Ethics Consultation & Beyond: A Primer for Health Care Ethics Committee Members
Sponsored by the Harbor Hospital Ethics Committee
In Partnership with
the Maryland Healthcare Ethics Committee Network
at the University of Maryland School of Law
and the Center for Ethics at Washington Hospital Center
Wednesday, June 29, 2011
8:30 a.m. – 4:15 p.m.
3001 S. Hanover St., Baltimore, MD, 21225
CEUs for nurses and social workers (6.0 hrs), and CMEs for physicians (6.0 hrs) will be available at the registration table at the end of the conference for those who sign in and submit a completed conference evaluation form. Attendance certificates are also available on request.
This one-day workshop will give health care ethics committee members practical experience addressing ethical issues at their organization, from handling ethics case consultation requests to addressing systemic problems that contribute to ethical questions, conflicts, and concerns, and moral distress among staff. Attendees will learn quality improvement methods for ethics committee functions, and methods of gaining institutional support for the work of the committee. Attendees will apply concepts presented throughout the workshop to two paradigm cases included below. Attendees may also bring a case from their own institution to discuss at the afternoon case consultation practicum.
CASE STUDY #1 – End-of-life decision-making
Mr. Jones is a 75 year old patient admitted to the ICU 2 weeks ago for advanced heart failure. He has a history of congestive heart failure, diabetes, and high blood pressure. He has no advance directive and is currently unconscious, on mechanical ventilation (without paralytics). His wife died 3 years ago, and he has 4 adult children and 9 grandchildren. The ICU staff has tried to talk with Mr. Jones’ children to explain that Mr. Jones' medical condition is worsening -he is developing kidney failure and his heart failure is worsening. He cannot be weaned off the ventilator and his kidneys may soon shut down. The staff have recommended a switch to "comfort care" that would focus on keeping Mr. Jones as comfortable as possible and providing emotional support to the family. Three of Mr. Jones' children insist that "everything be done" to keep him alive, including ventilator support, kidney dialysis, and CPR attempts were his heart to stop. The ICU staff calls for an ethics consultation to intervene.
CASE STUDY #2 – HIV Disclosure
Ms. C, who is HIV positive, delivers a full term baby boy. Neonatology treats the infant with antiretroviral (ARV) therapy and teaches Ms. C about her son's ARV regimen. Ms. C agrees to give her son the ARV drugs prescribed, but states that she will not be taking ARV drugs herself, for fear her boyfriend will find out about her HIV positive status. The medical team is concerned because the baby's grandmother will be the primary caregiver during the day, and the clinical team thinks that if the grandmother doesn't understand why treatment is needed, this may diminish adherence to appropriate ARV drug administration. When the team attempts to persuade Ms. C to disclose her HIV status to her mother, Ms. C declines emphatically, stating, "It is my right to keep this information private, and it would be a violation of my confidentiality if you told her. I will sue you and the hospital for a violation of my privacy if you tell." Although the physician continues to try to impress upon Ms. C the importance of disclosure to her mother to strengthen the possibility of optimal treatment of her infant, of taking ARV medications herself, and of telling her boyfriend so that he can be tested and (if needed) treated, Ms. C adamantly refuses to disclose. The physician requests an ethics consultation for guidance on how to proceed.