In the health field, ethicists inform and assist families and medical staff with ethical matters. Katarina Lee has been the clinical ethicist at St. Boniface Hospital (SBH) since September 2018, serving all the Catholic Health Corporation of Manitoba’s Communities of Services, including Actionmarguerite.
SBH’s Health Care Ethics Service was established in 1993 to provide support in four areas: policy development and review, research and research studies, clinical ethics consultations and ethics education. Katarina Lee is currently the province’s only full-time clinical ethicist.
“The region has one ethics director, but she doesn’t do clinical ethics consultations,” she says. “However, a recently hired part-time clinical ethicist does provide such services at Health Sciences Center. Other people in Manitoba work in this area but are not involved in the clinical ethics aspect.”
For Katarina Lee, no two workdays are alike. “It’s like having a different job every day. If an institution requests a protocol, I do research. I facilitate talks on ethics and related topics, including work policy. I am also an assistant professor in the Department of Family Medicine at University of Manitoba, I sit on committees and I do consultations.”
The ethicist identifies two kinds of consultation: “Clinical ethics consultations are individual consultations for people with ethical questions. I recommend ethics action plans that they can implement.”
The others are debriefing sessions. “We discuss moral distress and explore what could be improved to make the experience less difficult.”
Moral distress can be more intense in facilities like Actionmarguerite. “When patients go to the hospital, they leave as soon as they are better. In long-term care, the facility becomes their home, and they develop closer ties with staff. When residents pass away, it can be very painful for nursing staff.”
The Ethics Service plays an important role in that context. “I act as a mediator in conflict situations. I help people come to understand patients’ preferences and apply them. In long-term care homes, some people are no longer able to make decisions. When the patient is a believer or adheres to a certain philosophy, it can help the decision-making process.”
Katarina Lee is there to help families, residents, patients and physicians. “We always strive to inform the public about this service. It’s usually the doctors who reach out to me. I would welcome anyone contacting me for ethics assistance.”
To ease the decision-making burden for loved ones, Katarina Lee recommends that residents prepare a care plan in advance and share it with those nearest to them, even if the subject is not always easy to discuss.
“Long-term care decisions are not made in silos; each has a longer-term impact on things like diet and end-of-life options. While these are difficult conversations to have with loved ones, and we don’t tend to think about them when we are well, having them when the situation arises reduces stress on decision makers. If the resident has taken the time to consider all the possibilities, the process is much more straightforward when the time comes.”
Katarina Lee insists: “It’s important to start talking about our choices and what it means to live by our values early on. Without that information, decision-makers end up having to guess the patient/client’s wishes, which adds pressure and guilt. It’s simply a matter of finding the right opportunity to raise the issue.”