We all want to do what’s right. After all, we’re taught as young children the important differences between right and wrong.
But what if what’s right for one person is wrong for another? Or if there is no ‘wrong’ answer, but rather multiple choices, each with their own consequences?
Enter Eastern Health’s Ethics service. The men and women who work there regularly consult with staff and clients on questions such as:
- “Should I tell my mother, who has Alzheimer’s, that she has terminal cancer?”
- “Should I discontinue life-support for my husband? We never talked about his wishes and I’m not sure what he would want.”
And then there are questions related to policy – another significant area looked at by the Ethics service. Should vaccinations be mandatory for health care workers? Should e-cigarettes should be banned as part of the organization’s Smoke Free Environment Policy?
As the public is impacted by many of these issues, in 2012, the Ethics Department began inviting individuals from the community to become members of the various ethics committees at Eastern Health – to bring an important perspective, have a voice at the table – and potentially effect change.
Work that Matters
The committees cover the areas of adult acute care, maternal-child health, mental health and addictions, long-term care and administrative ethics. Each one is comprised of an ethics professional, health care providers and two to three members from the community.
They meet on a regular basis to plan ethics education events and to discuss policy questions which contribute to the development of Eastern Health’s health care policies. In addition, while they are not part of confidential ethics consults, their committee may be part of the debrief session to talk in general, non-client identifying terms about the issue and its outcome.
Community involvement brings a fresh perspective and community members have become an integral part of the work of the committees.
“We bring a different perspective because we are outside of the system, outside of the processes and outside of the framework,” says Gerry Organ, a community member of the Adult Acute Care Committee. “But it’s important to go into it without bias caused by coverage in the media or by our own personal agendas.”
Community members become involved for various reasons that in some cases can be quite personal, but one characteristic most share is passion – passion to effect change, passion to learn, and passion to make a difference.
Gerry became involved because he taught ethics in his professional life and saw this as an opportunity to pursue his personal interest in ethics. “I had no agenda, no beef,” he says. “But I did have a deep interest in ethics and was particularly interested in end-of-life care discussions.”
Dr. Fern Brunger is an ethicist with Memorial University and Eastern Health, who discussed the value of community representation in her 2014 StoryLine article “Doing it Right – Ethically.”
She’s a true believer in having community representation on ethics committees.
“That fresh perspective can – and has – completely reshaped the way that these committees function,” she stresses. “Community members have that critical out-of-the-box thinking and fresh perspective that sometimes makes us re-examine our approach.”
Susan Hyde, a member of the Mental Health and Addictions committee signed up because she had personal experience in the mental health system and, as she says, “I wanted to be an advocate – and I wanted to heal myself. I felt that becoming involved with the committee would help me do both of those things.”
Heather Elliott, a member of the Long-Term Care Committee, has a communications background and extensive personal experience with the health care system. “I had family members with Alzheimer’s and other medical conditions,” she says. “Like many people, I was challenged to find care, evaluate care and understand what good care is.
“I felt becoming involved with the committee would give me more insight.”
For Gerry, Susan and Heather, their involvement bought them even more than they’d expected. In their own way, each of them discovered the challenges that the health care system faces, and how much more in-depth it is than it appears from the surface.
And each of them without exception, felt valued in the work they did during their two-year terms.
“During my time on the committee I always felt listened to,” Susan says. “I always felt that the community reps’ voices were taken with such respect. I grew up on that committee – and they were respectful about my growing.”
In Fern Brunger’s experience, the people that have come forward as community representatives have been very engaged and not at all shy. “They have the confidence to understand that their voice is every bit as important as anyone else’s on the committee.”
“I discovered that members of the community don’t often get to see the complex issues that health care workers face on a day-to-day basis,” adds Gerry. “I remember listening to them speak at our meetings and was blown away by the decisions they have to face every day.”
One significant issue that committee members discussed was the Canada-wide drug shortage in 2012, when the drug manufacturing company Sandoz Canada shut down to re-engineer their Quebec plant.
That meant certain drugs were not always available or that alternative medications had to be found. Eastern Health, like other health care organizations across the country, had to manage the reduced supply and subsequent distribution of drugs.
Questions that arose during ethics committee meetings were complex, and were reminiscent of the provincial H1N1 drug shortage in 2010. They included: “How do you determine who gets a particular drug? Is it a pregnant woman, a child, an elderly person or a cancer patient? Who gets it first? Who gets it second and so on?”
“It was amazing being exposed to the extraordinary depth of compassion that the health care professionals had for their patients and their people and their field of interest,” says Heather. “I watched people on these committees talk passionately about what is the right thing to do – not what’s the easiest thing to do or what’s the politically correct thing to do – but to talk ethically about what is right.
“It is rare to be so close to something as deep and profound.” ■
Eastern Health recently completed the recruitment process for community members for the 2015-2017 term. To learn more about ethics at Eastern Health, visit our website.
This story was written by Robyn Lush, a communications specialist with Eastern Health.