[As written/circulated 2008-09 for the Barnes-Jewish Hospital Ethics Committee members]
I remember being mesmerized watching a lineman strap heavy spikes around his work boots and loop a long leather belt around the utility pole before buckling it to his waist work belt that was full of tools. I had to crane my neck upward as I watched the workman ‘walk’ up the utility pole to his work station. I stood in amazement as the workman turned loose of the pole and leaned away from the pole. Each time my father patiently explained the workman’s counter-intuitive actions based on trust that the long leather belt wrapped around the pole would hold.
The basic tool I use when analyzing the ethical dimensions of patient care proposes four answers to the question – “What does the hospital invite patients and families to trust about you and your co-workers?”
Each answer puts into everyday and clinically familiar language one of the four standards of medical ethics -- i.e., non-maleficence, beneficence, autonomy, and justice. When those involved in a patient’s care are able to follow through on these four intentions in a balanced/integrated way, the ethical dimensions of the patient’s care are sound. And the caregivers’ comments indicate they have experienced what brought them into the medical profession. For cases in which the ethical dimensions of care are deteriorating, I use this basic tool as a starting point for determining which one or combination of the four intentions has failed to such a degree that respect has given way to loss of confidence, suspicion, adversarial defensiveness.
Re this tool’s four concentric circles –
The root meaning of ‘intention’ is ‘to stretch or reach toward’. ‘Intention’ is used here in place of the more common ‘principle’ due to the reservation clinicians often have about ‘principle’ (e.g., “the word ‘principle’ is cold, mathematical – like a geometry axiom” or “the word ‘principle’ is easy to stay detached from” or “the word ‘principle’ is abstract”).
The focus is ‘patient/s’ and ‘families’ (pl). Caregivers appropriately take into account their other patients as they attend to any one patient.
‘Professional’ is in single quotes to indicate this subject should not be equated with ‘code/s of ethics’. To profess is to acknowledge openly before others (L., pro + fateri). For the care of patients to be a ‘profession’, caregivers use their base of knowledge and technical skills for the stated purpose of delivering healthcare services that contribute to the public’s well-being.
Those involved in a patient’s healthcare make ‘professional’ and ‘code/s of ethics’ commitments to the public as well as to their peers. These commitments should function as filters or lenses that orient caregivers toward alignment with the intentions patients and their families are invited to expect/trust when in their care.
Walking into the hospital in professional dress and with professional identification is an invitation to patients and their families to expect that we will be respectful/altruistic toward them. This professional dress and accompanying identification fit some of us more naturally/easily than they do for others of us. Self-care must not be ignored. Authentic interest in others’ well-being is an exhaustible disposition.
“What do we invite patients and families to trust?”Do you have an experience or event that helps you visualize the concept ‘trust’? Mine is from childhood back in the late 1950s and early 1960s when I would accompany my father -- a Western Kentucky group manager for the phone company -- to work sites where linemen would be repairing, upgrading, or expanding the phone lines.
I remember being mesmerized watching a lineman strap heavy spikes around his work boots and loop a long leather belt around the utility pole before buckling it to his waist work belt that was full of tools. I had to crane my neck upward as I watched the workman ‘walk’ up the utility pole to his work station. I stood in amazement as the workman turned loose of the pole and leaned away from the pole. Each time my father patiently explained the workman’s counter-intuitive actions based on trust that the long leather belt wrapped around the pole would hold.
The basic tool I use when analyzing the ethical dimensions of patient care proposes four answers to the question – “What does the hospital invite patients and families to trust about you and your co-workers?”
Each answer puts into everyday and clinically familiar language one of the four standards of medical ethics -- i.e., non-maleficence, beneficence, autonomy, and justice. When those involved in a patient’s care are able to follow through on these four intentions in a balanced/integrated way, the ethical dimensions of the patient’s care are sound. And the caregivers’ comments indicate they have experienced what brought them into the medical profession. For cases in which the ethical dimensions of care are deteriorating, I use this basic tool as a starting point for determining which one or combination of the four intentions has failed to such a degree that respect has given way to loss of confidence, suspicion, adversarial defensiveness.
Re this tool’s four concentric circles –
The root meaning of ‘intention’ is ‘to stretch or reach toward’. ‘Intention’ is used here in place of the more common ‘principle’ due to the reservation clinicians often have about ‘principle’ (e.g., “the word ‘principle’ is cold, mathematical – like a geometry axiom” or “the word ‘principle’ is easy to stay detached from” or “the word ‘principle’ is abstract”).
The focus is ‘patient/s’ and ‘families’ (pl). Caregivers appropriately take into account their other patients as they attend to any one patient.
‘Professional’ is in single quotes to indicate this subject should not be equated with ‘code/s of ethics’. To profess is to acknowledge openly before others (L., pro + fateri). For the care of patients to be a ‘profession’, caregivers use their base of knowledge and technical skills for the stated purpose of delivering healthcare services that contribute to the public’s well-being.
Those involved in a patient’s healthcare make ‘professional’ and ‘code/s of ethics’ commitments to the public as well as to their peers. These commitments should function as filters or lenses that orient caregivers toward alignment with the intentions patients and their families are invited to expect/trust when in their care.
Walking into the hospital in professional dress and with professional identification is an invitation to patients and their families to expect that we will be respectful/altruistic toward them. This professional dress and accompanying identification fit some of us more naturally/easily than they do for others of us. Self-care must not be ignored. Authentic interest in others’ well-being is an exhaustible disposition.
