ETHICS ON CALL: The role of Bioethicists in health care - - PowerPoint PPT Presentation

ETHICS ON CALL:

The role of Bioethicists in health care organizations

January 2014

HELLO, MY NAME IS…

 Michelle Allain, MSc.

Bioethicist

The Runaway Streetcar: Part 1

3

 A runaway streetcar is hurtling towards five people.  They will all be killed…  Unless you throw a switch that will steer the trolley

• nto a sidewalk, where it will kill just one person

instead of five.

 Should you throw the switch?

The Runaway Streetcar: Part 2

4

 Now consider a variation…  As before, the streetcar threatens to kill five people.  This time you are standing next to a large stranger on

an overpass that arches over the tracks.

 Because you are small but agile, the only way to save

the five is to push the stranger off the bridge onto the tracks below;

 It is certain that the stranger will die, but his body will

stop the streetcar, saving the five others.

 Should you push the stranger to his death?

(BIO)ETHICS?

Goal of the ethics program: Support the improvement of patient care by assisting patients, families, staff, physicians & volunteers resolve ethical issues.

Ethics in the Media…

Top 10 Health Care Ethics Challenges Facing the Public:

Views of Toronto Bioethicists (Breslin, 2005)

1.

Disagreement between patients/families and health care professionals about treatment decisions

2.

Waiting lists

3.

Access to needed health care resources for the aged, chronically ill and mentally ill

4.

Shortage of family physicians or primary care teams in both rural and urban settings

5.

Medical error

6.

Withholding/withdrawing life sustaining treatment in the context of terminal or serious illness

7.

Achieving informed consent

8.

Ethical issues related to subject participation in research

9.

Substitute decision-making

10.

The ethics of surgical innovation and incorporating new technologies for patient care

Ethical Decision-Making in Healthcare… It’s complex!

 Federal, provincial & local laws & regulations  Professional values & codes of ethics  Organizational policies, procedures & values  Societal expectations & demands  Individual values & beliefs

 Patient  Family  Colleagues

Comprehensive Ethics Program

Consultation Policy Review & Development Education Research Bioethics Program Ethics Expertise Organizational Support

Who & How Bioethicists Help

 Who:

 Patients, families, SDM(s)  Staff  Volunteers

 How:

 Consultation (confidential)  Debriefings  Mediation  Education  Policy review/development

One on One Group

Anyone can call or email the bioethicist to request support

• r can ask a staff to do so on

their behalf. Confidential consultation available

Domains of Practice

 Purpose:

 Build ethics capacity & awareness across

the organization

 Value of building ethics capacity:

 Trust & organizational moral climate  Healthcare human resource retention  Client/caregiver experience  Staff quality of work life  Quality of care  Accreditation Canada

Education Education Bioethicist

Domains of Practice

 Discomfort or uncertainty about the ‘right’

thing to do – could vs. should

 Complex decisions that involved multiple

stakeholders, perspectives, or interests

 Disagreement about what is ‘right’  Competing values (e.g.: telling the whole truth vs.

preserving confidentiality)

 Knowing the ‘right’ thing to do in a situation, but

encountering organizational or personal barriers.

 Lingering distress as a result of unresolved ethical

issues Education

How do I know when I’m facing an ethical issue?

Domains of Practice



What is the Ethical Decision-Making Framework?



An analytic tool designed to help individuals work through & address ethical issues in client care.



When should I use it?



Use the tool as ethical issues or questions arise. The tool can be used at any point during the decision process, although the earlier the better.



Common triggers include:



Uncertainty about the ‘right’ course of action



Differences in values



Complex decision that involves multiple stakeholders etc..



Who should use the tool?



Anyone can use the tool. It may be especially helpful for: clinicians, health care teams, clients/families, administrators etc…



How do I use the tool?

Education

Domains of Practice

Education

Domains of Practice

 Purpose:

a)

Ethical review of research proposals & protocols  Research Ethics Board (REB)

b)

Advancement of health care through research on ethical issues

 Example:

Research Education Research Bioethics Program

A)

Domains of Practice

Research

Example: B)

Domains of Practice

Policy Review & Development

 Purpose:

 Ensure organizational policies &

guidelines meet ethical requirements.

