Coffee with Katarina: Relationships

Welcome to the second edition of Coffee with Katarina, a discussion with Katarina Lee-Ameduri, Clinical Ethicist for St. Boniface Hospital and the Catholic Health Corporation of Manitoba as well as an Assistant Professor in the Department of Family Medicine at the University of Manitoba.

This month our topic is relationships.  Relationships can bring up a lot of ethical questions and can sometimes be a difficult subject to navigate, distinguishing between our own judgments and our ethical duty.

If there are other hot topics and ethical discussions that you’d like to see discussed in this column, please email info@chcm-ccsm.ca

This is February; we’re right around Valentine’s Day, why don’t we talk about relationships? When talking about relationships and the people we support, how can we support without restricting relationships?

In general, there are a few dimensions to discuss when broaching a complicated topic, like relationships- two in particular are decision making and resources- or lack of resources.

Relationships of all sorts can be complicated, for example, a parent comes in to meet with a clinician seeking resources to help their child, their adult son or daughter is refusing to receive help. How can we help someone, an adult, who is refusing and may be in danger? Occasionally, families resort to wellness checks from police, which is sometimes effective but may not be the best use of resources. Is that person in a space to safely make their own decisions? They have many resources and support persons surrounding them- but their decision making ability might be compromised.

The other side would be access to resources, or lack of resources.

Let’s say someone has burned all their bridges with their support persons. They may not have the capacity to advocate for themselves AND are experiencing a mental health challenge that is impairing their judgment. They have a spouse that health care professionals are weary of, they suspect possible financial abuse.  The person is denying that they are being abused; the spouse is also denying it.

How do you prove it? Whose voice do we listen to? It may not be what the average person considers reasonable, but how do you determine what is a “good” relationship and what is a “bad” relationship? Everyone has the right to make choices.  

Can we trust that this person has the resources and decision making ability to be safe?  

Right, we don’t always like everyone’s partner, but we don’t often have a say in who our loved ones date or have as companions. I guess that’s where it can get complicated with people we’re supporting and the choices they make in relationships.

In my experience, I find that society seems to scrutinize the choices and decisions of people who may be considered vulnerable. It’s not fair, but the duty to protect a vulnerable person is part of our role, working in health and social services. This word- vulnerable- can itself be the cause of debate, my definition may vary from yours, and the person working in the office beside us.

In long term residency, technically the facility has the responsibility to protect a vulnerable person. Realistically, that lands on the shoulders of a social worker. Some may say it’s intrusive, to have to sit down with a social worker and discuss your relationship and what you’re both looking for. What if it doesn’t match? Not everyone is verbal, or can communicate specifically what they’re looking for in a relationship, so how can a social worker be expected to judge this from one meeting with a couple?

 Most of us in relationships don’t have to first, sit down with a social worker to make sure that we want the same thing from a relationship, is it fair for the people we support to have to do this? That’s where we need to find the line between safety and intrusion.

Speaking of safety and intrusion, we’ve heard about elderly people finding love again, later in life. Could there be some potential ethical discussions when a person re-discovering romance may, in some cases, be deemed vulnerable?

Certainly. I’ve seen individuals who have been widowed or divorced for many years find a companion in an assisted living situation and then make the leap to marriage. For most, there are some more legal rather than ethical discussions to go through, namely finances- does the “new” spouse receive assets in case of death? Life insurance? Do we need a prenuptial agreement to rectify any of these issues?

Ethical questions can often arise if a person is not of typical age to engage in a relationship, maybe very young or a little bit older, or maybe experiencing a different cognitive ability than they once were. What’s acceptable, in a relationship, based on who you are at this point in your life? Who is to judge that?

One possibility is creating a process that can assist with consent for people of all ages. It could be an assessment by a psychiatrist when a person receives acute medical care. This could take some of the guess work and individual judgment out of the process.

Questions of birth control can also come up when we deal with people experiencing different levels of cognition, at a younger age. Everyone has a personal opinion based on their own beliefs when it comes to birth control. Where is the line between, again, supporting someone to make a safe decision and passing your own judgment?

A lot to think about! Thanks Katarina! Where can we find you next?

There are a few upcoming events, but the next one is the Ethics in Healthcare Film series, we’ll be showing the film The Upside, which touches on a lot of the subjects we discussed today- relationships, intentions, caregivers- I hope to see you there.

For more information on upcoming events please visit chcm-ccsm.ca