Blank stares often greet Hamilton Health Sciences’ new clinical and organizational ethicist when she introduces herself.”People aren’t familiar with the term ‘ethicist,’ so they think I’ve said ‘atheist’ or ‘exorcist’ or ‘esthetician.’ Some look genuinely disappointed when they realize I’m not going to give them a pedicure,” says Andrea Frolic. “In every conversation, my first task is to explain who I am and how I can help.”
Frolic’s role is to help hospital staff, patients and their families, navigate the ethical dilemmas that emerge in patient care. Her goal is to build a sustainable and comprehensive health care ethics service for HHS in concert with the hospital’s long-standing clinical ethics committee.
“What I try to make clear up front is that I have no power, except the power of moral persuasion,” says Frolic. “I am not the ethics police. I don’t come into a situation and tell people what to do. That would be unethical because I don’t have to live with the consequences: the patient and family and caregivers do. My goal is to empower people struggling with ethical issues; to empower them to express the values that support different options and to be creative in their problem-solving.”
Frolic uses tools from her varied background to accomplish this goal. She is the only anthropologist working as an ethicist in a Canadian hospital, having completed her PhD in cultural anthropology at Rice University in Houston, Texas this year. While in Houston, she trained in clinical ethics during a two-year fellowship at the University of Texas M.D. Anderson Cancer Center. Frolic’s other academic interests include religion, ritual and literature. She received her master’s degree in religion and culture from Wilfrid Laurier University and her bachelor’s degree in religious studies from Queen’s University.
“Anthropology examines social and cultural systems. Religious studies involves the spiritual dimensions of human life. Clinical ethics focuses on the best interests of particular patients. My role as the clinical and organizational ethicist is to think about how the hospital’s systems impact decisions about individual patients. My diverse background helps me to consider both the macro and micro aspects of an ethical problem.”
For example, by law and hospital policy, people over the age of 18 can made their own medical decisions. Sometimes, however, young adults make treatment decisions that endanger their health. This presents a dilemma for parents and caregivers who want to respect the patient’s legal rights, but also feel a responsibility to give the patient the best chance of survival. Ethical issues span the lifespan, from selective abortion of fetuses with devastating disabilities to the resuscitation of frail elderly patients.
Frolic sees her primary role as an educator. “People think ethics is esoteric and unrelated to their daily lives. But almost every time you make a choice – whether it’s how you discipline your child or what products you buy – you are making an ethical decision. A big part of my job is to make people aware of the ethical aspects of routine patient care and to give them tools to make ethical decisions effectively.”
Frolic also acts as a consultant when people “get stuck.”
“The values of Hamilton Health Sciences ? caring, respect, innovation and accountability ? provide good ethical sign posts to point us toward the right decision. But sometimes a situation comes up that is novel or complex, or there are intractable conflicts regarding the right thing to do. In those situations people can call me to help mediate or facilitate reasoned discussions.”
As an ethics consultant, Frolic helps people clarify the relevant ethical principles, identify their options, justify their choices and develop a strategy for implementing their decision.
Frolic’s third role is to support the creation of hospital policies that support “patient-centered care,” a philosophy recently launched by Hamilton Health Sciences.
“Good healthcare management and policies are the foundation of excellent patient care. Though sometimes it is a challenge to juggle both the clinical and organizational aspects of my role, the two are really inseparable.”