“[Civility] makes us enter deeply into each other’s sentiments, and causes like passions and inclinations to run, as it were, by contagion”
David Hume, 18th century philosopher
I've been a doctor for over 45 years. I now work as a clinical ethics advisor. Last year I was unlucky enough to be hospitalised on two occasions. When you’re lying around feeling sorry for yourself in bed, there's plenty of time for reflection. Let me share a few thoughts with you. I like the word “civility”. This term describes an often unspoken language or set of gestures for interaction which provides the basis for achieving a “good society”.
If you’re driving to work, why not let that driver on your left into the line of traffic? If you do; they are more likely to give way to someone else in the next thirty seconds. When you’re climbing the stairs in the hospital, you actually feel better if you say “gidday” to the person with a mop helping to keep the hospital looking good. These small gestures help to make the world a better place for all of us.
Trust is a useful proxy for measuring civility. In 2007, the Pew Global Attitudes Survey highlighted the degree of trust in different countries. When presented with the statement “Most people in society are trustworthy,” 65 per cent of British people agreed. This was lower than Sweden (where 78 per cent agreed) and Canada (71 per cent), but significantly ahead of all other Western European countries, the US, South Korea and Japan (in the latter two fewer than half agreed with the statement).
Civility may exercise its positive influence through an emphasis on qualities such as respect, empathy and compassion. It is a form of behaviour through which people express their own, and recognise other people’s humanity.
When I was in hospital I experienced civility from a variety of staff beyond the nurses and doctors caring for me. Orderlies, cleaners, the newspaper seller and kitchen staff; treated me with gestures of kindness, politeness, humour and respect. Civility makes us feel better, it fosters hope.
Civility engenders reciprocity, we are hard wired for the feeling of empathy that is evoked by gestures of civility. In his book, The Age of Empathy, Frans de Waal argues that society depends on our innate instinct to reach out to others, a type of herd instinct that pre-disposes us to read others’ feelings and pursue the common good because we are all better for it; what he calls the “invisible helping hand”. Behaving in an uncivil manner is likely to have reciprocal powerful effects which can have very negative consequences.
Civil behaviour therefore seems to be a good thing. It should come naturally to us all in the hospital environment. It also seems to be the right thing to do. A “sense of the other” is a powerful expression and is more likely to result in patients feeling that they have not been ignored; rather that they have been respected.
In my job as a renal physician I had to know such things as how to interpret a kidney biopsy, to be aware of drug interactions and how to assess someone’s fluid balance. These are the “tools of the trade”. However there is an equally important part of my job which is to go beyond civility and explore the concept of civility’s near cousin - “compassion”. For some this is a path less travelled. For others it can be a challenge to venture in this direction. However the career rewards can be well worth the challenge. Becoming adept at practising in this domain is to explore the deeply satisfying concept of “the art of medicine”
I know of no better description of “compassion” than Ian McEwan’s quote:
“Imagining what it is like to be someone other than yourself is at the core of our
humanity. It is the essence of compassion and the beginning of morality”(1)
Doing the right thing, respecting the whole person, the patient’s voice, attempting to establish societal ethical norms, autonomy, beneficence, non - maleficence, fidelity, veracity and justice and most of the ethical principles are implicit in this simple; but profound statement.
These words provide an inspiration for me in the context of working to try to increase the profile of clinical ethics locally and nationally in New Zealand. On June 25th 2015 we are hosting the Clinical Ethics Advisory Groups' National Meeting in Wellington, New Zealand. David Hume, 18th century philosopher
I've been a doctor for over 45 years. I now work as a clinical ethics advisor. Last year I was unlucky enough to be hospitalised on two occasions. When you’re lying around feeling sorry for yourself in bed, there's plenty of time for reflection. Let me share a few thoughts with you. I like the word “civility”. This term describes an often unspoken language or set of gestures for interaction which provides the basis for achieving a “good society”.
If you’re driving to work, why not let that driver on your left into the line of traffic? If you do; they are more likely to give way to someone else in the next thirty seconds. When you’re climbing the stairs in the hospital, you actually feel better if you say “gidday” to the person with a mop helping to keep the hospital looking good. These small gestures help to make the world a better place for all of us.
