Listening to the Whispers: Re-thinking Ethics in Healthcare

Introduction

Introduction christine s. dinkins and jeanne m. sorrell Ethics is a pause to wonder, to question, to step back, to notice. And this teacher . . . did that through her being open to the angst that the silence brought, through a willingness to let it sit, through a knowingness that ethics are Always, and necessarily, inhabited by silence. This is what I saw. This is my participant observation. Nancy J. Moules, March 5, 2004 This fifth volume of the Series on Interpretive Studies in Healthcare and the Human Sciences gives voice to scholars in philosophy, medical anthropology , physical therapy, and nursing, gathering together each scholar’s understandings of ethics in his or her own discipline. The studies contained herein reflect different interpretive methodologies to help us rethink ethics in the context of today’s healthcare system. The diverse voices of these authors encourage us to enlarge the circle of our ethical concerns , step back from the pressures of our personal and professional lives, and take time to notice, to question, and to wonder. Contained in these essays, too, are stories told by voices often unheard, alongside silences that provide an eternal challenge to the understanding of ethics. The story of ethics in this volume opens with a poem, A Whispered Story, which came forth as an intuitive response from Nancy Moules, a 3 reviewer of one of the manuscripts for the volume. During the period of time Nancy was reviewing the manuscript, she was also teaching a qualitative research class. Brenda Paton, a guest for her class, presented a research ethical dilemma, paused, and then invited the class into a discussion of pauses as ethics. It created a wonderful discussion with the students, and Nancy felt called to write about it. She read her writing to the class, and one person suggested that it was an invitation to hermeneutics . Thus, it is presented here also as an invitation to hermeneutics. The poem invites us to listen to the essays in the volume, reminding us that we can listen best in the pauses and silences of ethics. The poem beckons us on as participant observers to five diverse studies of ethics. The first essay, by Tobie Olsan, opens up for the reader some of the central problems facing healthcare today, particularly in the context of corporatization and a managed care environment. “Corporatization and the Institutional Aspects of Morality in Home Care,” an ethnographic study, uncovers and unconceals the moral problems experienced by a group of community health nurses at one home care agency. Expressions of personhood can raise individual and group consciousness about changing contexts in healthcare and the significance of new circumstances. To understand how to improve the whole institution, we must listen to the individuals within it, even those who at first may be difficult to hear. Giving these persons a voice in home care policy reform is essential in addressing the moral problems created by corporate healthcare. The second essay, “Ethics of Articulation: Constituting Organizational Identity in One Catholic Hospital,” may offer a possible solution to the problems uncovered in Olsan’s study. Simon Lee’s ethnographic study brings us an inside out picture of how values in a Catholic hospital system guide the functions of the organization. The historical overview of the women religious in healthcare provides a valuable description of their unique contribution. The study juxtaposes business and religious values and considers the question of “no margin, no mission,” observing that while it may be the margin that makes the mission possible, the mission makes the margin necessary. Findings of the study demonstrate that even in a Catholic hospital system, dominant conversations contain silences, and the social practice of ethics is inherently political. The re-thinking of ethics requires that ethical spaces be created in healthcare organizations to articulate their values and sustain themselves as ethico-political entities in today’s managed care environment. 4 introduction Given the problems and concerns revealed in the first two essays, John Paul Slosar’s “Teleology, the Modern Moral Dichotomy, and Postmodern Bioethics in the 21st Century” offers a possible philosophical framework with which to approach these problems. Slosar looks between and beyond traditional categories of ethics to recover the approach of the ancients, primarily Aristotle, for contemporary healthcare. The dominant paradigms in modern ethics are inadequate for guiding moral decisions in the face of the complexities of 21st-century healthcare, and they are also troubling simply...