Tuesday, 11 August 2009

Member Care and the Hippocratic Oath, Part 6

La Era (garden), Diego Rivera, 1904
El sabio, con corona,
como leon semeja;
la verdad es leona
la mentira es gulpeja.
Sem Tob, 14th century, Spain

Translation :
Wise people are like lions:
Crowned in truth they hold their ground.
But lying foxes run around.
But I will preserve the purity of my life and my arts.
I will not cut for stone,
even for patients in whom the disease is manifest;
I will leave this operation to be performed by practitioners,
specialists in this art.
Hippoctratic Oath
For member care practitioners, and all of us with member care responsibility, character and competence are inseparable in our lives. Said another way, we want to extol and develop both virtue and skill. And we want to help others–-fellow practitioners, organizations, clients, etc—to do the same.
The notion of character, broadly speaking, is embodied in the Hippocratic commitment to “preserve the purity of my life and arts”. It necessitates practicing ethically and living ethically.
The notion of competence—or more specifically working within one’s sphere of competency—is seen in the commitment to “not cut for stone”. Apparently this refers to the surgical removal of things like gall stones or kidney stones. Such practices at that time in 4th century Greece were not part of the purview of medical practitioners.
It bears mentioning that during our work in member care we are often stretched both:
**ethically (not everything in our work of course is black and white—and we cannot always know the consequences of our interventions) and
**experientially (not everything we do fits neatly into our training backgrounds—and we cannot always know what the “best practice” will be).
I appreciate the simile of the lion cited above from Rabbi Sem Tob’s heptasyllabic quartet (that sounds serious—well, what I mean is that it is a short poem written in a certain manner :-) Tob's creative gem states that our crowning wisdom is demonstrated through our courage and clarity in speaking/acting truthfully (holding our ground with the truth, not being distracted from our course, and being open to input when the truth is not clear).
By “truth” I mean the conformity of mind to reality, as the Scholastics would say (e.g., Thomas Aquinas et al). Of course we could then ask what is mind and what is reality! But I will leave that for others to deal with who are far more learned than I am.
What I am really getting at here via the blend of Sem Tob's morality poem, Hippocrates' oath, and Rivera's painting, is that we are committed in the member care field to work knowledgeably and ethically within our "gardens"--that is, our spheres of influence. Knowledge and ethics are all part of the character/competency core.
Here are three related items--resources--that you will hopefully find helpful. (from Kelly O’Donnell)
1. Some Suggested Ethical Guidelines for the Delivery of Mental Health Services in Mission Settings, Helping Missionaries Grow, (1988) p. 469
**MHPs [mental health practitioners in missions] are dedicated to high standards of competence in the interest of the individuals and mission agencies which they serve. They recognize the limits of their training, experience, and skills, and endeavor to develop and maintain professional competencies. MHPs keep abreast with current professional information and scientific research related to their work in mission settings.
2. Upgrading Member Care: Five Stones for Ethical Practice (2009)
**MCWs are committed to provide the best services possible in the best interests of the people whom they serve…. Character, competence, and compassion are necessary to practice member care well.
**[Character] refers to moral virtue, emotional stability, and overall maturity. Basically, the qualifications for leaders in Timothy and Titus reflect the types of character traits needed for MCWs. Those in member care ministry have positions of trust and responsibility, and work with people who are often in a vulnerable place. Therefore they need to model godly characteristics as they minister responsibly—to protect/provide for those who receive their services…
**[Competence] refers to having the necessary skills to help well (via life experience and training). I have found that competence is not necessarily based on degrees or certification, although the systematic training that is required to get these “validations” is a very important consideration. Others without such institutional validation are also capable of doing member care well (usually via more supportive than specialized care), and indeed in many places they are the primary service providers (e.g., peers, team leaders). Note that MCWs, like others in the health care fields, can be “stretched” at times to work in ways that may go beyond their skill level. And many services can be in ambiguous, complex, and difficult settings, with the outcomes (positive or negative) not easy to predict. Caution and consultation with others are needed in such cases…
**[Compassion] refers to our core motivation for member care work. It is the love of Christ that compels us. We value people for their inherent worth, and just for their “important” work.
3. Member Care Involvement Grid—Strengths and Preferences (2003, adapted)
This grid helps us to identify the “fit” and practice parameters for ourselves and colleagues. This grid is a continuum. It could also be used as part of a simple/informal team building exercise as a way to get to know other MCWs and understand their strengths and preferences. Note that there are many other items that cold be included on this grid. What would you include?
Administration focus/involvement-----People focus/involvement
Working by oneself mostly-----Working as part of a group mostly
Mostly provide member care-----Mostly develop member care
Working groups that Talk/think-----Work groups that “Task”/do
Services as needed/requested-----Systematic/planned services
Local geographic focus-----International geographic focus
One main ministry focus-----Multiple ministry focus
One specialty-----Many specialities
One organization focus------Interagency focus
Connection in a sector-----Connection in many sectors

Reflection and Discussion (apologies for the “leading questions”!)
1. Should the member care field be regulated to better ensure the quality of services and qualifications of service providers? If so, how?
2. How do we measure competence in member care practitioners?
What could be some specific behavioural criteria to consider (so not just academic degrees, titles, job descriptions, time living in another culture etc.)?
3. How could the member care sector build program evaluation/outcome studies/research into the member care field in order to empirically measure the effectiveness of the various types of services/interventions that we provide? Is it appropriate—ethical--to continue providing and developing services without assessing their effectiveness?
4. How relevant is the notion of developing evidence-based, expert-consensus guidelines for member care practice? What are the criteria for "evidence"--"expert"--"consensus"?!

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