Ethicist says religious health care directives provide 'marching orders to do good work'

August 15, 2015

By BETSY TAYLOR

When health care providers interview with Bon Secours Health System, a mission leader or ethicist is part of the interview process, discussing the standards of behavior in health care that flow from the church's teachings about human dignity and talking with candidates about the Ethical and Religious Directives for Catholic Health Care Services and the directives' authoritative guidance on several moral issues in Catholic health care.

New employees and care providers receive a copy of the ERDs as well as an overview of the document during their job orientation. But when a clinician or administrator starts at a new health care system, the early days are filled with lots of things to learn and tasks to complete — getting credentialed at the hospital, figuring out its electronic medical record system, meeting new colleagues and getting situated in a new environment.


Stuart

Dr. Kelly Stuart, a neonatologist who remains licensed and practiced in her specialty for 15 years, now works full-time as a health care ethicist for Marriottsville, Md.-based Bon Secours Health System. She knows from her own experience that care providers in a new setting may need to learn more about the ERDs after they settle in to a new position. She spoke with Catholic Health World about how Bon Secours Health System teaches the ERDs and how her experience as a doctor and an ethicist helps shape where and how she reaches out to Bon Secours employees to educate and answer questions about the ERDs.

What level of care providers do you meet with in small group sessions on the ERDs?
We meet with physicians, nurse practitioners, physician assistants, nurses, behavioral health providers, hospital administrators and administrators of physician practices. It allows for a holistic understanding within an organization when leaders, administrators and frontline care providers all know about the ERDs.

With more medical services being provided outside a hospital's walls, do you teach about the ERDs in other care settings too?
Yes. As we know, providers and patients both are in the hospital setting less and less and some of the ethical issues (arise) outside the hospital. So Peter McCourt, vice president of mission for Bon Secours Virginia Health System and mission leader for both Bon Secours St. Mary's Hospital and Bon Secours Medical Group, and I have developed a program we jokingly refer to as "the road show." Other mission leaders participate depending on availability. McCourt and I set specific times to meet with health care providers or administrators at a specific health care location. He'll give an overview of Catholic identity, and I talk about the Ethical and Religious Directives.

We want to raise ethical literacy about health care ethics in general but we also want to raise awareness and familiarity with the Ethical and Religious Directives for Catholic Health Care Services. It's specific to our Catholic identity. The providers who are Catholic, which is not the majority of providers, who understand the Catholic faith from a personal level, (often) don't have an understanding of Catholic moral theology in health care.

What's your approach to instructing providers and executives of all faiths?
The sessions we offer take anywhere from an hour to a half a day. If we want to do a really robust session on the ERDs for health care professionals, it takes about a half a day for a good conversation, a chance go over some cases, encourage dialogue.

We give everybody a hard copy of the ERDs. We don't read all the ERDs together, but we take them section by section. I raise issues where I know we have recently been asked questions and areas of common misperceptions.

If we have a group of obstetricians I might focus much more on the beginning of life. If we have a group of palliative care providers or hospitalists or adult intensivists, I might focus more on the end of life (ethical issues). For a group with organizational leaders, I focus more on partnerships between organizations and ethical considerations.

We have someone in the group read a portion of the ERDs aloud. For each section, we have one case study that we can discuss.

It's not all about solving the case. Very often it's about the process and moral theology and empowering health care professionals to ask questions and approach us because part of the problem with having ERD discussions in a clinical context is that everybody's afraid they're doing something wrong. This isn't a big taboo moment where we're going to say, "Oh, bad you." We're going to say, "Thank you for asking that question and this is how we would approach the question."

Are there aspects of the ERDs that you're most often asked about?
The reproductive questions are always difficult; partly it's because medical language and theological language may use the same words, but the words don't necessarily have the same meaning. The other part of that is that physicians aren't used to talking about intention. They talk about what they do, and what the result is, but they don't really have a framework for talking about intention.

So having a conversation about our intentions and about using precise language about intention and about what we're actually doing and treating is very important. That precise language is so important. If you can really sort through those matters with physicians, they're much more empowered to do their work.

How do you frame discussions about the ERDs' content and intent?
We try not to be absolutist in how we frame the ERDs. Everything is in a context, so we must always hear the story, hear the narrative and then we can consider the context. When you look at the ERDs overall, they should be liberating and empowering to do good work and offer healing and support of vulnerable people and focus on treating the poor and helping providers do the good work that they do. If we approach it really from that perspective, that's an abundance approach, and then the ERDs are empowering and liberating. If we approach the ERDs just as a set of rules and restrictions, then that's less empowering and more intimidating. That's an approach of scarcity. So while I would say the ERDs certainly are a compliance document, we cannot leave that out of this, I would say even more than they are a compliance document, they are our marching orders to do good work.

 

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