ETHICS MADE REAL

GORDON SELF

I am fascinated by how we make decisions. If you pay careful attention, your decisions reveal a lot about your character and what you hold to be important, or of fundamental value.

So, for example, if you value exercise, you will be motivated to get up early in the morning to go for your jog, walk the dog or jump on your stationary bike. But if you keep finding another excuse to press the snooze alarm button and stay in bed long after you intended to get up, then you need to be honest whether exercise is important after all.

This may sound like a trivial example, but think about the major decisions in your life — whom you married, what profession you entered, how you spend your money, what you teach your kids, what you stand up for — all these decisions reveal what is important to you.

In Scripture, Jesus compares the kingdom of heaven to a merchant in search of fine pearls, who on finding one pearl of great value, sold all he had and bought it (Matthew 13.45-46). Our values are the fine pearls that we must be prepared to defend and safeguard. I contend we do not possess our values, but rather, they possess us.

TAKE A STAND

In last month’s column I challenged readers to take a stand for what we do believe — to be clear about what deem of fundamental value, the fine pearl that we will sell all we have to possess. Often it is only when something important to us is threatened or taken away, or when we find ourselves in a compromising situation that we become clear what we truly value.

For example, I am writing this article on Father’s Day. My second grandchild was born the day before, and I realize, regrettably, as in the Harry Chapin song, Cat’s in the Cradle, just how much quality time I have lost out on over the years with my family. Work has been important in my life, but I need to ask myself, what is of fundamental value?

These everyday examples provide a framework for dealing with the more difficult ethical dilemmas we face in health care. At the end of the day, ethics is about being able to name for an individual or group what they consider of fundamental value — the fine pearl — and to act in accordance with those values without compromising deeply held conscientious beliefs.

LIFE AND DEATH

For families in ICU waiting rooms, the threat of losing their loved one brings into sharper focus the patient’s real needs, wishes and values, which may not always be about “doing everything possible.” For those doctors and nurses who may have been pressured previously in carrying out burdensome treatment, which they genuinely believed harmed patients, their experience also brings into focus what is of fundamental value.

Both experiences can lead us to draw a non-negotiable moral line that we can never cross again.

So how do we work through conflict when there are apparently two or more “pearls” at stake?

When conflict around the goals of care occur, as they will often do in emotionally charged situations, it is important that we probe deeper to find the pearl of fine value that informs each party’s perspective.

Sometimes ethics consults become polarized around doing x, or doing y, and we fail to see the meaning behind each person’s views that may make option z possible.

This is where careful discernment comes into play. There are no cookie-cutter formulas when it comes to ethical discernment. Real ethics is about having the courage and moral imagination to stay engaged with one another to resolve conflict and to find a way forward without anyone compromising their deeply held conscientious beliefs.

Dispute resolution processes and mediation practices are important for civil conduct. But unless we become skilled in naming and talking about our values, and knowing how they drive our decision-making, we may find ourselves searching for our pearls in the wrong field.

LATE LESSON

I learned late in life that I ought to spend more time with my children, and have the gift of another grandchild to remind me what I can still do.

In next month’s column we will talk about dispute resolution processes, codes of conduct and the Health Ethics Guide — some of the ways in which we apply good ethics in real situations.

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