Volume 1, Issue 05 - July 1998

A Bio-Ethics Committee Experiences Adolescence

Guest Writer Profile:
Ray Biggs, BA, BSW.

This month we are very pleased to have as our guest writer, Ray Biggs, BA, BSW.

Ray was born and raised in Victoria, BC. He graduated from the University of Victoria, with degrees in Arts and Social Work, and a passion for salmon fishing. The UVic program emphasized practice in Northern communities and this brought him to the Queen Elizabeth II Hospital in Grande Prairie.

Ray has been employed as a social worker here since August of 1993, working mainly in ICU and Acute Care Medical Units. In 1996, while continuing half-time at QE II Hospital, Ray accepted half-time responsibilities with the C.A.R.E. Program in NW Alberta. (Consultation & Assessment Resource for the Elderly).

Ray's interest in health ethics stems from his work in mental health, particularly with older adults. Ray has been an active member of The Mistahia Health Region Bio-Ethics Committee since 1996 .

"All this Bio-Ethics Committee ever does," laments a parting member, "is set a date for the next meeting."

The current agenda for the Mistahia Health Region Bio-Ethics Committee features a lengthy discussion on its future direction, on its reason for existence. It is not a new topic. Having three of our members recently attend the Provincial Health Ethics Network (PHEN) Annual General Meeting featuring the "Role of Ethics Committees in Health Care", there is relief to know that we are developmentally on track, pimples and all. We are eager to do what more mature committees have taken years to learn. We endeavor to apply an ethics framework to decision-making processes that appear by many to be arbitrarily set.

This past year of our committee's relatively young history has been shaped by PHEN's input in the areas of, among many others: (1) identifying a framework for discussion ethical issues; (2) respecting diversity of values; and (3) clarifying a future direction.

Identifying a Framework

Prior to PHEN's 1997 conference in Red Deer, we were frustrated in our efforts at giving structure to reviewing case studies generated for our own education. We were easily bogged down by the complexity of issues vying for attention. Learning about the "four-box method" has provided us with a way to map out the fundamental tenets of ethics in reviewing clinical cases.

At the macro level, we arrange to have PHEN's Module 6 - "Corporate Ethics in Allocating Healthcare Resources" - presented to physicians, Mistahia Board Members, the Budget Advisory and Bio-Ethics Committees. This highlights the year's activities. Perhaps the presence of food - the great social glue - relaxes people and they talk. Following Mr. Bashir Jiwani's overview of ethics principles, we try out the decision-making framework presented. Several small groups representing diverse backgrounds wrestle with satisfying competing budget demands with limited funds. We are to identify and defend ethical principles we select in reaching a decision, a decision to be reached by consensus. For many, it is the first time recognizing that every decision made in health care in essentially an ethical one. Differences of opinion are based not along professional, organizational or even political lines, but upon various ethical perspectives. Effort is required in understanding each other's values.

Respecting Value Diversity

Values. Elusive, difficult to articulate, easy to overlook. The very genesis of our committee, for example, imposes a value set on our activities. It is the Regional Health Authority (RHA) Board that provides our funding and administrative support. Legitimacy is therefore conferred, however, value assumptions risk being blurred. A constituent suspects that the committee serves only a cosmetic function for accreditation purposes. Others are reluctant to participate because they may feel their opinions bear no consequence or do not pertain to the grander issues.

Opinions do matter, value differences strengthen. This is a significant realization for many at the resource allocation workshop who previously have never (a) participated in an ethics discussion or (b) talked to others in their group beyond conventional parameters. As a social worker, it is invigorating to talk to a physiotherapist, board member, and internist to discover the scope of values we have in common and to listen to and respect each other's perspectives. Some express astonishment at hearing values they assume are incongruent with the participant's role. We need ongoing practice in clarifying our values.

As a committee, we continually strive for inclusive, representative membership. Increasing the frequency of meeting times from bi-monthly to monthly is viewed by some as imperative in generating trust and maintaining momentum. We are introduced to the language of unconditional positive regard, empathetic understanding, respect.

Clarifying Future Direction

So where are we heading? Opinions range from "Why bother?" to, "Let's set up a clinical consultation sub-committee." None of us is an expert in health ethics. Some have benefited from participating in PHEN-sponsored events and recognize that changes in health care demand our attention and serious study of ethics. We have been learning, but like some teenagers, we are not yet cognizant of some of the questions worth asking.

