Virtues for an Ethicist

FEATURE ARTICLE

Patricia Talone, RSM, Ph.D. Vice President, Mission Services Catholic Health Association of the United States St. Louis, MO [email protected]

In the past 15 years, the number of education. However, recognizing the ethicists at Catholic health care systems, complexity of health care systems, it was hospitals, and ethics centers has increased not long before these ethicists also significantly. Although Catholic health addressed the less acute but no less care had long been a pioneer in the field challenging dilemmas faced by health care of bioethics, forces like the Joint administrators in executive suites and Commission on Accreditation of Health boardrooms. Care Organizations (JCAHO), by insisting that facilities have a “mechanism” While there is a growing cadre of to resolve ethical conflicts, have committed persons academically primed contributed to this growth, as have federal for this challenging career, academic Corporate Compliance programs and preparedness alone is insufficient for the federal offices like the Office for task at hand. In ethics, it is not simply Protection from Research Risks and Office what one knows, but who one is that for Human Research Protection. The insures credibility, efficacy and endurance increasing complexity of medical in the field. The ethicist must be technology likewise raises ethical knowledgeable, but if he or she is not also challenges for patients, families and virtuous, they will do little to advance the clinicians. Catholic theologians, ministry of the systems they purport to philosophers and multi-disciplinary serve. After 25 years in the field, and a bioethicists, whose tradition of addressing personal list of both successes and failures, medical moral issues systematically several virtues stand out as necessary for develops from at least the end of the 16th contemporary ethicists in Catholic health century, are uniquely prepared to assist care. By no means an exhaustive or with the thorny dilemmas facing these exclusive list, these qualities ably serve groups. Health care systems scrambled to administrators and clinicians in health hire qualified women and men to help care as well as their ethics colleagues. steer them through the turbulent seas of technology, managed care, diminished Ethicists stand at a bustling crossroad of staffing and fiscal restraint. Most of these humanity. It is a place where the healthy individuals began their work as clinical meet the sick, the educated teach those ethicists, assisting in emergency rooms, who are untutored, life gives way to death, intensive care units and medical-staff science faces mystery, and doubt and

FEATURE ARTICLE despair seek faith and understanding. habitual modes of action or, in the words While the discipline requires a strong of Robert Bellah, et al, “habits of the academic and doctrinal foundation, heart.”1 They give structure and ethicists are also involved in a ministry expression to one’s character and that is first and foremost relational. Not contribute to good actions, good persons ivory tower philosophers or theologians, and a good society. Virtues can be innate they have no choice but to work with or connatural – some individuals seem people with a variety of needs. Daily they born with a particular gift. They may also encounter people in crisis, persons who be infused through grace, a gift from God. are extremely vulnerable, persons from a And they may be acquired, that is, variety of cultural, ethnic and religious developed through discipline and hard backgrounds. Although there is a growing work because one recognizes the need to number of nurse/ethicists and enhance one’s character. Because ethicists, physician/ethicists, for the most part the whether clinical or organizational, ethicist is neither a clinical insider nor an function in a milieu in which time is of outsider, but often serves as a facilitator the essence, it is vital that virtues become and negotiator, a listener and a guide for second nature, drawn upon at a moment’s many disciplines. notice.

How does one determine the most Reflection throughout my years of important virtues for one’s profession or experience as both a clinical and calling? Virtues are constitutive aspects of organizational ethicist elevates five virtues a person’s character and the most as particularly helpful for contemporary important of them will reflect the bioethicists. They may reflect the character that is presented as normative. character of the writer whom, while For Socrates, for example, the greatest highlighting them, acknowledges that they virtue was wisdom, but he also are, for her, by no means connatural. emphasized temperance, justice and piety, focusing on the more rational aspect of The great Jesuit spiritual writer, Alonso humanity. Aristotle included the Rodriguez (1526-1616), in his three- intellectual virtues but underscored more volume tome, The Practice of Christian affective ones as well, including humility, Perfection, wisely cited humility as the honor, self-respect and “grandness of primary virtue, addressing it in his first character.” Christian asceticism chapter. The Latin root “humus” denotes emphasizes the theological virtues of faith, the earth, standing firmly upon the hope and charity above all others, while ground. Aquinas calls humility “keeping also upholding the cardinal virtues of oneself within one’s own bounds, not prudence, justice, fortitude and reaching out to things above one, but temperance. Thomas Aquinas summed submitting to one’s superior.” Humility up virtue in the definition “habitus moderates pride and vainglory; it calls operativus bonus” an operative habit that forth a modest estimate of one’s own is essentially good. Virtues, then, are worth and is willing to defer to others.

