Too much information?

Margaret Somerville
23 August 2011
Reproduced with Permission

The ethics of communication - whether over-communication or under-communication - have been in the news over the last few months. WikiLeaks, the Murdoch press affair in Britain, and in Canada the public's right to be informed of the details of the health status of the leader of the federal opposition, Jack Layton, have all made headlines. A recent incident caused me to look at the ethics that should govern communications in a very everyday context, that of hospital patients' committees communications to patients. Here's the story.

The patients' committee of a teaching hospital recently held its annual dinner meeting. They invited me to be their 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.

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:

[Somerville] proposed that one question we need to explore is why now, after seeing euthanasia as ethically wrong for millennia, Quebec society would see legalizing it as a good idea? "Societies like ours have been saying for years and years that euthanasia is ethically wrong. Why would we change our minds now?" she asked. She suggested that perhaps one reason is that Quebec "has made a radical change from a profoundly religious society to a militantly secular one," and the traditional ethical safeguards are no longer operative.

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.

Dr. Somerville spoke of the situation in the Netherlands, where euthanasia has been legalized for over thirty 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 at the … Hospital. The committee includes patients as well as representatives for physicians, nurses, and staff. The committee works closely with [the hospital] ombudsman … to deal with patient complaints and also focuses on issues [affecting patients]. ... Patient education and advocacy issues are an important part of the committee's agenda." This would seem to strongly support reporting on educational events organized by the committee. Members of the committee have made clear to me that they believe it is important that patients are informed about 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, including that by the Farewell Foundation, this is not just a theoretical concern.

A short time later, 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 "we allow them to publish a blurb [just] about our 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."

So it seems they've placed the ball is 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 PR people indicates that they regard the topic, itself, as too controversial for their newsletter.

I understand that hospital public relations people need to stay on good terms with as many of their supporters as possible and, almost certainly, some of them agree with legalizing euthanasia and might object to my comments. But, as I said in my reply to the email from the committee's chair,

this is indeed worrying, way beyond the refusal to circulate any report of my simple remarks, but I am not surprised. It doesn't "appear to be censoring", as you query - it is censoring, although I can understand that the [hospital's] PR office doesn't want to offend anyone.

And 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.

Apropos the current incident, I have long taught my students that many ethical mistakes are made when an ethical issue is taken over as a PR or communications issue and wrongly dealt with. What starts as one ethical problem is often spin-doctored into many.

So where should we draw the line, ethically, in such situations? Was the topic "the problem"? Was it the words I used? Was it my reputation for being "controversial"? Or was it something else? And while the PR people are acting fully within their rights, is their decision ethically acceptable? Is it wise, in the larger scheme of things?

I'm sure many people will see my writing this article as a gross overreaction to a minor restriction, well within the PR office's realm of discretion and rights, the latter of which is correct. But 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.

And while this patients' committee tells me it is not restricted by its hospital administration in raising its concerns, is the freedom to report of other such committees limited in even more worrying 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 and bringing to people's awareness matters of concern. 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, when they are not. In the latter, they know they have to be on their guard.

Censorship is the wrongful suppression of communication, distributing hacked material the wrongful promotion of communication. I hope that it might stimulate some insights for people to recognize that these undertakings are two sides of the same coin and, sometimes, it can be a difficult ethical judgment to decide whether it's wrong to withhold a given communication or wrong to circulate it. Both can be ethically wrong and both can be ethically right.