This past year we tried to elicit actual ethical concerns or case studies for the committee to review. The response was not overwhelming. This suggests that greater effort needs to be channeled towards educating health care stakeholders on what ethics is and is not, and how to apply ethical theories to decision-making and practice.

We need ongoing practice in clarifying our values.

Another issue. We call ourselves a regional committee, but there is no one attending from outside of Grande Prairie. From the perspective of a sparsely populated and geographically expansive RHA, resource allocation is, and will always be, a contentious issue in the context of discriminatory funding by population formulae. How can we best satisfy competing demands of maintaining viable secondary services in Grande Prairie while preserving accessibility to health services for all Mistahia residents? We believe continued orientation to basic ethical principles in a non-threatening manner to be foundational. Based on the success of Bashir's presentation, we are planning to present the workshop again to as many as possible - this time, before budget preparation for 1999/2000 begins.

Over the summer, we will be considering whether to remain focused on education, or to take on more of a clinical consultation role. We value the resource that PHEN has been to us and are thankful for this opportunity to communicate with our RHA counterparts. Your comments are welcomed.

The next meeting date has already been scheduled.


PHEN's Latest Venture

PHEN is in the process of making contact with daily and weekly newspapers across the province to set up an arrangement whereby Network members would regularly submit timely and relevant articles on ethical issues in health care. Most of the newspapers are particularly interested in articles written by local residents.

Suggestions for topics include: Ethical Aspects of Compensation for Hepatitis C Victims; Personal Directives; Confidentiality and Freedom of Information in Health Care; When Provider & Patient Disagree: Making Resource Allocation Decisions at the Bedside; Publicly-Funded Catholic Hospitals & "Family Planning": Who Decides?

Some of the newspapers that have expressed interest to date include: The Calgary Herald; The Edmonton Journal; The Banff Crag and Canyon; The Lethbridge Herald; The Canmore Leader; The Medicine Hat News; and The Red Deer Advocate.

If you are interested in writing an article, and particularly if you know a reporter/editor at a local paper, please contact the PHEN office closest to you.


Announcements

  • On June 22 and 24, PHEN hosted discussion groups on the topic of the Draft Joint Statement on Resolving Ethical Conflicts Between Health Care Providers and Persons Receiving Care, jointly authored by the Canadian Healthcare Association (CHA), Canadian Medical Association (CMA), Canadian Nurses Association (CNA) and Catholic Health Association of Canada. Comments from these sessions were compiled and sent to the CHA and CMA in the form of a discussion paper. If you wish to receive a copy of the PHEN submission (by fax or mail) please call Colette Mooney at the PHEN office in Edmonton. The document will also be available soon at our website.

  • PHEN's website (www.phen.ab.ca) has a new look! Jai Shah, a summer research assistant with the Network, is working on updating and expanding the site. Look for a new, comprehensive section on personal directives, as well as summaries of health ethics issues in the news, in the near future.

  • Correctional Services of Canada, in partnership with the Alberta Association of Registered Social Workers, Occupational and Environmental Health Services and University of Alberta Hospitals, is hosting a two-day workshop entitled, "Ethics for Human Service Providers: An Interagency Symposium." The keynote speaker for the event will be Philip Smith-Eivemark. The workshop is being held on September 24 and 25, 1998 at the Sheraton Grande Hotel in Edmonton. For information or to register for the conference, please contact Vicky Worrel at (403) 472-4921.

  • The 10th Annual Canadian Bioethics Society Meeting will be held in Toronto, Canada on October 15th-18th, 1998. The conference is hosted by the University of Toronto Joint Centre for Bioethics. Confirmed plenary speakers include James Childress, John Lantos, Robert Levine, Laura Purdy, and Judith Wilson Ross. For more information please contact (416) 478-1906 or see the CBS website at www.bioethics.ca.

  • The next application deadlines for PHEN's user fund are September 1 and November 15, 1998. Application forms can be obtained from either PHEN office.

  • A reminder that this space can be made available to advertise your upcoming event.

Views offered in this article are those of the author and do not necessarily reflect the position of the Provincial Health Ethics Network.