DR. DAVID UNGER – DIRECTOR AND ETHICIST
By Dave Lefebvre
“I remember the day when I decided that I wanted to do formal ethics training,” says Dr. David Unger, Providence’s physician-turned-ethicist who was recently named PHC’s Director of Ethics. “We had a very complex case on 10C and the question arose about what to do with a woman who had a significant infection in her foot—one that could threaten her life if it spread. As a physician, it was clear to me and the treating team that something definitive needed to be done and the offer was given to her to do a surgery to clear up the infection. And she refused. We really grappled with that and wondered how we could advocate for her and yet respect her autonomy over her healthcare decisions. I remember feeling powerless and thinking, ‘There’s got to be a way to think more critically about this.’ I wanted more tools in my toolkit to be able to explore these types of situations.”
Where Ethics Come Into Play at Providence
As a whole, the Ethics Services’ portfolio extends to clinical consultation, policy review and education. But as Dr. Unger, or Dave as he prefers to be called, notes, the majority of their cases are in a clinical capacity. “Typically we’re called in when there are the differing opinions between a patient and/or their family and the care team, or differences of opinion among the members of the care team who think treatment should go one way or the other.”
But a call into the Ethics team isn’t a direct shot to a definite solution. “When people call us, it’s not prescriptive. We don’t come in and decide right from wrong about the actions of people,” says Dave. “We come in and ask relevant questions to help stimulate ethical reflection. To give people a way, a process for thinking about the problems they’re confronting.”
Ethics: Giving Everyone a Voice
While the majority of the formal consults that Dave and his colleague Jenny Young receive in Ethics Services come in from staff, about 20% are initiated by family members. “As people, we often have an inkling about what ought to happen in a certain situation but don’t always know how to put that inkling into words,” Dave says. “We help find ethical or moral arguments for and against certain courses of action to give some options to those who maybe can’t articulate what they’re feeling. To give everyone a voice in the situation.”
Using an ethics framework to identify the stakeholders, the main ethical issues and the relevant information that needs to be thought of and gathered, Dave and Jenny then analyze the ethical issues and the principles coming to bear on the situation. A process, and subsequent outcome, that Dave sees as being the strength of adding an ethical consult to the very complex conversations and circumstances Providence staff, physicians, and patients find themselves in.
“The situations we get called into involve a number of stakeholders, the stakes are high, and there is a lot of emotion and anxiety,” says Dave. “I think that ethics enables people to make sense of some of that chaos. Not to necessarily come up with the answers but to at least get people to a place of discussion, where they can start to work on a resolution.”
Where Healthcare Meets Ethics
So what is it about healthcare that makes it so necessary for Providence to have a team of ethicists? “I guess there are two ways to approach that question,” Dave counters. “Why is it important to have ethics? With all of the technical innovation that we have in healthcare—we can keep people alive on machines, we can create life where there wasn’t life before—I think that we need an ethics team and a strong ethics presence to help reflect on these things, to ask the right questions to begin that conversation.”
And why is it important to have a team of ethicist at Providence? “Because when you’re dealing with questions that have no clear right and wrong, it’s important to have people to bounce things off of. And actually, the more opposition Jenny and I have about an issue, the better. We’re trying to find the full spectrum of an issue so that we can really explore the depths of the ethical issues we confront both as a healthcare provider and as a faith-based organization.”
Ethical Services’ Biggest Challenge
While people might think that the most challenging part of Dave’s job is going in with an idea of right and wrong and having the client not listen to or accept what’s been said. But it’s not.
“The biggest challenge Ethical Services faces is getting people to reach out and engage with us,” says Dave. “We see this play out often: we get called in too late or we get called after the fact and all you can think is: ‘wow, we could have really done something to help make that situation better.’ It’s not the failures that are frustrating, it’s the not starting.”
Have a situation you would like to consult with the Ethics team on? Visit the Ethics Services page or call the team directly at 604-806-9952.
Theme song of your life? It would have to be a collaboration between of Thom Yorke (of Radiohead), and Arvo Pärt (a modern Estonian composer) and likely, Jimi Hendrix would need to be reanimated for some guitar work. I don’t think the piece has been commissioned yet.
Favourite condiment? Does honey count as a condiment?
Guilty pleasure? Crappy movies. The ones you know you are going to regret staying up for but keep watching anyway.
Describe your perfect day off: Camping somewhere off the grid, going for a long bike ride or run, sitting by a campfire and reading Philosophy.
Dr. Scott MacDonald, Providence Crosstown Clinic