FEATURE ARTICLE

Why is this virtue necessary for an to apply to a specific case. One must judge ethicist? In some circles, clinicians and soundly the means suggested, and one administrators tend to see the ethicist as needed the strength to command or direct the “answer” man or woman, according their employment. Prudence seeks the the individual esteem and a sense of medium rationis, helping the moral agent power. Such treatment can go to one’s to maintain a balance in all things.2 head, fostering hubris, a fatal flaw for Without it, courage can be reckless, anyone claiming to be an expert in the kindness can be frailty, and fidelity can be ethical life. The ethicist moves in circles of stubbornness. Prudence requires foresight, experts: nurses, physicians, technicians, memory, circumspection, shrewdness, technologists, psychologists, social diligence, care and caution. It is not a workers, chaplains, and executives among virtue for the faint of heart, but vital for them. He or she is just one expert among an ethicist. many, neither above nor below others. The best ethicists approach their peers One cannot hold an indispensable role in with a deep sense of humility recognizing Catholic health care without the virtue of that years of academic preparation do not compassion. Precisely because the provide one with all the answers, all the ethicist stands at a crossroads in life, he or theological principles or all the she confronts vulnerable persons: philosophical syllogisms to approach life’s patients, grieving and often angry families, exigencies. disillusioned and displaced staff and employees, harried executives. While the One may achieve intellectual clarity about ethicist hones his or her skills through a a proper course of action and possess modicum of objective reality, he or she is proper humility to execute it, but never far from the suffering pulse of prudence demands that one know the humanity. The virtue of compassion right time, place and manner of allows one to suffer with the other. Not a addressing the situation. One image of distant or removed pity, it extends itself prudence depicted in medieval art and touches the other. In Mark 1:40-42, displayed the virtue as a woman with two we see Jesus confront a man with leprosy. faces, one looking forward and one “Moved with compassion,” Jesus reaches backward. She held what appears to be a out his hand, touching the leper, thus colander in one hand to sift through the healing him. Those in Catholic health facts before her, and a mirror in the other care, in whatever capacity they serve, for necessary self-reflection. Later, the commit themselves to “see suffering as a 16th century artist, Titian, portrayed the participation in the redemptive power of virtue of prudence as a three-headed man, Christ’s passion, death and denoting the need to consider past, resurrection….”3 Compassion does not present and future in one’s deliberations. remove objective reality or the need for Thomas Aquinas taught that prudence professionalism, but it serves as the demanded three things of the moral agent. backdrop from which one "does ethics.” One must seek counsel for the right means It grounds the individual in the realization

FEATURE ARTICLE that we are all sisters and brothers, sharing health care commits itself. While “ethics the same Creator and a common is not reducible to religion, or religion to humanity. It forces one to remember, at ethics, ethics opens up to religion as its the 250th family meeting about use or source and final fulfillment” as moral non-use of a ventilator, that one looks philosopher James Drane asserts in face-to-face with the visage of the suffering Becoming a Good Doctor.4 For an ethicist Christ. in Catholic health care, I would extend this virtue to include participation in the For those persons ministering as ethicists life of a believing community. Otherwise within Catholic health care, the virtue of it could easily become individual piety, religion is foundational to understanding removing the ethicist from the discerning one’s vocation. Traditionally referred to as wisdom of the community that he or she an inner willingness to offer oneself in purports to serve. God’s service, this virtue is not the same as religious practice or piety, although it Being an ethicist is serious business. The should foster such expression. The virtue ethicist deals with life and death issues. of religion engenders in the believer a Clinicians, administrators, patients and reverential awe in the presence of the families look to the ethicist for direction, transcendent other. It recognizes that, guidance, principles and truth. This is a whether on the clinical unit or in the heavy burden to carry. Therefore, the boardroom, one is privileged to “stand on final (and by no means conclusive) virtue I holy ground’” as one teaches, guides, and propose for ethicists is a sense of humor. directs others. It is what theologian Karl It circles around and connects again to the Barth (1886-1968), in his essay on virtue of humility. If one takes job, title, sanctity of life (Church Dogmatics, Vol. 1) position and even reputation too seriously, describes as awe, respect, reverence for the he or she runs the risk of losing touch other. The virtue of religion with one’s own grounding, and thus being contextualizes ethical decisions, providing ineffective in one’s ministry. Without a basis for wisdom and discernment. In being self-deprecating, the ethicist should the clinical arena, it recognizes that the be able to laugh at him or herself and at decision a patient and/or family faces is the numerous wry situations one meets on one moment in a continuum of this the elevator, in the halls and in the patient’s entire life and journey toward classrooms of one’s work. Cultivating the God. Similarly, in the business or virtue of a sense of humor gives one the organizational arena, looking at complex ability to have a light grasp on life, leaving challenges in light of the virtue of religion the ethicist open to listening to the voice enables the ethicist to facilitate decision- of God within oneself and in the many making mindful of the broader impact of grace-filled encounters of daily life. determinations like down-sizing, mergers, Furthermore, a sense of humor refreshes acquisitions, or large capital expenses, the soul through the gifts of both laughter aware that these actions either further or and tears, enabling one to persevere in the hinder the ministry to which Catholic good work to which one is called.

FEATURE ARTICLE

Development of virtues is an ongoing task for all persons. It involves practice, recognizes failure and persistently moves forward, recognizing that virtue is always Gabe und Aufgabe, both gift and task. Even those persons who possess an abundance of natural virtues must foster and acquire virtues. Through these habits of the heart we not only make choices and shape particular situations, but we form ourselves to become women and men of sound moral character, authentically able to lead others in pursuit of the good.

1 Robert Bellah et al., Habits of the Heart: Individualism and Commitment in American Life, Berkeley: University of California Press, 1985. 2 Thomas Aquinas, Summa Theologiae II-II, Q47, A7; Q49, A1-8. 3 United States Conference of Catholic Bishops, Ethical and Religious Directives for Catholic Health Care Services, Washington, DC:USCCB, 2009, p.3. 4 James Drane, Becoming a Good Doctor, New York: Sheed & Ward, 1995, p. 130.