Columns

ETHICS MADE REAL

GORDON SELF

My vision for this column is to present the everyday face of ethics – how we relate to one another and strive to live a moral life. In Catholic health care, there are unique and sometimes challenging issues related to clinical decision-making, for example, when to withhold or withdraw burdensome and futile treatment at the end-of-life, or questions around allocating scarce resources.

This month I would like to consider an even more basic ethical concern that impacts the moral fabric of any organization – the responsible use of power. In particular, when people abuse power and resort to bullying.

At its core, bullying is about the indiscriminate exercise of one's power to harm and control another. While few of us may consider ourselves in positions of formal leadership roles where we can wield such negative power and authority over others, certainly all of us have the capacity to influence other human beings, for good or for bad.

Power may be inherent as the power hierarchy within a family, recognizing the legitimate authority a mother and father have in parenting their young children, teaching them right from wrong.

The fact that we have varying degrees of power in different relationships is not the ethical question. What is wrong is when power and bullying tactics are used to achieve our own selfish ends without regard for the needs of others.

In fact, when there is a power imbalance, as with the power a health care provider possesses given their specialized knowledge and skill, there is a greater moral obligation that their power be used judiciously in the care of those who are vulnerable.

MORAL OUTRAGE

Think about your own sense of powerlessness waiting in the examination room, dressed in a flimsy gown, not knowing when the doctor will come through the door, or what news he or she will bring. We are morally outraged when those who have such power over vulnerable human beings misuse the trust given them. Those who abuse children or the elderly evoke our most visceral reactions.

But bullying plays out among peers, too. Bullies who torment their peers in school hallways, some even to the point that victims take their own lives, often go on to bully peers in the workplace.

The prevalence of "lateral abuse" underscores that some of the worse incidents against staff are from their co-workers themselves. Bullies may have no formal authority, but use their influence, size or sharpness of tongue to injure people.

MONTREAL MASSACRE

As I write this column the anniversary of Canada's own day of infamy approaches – the Montreal Massacre of 14 young women engineering students at l'École Polytechnique on Dec. 6, 1989. Their blood was shed at the hands of a young man who hated women.

Although the tragedy brought attention to violence against women and other gender-related issues in the workplace, 22 years later we still read stories of bullying women at work through intimidation and sexual harassment.

We are all sickened by such horrific crimes. But workplace abuse is not always a direct attack on another. We can overlook people's contributions through salary ceilings and pay inequities.

We can pretend staff do not exist and ignore the obligation to provide a rationale for those decisions that adversely impact them. We can insulate ourselves in our busyness and professionalism as a way to avoid having to deal with people.

MAKE THEM INVISIBLE

Those in formal positions of power can do irreparable damage to the psyche of staff by simply rendering people invisible. There is not a day that goes by that I do not reflect on how my own leadership may bring harm to others.

As a Catholic health care organization, we can do all kinds of wonderful things to heal the sick but unless we embrace what Cardinal Joseph Bernadin coined a "consistent ethic of life" to create an ethical environment that respects the dignity of all our staff, physicians and volunteers, including the sick and their families, our efforts are only half-realized.

I invite readers in this liturgical season to reflect on how we exercise the power with which God has graced us to help make people visible.

To fully celebrate the Incarnation of Jesus Christ by acknowledging every human being we encounter as a precious gift of God, and to resist, denounce, and say no to every act of abuse that robs our neighbour of their intrinsic dignity. This is not easy work but it is what the moral life informed by the Gospel calls us to do.

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