ETHICS MADE REAL

Gordon Self

January 28, 2013

There is a saying that "good ethics is good business." In 2007, our senior leadership team developed a policy to address the ethical issues related to accommodating special requests. We wanted to define for our staff and physicians how best to respond if asked to accommodate a person of VIP status.

That led to Covenant Health appearing before the Health Services Preferential Access Inquiry last month in Edmonton, testifying why we previously developed a policy and to speak about our approach from a Catholic moral and social justice tradition that upheld respect for clinical judgment.

We felt it was important to have a solid ethical foundation to prevent moral compromise and people leaving the professional altogether if pressured to yield to non-medically indicated requests. This has proved to be beneficial for us going forward.

From a "preventive ethics" perspective, we need to be constantly looking ahead at issues looming on the horizon in order to have some policy or framework to guide us. We risk inconsistent practices, poor quality care, and abandoning people if we leave our physicians and staff alone in the middle of the night to figure it out.

BE PREPARED

For this reason, we are anticipating what ethical and practical questions will arise if assisted suicide is ever legalized in Canada.

We will need to know how to respond to any requests that occur in a way that upholds our Catholic identity, as well as the professional and moral integrity of our providers, without simply walking away from a vulnerable person crying out in need.

Like our Accommodating Special Requests policy, we need to get ahead of the issues and lead informed, respectful dialogue, knowing there is a range of public opinion around assisted suicide, which no doubt will be mirrored in the public we serve.

Having a policy on hand is helpful. But long before pen is put to paper, there must be openness to discussing controversial issues. Good ethics requires good conversation. If we cannot talk about difficult issues in which there may be divisive opinion, we will certainly face conflict down the road.

For these reasons, Article 160 of the new Health Ethics Guide encourages organizations to reflect on the ethical dimensions of their work – that is, commit to make ethical reflection part of our everyday business.

The more we get used to reflecting ethically about everything we do, the better we will be able to think clearly when face-to-face with challenging ethical issues. Emergency contraception in cases of sexual assault, pandemic planning frameworks, palliative sedation, and chemical or physical restraints are issues that quickly come to mind.

As important as these clinical issues are, however, it is significant that one of the longest sections in the Health Ethics Guide is the section on employer/employee relationships.

WORKPLACE DIGNITY

Granted, this area does not seem dramatic compared with the current public inquiry on preferential access or society's ongoing preoccupation with sexual ethics, but human resource practices are no less important in defining the ethical culture of the organization.

Unjust and exploitive workforce practices are equally relevant moral matters. Catholic health care must always uphold human dignity – not just concerning the dignity of people's lives, but their livelihoods, too.

While few readers may be involved with the policy issues described above, many will have opinions on what a just workplace should look like, whether they work in private business, the public sector or a parish office.

Some may be involved in hiring and compensating staff. Some will be engaged in labour relations or contracting out services. Some may even be involved in disciplinary action. And many more will be impacted by the decisions of others around these various workplace practices in which they hope to have some voice.

GLOBAL IMPACT

The global economic forecast affects Covenant Health, and like other organizations, we will need to innovate and transform how care and service is delivered in a manner that balances quality, compassionate care and fiscal stewardship.

Like the sisters who founded our institutions, we have to be impeccably skilled business leaders. Like the sisters, we also need to base good business leadership on good ethics, ensuring a just workplace in which the lives of all we serve and work with can flourish.

This will challenge many organizations this year, and I encourage readers to reflect on what a just workplace means so as not to leave people guessing.

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