Gordon Self

February 28, 2011

A group of leaders in Catholic health care gathered recently to discuss many challenging ethical issues they face — ones that provide no easy solutions. For example, they spoke of how to respond to overwhelming health and social needs associated with those living on the streets when the IV drug user, homeless person, gang member or street worker suddenly finds themselves a patient in our facilities.

The reason for admission may be varied, but seldom do the medical interventions alleviate the reason which leads people to the streets. Caring for the whole person — body, mind and spirit — means we must do more than just treat the symptoms of disease or injury when a deeper pain is left unaddressed.

Like Jesus, we must lift people up in their human dignity and look for effective ways to break the cycle of despair and suffering that drug seeking and other self-destructive behaviours often attempt to numb.

But admittedly it is not easy to love some people. Practically, how do you care for a person who pushes you away? Or when their disruptive behaviour monopolizes the attention of staff, or threatens the safety of other patients and staff requiring a tough choice being made regarding the limits of care?

How do you respond when a person exercises their right to leave hospital against medical advice knowing it will only end up harming them further? And what of those whose home is the back alley or under the bridge? Is it morally justified to discharge a person back to such settings, especially when there are unending pressures for freeing up a bed for the next person coming into the facility?

While many readers will not know the ethical dilemma of contracting with a patient or resident to manage disruptive behaviour, or mustering the resolve to follow through on the care plan if the behaviour continues, many of us can certainly identify with family relationships where a tough love stance is required.

As parents, we will always worry about our children — "from cradle to the grave." Parents, especially, who lament a son or daughter struggling with addiction know something of the profound sense of helplessness their worry takes on.


My heart goes out to those family members reading this article who can only pray for their loved one's protection, unable to do anything more, not even sure of their whereabouts. Equal compassion must go out to all those having had to practise tough love with a son or daughter, brother or sister, husband or wife, by holding firm to boundaries around the limits of their care so as not to play into co-dependent behaviour, even though in doing so may break one's heart.

Asking a person to leave — whether the parental home or a hospital — is never easy, but at times necessary, to prevent further abuse from occurring, even violence.

As the leaders in Catholic health care discussed each ethical case, it became clear that despite the challenge posed, they will not abandon these individuals. Nor, as I hear of the struggle of many parents trying to reach out to their adult children, will they turn their back on their own.

Jesus invites us to place our fingers and our hands in his wounds, and thus we are also called to touch the Lord who is visible and present in our hurting brother and sister. Yes, we do not pick our patients or our family, but we do choose how we will respond to their needs.

Years ago I gave a copy of Norman Maclean's A River Runs Through It to someone I love. The story tells the journey of two brothers and their relationship with their father, together who share a love of fly-fishing. One brother finds his way through life; the other headlong on a path of self-destruction, eventually costing his life.

In the choices they both made, the surviving brother recounts how a river runs through life, "cut by the world's great flood and runs over rocks from the basement of time."


It is this living water of God's grace running through our lives that gives us strength to be there for those patients and residents, and our cherished family members, whose great need tests our moral imagination in responding to them. It is this grace that helps us look below the surface and see the word "under the rocks" — to look past the addiction to see our fellow human being who needs lifting up.

(Gordon Self is vice president, mission, ethics and spirituality for Covenant Health and can be reached at