ETHICS MADE REAL

Gordon Self

August 30, 2010

A true but humbling story from my past taught me about ethics. I swam often as an undergraduate student. I would wear a swim cap and goggles, placing the goggles high up on my forehead over the cap before or after entering the water.

One day there were several kids horsing around in the change room showers. I was suspicious of them because of a recent rash of locker room thefts. Going out to the pool deck I realized I left my goggles in the shower room. I returned to the showers but couldn’t find them.

I turned to the boys, and in an accusatory tone, said, “Have you seen my goggles?”

They looked confused, but said nothing. I went back to the pool, angry with the kids.

Suddenly, out of habit I reached up to my forehead, and felt the goggles over my swim cap.

To this day, I’m sure these kids, now adults, teach this story to their own children to think twice before making assumptions.

Whether at the local pool, work or at home, we make assumptions. I assume that my green light means the other cars approaching the intersection have a red. I assume when asking someone to keep my comments in confidence, they will. I assume the medication I am given is the correct order.

Given our history with traffic lights, relationships with close friends and trust in the health care system, these are reasonable assumptions.

Unfortunately we can assume wrong and can only hope to be more defensive drivers, discriminating in disclosing confidences and taking a time out to double check medication orders.

But it is the mean-spirited assumptions and judgments that we make of others that trigger so much unnecessary conflict. Our assumptions about the actions or motives of others can prevent us from seeing issues clearly, as with my mistaken assumptions about an innocent group of children.

WHAT MIGHT HAVE BEEN

If I hadn’t automatically assumed they stole my goggles, the kids may have pointed them out on my head. We would have all had a good laugh and moved on.

Most ethics consults in health care relate to communication, especially when coming to consensus around the goals of care. Families and clinicians may assume different meanings of “comfort measures,” for example.

Language and cultural barriers only add to potential miscommunication. Covenant Health’s Interpretive Services and Diversity Program helps facilitate clear communication between parties and to clarify what is actually intended when language poses a barrier.

But we are an equally diverse group of teams, professionals and sites with our own idiosyncrasies and cultures that do not always communicate well or understand each other. Magnified by the complexity and busyness of the health care system, we can sometimes make sweeping generalizations leading to conflict. So much of this can be avoided if we talk to people and check our assumptions.

To help diffuse and mediate conflict, we have some useful ethics resources. The Health Ethics Guide is the principal ethics framework used by Catholic hospitals in Canada. Covenant Health has also developed its own code of conduct, entitled, Our Commitment to Ethical Integrity.

An important principle in both documents is the need to address issues at the most basic level. This is known as the principle of subsidiarity. It means not going around people or unnecessarily escalating issues higher up without first trying to work it out at the appropriate level. Subsidiarity calls us to talk to people directly.

While presenting our new code of conduct this year, I suddenly stopped in the middle of my talk, realizing I had not worked out an issue with someone. I was challenged to put into action what I preached.

MAKE PEACE

After that session I went to talk to the person in private. While my heart was pounding, I asked if what I interpreted the person to be saying was correct, knowing that I can read into someone’s words thoughts that are not there. I am proud I checked out my assumptions, and celebrate having a better working relationship with this person today.

Sometimes we need expert mediation coaches, interpreters and ethics consults to clarify others’ intended meaning. I do not want to minimize this. We can’t do without these necessary resources. But we also can’t do without good listening skills, openness and honest dialogue to create the desired ethical culture.

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