ETHICS MADE REAL

Gordon Self

October 22, 2012

Is it time to get mad?" The question was posed during a recent multispecialty rounds at Covenant Health.

A respected infectious disease specialist described the events surrounding an outbreak of a very resistant pathogen reported in the media earlier this year at an Edmonton hospital. He recounted the lives impacted likely as a result of failing to comply with basic hand-washing protocols before and after contact with patients.

Many of us become momentarily indignant, he observed, discovering that a breach in infection control standards results in such egregious harm. But sadly, how few of us become angry in expecting, even demanding, sustained change in attitudes and behaviour around clinical practice.

Despite compelling peer-reviewed scientific evidence regarding the importance of hand washing, there are still infection control breaches, aside from those unique circumstances when a proportionate argument can be made from a benefit and burden perspective justifying urgent intervention.

As I listened to the speaker, the word "anger" did not seem adequate. "Moral outrage" came closer to the mark. How can we, given our professional and ethical obligations to "do no harm" condone such breaches?

EFFICIENT INFRASTRUCTURE

But to be fair, meeting these obligations requires the appropriate infection control education, policy and procedures, equipment and materials to help health care professionals be successful in achieving the highest standards of patient and resident care. It is also requires public policy support.

Care is provided in a context and thus the contextual realities in which our health-care professionals work needs to be carefully weighed, including the pressures to meet unrealistic demands for service or if lacking basic resources to do their job right.

When examining barriers around infection control compliance we need to understand some of the other competing pressures clinicians face, too. Morally, we have a shared responsibility to support making infection control a public priority and a matter of social justice.

Anger is an understandable response when judged prematurely without the facts. Sadly, we all judge people more than we care to admit. Everybody makes assumptions about politicians and movie stars and even our next door neighbours.

REALITY CHECK

Thus in humility we need to be on guard to check out our assumptions lest we damage someone's reputation.

But anger takes on a whole new level if we experience people tuning out our message on principle. Despite presenting objective facts in good faith and in a spirit of transparency, ideology can sweep aside our efforts to educate others about a credible position as if it were trivial.

Whether we are talking about infection control practices or more emotionally-charged issues like emergency wait times or executive compensation, we have a moral duty to inform our thinking before we render judgment. Understanding complex issues is never trivial.

Earlier this month, I spoke at the St. Luke's Physicians Guild on conscience. Exercising the right of conscience presumes we have first formed our conscientious beliefs, drawing on a variety of wisdom sources, authoritative moral teaching and reason.

Conscience must be oriented to seek the truth, not an "absolute placed above truth," as the Canadian bishops stated in their recent pastoral letter on freedom of conscience and religion. It also takes emotional intelligence, so that we are not blinded by our emotions, including anger.

What we vehemently hold to be true in conscience may not actually be true once we weigh the facts thoughtfully and dispassionately.

This month coincides with the launch of public education around influenza, reinforcing practical steps we can take to avoid spreading flu to others through proper hand hygiene, respiratory etiquette (coughing into our sleeve or using tissue) as well as prophylactic measures like flu shots.

Yet despite these efforts, there still appears to be a gap in public attitudes and behaviour supporting infection control practices - from outright denial of their efficacy, to half-hearted promises claiming, "I will try to get a flu shot this year," versus a commitment that says, "I will."

Genuine objection to these practices on conscientious grounds requires prudence and compassion, but not without losing sight of the "truth" of those harmed by infection control breaches.

TIME TO GET MAD

Is it time to get mad if both professional and public responses to reducing risk of harm appear half-hearted? Should we not all be morally outraged regarding persistent resistance to infection control practices in hospitals and in community, keeping before us the faces of the people represented by the outbreak statistics we track?

Real ethics involves asking tough questions, and being held accountable for the answers we give.

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