Ask the ethicist

What should we think about ethically when we develop clinical forms?

Barbara Russell

When I first started working as an ethics specialist in a hospital and staff would phone me with a question or ask me to join a team meeting and then provided a brief synopsis of the ethics issue, I thought, "This sounds straightforward." As it turned out, the question or concern consistently proved to be anything but. I quickly learned that health care is always ethically complex because people, their lives, our society and our health care institutions are complex. (See my June 2010 column for more about complexity and how to work with it.)

Barbara Russell

 ♪"Sticks and stones may break my bones, but words will never hurt me"♪ is a familiar idiom. It certainly wasn't true during childhood and it's not really true in adulthood. But it's a fitting opener for this blog entry. The type of words I want to examine here are adjectives. More specifically, three adjectives still used in conversations between clients and health care workers or among health care workers. One of them has been critiqued ethically quite a bit; the other two less so.

Barbara Russell

My last column talked about how health care workers deal with situations that are morally distressing or worrisome; how to respond to the situation they face "right now" and how to prevent it from happening again. When someone asks me for ethics-related analysis or advice (I'm starting my ninth year in this kind of work), it's either in the guise of what I call "rescue ethics" or "preventive ethics." Similar to other aspects of health care, prevention is always better: a person or team typically has more options to consider, less adrenalin is released, less sleep is lost, and fewer hasty words are spoken. But daily practice is busy; people change their minds; unexpected events occur, so the urgent or "right now" situations still happen.

Barbara Russell

Does moral action depend on reasoning? Reading this question, posed to several thinkers by the John Templeton Foundation  (its motto is: Supporting science, investing in the big questions), I automatically personalized it: When I act morally, do I first think about what I'm going to do? Or do I just act based on habit or intuition? But wait ... the Templeton question can be interpreted another way: When I act morally, am I using good reasons? And what counts as a good reason anyway?

Barbara Russell

Consider this conversation from the first episode of the popular television show House, M.D.

Foreman (a neurology fellow): "Shouldn't we be speaking to the patient before diagnosing?"

House (the hospital's diagnostic specialist): "Is she a doctor?"

Foreman: "No, but ..."

House: "Everybody lies."

Cameron (an immunology fellow): "Dr. House doesn't like dealing with patients."

Foreman: "Isn't treating patients why we became doctors?"

House: "No, treating illnesses is why we became doctors. Treating patients is what makes most doctors miserable."

Foreman: "So you're trying to eliminate the humanity from the practice of medicine?"

House: "If we don't talk to them, they can't lie to us, and we can't lie to them. Humanity is overrated."

In this new column, Barbara Russell, bioethicist at the Centre for Addiction and Mental Health in Toronto, answers ethics questions that may arise in the mental health and addiction fields. Barbara is connected with the University of Toronto's Joint Centre for Bioethics and heads the neuroethics interest group of the Canadian Bioethics Society. Barbara is also a contributing editor to the Journal of Ethics in Mental Health.

CrossCurrents asked Barbara: "What ethical issues come to mind when you think about stigma and discrimination in mental health and addiction?"