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ETHICS MADE REAL

GORDON SELF

One memorable event I witnessed in hospital many years ago involved a patient who suffered a stroke and was left with severe expressive aphasia. He could only utter, "yes" to questions, requiring careful interpretation if his "yes" really meant "no."

Assuming he was comfortable and didn't need pain medication, for example, underscored the risk of misinterpreting his intended meaning.

He would become visibly frustrated, challenging us to slow down and listen with both our eyes and ears, avoiding putting words in the patient's mouth. Over many weeks, the occupational therapists and speech language pathologists worked with the patient. As the extent of his deficits became apparent so did his level of frustration, especially when trying to communicate with his wife.

The team consulted a music therapist to explore whether intonation of song might stimulate other centres of his brain unaffected by the stroke. At first, the patient was only able to accompany the therapist in humming simple songs. Gradually, he was able to interject some words and refrains from familiar melodies.

The rapport between the patient and therapists was amazing, as was the patient's progress. Without anyone's knowledge, the patient and team secretly planned a surprise for his wife. During one of her regular afternoon visits to the hospital, the patient suddenly initiated the "conversation" in expressing his love for his wife by singing her Happy Birthday.

JOYOUS YES

No longer restricted to an ambiguous one-word response, he was able to sing loudly his clear "yes" to his wife. It was the most unforgettable birthday gift she ever received, leaving not a dry eye left in the room.

What is truly remarkable about this story is the creative imagination of the therapists. Not only did they help the patient reacquire practical skills to communicate, but at a deeper level, they helped him reclaim his human dignity.

The litmus test of good ethical reflection, too, is the measure we find practical ways to affirm and protect human dignity. So often ethics is viewed as an abstract discipline of norms, codes and principles without reference to real people and real circumstances.

When confronted by challenging ethical questions - for example, whether to waive hospital charges for visitors without insurance or realistic means of repayment, we have to consider what decision best upholds human dignity, as well as balancing our values of compassion and stewardship.

Keeping people forever in debt with no hope of ever getting beyond the weight of obligation undermines human dignity. But fostering a sense of entitlement will not preserve dignity, either.

Historically, even the sisters expected some modest repayment from patients - perhaps a chicken and some eggs, or an exchange of service such as working in the hospital vegetable gardens.

We must go beyond simple "yes" or "no" ethical analyses and be prepared to reflect on the application of moral principles and teachings to real life cases. In my 30 years in Catholic health care, I have yet to be convinced that we can apply good ethics without considering the patient's or resident's unique story.

I have been taught well. The different congregations of Catholic sisters who were formative in my health care ministry demonstrated a tremendous capacity for creative ethical imagination.

The sisters provided quality, non-judgmental, compassionate care to all who entered their health care facilities. They touched real people and real ethical issues, bringing a practical wisdom that is not readily translatable in ethics books.

As in the story above, the sisters would find creative ways to bridge a stronger connection with patients, together finding a way forward that would affirm the patient's dignity.

In a few short months a statue will be unveiled on the Alberta Legislature grounds that will commemorate the historic contribution of the Catholic sisters in health, social services and education in our province.

THE FACE OF CHRIST

This tribute is more than an acknowledgment of the pioneering and risk-taking spirit of religious women in establishing buildings, but in building and lifting up people in their human dignity.

It is a tribute to how they positively impacted the lives of others, being the face of Christ no matter how messy, or complicated, the circumstances in which people presented to them.

The sisters' legacy of service attests to their capacity for ethical imagination and creative solutions in the midst of the real moral quandaries of people's lives.

Yes, the sisters taught people to read, gave shelter to the poor, and tended the wounds of the sick. But fundamentally they affirmed and lifted people up in their human dignity and, by doing so, gave people their voice.

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