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ETHICS MADE REAL

GORDON SELF

John Steinbeck's literary classic, The Grapes of Wrath depicts a family's struggle for survival after being displaced from their Oklahoma farm in the wake of the Dust Bowl and economic collapse of the 1930's. Gathering what's left of their possessions on a rickety truck, the Joad family head west along Route 66 to California, hoping to start anew with the lure of fertile agricultural lands and plenty of work.

They are not alone. The massive exodus of other desperate families pouring into settlement camps along the California border creates a surplus of labour. Those lucky to get any work at all for meager wages and under poor working conditions are further exploited by the landowners driving up food prices. Desperation leads to unrest, violence and a collective despair. The migrant families cry out in hunger, not only for bread, but for their very dignity.

I read this novel with an expectant hope that resolution would be found; some practical way forward for the Joad family. But Steinbeck does not offer the reader an easy way out. Instead he leaves us with an image, powerful and controversial, by which we may glean hope.

After delivering a stillborn child, young Rose of Sharon offers her lactating breast to a man in a barn dying of hunger. "She looked up and across the barn, and her lips came together and smiled mysteriously."

WEIGHTY DECISIONS

The dramatic scene confronts our sensibilities of what is normal and proper. It takes some engagement of our moral imagination to look beyond our sense of propriety to see saving the stranger's life when her own child could not be saved was the right thing to do. We are reminded that desperate situations require desperate means, but doing so without compromising our ethical integrity.

Three times a year, leaders in Catholic health care, education and social services from the Western provinces gather to explore common issues. The formation program includes in-depth discussion regarding clinical and organizational ethics. The leaders are each asked to bring an ethics case from their respective Catholic ministry.

Other than a few instructions concerning respect for confidentiality, length and a clear statement of the issue, the assignment is wide open. Participants typically do not have much difficulty thinking about what to bring. Certainly there is no shortage of issues, and I am amazed each year by the complexity of cases that arise in our Catholic leadership roles.

For example, what do you do when the behaviour of the people we serve do not fit neatly into our pre-determined categories of right and wrong? It is not uncommon to find ourselves, like Jesus, in the proverbial company of tax collectors and prostitutes, called to meet people where they are and ministering to their whole needs - body, mind, and spirit.

The issues in health care, especially, can be complex. Discharge planning for the homeless. Sexual behaviours of head-injured young adults in residential care. A competent person's right to live at risk in actively pursuing their addiction away from the facility. Respect for the conscientious beliefs of staff and physicians without abandoning the people in our care.

These all require a moral imagination to carefully think through the issues, and find the right path forward. As in The Grapes of Wrath, there are seldom convenient resolutions to the stories of the real people we serve facing real life dilemmas. More often we face ethical choices between few good options, leaving us to discern the least harmful thing to do.

SECRET OF THE SMILE

Rose of Sharon smiles mysteriously as she offers practical support to another vulnerable human being. We can only imagine why she smiles. She has just lost her own child and no act of random kindness will ever erase that pain. Nor do I believe her smile is a smile of smugness, in a paternalistic gesture.

Similarly, the leaders in the formation program who wrestle with the complex ethics issues in their institutions do not offer Pollyanna smiles that deny the reality of the people in their service, nor lord it over them as moral purists.

But we can all hope to look ourselves in the mirror after debriefing each case, assured we have honestly engaged the issues, stretched our moral imagination, and acted in ways that were just and right in communion with the Church.

We can smile in humility that we have made a difference. We have acted with compassion, integrity, and courage to bear one another's sufferings, as Christ has taught us.

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