One of my jobs as a healthcare chaplain is to serve on the ethics committee. Hospital ethics committees are designed to be diverse and multidisciplinary; they often provide education about ethical dilemmas that emerge along with the benefits of modern healthcare. Ethics committees also provide consultation in patient situations where differing perspectives, goals of care or ethical principles seem impossible to navigate.
To begin our monthly meetings I facilitate a centering moment. Recently I took a kaleidoscope to pass around in ‘show and see for yourself’ fashion. It is beautifully handcrafted from glass cylinders and mirrors with its own display holder and three large colorful marbles which are designed to be individually inserted and turned while viewing toward the light. While fun, this kaleidoscope invites curiosity and inquiry; it requires an intentional relationship with the marble to see and know the fuller potential and possibilities.
I invite the committee to consider an ethics consult like looking through a kaleidoscope. Turning the marble in every direction into the light, our role is to intentionally and carefully come to know the patient situation and to respect the complex, multi-dimensional and ever-changing plot lines in the patient’s life and family dynamics.
Simultaneously, we are to be aware of and compassionate with that same complexity in our own lives. Just as our patients are not, we are not static, monochrome entities separate from our work and practice. And, when turning the marble, it takes little to see where layers of structural injustice in our society inform the ethical dilemma for everyone.
Ethics consults are often submitted when the patient/family and care team members are stuck, trying to navigate one version of reality or another. But looking through the kaleidoscope there are many versions of reality.
It is hard in healthcare delivery systems to build relationships where time and dollars are sadly always in competition. It is like trying to go to a family reunion in 15 minutes and to really learn what is important. In the time it takes to eat a deviled egg, the next patient is waiting to be seen by the provider.
While healthcare is shifting with new emphasis on narrative medicine, compassionate care and that oddly now-used phrase ‘Patient/family Centered Care,’ it is easy to talk over one another, to miss the kaleidoscopic dance of human encounter in the chaotic course of a hospitalization.
Note: I smile at the irony of the phrase ‘Patient Centered Care.’ Who were we treating before it came along? But we really do know, don’t we? ‘Medication and Intervention Centered Care’ was directed at a person like a scud missile, whether that fit the values, the spiritual practices and definition of hope for a patient/family or not.
I invite committee members to consider a patient they would see that day, to set an intention for them as they look through the kaleidoscope. And as is life, despite our best efforts several dropped their marble.
It is hard. Yet we keep looking, picking up our chipped marbles and lives because each intentional encounter with the other is an encounter with the Holy.
**See the Association of Professional Chaplains Guidelines for the Chaplain's Role in Health Care Ethics (http://www.professionalchaplai...
Liz Harris-Lamkin is an Alliance-endorsed chaplain and a member of the endorsing council. She is based in Atlanta, Ga.