Pluralism and ethical dialogue in Christian healthcare institutions: the view of Caritas Catholica Flanders

In this article, the place and the nature of an ethical dialogue that develops within Christian healthcare institutions in Flanders, Belgium is examined. More specifically, the question is asked how Christian healthcare institutions should position themselves ethically in a context of a pluralistic society. The profile developed by Caritas Catholica Flanders must take seriously not only the external pluralistic context of our society and the internal pluralistic worldviews by personnel/employees and patients, but also the inherent inspiration of a Christian healthcare institution. This article concludes with ten general orientations that could shape the ethical dialogue from a Christian inspiration in a pluralistic context.

On the impermissibility of euthanasia in Catholic healthcare organizations

Roman Catholic healthcare institutions in the United States face a number of threats to the integrity of their missions, including the increasing religious and moral pluralism of society and the financial crisis many organizations face. These organizations in the United States often have fought fervently to avoid being obligated to provide interventions they deem intrinsically immoral, such as abortion. Such institutions no doubt have made numerous accommodations and changes in how they operate in response to the growing pluralism of our society, but they have resisted crossing certain lines and providing particular interventions deemed objectively wrong. Catholic hospitals in Belgium have responded differently to pluralism. In response to a growing diversity of moral views and to the Belgian Act of Euthanasia of 2002, Catholic hospitals in Belgium now engage in euthanasia. This essay examines a defense that has been offered of this practice of euthanasia in Catholic hospitals and argues that it is misguided.

Hiring for "organizational fit". A St. Louis system has developed tools for assessing candidates' compatibility with the organization

To a great extent, the continued success of Catholic health care organizations is dependent on the selection of co-workers and leaders who are committed to carrying on the organization's mission. The Sisters of Mercy Health System, St. Louis, uses three tools to help leaders be more consistent and objective in assessing employment candidates for organizational fit. The first tool involves behavioral-based interviewing, which looks at a candidate's potential for future behaviors based on his or her past behaviors. The second tool assesses a candidate's values in such a way that accounts for and reduces the interviewer's own subjectivity. And the third tool-values-based interviewing-helps reveal a candidate's natural aptitude for, interest in, and personal agreement with the organization's charism, religious heritage, and values.

Finding a voice. Like individuals, organizations are moral speakers and actors

Though "good people' are important for the life of any organization, it is a myth to think that enough good people will make for a good organization. To break free of this myth, a health care organization, which is made up of numerous persons and groups, ought to be regarded as a single, unitary actor in society. When seen as a single actor, the organization's systems for carrying out its mission can be better assessed and improved if necessary. If the organization's systems are not functioning as they should, then even good people will be hindered in their efforts. It can be said, therefore, that organizational ethics takes seriously the idea that every Catholic health care organization is a moral actor needing to reflect carefully on what it does in relation to its employees, leaders, and the outside community. In an environment where the organization's actions are reflected upon, and its character is carefully and continually shaped according to its mission, individual persons in that organization will be better equipped for making and carrying out good decisions that are aligned with that same regard for the mission.

Bridging the gap. Catholic health care organizations need concrete ways to connect social principles to practice

Establishing and maintaining institutional identity is a challenge for leaders in Catholic health care. A process known as "progressive articulation" can be used to help leaders assess how well their organizations reflect Catholic social tradition and help them apply this tradition toward specific organizational practices. The particular approach described here is called the "Identity Inquiry and Improvement Process" (31P), and it takes Catholic social principles and translates them into criteria and benchmarks for assessing an organization's interactions with internal and external stakeholders. In other words, 31P seeks to make mission measurable and concrete.

Starting an organizational ethics committee. An ethicist suggests some practical and concrete steps

Establishing an organizational ethics committee (OEC) involves careful reflection on the needs of the organization and on the people who will serve on the committee. With concern for the "community of care" (the women and men who carry out the organization's mission), a comprehensive needs assessment will reveal areas of the organization where more education and policy analyses are needed. Volunteer members of the OEC are typically chosen according to a set of characteristics that include their knowledge and experience, ability to take on this added responsibility, familiarity with the Ethical and Religious Directives for Catholic Health Care Services and Catholic social justice teaching, and their honesty and integrity. Part of the success of an OEC can be attributed to how well it is supported by the organization. This includes administrative and financial support, use of public relations and educational services, and cooperation and active involvement of key managers in the organization. Once formed, the next important step is educating OEC members.

