Today - November 25, 2020. As I write this, Alberta is coming off successive days of over 1,000 COVID cases and ICU capacity is reaching pre-determined threshold limits in the province. We have the dubious distinction of leading the country. For days, weeks, and even months, our provincial government has been admonishing citizens to exercise personal responsibility in how they work, play, live, and socialize in order to flatten the COVID curve.
The current conservative government has been loathe to impose (and enforce?) more significant restrictions up to and including a circuit-breaker lockdown of between two to four weeks long. This would harken back to earlier this year when businesses were shuttered and schools either effectively closed or moved to virtual reality through to the end of June. Similar efforts have been used to positive affect in other jurisdictions like Australia.
In April, daily cases reported numbers in the low hundreds. Today we are multiples beyond that and likely to hit new highs in the coming days. The Grinch is likely to steal Christmas this year.
The current choice provincial political leadership seems to believe it is faced with is one between economic disaster that would arise from a lockdown, the potential backlash from some who believe any form of restrictions is a violation of their individual rights, and a continuing - and accelerated - rate of infection, hospitalization, and death of Albertans. Livelihoods or lives.
Leadership is about hard choices. Compounding that reality is that those hard choices are fraught with imperfect information, particularly around decisions where there are conflicting opinions, motivations, and truly unknown future outcomes. Leaders rarely get clear and distinct choices between right and wrong, yes or no, black and white. Leadership is about the courage to function and excel in the shades of gray.
Those choices can result in pain and anguish when we struggle through what is the right thing to do or we may even be actively prevented from doing the right thing. There may also be times where we feel we are forced to do the wrong thing. We experience moral distress. I can only imagine the moral distress that our Chief Medical Officer of Health (CMOH) faces each day as she watches the cases climb, contact tracing systems collapse under the volume of activity, citizens ignoring recommendations to promote their safety, and having to toe a political line relative to what should be done versus what will be allowed or tolerated.
Beyond the period of agonizing over that first big choice comes the consequence of having to now live with those choices. Moral residue follows moral distress - a feeling of having compromised ourselves, our ethics, our values, and ourselves when the anticipated and real consequences of our choices come home to roost. I believe the CMOH is trying to do the right thing. The question becomes is she being prevented from doing the right thing or is she even being forced to do the wrong thing.
The answers to whether our government is doing the right thing or the wrong thing will become much more abundantly clear in the next two to three weeks. In that time we will find out how much of a game of Russian roulette we have been playing. We will find out how many blanks or live ammo are in our collective gun. If we have guessed, hoped, or chosen wrong, we will put our healthcare system in another situation of moral distress. In fact, we already have. Elective and non-urgent surgeries have already been cancelled. Other appointments and diagnostic tests have been delayed or postponed. These consequences will pale in comparison to the choices we may be placing before our healthcare professionals in the weeks to come. We could be asking them to NOT put COVID patients on ventilators because we lack capacity. We may be asking them to CHOOSE between providing life-saving care for a 55-year-old father of three daughters, or the 80-year-old grandmother of six grandkids, or the 30-year-old just-married wife starting to really launch her career.
Moral distress. Moral residue. It's being writ large for all of us. Send our kids to school or not. Work from home or not. See our families or not. Support a lockdown or not.
This is the time for strong leadership. This is a time for courage. This is a time of commitment.
It's About Leadership. Period.
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Great blog and some challenging thoughts around moral distress. Front line health workers (nurses, physicians, allied health) are at the breaking point. Even in BC, hospitals are increasing usual 1:1 nursing ratios in Intensive Care to 5:1 in some sites. Alberta is proof that the right-wing bluster may appeal to a disaffected electorate (the base) but as we have seen the US and England, it's simply comes up short in a public health crisis. Leadership is about having the courage to make the right decision - not the popular one. And while diversifying the economy has been a distance pipe-dream (pun intended) in Alberta for 40+ years, the economic recession compounded by COVID has trapped Mssrs Kenney and Shandro. They've run out of rabbits to pull out of the hat - and people (mums, dads, aunties, grannies) are dying. It's sad to watch from this side of the Rockies but given our current hospitalizations/positivity rates, we are far from being smug about it! -Doug
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