Uncovering ethics: To stay or to go (Bob’s story)

“I am done. I am over,” says Bob before failing back to the pillow with quiet momentum.

“It’s like he is rushing down a river, and we have nothing we can do to slow him down,” says his daughter. Her voice is strong and carries the pain of her words in a no nonsense way, like it is not a burden at all. They are both strong like this, a family trait, and their strength fills the room. It almost vibrates with the effort.

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She stands next to us, Bob lying in his hospital bed and me sitting on the chair beside him. We have been talking for some time now about death and dying, about the how and where of it all.

Bob wants death now. He is a farmer, has been his whole life. His family are farmers. When we talk the imperatives of this become clearer to me. The land, the property, even the community needs tending; They are close knit. Bob’s sickness and his death are intertwined with the happenings on the farm. From here in town they can see all of those needs from an almost comfortable distance. It mutes them just enough that Bob and his daughter can be fully present with each other. If they go home they are not quite so sure they can hold it all. There will be so many things to do, so many people to see and say last things to. It is exhausting even to think about and they are already using so much of their energy just to stay together.

Bob and his daughter don’t decide to stay here in town. It seems none of us decide anything at all. One moment we are still talking through what might be, and how we feel, and then the next we all know the answer. The decision is buried somewhere in all of those moments. Or perhaps not within them but across them. Across the moments of listening, and speaking, and being with each other. The decision to stay in town unfolds and becomes clear like a picture creeping into focus.

This is microethics in action. That is to say that it is not so much a description of how we should practice but a recognition that this is how things actually happen. All moments of the clinical interaction have their ethical aspects regardless of our consciousness of them. Recognising this, the importance of clinical communication and reflective practice as a means for enhancing our ethical performance is easily apparent. In Bob’s story, for the clinician ethical practice is in allowing the “right thing” to be discovered while recognising that in fact the “right thing” only occurs through such a process of discovery. The role, our role, is to provide the support for this to occur while being a participant ourselves in the “uncontainable openness” of the encounter ¹. We have expert knowledge and experience to contribute, we have the backing of our roles to provide an opinion, but the decisions that are made resolve from more factors than this. For everyone involved how and who we are, what we say and do, and what we believe contributes to both the interaction and the result.

Remembering and reflecting the importance of this acknowledgment is also a practice of ethics. It is an opportunity to resist the frequent simplification of the richness of these moments down to the simple result of the decision: to stay or to go.

¹ From Paul Komesaroff.  Experiments in Love and Death: Medicine, Postmodernism, Microethics and the Body,  River Grove Books 2008.

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