Supporting complex decision-making in the community

People will have a new place to turn for guidance and support when they are faced with difficult decisions and ethical concerns, thanks to the expansion of Covenant Health’s Ethics and Discernment Centre.

The centre officially launched its online resources to benefit Covenant, along with other Catholic organizations in Canada and around the world, on March 22. That same day was the opening day of its first public conference.

Covenant’s team has been supporting ethical inquiries and decision-making for years, but the expansion means it can formally provide expertise for people outside Covenant Health, says Dr. Gordon Self, chief mission and ethics officer, who sponsors the centre’s work.

“Covenant Health has vast clinical and healthcare experience that we use when we reflect on issues,” says Gordon. While Canadian ethics institutes that provide academic perspectives already exist, there haven’t been many Catholic public healthcare organizations providing that much-needed integrated support. You need both an academic centre and a clinical and operational centre, Gordon says.

“Good ethical discernment and ethical reflection are based on good facts, so you need the scholarly discipline that an academic centre brings. But context is also important, especially the clinical and operational realities in health care, where we encounter the real ethical dilemmas of people’s lives. This is the ‘coal face,’ as they say. What we don’t need is lofty debates about how many angels are dancing on a pin,” says Gordon.

“Rather, we are helping to make the best and most meaningful clinical decision together with a patient and their family as they discern their goals of care.”

Covenant’s ethics team has served as a leader in this area and has been consulted nationally, even internationally, regarding its innovative ethics and discernment practices. For example, prior to the introduction of voluntary assisted dying (VAD) in Australia, Catholic healthcare representatives came to Canada to consult with Covenant about how it prepared for and responded to Canada’s medical assistance in dying (MAID) legislation. It’s one of the relationships that the centre has forged over the years where it shares resources and information.

Making supports available to other organizations around the world is one reason Covenant Health was recently recognized again by Ethisphere® as one of the World’s Most Ethical Companies®.

Accreditation Canada, a not-for-profit, independent organization that conducts continual quality assessments of healthcare organizations, also recognized Covenant for its leading practice in mission discernment. This was largely due to the development of a mission discernment tool, which is a values-based process for making difficult organizational decisions.

The tool has contributed to thoughtful and ethically balanced approaches to such issues as harm reduction, preferential access, co-gender room assignments, use of cameras in the clinical setting and resource allocation.

What is discernment?

By definition, discernment is the “ability to judge well,” and it’s so engrained at Covenant Health that it made sense to include it in the expanded centre’s name, says Gordon. “Discernment has become part of our very vocabulary that distinguishes Covenant from other Catholic healthcare organizations,” he adds.

It’s why discernment is not the sole domain of clinical ethicists.

“Any healthcare worker might discern options. They bring the best of their gifts to the conversation. They bring their experience, their clinical background, their expertise, their intuition. Discernment is the tradition around making good decisions,” says Gordon. “The complex decisions we often face require depth and critical analysis, informed by our ethical, moral and theological tradition.”

These complex decisions tend to involve controversial issues, things like early induction of labour, sexuality and intimacy in residential care and patient requests for specific gender providers.

At Covenant, discernment is part of a preventative ethics strategy to put in more work upfront to make the right decisions that align with its mission, vision, values and commitment to providing quality and compassionate care.

“We’re trying to prevent moral residue,” says Gordon. Moral residue is what is left after we’re forced to do something against our values. During the pandemic, things like having to enforce public health visitation guidelines could cause internal conflict.

The practicality of discernment is its use in the development of policies and processes. It helps people know they’re making informed decisions.

While the decisions that come out of a discernment process are unlikely to satisfy all parties, they demonstrate a truly thoughtful approach to complex issues. Having done the work and being able to show the thought process can help others feel better about the outcomes of such difficult decisions or at least understand the rationale for these decisions.

Ethics and diversity

The centre’s first public conference, a four-part series titled Ethics and Diversity in the Pursuit of Belonging, was designed to cover a broad range of important topics. Conference sessions include “Claims, Bias and Tensions Concerning Human Dignity in Catholic Health Care” and “Confronting Racism in Communities of Care.”

“We chose a diversity and inclusion theme for the conference because there really is a relationship between ethics and diversity. Diversity is not just about differences in race, colour or language. It’s also about diverse opinions and viewpoints,” says Gordon.

The need to combat racism also falls under the work done by the centre, says Gordon.

Other issues he expects to examine this year include equity, population health and psychological safety, especially in support of LGBTQ2S+ patients, residents and staff, as well as our ethical commitments around end-of-life care, seniors and those with addiction and mental health concerns.

“It really goes back to Pope Francis. He called us to go to the margins,” says Gordon. “He likens the church as the field hospital. So we meet people where they’re at. We’re called to go to those difficult places that invoke vulnerability.”

The centre is looking forward to its expanded role.

“We’ve always shared our learnings with people when they want us to,” says Gordon. “But now we’re signaling, in a sense, that we’re open. If you’re troubled by something, we invite you to consider reaching out to us at Covenant’s Ethics and Discernment Centre.”

For more information about the centre, please visit covenanthealth.ca/ethics-centre.