Wasylenko, awarded for his work in medical ethics, talks to Herald health reporter Jamie Komarnicki about pressing issues in palliative care and a new challenge addressing health-care ethics in Canada’s prison population.
This interview has been edited and condensed.
What is the most pressing issue in the field of medical ethics right now?
“Right now in the media spotlight and the national conversation with patient and providers are end of life issues. Those are really pressing because they’re top of mind, but also because they are so important to individuals who are facing end of life, who are thinking about it with their relatives or loved ones, and people who are providing health care and trying to do the best for individuals who are seeking their help in their vulnerability. We feel like we’re at the cusp of a societal decision point about how we will best honour and treat people who are facing end of life circumstances.”
What’s something you think is key to the debate about end of life issues?
“One of the really important things that hasn’t been deeply addressed, from what I’ve seen in the public discourse, is the notion of people not as individuals, but as people living as humans in a community … I’m hoping to see, over time, a shift toward a much more community-focused notion of ourselves than an individual rights focus.”
You’ve recently led the development of a national group to deal with ethics issues in health care among Canada’s prison population. What are some of those issues that need to be addressed?
“There’s a lot. There isn’t really well-developed capacity for making the difficult ethics decision for this population in Canada. We’re a bit behind from other countries, in Europe, the United States … If a health worker is employed, for instance, by a prison and they have particular, legitimate duties around safety for other workers, inmates and society, yet they still have primary professional duties as a physician or a nurse, to that individual patient as their treating physician or nurse, sometimes those commitments can come into conflict.”
Can you give an idea of those potential conflicts?
“If, for instance, you have somebody who is coming into a hospital from an incarcerated environment, they’re from the prison, they might happen to be labelled as a violent offender and need to have a security guard with them, and within arms-length proximity, how can that individual have a confidential conversation about say a lab test, about an infectious disease, or about some other mental health issue, when a guard that is helping keep the environment safe and secure is within earshot of that conversation between the prisoner or the patient, and the physician?
“When a mother who was incarcerated temporarily, is pregnant or has a baby just recently, or is actually going to deliver while she’s incarcerated, what’s the right thing to do about keeping that particular baby or child with her? Is it safe, does it help the mother, does it help the baby, does it help them as a unit, a family … Is there something really important from the rehabilitation point of view, as well as the mother-child connection, that we need to do, some different things to ensure there are special places for mothers and babies to be able to grow together as the mom is incarcerated for a temporary period of time?”
What needs to change when it comes ethics, patients and prisoners?
“We need to name the issues, then we need to identify some ways we can think through them logically and using principles and ethics language and frameworks, then develop a guide so that all people everywhere can be treated reasonably fairly.”