Chaplain Gerald Ash on Supporting an Ethical Care Environment

Supporting an Ethical Care Environment

Sound complicated? Not really.
Where’s it all start? Well, first think about how you would like to be treated.

Would you want your dignity respected? Would you want your voice to be heard? Would you want to have your care and decisions about your care to be based in your values, your goals — how you see life? That’s close to the heart of what ethics calls the principle of Autonomy.

Would you want everything that is done in the care environment to be done only for your good? Would you want the benefits of each care decision to be carefully weighed against risks to you? That’s close to the heart of what ethics calls the principle of Beneficence.

Would you want nothing done to you that is clearly not in your best interest — whether it is by act of commission or by act of omission? That’s close to the heart of what ethics calls the principle of Nonmaleficence.

Would you want to be treated equally and to receive an appropriate share of available care resources — without regard to your ability to pay, your culture, or any other criteria? That’s close to the heart of what ethics calls the principle of Justice.

These are the four principles upon which an ethical care environment turns: Autonomy, Beneficence, Nonmaleficence and Justice. Some big words, but we all understand their true meanings. Summarize them? It’s kind of folksy but we could do worse than by starting with this: Do unto others as you would have others do unto you. Or, do what is right and you’ll sleep well at night.

More reminders about the foundation of an ethical care environment:

Quite naturally we often find ourselves focused on the specifics of treatment decisions; we tend to see things from a black-and-white, biomedical perspective. But, patient and family preferences about tough care decisions are based in a broader context than this. These preferences are best understood in the context of their values, traditions, beliefs, goals, and relationships, in other words, how treatment decisions are going to affect their life. To complicate matters further, patient and family perspectives change over time as their circumstances or conditions change. Thus, it takes ongoing relationships between care givers and patients to support an ethical care environment.

Even so, sometimes it’s not clear how to work through tough decisions and balance everything outlined above. That’s when we’ll want to seek out other experienced persons to talk with. Some facilities have patient advisory groups or formal ethics committees that are available for consultation.. Outside consultations with independent bioethicists are also available. It’s important that chaplains are aware of existing resources.

Lastly, this reminder. The ethical care environment is based in: 1) the above principles, 2) the oaths that we take in our professions and 3) in the values of society as embodied in most state laws. In rare incidents there can get to be collisions between this set of core values and an individual’s demands. That’s when a lot of talking is needed. But it will work out, even if the process is painful, as long as we always embody the ethical care environment in everything that we do.
Supporting an ethical care environment. It’s the work of all of us.

Do you have thoughts about advocacy you’d like to share with your colleagues? Send an e-mail to info@PlainViews.org.