In the post-COVID era, there seems to be an increased promotion of self-care amidst the staffing challenges of “doing more with less.” This is true for not only frontline clinical staff, but also for all members of the care team, including ethicists.

Mercy’s Ethics Council of eleven people, scattered throughout the ministry, consists primarily of Directors of Ethics throughout the system in all the major markets, but also includes the Executive Director of Ethics at the ministry office and a couple mission leaders who have backgrounds in ethics. They convene weekly to discuss and collaborate on various needs throughout the ministry. In the years 2022 and 2023, the group was composed of a nice mix of veteran ethicists and those who had been in the role 2 years or less. However, due to the nature of those regular meetings, there was not ample opportunity for the newer ethicists to glean wisdom from the more senior members of the group. At that time, it also became apparent that the group needed space for respite from the pressures that come from the nature of their work.

Setting the Table

The Mercy Ethics Council was inspired by the work of Steven Squires and Andrea Thornton in their article, “Jacks and Jills of All Trades, Experts of Some: Process Skills Training for Ethics Programs” (HCEUSA, Fall 2022).¹ In discussing the article, the group felt that it would be to beneficial to grow in some of the skills discussed by Squires and Thornton. Of particular interest to the group was the idea of verbatims—a tool used to train chaplains in Clinical Pastoral Education (CPE).² Squires and Thornton describe the verbatim and its usefulness for ethicists:

A verbatim includes a transcript of a consult (from memory) with notes on context, nonverbal communication, the consultant’s mood, the consultant’s read on the interlocutor(s)’ mood(s), and interpersonal dynamics. The verbatim allows for reflection on one’s own performance, including the micro-politics and emotional factors that influence analysis and communication. These reflections are not simply private writing experiences; they are presented before a group of peers for discussion and evaluation. They invite others to broaden the consultant’s self-awareness, bringing attention to habits or styles of communication that may not serve the goals of the consultation. Implementing the verbatim in the training of ethics consultants will address the gaps in process learning that the profession currently experiences to improve ethics quality.³

Mercy’s Ethics Council members were interested in the prospect of developing these process skills and learning from the wisdom of the group through the sharing and discussing of cases using verbatims. Initially, the group agreed to do this at a meeting that would be separate from the weekly Ethics Council meetings. This time together was dubbed Ethics Tea Time as a nod to Mercy’s tradition surrounding the “comfortable cup of tea” that Catherine McAuley encouraged the sisters to share together upon her passing.⁴

Something’s Brewing…

Having gone through a unit of CPE myself, I felt comfortable leading the charge. I created a template to be used (included below) that was based off the verbatim template that was supplied for me when I did my unit of CPE. I also set up a rotating schedule of who would be tasked to ‘present.’

The following is the initial Mercy Ethics Council Verbatim template:

ETHICS COUNCIL VERBATIM TEMPLATE

Instructions: The purpose of these verbatims is manifold. The hope is that the writer would get out of the verbatims whatever it is that they felt they needed. This format is merely a suggested format based off a CPE template. As the writer of the verbatim, please include whatever details you feel are necessary in order that you and the group may get the most out of our time together (this, of course, may vary from following the template exactly to a product that’s more of a stream of consciousness with thoughts and questions at the end).

• Summary of the case:
• Description of Patient as a Person: what does the patient’s (and/or family/care team member’s) appearance, gender, race, diagnosis, language, etc. tell you about him or her? Track your reactions to any of the above here.
• Verbatim Dialogue (if you feel inclined to recount, verbatim, part of the consult, you may do so here)⁵

• Competence: Reflect on the ethics “interventions” (logic-related or as a facilitator) you used. How were they guided by your interior process? What pastoral skills did you use? Mention specific areas of challenge by letter and number (like C2, etc.) if you chose to include a verbatim.
• What are some things you want to get out of the group discussion of this verbatim (e.g., help with skills, answering specific questions, feedback, group case discussion, rapport building with the ethics group)?
• Answer this question: “What do I want to learn from this verbatim?” Please do not ask the group to tell you what you did well or did poorly. Explore those here for discussion with the group.

ADJUSTING THE RECIPE... ADDING MILK & SUGAR

Fairly quickly, there was a need to change.

The verbatim became just another thing to do for our busy ethicists. There was near-unanimous agreement that the time it would take to engage in a verbatim with the accuracy and intention that the exercise intends, and that the group wanted to give, would not be possible. The move was then made away from assigned, formatted verbatims to maintaining a regular time for general case discussion that was optional to attend. At times when no one had a case to present, the time together was oriented towards fellowship and enjoying the company of peers. Currently, Ethics Tea Time has a spot on everyone’s calendar every week. On even weeks, it is held in the morning, and occurs in the afternoon on odd weeks. Both instances of Tea Time take place on different days of the week to maximize the possibility that one might work with people’s schedules.

FINDING THAT COMFORTABLE CUP OF TEA

The Mercy Ethics Council is still working to find a version of Ethics Tea Time that suits the needs of the group. Feedback about the time together has been overwhelmingly positive as it has been an opportunity for many to enjoy fellowship with those who can intimately relate to the challenges and opportunities that come with the role. One of the main opportunities moving forward for Teat Time is to find the balance between the original intention of growing in those process skills that are critical to the role and not making the event an onerous one, all the while creating an opportunity for fellowship. The future goal for Ethics Tea Time is that it can continue to adapt to suit the group’s changing needs and fill the Mercy ethicists’ cups.

ADDISON S. TENORIO, PHD(C)

Executive Director of Mission

Mercy Hospital Ardmore

Ardmore, Oklahoma

ENDNOTES

1. Jacks and Jills of All Trades, Experts of Some: Process Skills Training for Ethics Programs (chausa.org)
2. Ibid., pg. 15.
3. Ibid.
4. For more on the tradition surrounding the “comfortable cup of tea”: The Power of Tea - Sisters of Mercy.
5. Of note, this chart is small simply to demonstrate the format. A verbatim is typically the recounting of a whole or part of a conversation. Therefore, it has many back-and-forth interactions (often, between multiple people).