To assure that our Mission is fulfilled as we address these challenges, we have developed systems to support ethical deliberation and decision-making. One such system is our ethics team structure, which includes our system-wide Ethics Council with oversight of our various single-hospital based Ethics Committees and our continuum of care-focused Ethics Committees (such as our Home Care, Behavioral Health and Improving End-of-Life Care Committee). This structure is organized through our Ethics Center in partnership with the office of Mission Integration Leadership. Through this team structure topics of emerging concern within the health care arena are discussed as they relate to Alegent Health and those we serve, and opportunities for ethical deliberation, education, and policy and practice improvement are identified.
 At its foundation, this system of ethical deliberation and decision-making is rooted within the principle of health as a shared endeavor between providers, individuals, social networks and society. As it says in the ELCA’s Social Statement on health care, “Just as each person’s health relies on others, health care depends on our caring for others and ourselves.” As a shared endeavor, the system of teams engaging in ethical deliberation within our organization and within the communities we serve, allows us to collaborate both internally and externally as we address such challenges as access to limited healthcare resources, care for the poor and disadvantaged, and emergency response and preparedness.
 As a starting point, we approach ethical deliberation with a spirit of discernment. This spirit of discernment calls us to enter into dialogue with a readiness to engage with others, an openness to hear ideas that may be new or different than our own, and a willingness to learn, understand and be surprised by what we find through the process of ethical deliberation. Dialogue within this approach of ethical deliberation is facilitated using a framework that includes an exploration of the situation as it relates to the social teachings of our sponsors, the Alegent Health Mission and such principles as self-determination (or respect for autonomy), justice, stewardship, and health & finitude. We use a tool called the “Arenas of Inquiry” as part of our deliberation and decision-making journey to help us structure our analysis of options through a discernment process that centers on faithfulness to our mission, engagement with our stakeholders and commitment to our identity and vision. See Arenas of inquiry for Mission-Based Decision Making. By using this framework for our dialogue, Alegent Health leaders, providers, ethics team members and key stakeholders are better able to identify, explore and understand the tensions inherent within the situation, and are better prepared to address emerging concerns related to the health and well-being of our community.
 One example of this model for ethical deliberation, discernment and decision-making in action has been in response to the recent outbreak of the H1N1 flu virus in our communities. In preparation for this particular emerging issue, the Alegent Health Ethics Council began a process of ethical deliberation nearly two years ago in collaboration with key organizational and community stakeholders. Using the learnings from other communities who had faced similar outbreaks, and building on the frameworks developed by colleagues from throughout the country, Alegent Health ethics team members and others began a dialogue about the competing tensions inherent within a pandemic situation. Teams at various levels within the Alegent Health ethics structure discussed such things as:
 As the recent H1N1 outbreaks were developing in the communities served by Alegent Health, representatives from ethics teams were involved in numerous components of the response. Because the ethics team structures and the systems to support ethical discernment and decision-making processes were already in place, many members of the response teams had already been trained to engage in ethical deliberation. In some cases, such as the allocation of scarce resources and upholding the duty to care, teams had already participated in preliminary deliberation around a number of complex questions. In other cases, team members were able to engage with openness to consider additional ethical dimensions of the situation. Now – as the H1N1 outbreaks wind down we are preparing to use the framework of ethical deliberation and the guidance of our sponsors to better understand our recent response and better prepare our future response to outbreaks and pandemics as they emerge.
 As the above experiences illustrate, at Alegent Health we turn to our ethical deliberation structure when we are especially challenged as a health care provider to understand how we are called to love our neighbor while managing competing tensions. There are always opportunities to continue to grow in our abilities to serve on this ever-evolving journey, and we learn from each other as we continue on this shared endeavor to care for the health care needs of ourselves and of others.
© January 2010
Journal of Lutheran Ethics
Volume 10, Issue 1