ETHICS MADE REAL

Gordon Self

January 30, 2012

New Year's heralds all kinds of personal resolutions to improve our lives - spend quality time with family, get back into shape, pray more, give to charities, and so forth.

But we know the dismal track record of Jan. 1 resolutions if they remain a half-hearted, private wish. Thinking them through, writing them down and publicly acknowledging what I resolve to do with a trusted friend or family member helps deepen the level of commitment and make it real.

Having an honest conversation with another person also helps them support me in my commitment, too. They can remind me of my sincere desires that I made in a moment of confidence if later my will happens to falter.

This can be humbling if I find myself relapsing into old patterns and I am confronted by those who love me for not living up to what I promised to do. It is even more humbling if I have painted myself as the poster child for moral virtue, while criticizing others for their own perceived lack of stick-to-it-ness.

Far from an ivory tower experience, living a moral life involves having honest conversations with oneself and others about the choices we make in life and what we hold to be of fundamental value. This takes courage and the ability to name resistance.

Like the Samaritan woman whom Jesus encounters at the well, such honest conversations may reveal untruths in our life where we generally do not wish to acknowledge. Jesus calls us to look deeply into the well of our experience and see our true reflection in the water below.

We are all fragile, mortal beings and illness has a peculiar way of exposing this truth. There is nothing like a health crisis to bring into singular focus what really matters, which often is reported to be about quality of life, rather than quantity of days.

HOSPITAL BED PERSPECTIVE

Indeed, sometimes it is from the perspective from the hospital bed, not the church pew, that we confront the real stuff of our lives. Thus health care professionals are often privileged as a listening presence, helping the person in our care who struggles with a decision to forgo more surgery or dialysis, for example, when continuing on is no longer possible or beneficial.

Resolve to discuss your 'end of days' wishes with family and friends.

Resolve to discuss your 'end of days' wishes with family and friends.

Those who have taken time to prayerfully reflect in general what is life-giving and meaningful for them before getting sick may be better positioned to navigate the tough conversations around the specific goals of care they will face later in hospital, underscoring the importance to not put off until tomorrow what can be done today.

Naming an agent or proxy to speak for you if one day you lack capacity to make health care decisions is one good place to start. But there is no point naming an agent unless you have the conversation with your family and your agent first about what it is you value.

Again, don't wait to reflect on your values. My family took this to heart recently when we gathered around the supper table and discussed our health care and end-of-life needs. As hard as this was, it was an unforgettable conversation.

Covenant Health is implementing Advanced Care Planning and Goals of Care Designations across the organization to better serve patient and resident needs, especially those at the end-of-life.

This is not a tick-box approach to care. Rather, it involves having honest, proactive conversations as early as possible in a person's care about treatment options that are meaningful, appropriate and truly beneficial.

We live in a society that has an uncanny reluctance to talk about death, in which ironically our health care community is also complicit. There are undeniable limits to what we can or should do medically and ethically, but unless we are honest about our own powerlessness in staving off death at all times how can we ever expect to have such important conversations with others?

Advanced care planning and goals of care designation are vehicles for a good conversation, which like any conversation, is a two-way street.

LOOK DOWN THE WELL

We must be prepared to peer down the well of a patient's own experience to focus on treatment goals that are truly life-giving – even in the face of death – as well as having the courage to look down our own well.

In dialogue, we can together focus on appropriate goals of care and avoid any unnecessary conflict and misunderstanding at the bedside. That is certainly a New Year's resolution worthy of all our efforts.

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