SYDNEY, N.S. — When Dr. Christy Simpson’s father suffered a heart attack, she saw first-hand how living in a small community can affect your experiences in the health system and the confidentiality of your health information.
Having grown up in a rural area on a dairy farm, when a neighbour who worked at the hospital saw her family at the emergency department, she approached and asked what brought them there. By the time they returned home that day, word had gotten around and their former hired hand arrived to help with farm duties.
“I didn’t think twice about it because I was just so grateful to have somebody there to help us out,” Simpson said.
Normally, the directions that those working in the health-care system are given when they encounter someone they know is to wait until they are acknowledged, Simpson said. In the situation involving her father, however, she said her family welcomed the assistance around the farm that was offered.
It was months later when she was teaching a session on confidentiality when she got to thinking about the fact that their neighbour hadn’t followed that advice.
“I’m still not sure that technically it was wrong,” Simpson said. “Was it the fact that we were good neighbours that she didn’t need to ask … was it the fact that it was a heart attack and may not be something that had a bit of stigma attached to it, would it have been the same if it was a mental health crisis?”
Simpson was the keynote speaker at the 19th annual cancer care symposium held in Sydney on Friday, speaking on rural perspectives on health ethics.
Simpson said it essentially boils down to what is the best thing to do for this patient and how to talk about difficult things, adding it’s not an easy discussion to have because people can see things very differently.
“It’s different when you’re a provider, it’s different when you’re a patient,” she said. “The choice that you might make when you’re the clinician might be very different when you’re the patient.”
She encouraged people to think about what they consider to be the top ethical challenges they would encounter when in a rural setting, noting confidentiality and privacy are often cited, especially in a small community, where everyone knows everyone and even knows the cars that they drive.
“Ethics, for me, involves really those questions about how we should treat each other, knowing that the 'should' word is the hard word in there,” Simpson said. “Whether it’s a cancer patient, whether it’s a family and whether it’s, as we’re going through lots of change in our health-care system in Nova Scotia, how do we treat other knowing that we each want to receive health care when we need it, we want to know that we’re getting the best possible care but also recognizing it’s about all of us at the same time and what are those trade-offs that might be made as part of that.”
She noted that, when it comes to ethics, it can often end up being about what is the “more right” or the least harmful thing to do.
The symposium is presented annually by Nova Scotia Health Authority, the Cape Breton Cancer Centre, Nova Scotia Cancer Care Program and Dalhousie University Continuing Medical Education.
Other sessions during the day discussed topics including immunotherapy, the evolving role of the nurse practitioner and opportunities that the Cape Breton Regional Municipality's health-care redevelopment will offer to rethink cancer care.
