[As written/circulated 2008-09 for the Barnes-Jewish Hospital Ethics Committee members]
We make frequent use of the words ‘consider’ and ‘consideration’. Many etymologists think these words had their origin in a marvelously engaging Latin combination that means to gaze at the stars. Thus, to consider is to look intently at, to think carefully about, to pay attention to, to regard with respect.
I have the opportunity to round in various patient care settings two or three weeks of most months. I always take copious notes as I move with the medical team from patient to patient. It hardly ever fails that members of the medical team -- perhaps a resident, or a nurse, or a medical student, or . . . -- will pull me aside at some point to ask, “What are you writing down? What are you hearing?” I will often answer – “I am listening to how you and your colleagues are talking about the experience of caring for the patient. Not so much what you eventually write in the chart. But the discourse that includes your adjectives, your adverbs, your emotions, your metaphors, your narratives, your whispered exchanges, your humor, your editorial comments. That discourse -- not the note in the chart -- reveals far more completely what you and your colleagues consider important enough to influence what you think should be done in caring for the patient.”
So a few months ago, I created for didactic sessions the two-part exercise below. The exercise begins by asking the caregiver/s to imagine being in the middle of a busy day with a complicated/difficult patient. The first part of the exercise then introduces in clinically relevant wording several theories of ethics, with each one accompanied by a ‘marginal to ultimate’ scale of weight/importance. The second part of the exercise introduces several other considerations I routinely detect on rounds. The considerations introduced in the second part of the exercise are rarely addressed in textbooks or courses about ethics (including biomedical ethics). These considerations nonetheless often deeply influence the judgments medical team members make about what should be done in caring for a patient.
It is vitally important to encourage conflicted parties to cling to the ‘well-intended’ assumption about each other as long as possible and only surrender the assumption after careful/thorough examination produces overwhelming evidence to the contrary.
“Why do well-intended individuals come to different conclusions about what ought to be done?”Reworded for application to the patient care setting – “What might well-intentioned patients, family members, medical team members, administrative personnel, et al be considering when they disagree about what should be done in a patient’s care?” The ‘all things considered’ phrase in the previous post's definition of ‘ethics’ provides a way into the question. One reason well-intentioned individuals come to different judgments about what should be done in a situation has to do with what they are considering -- i.e., they may be considering quite different aspects of the situation and/or they may be assigning different weight, priority, value to considerations they share in common.
We make frequent use of the words ‘consider’ and ‘consideration’. Many etymologists think these words had their origin in a marvelously engaging Latin combination that means to gaze at the stars. Thus, to consider is to look intently at, to think carefully about, to pay attention to, to regard with respect.
I have the opportunity to round in various patient care settings two or three weeks of most months. I always take copious notes as I move with the medical team from patient to patient. It hardly ever fails that members of the medical team -- perhaps a resident, or a nurse, or a medical student, or . . . -- will pull me aside at some point to ask, “What are you writing down? What are you hearing?” I will often answer – “I am listening to how you and your colleagues are talking about the experience of caring for the patient. Not so much what you eventually write in the chart. But the discourse that includes your adjectives, your adverbs, your emotions, your metaphors, your narratives, your whispered exchanges, your humor, your editorial comments. That discourse -- not the note in the chart -- reveals far more completely what you and your colleagues consider important enough to influence what you think should be done in caring for the patient.”
So a few months ago, I created for didactic sessions the two-part exercise below. The exercise begins by asking the caregiver/s to imagine being in the middle of a busy day with a complicated/difficult patient. The first part of the exercise then introduces in clinically relevant wording several theories of ethics, with each one accompanied by a ‘marginal to ultimate’ scale of weight/importance. The second part of the exercise introduces several other considerations I routinely detect on rounds. The considerations introduced in the second part of the exercise are rarely addressed in textbooks or courses about ethics (including biomedical ethics). These considerations nonetheless often deeply influence the judgments medical team members make about what should be done in caring for a patient.
It is vitally important to encourage conflicted parties to cling to the ‘well-intended’ assumption about each other as long as possible and only surrender the assumption after careful/thorough examination produces overwhelming evidence to the contrary.
