ETHICS MADE REAL

Gordon Self

December 23, 2013

There is a lot of policy work to health care that often goes unrecognized. After all, some cynics might say, it is just a bunch of paper that no one bothers to read. Our real job is getting on with the business of running the health system and saving lives. I agree.

No collection of paper can ever replace the practical, face-to-face encounter between health professionals and the person in our care. That is the real context and meaning in which the ministry of Catholic health care operates.

Yet, how we communicate and document that healing encounter which honours our commitment to privacy and informed consent, for example, or the safe use of medical equipment and drugs, or the corrective steps required if quality is compromised in the process in caring for another are all rooted in the statements we call policy.

These statements shape the culture or character of the organization. They define what is non-negotiable. In that way, every policy is ethical by nature, as the word ethics is derived from the Greek ethos, meaning character. A surveyor with Accreditation Canada should be able to see coherence in a health care organization's suite of clinical, administrative and governance policies pointing to the same moral character.

ETHICS INTEGRATED

The strength of Catholic health care is that our ethics is integrated in everything we say or do. Ethics is part of our DNA. That same genetic code should be evident in every policy statement, memo, press release or quality report.

Obviously, having policy is not enough. We can all point to some institution or individual and question if what they publicly espouse as important is actually operative in daily practice. The challenge is more than just having documents on file, or respectfully consulting others in policy development, but testing consistent application of policy and holding people accountable for their compliance.

This begins with the cornerstone policy statements of the organization's mission, vision and values. As we prepare for opening the first of several supportive living facilities in Red Deer and Calgary under the banner of our new sister organization, Covenant Care, there is a flurry of policy work underway. This includes human resource policies on confidentiality and abuse; quality policies to ensure safe medication management; clinical policies on infection, protection and control, as well as specific ethics policies on conflict of interest or codes of conduct.

This is necessary work in establishing the ethos of Covenant Care. But even the specific ethics policies mentioned above do not guarantee we will create the desired ethical culture unless we are intentional about the expected behaviours that go with them.

As ministries of the Catholic Church, both Covenant Health and Covenant Care are called to carry on the healing and reconciling ministry of Jesus.

The people whom Jesus heals are first seen and heard. They are made visible as persons with dignity, even if sometimes they must climb a tree or press through a crowd to be noticed.

In like fashion, every policy we promulgate has to ensure the patient or resident is visibly at the centre of all we do. This commitment has to be noticeable in our policy language.

A COMMUNITY MEMBER

Second, the person healed by Jesus is restored to community. Catholic health care can never lose sight that every person in our care belongs to a wider network of family and community. Our staff, too, belongs to a community, and thus any administrative or clinical policy has to work towards strengthening or restoring relationships on which most ethical issues hinge. These two fundamental ethical prerogatives, human dignity and human sociality, define our ethos. We need to stand from the balcony to see if what we have assembled as a body of policy documents reflects our character as an ethical organization.

We require consistent, self-reinforcing language that affirms every human being in our midst is a person with intrinsic dignity and incalculable worth, and who belongs to and is shaped by a complex web of relationships. No person in our care or the people privileged or employed in our facilities to serve them can be treated any less. Neither should our policy statements say otherwise.

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