Checking My Values and Beliefs

I recently attended the Central West Palliative Care Network Conference.  This is an annual event that brings hospice and palliative caregivers together to educate themselves on current happenings in their field of expertise.  The agenda included numerous physicians, PhD’s and experts in hospice and palliative care who shared their knowledge with the participants.

Some of the topics presented were Caring for the Spirit, The Legal Aspects of How and Why to Discuss Advance Care Planning, Volunteer Excellence in Palliative Care, etc.  I am going to share my thoughts on two of the sessions offered at the Conference. 

The opening speaker was Dr. Kerry Bowman, PhD, a Canadian bioethicist and conservationist. In the field of clinical ethics, Dr. Bowman specializes in end-of-life decision-making and cross-cultural healthcare delivery, as well as genetics, genomics, cloning-animal ethics and ethical questions in emerging medical technologies.  Dr. Bowman is the clinical ethicist for Mount Sinai Hospital in Toronto and holds an academic appointment with The University of Toronto in Family and Community Medicine. He also serves with The University of Toronto Joint Centre for Bioethics and The University of Toronto Centre for Environment.

Dr. Bowman spoke about whether people should have more control over their personal end of life decisions and the changing cultural/social attitudes towards death.  Many years ago, death was an incredible spiritual adventure.  In places such as ancient Egypt death was glorified and celebrated; today death is often viewed as the worst possible outcome.

Historically there was no machinery intervention in the prolonging of life; that came into play in the 1940’s.  For the first time in human history, death became a negotiated event.  Mankind developed equipment that could prolong life, if we chose to use it.  In many circumstances, death was no longer inevitable, it became a decision to be made.  Often those decisions are placed on family members, which place a huge burden on them.  Imagine being in that position – when is the timing right, what if I make the wrong decision, how will my decision impact my family – so many things to think about that could impact the decision maker for the rest of their life. 

We are now in a position where medical facts are being set against values.  We have seen examples of this in the media where families do not want to make an end of life decision because they still have hope, which conflicts with the doctor’s prognosis that there is no chance of the patient recovering, based on their medical expertise.  Some of these cases have gone to court with mixed outcomes; I would expect that we will see more of these in the future.

Society is changing; we now have a new group of aged people.  Baby boomers are becoming “elderly”.  People in general are more knowledgeable about healthcare and options available to them.  Each generation has larger, more vocal groups that are “rights-oriented”, they expect and demand change and progress.  Society is not happy with the experiences their parents went through; we now challenge our physicians rather than taking their word as gospel.

Dr. Bowman stated that the “genie is out of the bottle” and society will have to make some decisions on things like euthanasia and physician assisted suicide for people dealing with a life-ending or life-limiting disease.  This is not going away; governments are talking about it, citizens are talking about it and soon lawmakers will need to set a standard for what is/is not socially acceptable. 

Before attending this session I had some personal views on sustaining life, euthanasia and doctor assisted suicide.  Dr. Bowman, with his insight, has made me dig a little deeper within myself to reconsider my beliefs.  I’m not sure where I will land on this; the concept is so complex that I need to think more on this.  Perhaps I will remain on the fence, hoping that I am never faced with a situation that will force me to make this type of decision, either for myself or for someone that I care about.

Another topic at the event was “Understanding Palliative Care in the Cultural Context”.  This particular session was focused on the South Asian Community but is also applicable to any culture.  I did not attend this session but through my work at Bethell Hospice I have been involved in discussions on this topic.

Hospice and palliative care networks, along with every other service provider in Canada, must deal with the changing demographics of our country.  We are seeing many new nationalities living in Canada and we must understand their wants/needs when it comes to end of life decisions.  There is a huge focus on how to make the provision of healthcare align with people’s values and beliefs.

The conflict with this opportunity is that some cultures do not believe in medical intervention, prolonging life, or hospice care.  The challenge comes in how to become educated on the emotional and spiritual needs of the many cultures that need to be supported, while ensuring that the services offered reflect what the client wants/needs/is willing to accept.  Is the effort required the best use of limited resources if some cultures  do not believe in the services offered and as a result do not have a need?  Does the healthcare industry focus on the younger generations who may be more willing to embrace or demand a different service than their parents would accept?

Balancing effort vs impact is something that healthcare providers struggle with continually.  With limited resources, both financially and in people resources, the focus must be on areas that can have the most positive outcomes.  We cannot ignore people whose beliefs do not align with what we are used to; we must embrace diversity and know that making the difference in people’s lives is the most important step we can take.  Ensuring that the offerings within the healthcare industry value other cultures is critical.

Once again I have been enlightened and challenged as a result of my PULSE experience.  I am excited that I am being forced to do a check of my values and beliefs and delve more thoughtfully into them.  I hope that this blog has made you consider your beliefs and challenge your ways of thinking.  You may land exactly where you started, but it is healthy to challenge yourself to think about what you believe and how you got there.  Until next time….