ETHICS MADE REAL

GORDON SELF

An ethicist in Catholic health care once said there are "no ethics-free zones." Jack Glaser's comment is relevant as we prepare for the launch of the new Health Ethics Guide, addressing both clinical decisions at the bedside, as well as the organizational issues in matters of governance and administration around the board table.

Everything we do in Catholic health care must be directed to building up what the guide calls the moral community, to which we are accountable. This includes how we make decisions in alignment with our mission and values, as well as transparently communicating their rationale, even publicly if appropriate to do so.

Since there are no ethics-free zones, the entire context in which decisions are made, articulated and reported must be duly considered.

For example, during the Deepwater oil spill in the Gulf of Mexico in 2010, former CEO of BP, Tony Hayward, was quoted by media, saying: "There's no one who wants this over more than I do. I would like my life back." The quote went viral, intimating a defensive stance by a self-serving, insensitive executive, disregarding the environmental disaster his company caused.

In ethics, context is everything. Consider what Hayward said in its entirety, suggesting a different perspective: "I'm sorry. We're sorry for the massive disruption it's caused their lives. There's no one who wants this over more than I do. I would like my life back. So there's no one who wants this done more than I do. And we are doing everything we can to contain the oil offshore, defend the shoreline and return people's lives to normal as soon as we can."

ENTIRE CONTEXT

In making good decisions and understanding their rationale, it is important we have the entire context. There is indeed a moral dimension to everything we do, say and write.

A poignant story comes to mind. Years ago, I was privileged to be with a family who faced an unimaginably difficult decision. Their son suffered an irreversible severe brain injury after falling from the hood of a moving car while engaged in a teen prank known as "surfing." A senseless tragedy in which there was no hope of recovery.

The family consented to the medical decision to withdraw ventilator support and shift to a compassionate care approach, for which there is complete moral justification in the Catholic tradition.

ONLY YOU

During the many conversations with the grieving family, one of my ethics mentors offered these words of wisdom that I have never forgotten: "No one else is with you in this room to fully understand the magnitude of this decision, and the clinical facts of the case.

"Be prepared that well-meaning family may question you later, asking why you didn't try to save his life, or that you gave up too soon. Just remember they were not here with you in this room, and can never fully appreciate what you are going through and what you had to do out of love for your son. You have to be ready for this."

While few will ever face such tragedy, all of us have experienced some misunderstanding in our lives. Probably all of us have inadvertently contributed to misunderstanding by virtue of not being, proverbially, in the same room with the other.

Parents of adult children know this lesson all too well. As much as we think we know our married children, we can only speculate at times the private side of their marital relationship, nor always understand the choices they make. As parents, all we can do is support them, lending a caring hand without judgment.

Real ethics is not simply application of principles and rules. It is about compassion and empathy . . . standing with another and offering support in the face of difficult moral decisions. There is nothing easy about withdrawing life support from your child.

For this couple it was the right decision. Unforgettable, painful, but the right decision. What is required is a supportive community to help them live with that decision and carry on.

SEEK TO UNDERSTAND

As the feast of St. Francis of Assisi approaches, the prayer seeking not so much "to be understood as to understand" comes to mind. It reminds us that good ethics requires widening our appreciation of the full context in which decisions are made and communicated.

To understand the values that drive decision-making, the clinical facts and objective criteria that ground them, and the informed conscientious beliefs that defend them.

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