BACKGROUND AND CONCEPT
Those who study and do the work of ethics may notice a tension within health care. The signs are everywhere. They are in comments from health care colleagues such as, "things work differently out here in the field," "ethics articles and literature are way too theoretical," and even "the home office doesn't understand the other ministries." Attending to these responses demands active listening, facilitating, and resolving each issue. Using data-driven or reactive-proactive ethics methods, we can treat such comments as being disconnected or as evidence of a deeper wound or tension.
A possibility is that ethics has a town-gown dichotomy or distinction. The Cambridge Advanced Learner's Dictionary & Thesaurus defines town and gown as "the university and the local people of a city, considered together … posed in opposition to one another." In its most pure or absolute form, people at the university or gown, on one side, view those in the town as unable to understand nuance and distinctions, unsophisticated, and undereducated. Those in the town view those in the university as being out-of-touch, too theoretical, and therefore impractical.
Ethics is not the only field to experience this disconnect. Universities and the hard sciences have worked to create alignment between communities and higher education. It is a continuous work in progress involving presence, listening to understand, and adaptive communication. For instance, a tour of a Big Ten university's labs in the early 2000s described the labs' work in terms that only a physicist would understand. The explanation stuck when described in layperson's terms - the labs were trying to develop advanced scanning technology machines and microchips that could detect hazardous chemicals quickly and cheaply. Bottom line, these advancements could save many lives, town and gown.
The ideal state is to treat town and gown as a false dichotomy. Universities' community grants, community relations boards, community partnerships, and institutional research may not blur the lines but create more opportunities for dialogue and interaction. The model of the reclusive academic banished to gothic buildings on the edge of town seems antiquated. Universities along with their faculty and staff members are much more in the town than ever before.
What does this mean for ethics? On the heels of Pope Francis' death, we need to remember his advice and great commission from over a decade ago. He said that the Church must be a field hospital after a battle in America magazine.1 While it's true this pertains to our patients and communities, it also refers to being open to our own collective wisdom, whether in the field or behind a desk. After listening, communication must happen in a way that the person receiving a comment understands it, similar to a clinician assessing and using the knowledge and language of the patient during the informed consent dialogue. Or else, what good is communication? What is the point of talking past one another?
One of our professors once said, "describing nuance matters because ethics is a field of nuance." Former Speaker of the House, Nancy Pelosi combined two moral axioms when she remarked that "the devil and the angels are in the details."2 Perhaps the focus of those with formal ethics education, much less anyone communicating ethics, should be that God is in the process or, as Pope Francis said, the encounter. Communication plays an inherent role in the three-legged stool of clinical ethics - education, case consultation, and policy review.
FORMAT AND CONTENT
This special edition of Health Care Ethics USA addresses various models and modes for transmitting ethics education. While all scholarship (including this) attempts to be pragmatic, this issue does not heavily rely on academic sources, nor does it need to be read cover-to-cover or initial header to final footer in this electronic journal. Readers should find the sections that resonate most with them (virtue ethic approach) or will result in the most good for your organization or ministry (consequence-based ethic approach).
The content's sequence begins with the responses from three universities that were invited to contribute. Universities make tough decisions, both in general and with respect to forming a bioethics curriculum. Imagine having to choose the components of a core curriculum and, if applicable, electives for a certificate, masters, or doctorate program. Would a public health course benefit students more than a family dynamics or counseling course? What about process improvement or strategic planning courses? On the one hand, what education and training would help to feature ethics on the global stage? On the other hand, what would help health care clinicians or ethicists focus on the most vulnerable, whether among us or in our communities?
In this section, professors and students respond to some of these questions. The trend of ethicists going into mission roles is a topic. Over the years, ethics colleagues have shared the reasons for seeking mission roles, including some health systems combining mission and ethics roles into one, mission having "better job security" than ethics, and mission roles are "easier" than ethics roles. A program administrator comments that ethics teaches a skill set that may apply to any number of roles.
While it is true, mission and ethics are separate yet overlapping fields. It takes a special ethicist and skillset to be a Catholic healthcare mission leader (not all ethicists make good mission leaders), just as a mission leader needs special training and skillsets to be an ethicist. The idea that mission and ethics are completely interchangeable skill sets seems grounded in a fundamental misunderstanding of the practice of both fields. We hope that this is just the beginning of a discussion that is too big to happen in this issue and setting.
If ethics theory is a language and practice is another, then ethics practica, fellowships, and internships are the translators between the two. The middle segment begins with a history of COPACET, which will formalize, and hopefully reimburse, ethics internships. It continues with a template for a Catholic health care fellowship curriculum developed by a working group that originated from a CHIEF meeting.
The final section is about methods used to teach clinicians and other health care professionals about ethics. Both curriculum and pedagogy have academic connotations. However, all these terms mean is to have an intentional education plan and method, respectively, which are hardly bad things. The methods here shift traditional curricula and pedagogies for ethics education and dialogue in ways that benefit stakeholders. Articles address coaching as a mode or pedagogy, using behavioral health content in education, and an education plan tailored to clinicians, particularly nurses.
Enjoy and let's make these conversations so that we keep going into the future.
STEVEN SQUIRES, PHD
Director of Ethics
CHRISTUS Health
Irving, Texas
BECKET GREMMELS, PHD
System Vice President, Theology and Ethics
CommonSpirit Health
Dallas-Fort Worth, Texas
ENDNOTES
- Antonio Spadaro, "A Big Heart Open to God: An Interview with Pope Francis," America Magazine, September 30, 2013, https://www.americamagazine.org/faith/2013/09/30/big-heart-open-god-interview-pope-francis/.
- "US Increases Fiscal-Stimulus Offer to $1.8 Trillion to Fight Covid-19: Report," Mint, October 9, 2020, https://www.livemint.com/news/world/us-increases-fiscal-stimulus-offer-to-1-8-trillion-to-fight-covid-19-report-11602260810732.html.