Ethics - Ramping Up Ethics' Role: It Is at the Heart of Health Care Mission

September-October 2011

BY: RON HAMEL, Ph.D.

"Opportunity Now: How Reform Will Advance the Healing Mission." This was the theme of the 2011 Catholic Health Assembly and, indeed, the Affordable Care Act and other initiatives to reform our ailing health care system provide numerous opportunities for furthering and strengthening the mission of Catholic health care. That mission, of course, is to extend God's healing and reconciling presence in the world in imitation of Jesus' life and ministry, thereby promoting God's reign of love and justice. Increasing access to health care for the tens of millions of uninsured and striving to improve the quality of health care will promote human dignity and the common good.

A more equitable distribution of the social good of health care and dealing with inequities in the insurance pool should foster justice. The emphasis on prevention and quality and the elimination of waste and improved care coordination should contribute to better stewardship of resources. Increasing access to health insurance and the expansion of Medicaid should promote concern for the poor and vulnerable.

These are just a few examples. There is much in the new, changing delivery system that supports and promotes Catholic health care as a ministry that seeks to further the reign of God. With the opportunities, however, also come challenges. Some of these challenges result from the Affordable Care Act; others are the result of developments and forces in the health care marketplace.

Forming accountable care organizations, reducing the number of unnecessary hospital readmissions, improving coordination of care will require partnerships with a variety of other-than-Catholic health care entities. Catholic hospitals are being sold to for-profit companies while remaining Catholic. More and more physicians are being employed, including OB-GYNs and urologists.

Thus, chief among the challenges to Catholic health care would seem to be maintaining and strengthening Catholic identity. Vigilance and diligence are required of all in Catholic health care, especially leaders — vigilance regarding how Catholic identity is being affected and diligence regarding measures to strengthen that identity.

One such measure is attending to ethics in our organizations. Carrying out the healing mission of Jesus and thereby advancing the reign of God is a fundamentally ethical endeavor. It requires acting in certain kinds of ways and being persons and organizations with certain characteristics or qualities or virtues.

Ethics by its very nature is concerned with the kinds of persons and organizations we are and become, as well as with what we do. For those in the Catholic-Christian tradition, that means both behavior and identity first reflect a Gospel way of life and then reflect the practices and teachings of the church.

Sadly, some tend to reduce Catholic identity to the observance of a handful of requirements from the Ethical and Religious Directives for Catholic Health Care Services. While the Directives are a critical element of Catholic identity, observing them does not constitute Catholic identity. Catholic identity is much broader and far richer, as being God's healing and reconciling presence in the world and embodying and advancing the reign of God suggest.

Catholic identity also means the fostering of an ethical culture, a culture in which certain values and attitudes prevail, where particular behavioral patterns are regularly exhibited (e.g., respect, compassion, honesty), where decisions are made that reflect the mission and values of Catholic health care generally and of the particular organization, where ethical issues are recognized and addressed.

Leadership is perhaps most responsible for fostering and contributing to an ethical culture. But so are those persons and entities formally charged with responsibility for ethics — ethicists, mission leaders who also wear an ethics hat, and ethics committees — clinical and organizational.

In most Catholic health care organizations, the ethics committee is a primary locus of ethics-related activities (e.g., consultation, advisement, education). Many of these committees are well prepared and function well, but this is not true of all. Given the challenges to Catholic identity in the health care environment for the foreseeable future and the importance of ethics in strengthening Catholic identity, it would seem that attention to the quality of ethics services and programming in our organizations would be of utmost importance as we move into major transitions in health care delivery.

Some suggestions for health care leadership:

  • Affirm the critical role of ethics through example, verbal reinforcement, setting expectations and holding all accountable
  • Provide support and resources for robust ethics services and programming
  • Strengthen the organization's ethics committee, especially through the preparation and ongoing education of members; increase the committee's visibility; and thoroughly integrate the committee with the rest of the organization
  • Broaden the focus of ethics beyond the clinical to include preventive ethics and organizational ethics
  • Educate staff in an ongoing manner in the basics of ethics and a range of ethical issues
  • Employ values-based decision making and an ethical discernment process
  • Educate on the Directives

CHA and Ascension Health have developed a resource — Striving for Excellence in Ethics — to assist in strengthening ethics services and programming in Catholic health care organizations in order to help foster a broad and deep ethical culture. Helpful as it is, however, this resource cannot do it all. Strengthening ethics and, through that, Catholic identity, depends ultimately on the resolve, initiative and collaboration of individuals within organizations. But perhaps the release of Striving for Excellence in Ethics can be an impetus for doubling efforts in the realm of ethics.

There always will be those who criticize Catholic health care and Catholic health care organizations for one ethical shortcoming or other, while failing to consider all that Catholic health care or the particular organization does well. In the face of such criticism, we should be able to say to ourselves and to others that we have been diligent in our efforts to foster a culture that is deeply ethical, that strives to advance the reign of God and be faithful to the teaching of the church.

Implementing new ways of organizing and delivering health care can surely advance the healing mission. But this is not sufficient. Far more is required to ensure that Catholic health care continues and thrives as Catholic health care. Ethics is at the heart of what we do as a ministry of healing. It should be one of the things we do best.

RON HAMEL, Ph.D., is senior director of ethics, Catholic Health Association, St. Louis. Write to him at rhamel@chausa.org.

 

Copyright © 2011 by the Catholic Health Association of the United States
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