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ETHICS MADE REAL

GORDON SELF

I have seen a growth in public service announcements over the years promoting physical fitness and health. The ParticipACTION commercials of the early '70s (that is, Hal Johnson and Joanne McLeod of BodyBreak) stand out in my memory among the first, followed by anti-smoking cartoons, agricultural producers endorsements, UV Index reports and consumer tips based on Canada's Food Guide.

While these all serve to educate Canadians about healthy lifestyle choices, proponents of preventive medicine argue more can be done to wake people up that you and I — not doctors, or "the health care system" — are ultimately responsible for our health.

Some even question whether publicly funded resources should be directed to those who seem unwilling or unable to take responsibility for their health, continually engaging in poor health habits.

This is a delicate moral question. Personally, I do not believe it is ethically justifiable to refuse care to chronic smokers, or to set limits on the number of times a person can receive coronary artery bypass, for example, especially if they remain noncompliant with diet and exercise regimes after surgery.

Nor do I suggest we ever withhold medical services to patients based on at-risk activities they participated in, less we refuse care to anyone involved in a motor vehicle accident given the known risks associated with driving. We cannot blame and punish people needing care.

HARBOURING RESENTMENT

But in the secret of our hearts, do we not sometimes harbour resentment regarding those who irresponsibly "eat, drink and be merry," ending up using health care services? Public attitudes may reveal who is more "deserving" of care. In reality, the choice where we allocate our resources — and our compassion — for persons struggling with morbid obesity or alcoholism also has life-threatening implications.

I am writing this following a recent family holiday. Every day I walked around the deck on our cruise ship for exercise. I applied lots of sunscreen, wore sunglasses and a hat, and limited myself to the duration and time of the day under the sun.

My route took me past sunbathers who likely chose to forgo sunscreen, turning a darker shade of brown (or red!) with each circuit around the ship. And because sun tanning works up a powerful thirst you can imagine how the alcohol was flowing, not to mention the plates of bar food. Whoever has been on a cruise will tell you about the excessive eating and drinking.

virtue of moderation

In case I sound judgmental, I admit soaking in the sun myself, having a few rum punches and indulging in apple pie for dessert every night. As a lay Benedictine Oblate, my spiritual roots remind me of the virtue of moderation, avoiding excessive sun, liquor and food.

Despite my own admonitions for physical and spiritual balance in my life, I must admit the elaborate mental gymnastics I took calculating how much I could indulge given the risk factors of cancer that run in my family.

IMPACTS ON OTHERS

But my health choices are not merely a private matter that I can simply work out in my own mind. How I choose to live at risk impacts my family, my employer and ultimately my fellow taxpayer.

The Health Ethics Guide reminds us that "all persons have a responsibility to make lifestyle choices that will have a positive effect on their health and well-being, and to participate in the promotion of the health of the community" (n. 4).

We are stewards of our bodies, called to exercise prudential judgment regarding the health choices we make, recognizing all life will involve some element of risk, whether it be driving or moderate sun exposure.

TRUE COMPASSION

As we celebrate the Paschal Mystery of the suffering, death and resurrection of Jesus Christ, we are reminded what true compassion means. Ethically, we are called to be Christ to each other, at times confronting another if over-indulgence of our bodies risks hurting ourselves, our families, or the community at large.

Sometimes we may even need to confront obsessive spiritual practices that are unhealthy, as St. Ignatius learned in his struggle with scruples. But it also means standing with the person struggling with physical, spiritual or mental health issues and not holding back the care they need, regardless of their life circumstances.

This is the ultimate expression of participACTION in the life of Christ — entering fully into the experience of a hurting brother and sister, and lifting them up through education, support and quality care to help them make better health choices, even if only an incremental step forward.

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