Trust is a useful proxy for measuring civility. In 2007, the Pew Global Attitudes Survey highlighted the degree of trust in different countries. When presented with the statement “Most people in society are trustworthy,” 65 per cent of British people agreed. This was lower than Sweden (where 78 per cent agreed) and Canada (71 per cent), but significantly ahead of all other Western European countries, the US, South Korea and Japan (in the latter two fewer than half agreed with the statement).
Civility may exercise its positive influence through an emphasis on qualities such as respect, empathy and compassion. It is a form of behaviour through which people express their own, and recognise other people’s humanity.
When I was in hospital I experienced civility from a variety of staff beyond the nurses and doctors caring for me. Orderlies, cleaners, the newspaper seller and kitchen staff; treated me with gestures of kindness, politeness, humour and respect. Civility makes us feel better, it fosters hope.
Civility engenders reciprocity, we are hard wired for the feeling of empathy that is evoked by gestures of civility. In his book, The Age of Empathy, Frans de Waal argues that society depends on our innate instinct to reach out to others, a type of herd instinct that pre-disposes us to read others’ feelings and pursue the common good because we are all better for it; what he calls the “invisible helping hand”. Behaving in an uncivil manner is likely to have reciprocal powerful effects which can have very negative consequences.
Civil behaviour therefore seems to be a good thing. It should come naturally to us all in the hospital environment. It also seems to be the right thing to do. A “sense of the other” is a powerful expression and is more likely to result in patients feeling that they have not been ignored; rather that they have been respected.
In my job as a renal physician I had to know such things as how to interpret a kidney biopsy, to be aware of drug interactions and how to assess someone’s fluid balance. These are the “tools of the trade”. However there is an equally important part of my job which is to go beyond civility and explore the concept of civility’s near cousin - “compassion”. For some this is a path less travelled. For others it can be a challenge to venture in this direction. However the career rewards can be well worth the challenge. Becoming adept at practising in this domain is to explore the deeply satisfying concept of “the art of medicine”
I know of no better description of “compassion” than Ian McEwan’s quote:
“Imagining what it is like to be someone other than yourself is at the core of our
humanity. It is the essence of compassion and the beginning of morality”(1)
Doing the right thing, respecting the whole person, the patient’s voice, attempting to establish societal ethical norms, autonomy, beneficence, non - maleficence, fidelity, veracity and justice and most of the ethical principles are implicit in this simple; but profound statement.
We will explore how CEAGs function in the different DHBs throughout New Zealand. We need to learn from each other’s similarities and differences. It may be that the conference provides a catalyst for the formation of a national clinical ethics network.
This brings me back to civility and its relevance to ethics. In the same way that civility can be seen as an inherently positive human attribute, clinical ethics must become an integral part of our work in health care.
In the future delivery of healthcare there will be increasingly difficult decision making in the context of changing and more challenging demographics, tight budgets, health technology innovation, appropriate staffing levels, and people’s expectations of what health care they should receive. A commitment to the principles and the practice of clinical ethics needs to be viewed as vital component in the collective decision in this complex matrix.
Clinical ethics should not be viewed as being a rarefied set of abstract principles, rather as a sound basis for good practice. You do not have to search too deeply to find examples of ethical issues and dilemmas in your everyday work.
Just try thinking ethically and you will be well down the path to ensuring that:
“Clinical ethics is everyone’s business”
This brings me back to civility and its relevance to ethics. In the same way that civility can be seen as an inherently positive human attribute, clinical ethics must become an integral part of our work in health care.
In the future delivery of healthcare there will be increasingly difficult decision making in the context of changing and more challenging demographics, tight budgets, health technology innovation, appropriate staffing levels, and people’s expectations of what health care they should receive. A commitment to the principles and the practice of clinical ethics needs to be viewed as vital component in the collective decision in this complex matrix.
Clinical ethics should not be viewed as being a rarefied set of abstract principles, rather as a sound basis for good practice. You do not have to search too deeply to find examples of ethical issues and dilemmas in your everyday work.
Just try thinking ethically and you will be well down the path to ensuring that:
“Clinical ethics is everyone’s business”
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