"Like shining from shook foil". A "virtuous organization" is prepared to treat both the body and the soul

The Catholic health care ministry is about mission, and the role of organizational ethical reflection is to encourage people in the ministry to think about the institutional performance and practice of medicine within a ministry of the Catholic Church. By engaging a creative process that identifies the needs of people served by Catholic health care, institutions are able to mediate the healing and redeeming power of Jesus, thereby creating virtuous organizations. To depict the mission of Catholic health care as an extension of the healing ministry of Jesus is to evoke explicitly Catholic theological language, and such language is appropriate because Catholic health care is a ministry of the Catholic Church. The church itself is the embodiment of the healing and redeeming ministry of Jesus, and the institutional ministries it has created over time need to bear witness to this fundamental reason for their existence.

Development and communication of written ethics policies on euthanasia in Catholic hospitals and nursing homes in Belgium (Flanders)

OBJECTIVE

To describe whether and how Catholic hospitals and nursing homes in Belgium (Flanders) have developed written ethics policies on euthanasia and communicated these policies to their employees, patients, and patient's relatives.

METHODS

A cross-sectional mail survey of general directors of Catholic hospitals and nursing homes in Belgium (Flanders).

RESULTS

Of the 298 targeted institutions, 81% of hospitals and 62% of nursing homes returned complete questionnaires. A high percentage of Catholic hospitals (79%) and a moderate percentage of nursing homes (30%) had written ethics policies on euthanasia. Both caregivers and healthcare administrators were involved in the development and approval of these policies. Physicians and nurses were best informed about the policies. More than half of the nursing homes (57%) took the initiative to inform both residents and relatives about the policies, while only one hospital did so.

CONCLUSION

The high prevalence of written ethics policies on euthanasia in Flemish Catholic hospitals may reflect the concern of healthcare administrators to maintain the quality of care for patients requesting euthanasia. However, the true contribution of these policies to quality end-of-life care and to supporting caregivers remains unknown and needs further research.

PRACTICE IMPLICATIONS

Legislation and centrally developed guidelines might influence healthcare institutions to develop ethics policies.

Role of nurses in institutional ethics policies on euthanasia

AIM

This paper reports the findings of a survey that investigated whether Flemish Catholic hospitals and nursing homes had developed written ethics policies on euthanasia and how the role of nurses was described in these policies.

BACKGROUND

International research shows undeniably that nurses are confronted with patients requesting euthanasia. Euthanasia has been legal in Belgium since 2002 and in Holland since 2001. Because of the vagueness in formal documents and policies on the role of nurses in euthanasia, there is an increasing need to establish institutional ethics policies that clearly describe the role of nurses in the euthanasia process.

METHODS

We used a cross-sectional descriptive mail questionnaire to survey the general directors of Catholic hospitals and nursing homes in Belgium (Flanders). Data were collected between October 2003 and February 2004.

RESULTS

Of the 298 institutions targeted for survey, 81% of hospitals, 62% of nursing homes returned completed questionnaires. Of these, 79% of the hospitals and 30% of the nursing homes had a written ethics policy on euthanasia. The ethics policies of 87% of the hospitals and 77% of the nursing homes explicitly addressed the role of nurses in the euthanasia process. In the majority of hospitals and nursing homes, the ethics policies addressed the conscientious objections of nurses to euthanasia. Most hospitals and nursing homes voluntarily communicated their ethics policies to the nurses they employed.

CONCLUSION

The written ethics policies of most Catholic healthcare institutions give explicit attention to the role of nurses in the euthanasia process. However, the meaning and content of the role of nurses, as indicated in these ethics policies, continue to be an issue. Further research is needed to verify how these policies are actually implemented within the institutions and whether they contribute to better support for nurses and to ethical care for patients.

Hospital Service Offerings

Controlling for market and organizational characteristics, Catholic hospitals in 2001 offered more stigmatized and compassionate care services than investor-owned hospitals, and more stigmatized services than public hospitals. There were no differences between Catholic hospitals and other nonprofit hospitals, however, in the number of compassionate, stigmatized, and access services offered. This may reflect growing isomorphism in the nonprofit hospital sector.

Stem cell research in a Catholic institution: yes or no?

Catholic teaching has no moral difficulties with research on stem cells derived from adult stem cells or fetal cord blood. The ethical problem comes with embryonic stem cells since their genesis involves the destruction of a human embryo. However, there seems to be significant promise of health benefits from such research. Although Catholic teaching does not permit any destruction of human embryos, the question remains whether researchers in a Catholic institution, or any researchers opposed to destruction of human embryos, could participate in research on cultured embryonic stem cells, or whether a Catholic institution could use any therapy that ultimately results from such research. This position paper examines how such research could be conducted legitimately in a Catholic institution by using an ethical analysis involving a narrative context, the nature of the moral act, and the principle of material cooperation, along with references to significant ethical assessments. It also offers tentative guidelines that could be used by a Catholic institution in implementing such research.