Compromise, Consensus, and System-ness: Developing a Community - - PowerPoint PPT Presentation

Compromise, Consensus, and ‘System-ness:’

Developing a Community “Crisis Standards of Care” Policy in Light of Competing Ethical and Practical Commitments

Patrick McCruden, DBe, MTS, HEC-C Chief Mission Integration Officer-SSM Health Jenny Heyl, PhD, HEC-C Executive Director Ethics-Mercy

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Background

• Impetus for common Crisis Standards of Care (CSC) Policy:

A strong well-organized Regional Pandemic Task Force

• Between Mercy, SSM, BJC (Barnes-Jewish-Christian) and St.

Luke’s >90% of the hospital beds in the region

• Articulated at first small group meeting:

“A patient should be able to come to any of our hospitals and get the same triage”

• Was that a worthy endeavor?

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Starting Points…

• Consensus as part of the founding myth of secular bioethics
• Ethics has a role in improving the ethical care across the

community, why not with Crisis Standards of Care?

• Competing commitments: “System-ness” Command Center

approach which rejects uncontrolled variation, but regional realities exist

• How to balance?
• Lack of consensus on “Catholic” approach
• Can ethicists agree?

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Resolution/Success?

• Pragmatic approach: deadlines drove consensus
• CSC: 90% medicine, 10% ethics (but an important 10%)
• Clinical leadership crucial
• Pittsburgh protocol had wide support among clinical leaders
• Should clinical leaders have the final say?
• Sticking points:
• Health Care Workers priority
• tie-breakers: pregnant women, age,
• “Reallocation”
• Conclusion: 95% common with flexibility on tie-breakers