A Quebec hospital’s decision to censor its newsletter forces us to rethink the ethics of communication.
On first publication, this article was mistakenly posted with a photograph of Montreal General Hospital (MGH). The hospital described in this article is not MGH. Dr. Somerville has not revealed the identity of the hospital described below.
The ethics of communication – both over-communication and under-communication – has been a popular topic in the news over the last few months: internationally, WikiLeaks; in Britain, the Rupert Murdoch affair; and in Canada, the public’s right to be informed of the details of the recently deceased NDP leader, Jack Layton’s, health. A recent incident caused me to look at the ethics that should govern communications in a very everyday context – those pertaining to hospital patients’ committees. Here’s the story.
The patients’ committee of a teaching hospital recently held its annual dinner meeting. The group invited me to be its guest speaker, and asked me to talk about “ethics issues at the end of life […] in particular, the current debate on the controversial issue of legalizing euthanasia in Quebec.” I agreed to lead an interactive discussion, which everyone engaged in enthusiastically.
Should assisted suicide be legalized? The Mark hosts an exclusive debate here.
After the dinner, the committee secretary wrote a report of the discussion for the hospital’s e-newsletter, a copy of which she sent to me for approval, which I gave. The report, which I quote with the permission of its author and other executive members of the committee, started by saying that I am “strongly opposed” to euthanasia, which is correct. It continued:
The reasons [for current calls to legalize euthanasia], Dr. Somerville explained, lie beyond dealing with the suffering of terminally ill individuals. People have always become terminally ill, suffered, and we could kill them, so there’s nothing new there. Indeed, there is vastly more we can do now than in the past to relieve their suffering. What has changed are people’s claims to rights to autonomy and self-determination. People [claim they] have a right to control their lives and death[s].
Dr. Somerville spoke of the situation in the Netherlands, where euthanasia has been legalized for over 30 years. She explained that the Dutch have expanded the criteria for allowing euthanasia and that government-sponsored studies show that there is some abuse of the practice, which could also happen here in Quebec. There are reports that some elderly Dutch people are afraid to go into their own hospitals, because they fear being euthanized and that some are crossing the border to go into the German hospitals, where, as a result of the Nazi legacy, euthanasia is rejected. “In short, euthanasia involves physicians killing their patients; it is presently the crime of murder [in Canada] and should remain such,” concluded Dr. Somerville.
This article for the e-newsletter also explained that,
[the] Patients’ Committee is a group dedicated to patient advocacy with particular focus on issues that affect patients … Patient education and advocacy issues are an important part of the committee’s agenda.
From this description, it would seem that the committee strongly supports educating patients, and that it would thus be in favour of accurately reporting on educational events that it is organizes, such as the one at which I spoke. Members of the committee have made clear to me that they believe it is important that patients are informed of the issues in the euthanasia debate, as, if legalized, it could affect many of them. As the current court challenges in British Columbia to the criminal prohibition on assisted suicide show, this is not just a theoretical concern.
A short time after receiving the above-mentioned e-newsletter, I received an email from the Patients’ Committee’s chair, explaining that the hospital’s public-relations office had decided that “everything written about what Margaret Somerville said will be omitted [from the e-newsletter report of the dinner], because it is very controversial and the [office] will not print anything controversial!” In response, one committee member suggested that they “allow [the public-relations office] to publish [just] a blurb about [the] committee, the dinner, and the fact that Margaret Somerville was the speaker.” The chair sent me a copy of her response to this proposal: “At first, I absolutely refused and [the secretary] did too. I tend to react strongly to anything that appears to be censoring. However, I now feel this is not my decision to make. I leave the decision to Margaret.”
Read more from Margaret Somerville on Quebec’s attempt to legalize euthanasia here.
So, it seems they’ve placed the ball in my court. Now, I agree that my use of the words “killing” and “murder” are confrontational, and I’d be less likely to use them in writing for publication than in speaking, although I’ve done both. And I could have been asked whether I was willing to change these words to something less dramatic. But I’m not sure this would have solved the problem. The email from the public-relations office indicates that its staff regards the topic itself as too controversial for its newsletter.
I understand that hospital public-relations staff need to stay on good terms with as many of their supporters as possible, and that some of them almost certainly agree with legalizing euthanasia, and thus might object to my comments. But, as I said in my reply to the email from the committee’s chair,
If something that is a factual report of a discussion can’t be published, when will we face the reality that the discussion itself will not be allowed to take place? Such censorship is of grave concern in our universities, including McGill, which try to prevent it. … And such censorship is insidious, because it need not be overt and direct. Its presence causes people to engage in self-censoring in order not to be shunned or shamed, or out of fear or loss of promotion and privileges, or even loss of friends.
So where should we draw the line, ethically, in such situations? Was the problem the topic? Was it the words I used? Was it my reputation for being “controversial”? Or was it something else? And, while the PR staff are acting fully within their rights, is their decision ethically acceptable? Is it wise, in the larger scheme of things?
Some of the most serious threats to basic freedoms, such as freedom of speech, will not come in the context of international incidents, but in small, everyday restrictions, such as this one, when the rest of us just accept and normalize them.
Are Canadian journalists and columnists actively self-censoring. Read one expert’s view here.
And while this patients’ committee tells me it is not restricted by its hospital administration in raising its concerns, are other such committees limited in ways that could place patients at risk? The job of the hospital’s PR office is to present the hospital only in the best light, and hospital administrators usually try very hard to avoid bad publicity – goals which could be in conflict with providing information that patients’ committees believe should be made public.
Moreover, a patients’ committee is a safeguard mechanism that operates through consultation and involvement in decision-making in order to bring matters of concern to patients’ awareness. We should keep in mind that it’s much more dangerous to have safeguards that are ineffective than to have no safeguards at all. In the former case, everyone assumes all the necessary checks and balances are operating, even though they are not. In the latter, individuals know they have to be on their guard.
Distributing hacked material, examples of which I gave at the beginning of this discussion, is the wrongful promotion of communication. Censorship is the wrongful suppression of communication. These undertakings are two sides of the same coin, and both can present the same problem: Sometimes, it can be a difficult ethical judgment to decide whether it’s wrong to circulate hacked communications and, sometimes, it can be a difficult ethical judgment to decide whether it’s wrong to withhold a given communication.