By LISA EISENHAUER
The role of the Catholic bioethicist does not end at sharing theories and reviewing options on ethical conundrums, in the view of the Most Rev. Anthony Fisher, archbishop of Sydney.
Most Rev. Fisher
Archbishop Fisher, who has published extensively on bioethics, moral theology, history, law and spirituality, said Catholic health care ethicists have a duty to use their knowledge of the church's teachings and medical ethics to offer specific guidance to patients, families, professionals and institutions.
"Bioethicists must assist in good health care decision-making and in sound education of professional or institutional consciences, rather than confusing everyone or making them unconfident about the way forward or unconcerned about the ethical implications of their choices," Archbishop Fisher said.
He shared his thoughts during a discussion titled "The Vocation of the Healthcare Ethicist" that closed out the 2021 CHA Theology and Ethics Colloquium on March 10. The one-day event was held virtually.
Archbishop Fisher reviewed the Hippocratic, Jewish and Christian traditions that he said have provided the foundation for the medical profession and shaped modern health care ethics. He pointed out that those traditions are reflected in the most recent version of the "New Charter for Health Care Workers" drafted by the Pontifical Council for Pastoral Assistance to Health Care Workers.
Bioethicists with Catholic health care organizations have a role to play beyond consulting, says Archbishop Anthony Fisher of Sydney.
The responsibilities the charter gives to health care ethicists and hospital ethics committees include covering for deficits in experience and sensitivity, articulating what values and principles are at stake, assisting in resolving conflicts or doubt, and enabling more reasonable clinical decision making.
"Ethicists are wise advisers, teachers and mentors who help form the consciences of health practitioners and managers, always challenging them to do more and better," the archbishop said.
To be effective, he said, bioethicists need appropriate education or apprenticeship as well as conviction about the importance of their service, willingness to immerse themselves in the practice, and readiness to be public advocates for moral decisions.
"If the idea of a medical or nursing profession itself is an ethical notion, then the profession of bioethicist, at least in part, is to support his or her medical colleagues in being faithful to their profession," Archbishop Fisher said. "When patients, relatives, colleagues, insurers or others press the health care worker to act contrary to sound ethics and professional conscience, the ethics advisers can both support them in their resolve and advance education and discussion with those promoting a contrary agenda."
The archbishop sees a spiritual dimension to the role of Catholic bioethicists similar to that of others called to religious life. For the ethicists, he said, their vocation requires them to serve a sort of missionary role in health care institutions, making clear the ethical course that aligns with Catholic teachings.
"Even in the face of such intractable issues as abortion, euthanasia, sterilization, sex change, or vaccine hesitancy, bioethicists can share with people a broader historical, cultural and spiritual vision, and invite them into a conversation that is at once candid about basic norms yet respectful of those who think differently," Archbishop Fisher said.
In concluding his discussion, he noted: "In turbulent times like these, as several CHA ethicists have pointed out, ethicists are critical to preserving the identity and integrity of Catholic health care, in assisting people in dealing with ethically complex matters, in challenging some individual behavior and organizational culture, and in engaging in the ongoing formation of leaders and staff."
Expanding palliative care
In her presentation, Dr. Marie-Charlotte Bouësseau, adviser on integrated health services for the World Health Organization, discussed that organization's push for a global commitment to palliative care. She said WHO estimates that 56.8 million people around the world would benefit from palliative care aimed at preventing and relieving suffering from life-threatening illness but only 12% of that need is met.
The agency is working with partners across the globe to address hurdles to palliative care that include poor access to medication, lack of trained professionals and insufficient national and community support. Palliative care "has to be carefully adapted to the cultural social setting, to the health system and obviously the resources available," Bouësseau said.
She shared a success story from a hospice in Kampala, Uganda, where the staff found a way to manufacture oral morphine to alleviate the misery of some patients. "This is actually changing the lives of hundreds of people in a simple way, in a very cheap way," she said. "I think it's the kind innovation that can come from very vulnerable settings to try to improve the quality of life and serve the dignity of the people."
In another session, Yolonda Wilson, an associate professor in health care ethics at Saint Louis University, explored whether trust on its own is an adequate measure of how well care providers are serving patients.
"In questioning whether trust is enough, I'm acknowledging that trust can and does serve an important function," Wilson said. "In general, trust fosters social cooperation while the absence of trust inhibits it."
However, she said she wonders if more concrete measures – such as how vaccines get distributed — might be better gauges of quality and access to care for minority communities.
"Part of fostering trust is for institutions to show themselves to be trustworthy and it's worth thinking about what steps should be taken in order to achieve this," she said.
Wilson said she sees it as part of the role of bioethicists to facilitate trust between communities and health care institutions. To do that, she said, requires intention and collaboration.
Poet, essayist and funeral director Thomas Lynch wove a commentary on his life as a man of letters with insights on loss, tragedy and the role of ritual in the grieving cycle. He drew on personal losses and his career in the Michigan mortuary business founded by his father. He said he thinks that one lesson from the COVID-19 pandemic has been in reinforcing how essential funeral rites and practices are to assist mourners through their grief.
"I think as Catholic health care workers you should be alert to a generation hobbled and damaged by a pandemic that removed the normal offices of community mourning and public grief from the world, and we'll have to be playing catch up in the best way we can," Lynch said to those attending the colloquium.
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