 Examples:

 End of Life  Confidentiality  Conflict of interest

Policy Review & Development Education Research Bioethics Program

Domains of Practice

 Clinical  “…improve the process &

• utcome of care by helping

clinicians to identify, analyze & resolve ethical problems that arise in specific clinical cases”

(Source: Agich, 1996: 125, Cited in Gordon 2007:27.)

Example:

Consultation Consultation Policy Review & Development Education Research Bioethics Program

Domains of Practice

 Clinical  “…improve the process &

• utcome of care by helping

clinicians to identify, analyze & resolve ethical problems that arise in specific clinical cases”

(Source: Agich, 1996: 125, Cited in Gordon 2007:27.)

Example:

Consultation Policy Review & Development Research Bioethics Program

Effect of Ethics Consultations on Nonbeneficial Life-Sustaining Treatments in the Intensive Care Setting: A randomized controlled trial

Schneiderman et. al., 2003

Purpose:



Investigate if consultations in the ICU reduce the use of life-sustaining treatments delivered to patients who ultimately did not survive to hospital discharge



Investigate the reactions of HCPs & patients/SDMs Results:



Usual-care groups showed no difference in mortality



Ethics consultations were associated with reduced hospital & ICU days & life sustaining treatments



87% of physicians, nurses and patients/surrogates found ethics consultations in the ICU were helpful in addressing treatment conflicts

Domains of Practice

 Clinical  “…improve the process &

• utcome of care by helping

clinicians to identify, analyze & resolve ethical problems that arise in specific clinical cases”

(Source: Agich, 1996: 125, Cited in Gordon 2007:27.)

Example:

Consultation Consultation Policy Review & Development Education Research Bioethics Program

Domains of Practice

 Clinical  “…improve the process &

• utcome of care by helping

clinicians to identify, analyze & resolve ethical problems that arise in specific clinical cases”

(Source: Agich, 1996: 125, Cited in Gordon 2007:27.)

Example:

Consultation Consultation Policy Review & Development Education Research Bioethics Program

Domains of Practice

 Organizational  The systems-level prevention/

management of ethical issues that affect the management of the organizational &/or patient care.

 Importance of Organizational

Ethics:

• Organizational issues are inherently

value driven

• Organizations have a mandate to uphold

institutional mission/vision/values

• Breadth of impact
• Public accountability

Consultation Consultation Policy Review & Development Education Research Bioethics Program

“Organizational ethics calls on health care managers & board members to:

• Champion the organization’s efforts to define its core values

and mission,

• Identify areas in which important values come into conflict,
• Seek the best possible resolution of these conflicts and,
• Manage its own performance to ensure that it acts in accord

with espoused values”(Gibson, 2007, Healthcare Management Forum, p. 34)

COMMON ORGANIZATIONAL ETHICS CHALLENGES (Gibson, 2007)

• Resource allocation
• Business development
• Charitable fundraising
• Access to care
• Workplace ethics
• Relationships with vendors
• Conflict of interest
• Relationships with other providers in the community

Domains of Practice

 Organizational  The systems-level prevention/

management of ethical issues that affect the management of the organizational &/or patient care.

Example:

Consultation Consultation Policy Review & Development Education Research Bioethics Program

APPROACHING ORGANIZATIONAL ETHICS IN PRACTICE…

• 1. Organizational ethics depends on leadership
• 2. The mission, vision & values of an organization should be

the foundation for all decisions & actions

• 3. Ethical guidelines, policies & decision-making frameworks

should be in place

• 4. Processes should ensure ethical decision-making processes

& mechanisms make use of these tools, promoting an

• pen & transparent organizational culture
• 5. Evaluation should be ongoing

(Gibson, 2007, Healthcare Management Forum)

In Summary…

 Ethical issues will continue to be generated within health

care and will likely become increasingly complex.

 Bioethicists work to support ongoing initiatives and the

work of health care organizations from front line encounters to administrative decisions.

 Bioethicists do not have magic wands, but bring

valuable skills such as moral reasoning techniques, mediation, and a ‘unique’ perspective to challenging issues/situations.

 Organizations & the quality of care they provide to the

community can be enhanced by access to bioethicist support.

CALL, EMAIL, STOP BY!

 On site:

 TBRHSC – 3024B  SJCG – LPH Ca339  CCAC – Thunder Bay main office  CHCE & NOSM – CHCE office

 Call:

 (807) 630-0406

 Email:



allainm@tbh.net

Ethics

Bioethicist

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