SYDNEY — The coronavirus pandemic has multiplied the number of ethical dilemmas that health care workers, health care systems, governments and individuals face which require the specialized assistance ethicists can provide, Sydney Archbishop Anthony Fisher told the Catholic Health Association of the United States.
But while health care ethicists are more relevant than ever and must be prepared to call out unethical behavior, they also must be wary of risks that can undermine their role such as being “tamed” by the health care institutions who employ them, Archbishop Fisher said in an address delivered via Zoom March 10 to the association’s 2021 Theology and Ethics Colloquium.
Among risks the archbishop identified include the situation that an ethicist “may think, teach and advise from a position so theoretical as to be ill-informed, irrelevant or unintelligible, and the practitioner may pay lip service to professional ethics but in fact be guided by personal preference, professional fashion, civil law, and/or income maximization, and not much more,” he told participants.
“Secondly, there is a danger of individuals or whole institutions outsourcing conscience and moral decision-making to some expert or committee of experts whose ‘job it is’ to deal with ethical matters,” said the archbishop, who holds a doctorate in bioethics from the University of Oxford.
Such a case could lead to several related but distinct risks, he explained, including that the ethicist, who scores higher on “moral reasoning” becomes an “ethical know-all” in the minds of others or in his or her own mind; that patients and families are disabled in favor of the “expert” opinion of the ethicist; and that medical professionals abrogate their personal moral responsibility in the face of vexing issues.
Meanwhile, at the other end of the spectrum, are ethicists who avoid shouldering grave responsibilities and become so vague or evasive as to be unhelpful, he said.
Fisher explained that it is clear from secular, Jewish and Christian traditions that ethical advisers are expected guide choices and action rather than offer grand theories or speculate about a range of options available.
“Bioethicists must assist in good health care decision-making and in sound education of professional or institutional consciences, rather than confusing everyone, making them unconfident about the way forward, or unconcerned about the ethical implications of their choices,” he said.
Being an ethicist requires serious study and training, he advised, cautioning that someone “might gain expertise as a bioethicist by doing a course or conference here and there, but with no serious grounding in one or more of the relevant disciplines of moral philosophy, moral theology, biology, health care or pastoral theology.”
“If people are free to erect a shingle announcing themselves as a health ethicist without serious credentials, individual practitioners may imagine themselves well formed in ethical matters after very little formal study of ethics or formation in the application of ethics to their behavior,” he said.
Fisher identified another danger of which bioethicists and those who seek their advice must be aware: That “consciously or not the ethicist can be ‘tamed’ by their institution.”
“We all want to get along with our comrades at arms in a health care setting; to be a team player, not a naysayer who gets in the way of technical progress, fiscal responsibility or current practice. We don’t want to be branded as a ‘hard-liner’ or a ‘difficult person,'” he said.
“The risk here is that the ethicist’s desire to get along with or within the institution blunts (the) willingness to ask hard questions and press for limits. In such a case, the ethicist loses purpose or, worse, ends up as window-dressing for ethically dubious decisions,” he said.
While aspects of the contemporary West are supportive of sound ethics, there are also pressures to secularize, accommodate and abandon Hippocratic, Jewish and Christian “streams of sound health ethics,” the archbishop warned.
Such pressures will seek to “diminish the senses” of health care workers and their advisers “or to disallow Catholic institutions to be different in some ways,” he said.
“Buzzwords like ‘transparency’, ‘reproductive health,’ ‘separation of church and state’ and more, have been weaponized as have some laws and policies addressing these matters. People are de-platformed, trolled and otherwise treated with ruin if they do not conform,” he said.
However, he continued, ethicists are of fundamental importance to good health care, noting that the Vatican’s new Charter for Health Care Workers characterizes the activity of health care professionals as “guardians and servants of human life, health and dignity.”
“They serve human beings respectfully at their most fragile, thereby contribute to the common good of their community, and give witness to moral norms and the spiritual life,” he said.
In addition, the archbishop added, health ethicists can be instruments of peace in a polarized church and society, or when patients, family members and health care workers have opposing views.
“Even in the face of intractable issues like abortion, euthanasia, sterilization, sex-change or vaccine hesitancy, bioethicists can share with people a broader historical, cultural and spiritual vision and invite them into a conversation that is at once candid about basic norms yet respectful of those who think differently,” he said.