Gerry Martin, Gerry Martin, Jaro Kotalik Jaro Kotalik Centre for Health Care Ethics Centre for Health Care Ethics Lakehead University Lakehead University September 25, 2013 September 25, 2013
Outline 1. Scenario: How to respond to a medication error JK 2. Seeking guidance: Gifts of Seven Grandfathers GM 3. Seeking guidance: virtue ethics JK 4. What about the scenario? GM, JK 5. Examining common ground JK, GM 6. Where do we go from here ? Aboriginal health care ethics? JK, GM
A fictional scenario 1 Sandy and Amy are assigned the same nursing shift. Tonight they discovered a problem: Magda, a senior nurse who worked the earlier shift, accidentally gave a double dose of medication to a patient, Mrs. White • Magda is a union representative dealing with a grievance involving both Sandy and Amy. • Mrs. White is well and not aware of the error.
A fictional scenario 2 • Amy and Sandy have to decide what is to be done about the error- report the incident ? do nothing ? or.... ? • They agreed that each of them will spend their coffee break thinking about this situation and they will meet and decide together what to do at the end of the shift. WHAT GUIDANCE COULD BE GIVEN TO THEM?
Bawdwaywidun, or Edward Benton- Banai, is an Ojibway- Anishinabe of the Fish Clan from the Lac Courte Oreilles Reservation in Wisconsin. A strong advocate for culture-based education and the relearning of our sacred Anishinabemowin language,
The Teaching of the Seven Grandfathers One story in the oral tradition of Anishnaabe (Ojibway) People Incorporated by Edward Benton-Banai into his 1988 “The Mishomis Book” Accepted among Great Lakes tribes & throughout the continent 7.7 million hits on Google
Mnaadendmowin -To honour all the creation is to have RESPECT
Zaagidwin To know LOVE is to know peace
Aakdehewin - BRAVERY is to face the foe with integrity
Gwekwaadziwin - HONESTY in facing a situation is to be brave
Dbaadendiziwin- HUMILITY is to know yourself as a sacred part of the creation.
Debwewin- TRUTH is to know all of these things
Nbwaakaawin - To cherish knowledge is to know WISDOM .
Guidance of health care ethics Usually is based on Ethical principles Rules Obligations Rights Alternative approach is to concentrate on moral character and moral virtues
Virtues Virtues are habits of thoughts, expressions and actions which are considered morally good and desirable Acquired human quality the possession and exercise of which unable us to achieve those goods which are internal to a practice ( e.g. achieve objectives of health care)
Virtue Ethics Approach Moral question not “what to do”, but “what kind of person should I be” Emphasis on motivation Acknowledging role of emotions Emphasis on social nature of morality Emphasis on character development through moral education (D. CAMPBELL, 2012)
Virtues Historically the oldest approach to decide how what is ethical/moral ( Homer, Plato, Aristotle, New Testament, Jane Austin, Benjamin Franklin, Alasdair MacIntyre) Many lists of virtues were offered: Temperance, prudence, courage, justice Love, faith, hope Filial piety, humanity Rectitude, courage, benevolence, respect, honesty, honor, loyalty
Back to our fictional scenario Sandy and Amy are assigned the same nursing shift Tonight they discovered a problem: Magda, a senior nurse who worked before them, accidentally gave a double dose of medication to Mrs. White, • Magda is a union representative dealing with a grievance involving both Sandy and Amy. • Mrs. White is well •Amy and Sandy have to decide what is to be done about the overdose, whether to report the incident or do nothing • They agreed that each of them will spend their coffee break thinking about this situation and they will decide together what to do at the end of the shift.
Sandy is a member of a First Nation Sandy’s grandfather is an elder • He has talked to Sandy many times about “the • teachings of the seven grandfathers”: respect, love, courage, honesty, humility, truth, wisdom Sandy decided that she will rely on this wisdom to • guide her.
Sandy is thinking about the incident It would not be wise, to do nothing- a next error could really harm a patient. I love may friend Amy but I also should love Magda and she deserve my respect. I guess that I will have to be brave and honest and talk to Magda, giving her a chance to report the error or I will have to report it myself. I have to do that with humility, this could happened to myself, everyone can make a mistake. But the truth has to come out
Amy recently attended an ethics education session on virtues • Amy previously studied principles and codes of ethics • She found thinking about virtues as guidance to ethical decision-making refreshing and worth trying and it reminded her of a teacher, her role model
Amy’s list: Health Care Virtues Honesty Integrity Discernment Compassion Courage Respectfulness Humility
Amy is thinking about the incident • What kind of person do I want to be? For sure, honest, and with integrity, and that means not to ignore an error which next time could be serious • What virtues and are important to this situation? I have to have compassion and respect for Magda but courage to report the error, even if I risk her hostility. • What action should I take if I want to act at my best? I have to approach Magda first to give her a chance to report the error.
Common ground Seven Grandfathers Virtues Wisdom Discernment……… Respect Respectfulness….. Love Compassion……… Bravery Courage………….. Honesty Honesty…………… Humility…………... Humility Integrity…………… Truth .
Similarity may be hiding important differences Discussion topic
Concluding questions Given that Aboriginal patients represent about 20% of our hospital population, should we not provide alternative bioethics advice on ethical decision making based on traditional Aboriginal teaching?
Concluding questions Would it be possible to develop an full fledged Aboriginal health care ethics as a discipline grounded in traditional teachings?
Thank You jkotalik@lakeheadu.ca gvmartin@shaw.ca
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