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

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? 2

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? 3

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 4