Chaplain's Corner

Many people think that ethical considerations are rather exotic, that they involve extraordinary situations that rarely arise – NOT SO!  What is ethics anyway?  Chris Summerville, one of our RHA Board Members and a member of our Regional ethics Committee defines ethics as “a way of doing relationship”.  Ethical considerations like relationships are an integral part of living.  Because health care is at its most basic level the relationship between one who is sick or injured and those who seek to care and cure, ethics considerations are part of the every day business of providing health care. The problem is that most of the time we relate ethically without much thought.  Sometimes the thoughtlessness is due to a lack of concern about ethics.  But many times it can be explained in other ways.

Sometimes the thoughtlessness springs from the fact that many ethical concerns are covered by well established policies and procedures that have become second nature to the health care staff.  When these issues arise, as they do each week, staff members simply follow the policies and procedures that were written and put in place to insure a consistent response to common ethical issues.  At other times the thoughtlessness may also spring from a well formed, habit of behaving ethically.  Many of us, not only in health care, are concerned about right and wrong, good and evil, ethical and unethical behavior and over the many years of our lives we have been trained and trained ourselves to respond to situations with a choice for the right, the good and the ethical. 

But then there arise situations that are not so easily placed in these neat, precise categories.  Such situations cause us to hesitate, ponder and ask the question, “I think I know what is right, good and ethical in this situation, but I’m not sure?”  These happen with more frequency than we might think, for much to our chagrin, life isn’t nearly as black and white as we wish it were and many shades of gray exist between the clarity of black and white which often leave us wondering, “What should we do in this situation?”

Next week is Ethics Week at Manitoba Health; a week when those of us that work in Health Care are encouraged to stop and reflect on the fact that there are more ethical considerations to ponder than we might normally realize.  Because ethics involves values and we all bring different values to relationship, as we seek to provide care and cure to those we serve, sometimes conflict and chaos arise.  Let me share a few of these situations that I have  confronted in the last year, it might help us all recognize just how often we ought to give more careful consideration and thought to the ethics of living in the complexities of our world.

Take for instance a situation I was asked to reflect on recently.  A patient in the hospital had come to us after having a severe stroke.  The patient had a very clear, written health care directive.  As the family gathered, the adult child who lived close and cared for the aging parent knew of the directive and insured that it was posted on the patients chart so that doctors, nurses and all involved knew the limits the patient had set around end of life care.  However, an adult child who lived at significant distance and was not deeply connected with the now dying parent came to town and immediately began pressing the medical staff to do everything possible to save the life of the dying parent.  The close sibling explained that the parent had left instructions that such things should not be pursued, the far away one didn’t care and the struggle began.  Different values, confusion and chaos, the context in which ethics need to be considered.

Or a young palliative patient is certainly dying but dying too slowly.  Pressure is applied to panel the patient and send the patient to live out the rest of life in a PCH.  However, to do that would result in the patient’s spouse losing the family home, because care in a PCH would costs a minimum of thirty some dollars a day, an expense that the partner couldn’t manage;   whereas care in the hospital is covered by Manitoba Health.  Is it ethical to cause further distress for the spouse of a dying patient by pushing for paneling and transfer to a PCH that would result in financial ruin for the spouse?  Isn’t that what universal healthcare was intended to prevent? 

Or suppose you were confronted with a situation where a patient in the hospital can not return home because Home Care refuses to provide care in the home any longer?  On further examination and a visit to the home, you realize that the Home Care staff are not able to safely provide care in the home because of the condition of the home.  The patient and family do not believe there is anything wrong with the way the house it and the patient wants to go home.  Does a community health program have a right to refuse care if the home is not “up to snuff?  Does a patient have the right to insist that community health care staff come in and out of a home that the patient believes is fine?  How do those involve sort out such a reality?

Or the ever so common dilemma which involves taking an elderly member of a community and sending them against their will and against their families will to await placement in the Personal Care Home they believe is substandard just because the RHA has set a policy that only a few awaiting placement patients can be kept in the hospital at any one time?  This is the policy, it is the way things are done, but are their ethical issues involved here?

Have you ever considered how often consent for treatment is needed but the medial staff isn’t 100% sure that the client understands what he is being asked to consent to?  We have many immigrant people in our region, many whose first language is not English, many who come from cultures quite different than our own; yet informed consent is supposed to be an ethical value in our medical system.  Is it unethical to move forward with a non emergent procedure or treatment plan if there is any question about the patient’s ability to clearly understand what the doctor is suggesting? 

Or in the same vein, how many people take prescription medications but have no idea what medical condition the medicine is supposed to be addressing.  When people are sent home with a prescription and the doctor knows the person will not remember or understand what the medication is for, are they being treated without informed consent?  It t is an ethical reality that is happening every day.

Ethics is the business of every doctor, every nurse, every health care aid, and every community health worker; for the work we do continually requires that we think about issues that understand and respect the limits of our influence and the rights of those we care for to make choices about the care they are receiving without coercion or manipulation.  So, maybe it would be good for us all to be more thoughtful about the ethical implications of our relationships and work; for it is so easy to forget these ethical issues in the hurried business of caring in a health care system that is so often overloaded and under resourced.