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ETHICS MADE REAL

GORDON SELF

I have spent a lot of free evenings and weekends lately on kitchen renovations. It is rewarding to use my hands to create something new.

Visits to the lumber yard evoke memories of many such trips with my dad as a young boy, recalling the smell of freshly cut plywood that lingers on now in our kitchen, transformed as a new fridge oak cabinet.

But anyone who has ever undertaken a major home renovation, especially a project in the kitchen which is arguably the busiest place in the home, knows there is a limit to how long families can put up with the disruption, let alone sawdust.

Despite the benefits of a new and improved kitchen, I am reminded of the daily stressors in achieving this goal. Both what I achieve and how I achieve it, matters. After all, what good is a new kitchen if divorce is part of the process? The 1986 comedy, The Money Pit, illustrates this in spades.

FINDING A BALANCE

Balancing the ends and means in clinical decision-making is important, too. The new edition of the Health Ethics Guide speaks to this with equal attention. For example, subjecting a patient to life-prolonging therapies that are clearly burdensome and futile may extend life briefly, but at what cost to their dignity and comfort?

New therapeutic research may bring about a good outcome as well, but only if free and informed consent of participants taking part in the studies has been sought first.

Still further, patient and resident care may receive the highest quality standards and excellence, but if achieved on the backs of health care staff then something is clearly wrong.

The boom and bust economic cycle so familiar to Albertans can also reveal much about balancing the means and ends of health care decision-making. I recall vividly the pressure to have enough trained clinical staff to meet the demand for beds during a previous boom, requiring our recruiters to look overseas for an additional source of labour.

As an organization, we asked many ethical questions about recruiting international health care workers, careful that we not exploit staff nor rob another country of its own scarce resource.

Today, we are faced with a different set of ethical questions associated with the economic downturn and mounting health care costs. This requires redesigning care and service, and bringing innovation to the health care system to better meet the needs of people we serve, both now and into the future.

We need to find the right balance in providing a quality care experience while also ensuring a just workplace for those who provide the care. We need to consider both the what and the how in decision-making.

FUTURE GENERATIONS

In his encyclical Caritas in Veritate (Charity in Truth), Pope Benedict XVI reminds us about the intergenerational nature of such decisions. "Every economic decision has a moral consequence" (37); thus we need to consider the long-term implications of decision-making so as not to burden future generations.

In Alberta, we need to always keep before us the cyclical nature of health care so as not to later regret our decisions, and how they were made, implemented, communicated and defended.

Like a kitchen renovation, we need to consider the long-term impact of decisions, especially if it leaves a family saddled with debt and bitter feelings of painful disruption long after the (saw) dust settles.

While no one has a crystal ball, good ethics requires we at least discern all the possible options and alternatives when faced with a major decision before making a prudential judgment. That is not always easy, or popular, especially if we are swept along with the momentum of change or pressured to work with new funding models.

ASK QUESTIONS FIRST

It is counter-cultural to ask the ethical questions up front because one may be seen as obstructive. It means investing the time now to consider the means and ends of decision-making that we can live with years later, without lingering moral residue.

This requires due consideration of both the reality of what we must achieve as a financial target or end, as well as the means by which we will engage our staff and physicians to find creative solutions, consistently applying objective criteria based on our mission, values and ethical principles.

While innovation and redesign of care and service in health care is indeed a much needed intervention, how we achieve these goals must also be thoughtfully and respectfully discerned.

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