individual, with their own unique history, needs, hopes, fears and set of values. A person can never be reduced to "the gallbladder in 14-2," or the "FTE" (full-time equivalent employee), even if that is how we routinely talk.

AN INDIVIDUAL, NOT A LABEL

Respect for human dignity calls us to treat both patients and employees as individuals, not labels. So much conflict can be completely avoided if we take time to engage others in active listening and if we do not label people.

But even when we do listen carefully, we may not like what we hear. People have different views on life, and will make choices based on their values and sense of "the good." We see this often in health care around treatment decisions, where the patient or resident, family members, and health care team may all have different ideas of what treatment goals to pursue.

What are our moral and ethical obligations if we do find ourselves in conflict with others over fundamental value choices, for example, limits regarding medically administered nutrition and hydration?

One of my other esteemed ethics mentors taught me about staying engaged with others when value conflicts occur. This means wanting to work through conflict. Yes, we need to claim what we believe to be true, but it's also a question of what we are going to do to help bridge understanding with someone else's deeply held truth.

STAY ENGAGED

Jesus taught his disciples about living in community. His exhortation to love our enemies, to forgive and to wash one another's feet are examples of staying engaged in right relationship. The encounter with the woman at the well underscores what is possible in restoring community when conversation moves to a deeper place around fundamental values (John 4.7-30).

The word "engagement" is popular in the business world today. Employee engagement surveys and community engagement forums are two such examples. But the more common use of the word reveals richer theological meaning.

When a couple announces their engagement, they take their first steps leading to a vowed, covenantal relationship in marriage. They choose to remain engaged with one another for a lifetime, to share both joy and sorrow. When marital conflict ensues, as it will, they promise one another to work through their issues, to deepen their patience and understanding, and not walk away if tensions escalate.

Like the encounter at the well in Scripture, the couple confronts one another about the truth of their lives. Sadly, so many marriages fail because of incapacity for deeper level conversation.

To stay engaged with one another then means becoming vulnerable. We may have to admit when our assumptions are mistaken or opinions close us off from listening. The encounter at the well reveals as much about our imperfect selves as it does the other.

In health care, we see people at some of the most vulnerable times of their lives. A family's emotional plea to continue a tube feed when their loved one can no longer tolerate and benefit from it may mask deeper fears that clinicians must listen for, and be prepared to help family members name.

WORK FOR CONSENSUS

In those very emotionally charged encounters, we need to listen carefully to what people value underlying their plea, and to work towards consensus in what will truly provide patient comfort even when cure is no longer possible.

I am proud of our tradition in Catholic health care to stay engaged with others to work through value conflict. The name of our organization, Covenant Health, reminds us of our commitment to one another - the covenantal promise to listen, to be real, and to be vulnerable for the sake of relationship.

(Gordon Self: mes@covenanthealth.ca)

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