BY: RON HAMEL, PH.D.
The theme of the 2010 Assembly — "Forging our Future: Strengthening the Ministry in Turbulent Times" — provides an opportunity to consider the role of ethics in Catholic health care and to find ways to strengthen its presence and its contributions.
Ethics may not be the first thing that comes to mind when thinking about "strengthening the ministry in turbulent times," or perhaps even the second or third thing. But it is critical. It is critical because beneath the many factors that make up "turbulent times" are the identity and integrity of Catholic health care.
Above all, through turbulent times, Catholic health care must remain true to itself — true to who it is and claims to be, and true in what it does and should do. Identity and integrity are the ultimate goals of whatever strengthening occurs. If the ministry loses either, it probably should not exist, at least as "Catholic" health care.
Ethics is critical to promoting and supporting the identity and integrity of Catholic health care as a whole, and of individual Catholic health care organizations. "Catholic health care ethics ... is central not only to helping shape the culture of an organization, its identity, but is also central to guiding the organization's decision-making and behavior, its integrity. Ethics should assist the organization to be what it claims to be in regard to identity, character and culture, and to discern what it ought to do (and not do) in light of who it claims to be. It should help Catholic identity to permeate the entire organization and to be integrated throughout the organization."1 Ethics in Catholic health care, then, has a dual focus (as it does generally) — identity and integrity, character and behavior, who Catholic health care is and should be, and what Catholic health care does and should do. The first has much to do with formation, and the second with discernment, decision-making and action.
One of ethics' primary roles, in collaboration with mission, is to help nourish, sustain, promote and even challenge the culture of the organization and to engage in the ongoing formation of leaders and staff into the desired culture. Ethics is central to these efforts because ethics deals with the very substance of culture — values, beliefs, practices and policies. Especially in turbulent times, the issue of culture is paramount. Will the culture of the organization and the ministry be one informed by the values and beliefs of the Gospel and of the sponsors, or will the culture instead predominantly reflect the values, beliefs, practices and dynamics of the marketplace and of the broader American culture? In challenging times, there may be a tendency to address immediate threats, to "put out fires," to the neglect of fundamentals. But in the long run, this will exact a high price. Dealing with the challenges as well as continued efforts to strengthen identity must go hand-in-hand.
Helping to create a culture reflective of the organization's identity is not the sole formative contribution of ethics. It should also seek to form communities of moral discourse, places where ethical issues are acknowledged and taken seriously, where conversations can take place about ethical concerns and issues, and where ethical discernment can take place. "[E]thics practice provides a means for creating communities of concern and meaning. Although ethics in Catholic health care certainly helps with complex clinical and business decisions, it is also, and importantly, about cultivating an environment in which meaningful conversation about values can occur, and from which values-based actions arise."2 Ethical discourse on critical issues also has the ability to change hearts and minds in ways that are better aligned with the identity of the organization.
The contribution of ethics in ethical discourse is not to provide answers, but to be a resource — to help people identify ethical issues, to bring knowledge and an understanding of ethical principles including the Ethical and Religious Directives, the church's moral teaching and Catholic social teaching. Even more deeply, ethics brings a perspective on what it means to be human and what it means to be part of a larger society. When ethics comes out of a theological perspective, all of this is seen in the context of the Hebrew and Christian scriptures and the church's theological tradition.
The second of ethics' primary roles is to support decision-making and behavior that express and further strengthen the desired culture. This might consist of raising to awareness the ethical dimensions of particular decisions, behaviors, practices, plans or policies. As theologian and ethicist Jack Glaser has pointed out, "There are no ethics-free zones." Whenever we are dealing with decisions or actions that affect human dignity and well-being, in addition to being in the realm of business, strategic planning, business development, human resources, delivery of care and the like, we are also in the realm of ethics. So often, the ethical dimension of these everyday organizational and clinical decisions is not recognized. The concerns, the concepts, the thought patterns and the language of the particular discipline bury it. Raising to awareness the ethical dimension can help ensure that what is decided or done is consistent with the identity claims of the organization and will, in fact, respect the dignity and promote the well-being of those who will be affected.
In this role, ethics might assist boards, leadership and others in discernment or decision-making processes. These processes generally have built in a consideration of the organization's mission and core values, as well as the core commitments of Catholic health care. They also urge consideration of relevant moral principles and the Ethical and Religious Directives. These can be helpful in ensuring consideration of a range of factors when making such significant business decisions as new partnerships, initiating or discontinuing service lines, downsizing and the like. These are decisions that directly affect people and the identity and integrity of the organization in profound ways.
Strengthening the role and contributions of ethics in Catholic health care organizations is ultimately dependent on the sponsors and on senior leadership, especially the CEO. Unless ethics is valued at the top, it will always struggle to achieve its place and credibility. On the other hand, those doing ethics in the organization — whether a professional ethicist, a mission leader who also does ethics, and/or an ethics committee — must work diligently to gain the respect and the trust of administrators and clinicians. Competency, ongoing efforts at quality improvement and significant contributions to the culture and activities of the organization are essential.
Strengthening the ministry in turbulent times is an opportunity to strengthen ethics in our organizations and to allow it to play the role that it can and should play. A vibrant ethics presence (in the many forms in which that can occur) should greatly contribute to a vibrant ethical culture and, if it is deeply integrated into the very fiber of the organization, will do much to strengthen its Catholic identity and its integrity.
NOTES
- Ron Hamel, "Health Care Ethics: Changes on the Way," Health Progress 89, no. 5 (September-October 2008): 5.
- Sr. Patricia Eck and John Wallenhorst, "The Emerging Role of Ethics: A Sponsorship View," Health Progress 90, no. 2 (March-April 2009): 36. See also Jack Glaser, "The Community of Concern," Health Progress 83, no. 2 (March-April 2002): 17-20.
RON HAMEL, PH.D., is senior director, ethics, Catholic Health Association, St. Louis.