Conscientious objection and referral: words, principles and compromise.October 19, 2016
“Brain Death” and discontinuing “treatment.”November 7, 2016
Compassion is a virtue much touted in health care. Many organizations and individuals would claim compassion as one of their key values. Good thing too – compassion is the sympathetic feeling of another’s pain and suffering. Compassion requires us to put ourselves in another’s position and to see and feel the world as he or she does. Compassion requires us to see others as persons and to treat them accordingly. But what happens when compassion runs into conflict with other, deeply held, values?
What does an organization – or an individual, do then?
For organizations, “accountability, or stewardship” have always been values in potential conflict with compassion. Accountability and stewardship are values of fairness, and resource management for organizations. A health care organization ought to make the most efficient use of its resources as possible. (“Efficient,” of course, is a loaded term, and might mean a variety of things, but at its heart is something like getting the best health care results possible for the available resources.) But accountability and stewardship require declining to do certain things or provide certain services. Stewardship and accountability require saying no to patient or community requests that, for example, have a low probability of success, or that bring minimal improvements to health and well-being. But that, of course, may well mean saying no to someone, begging for hope, a person in the extremity of his or her need, to whom one’s heart goes out in compassion. What should the “good” administrator or organization do?
Medical Aid in Dying (MAID) poses a new challenge in compassion for both organizations – and individuals. It is clear, that for many people seeking MAID this is a last desperate request for an end to intolerable suffering. From the perspective of the person concerned his or her suffering is intolerable and cannot be relieved by any method that person him or herself can accept. For such a person death may be the choice as the “least worst” option. Anyone in such a situation demands our compassion. But what happens if that demand on compassion conflicts with, for instance, the religious beliefs of the faith-based, health care organization, or an organization’s foundational professional commitments (some understandings of hospice-based palliative care)? Is it compassionate to transfer a dying patient out of a faith-based hospital, or out of a Hospice, to receive medical aid in dying at another facility?
The same moral dilemma exists for individuals. While a person’s personal and professional moral or ethical commitments may well have assumed “Do no harm,” Medical Aid in Dying poses a compassionate challenge to exactly what is meant by “harm.” The patient seeking Medical Aid In Dying is asking us to understand that from his or her perspective it is continued life that is the harm, and death is the compassionately granted relief.
As usual, there is not an answer here – just another example of the complexity of our moral lives.