The Pivotal Role of Hospital Ethics Committees In This Age of Medicine Kathleen Benton, DrPH, MA

Why Are Ethics Committees Important In This Age of Medicine? The burden of technology has increased Communication has decreased Autonomy is threatened

The Burden of Technology Has Increased and Autonomy is Threatened

The Acuity in ethics Reactive Issues: A case 70 yr old female, living with mother, past NH resident Past CVA, multiple readmissions for respiratory failure/aspiration pneumonia, aphasia, contracted, multiple wounds, non-responsive Prior trach, current PEG, in through ED, intubated after quick code discussion with mom MD writes “inhumane to continue to provide life support…when…coming back and forth…ethics should communicate with patient’s mother who does not understand patient’s quality of life”

Pre-emptive ethics What is an ethicist/ ”exorcist” in the US? An anecdotal case to start with… Daniel Now let’s look at application in the outpatient environment,

The Chronicity in ethics Growth in the elderly population Average patient comorbidities and number of drugs Average likelihood of end-of-life discussion: when do they occur, and are appropriate A death-denying culture An imbalance of resources

Ethical Need to Go Beyond the Physical Person Managing patients instead of just treating patients Population health Social determinants listening abandoning the silos Integrating with outreach facilities The Advance Directive comes first

The Basics of Establishing Ethical Committees Needs to be an interdisciplinary group Needs to meet regularly and have goals of continued education Must be accessible and known to be accessible to the healthcare staff

Needs to be an interdisciplinary group Doctor Registered Nurse (RN) Pastor/ Spiritual Support Community Member Risk/Legal Other Allied Services

Needs to meet regularly and have goals of continued education Our process Our trended primary reason for triggering ethics ‘07-’13 [focused on external factors] -Advance Directive/Autonomy, Beginning of Life Issues, Cultural Competence, Futility, DNR Issue, Lack of Consensus Among Family, Lack of Surrogate, Lack of care continuity, Hospice issue

Must be accessible and be known to be accessible to the healthcare staff Created by-laws and our protocol for chronically ill and quality treatment (available) Reviewed and allowed a place to discuss cases Quarterly meetings Ongoing staff education and our own learning curve.

Back to the basics: proactive ethics is COMMUNICATION Listening to patient needs Be unafraid, be uncomfortable, Be ok to read the notes Understanding patient barriers: language, literacy, home support, surrogate appointment and understanding, knowing hospice concepts Scripting the discussion within reason and keeping value based ethics Losing fear of offering opinions at end of life Understanding the ethics may be in giving options which are unrealistic and futile

Communication Skills Ethics Committee Must Embody Professional Dialogue Start the Conversation Early Recognize Cultural Barriers Define Privacy Verse the Need to Be Informed Recognize Capacity Encourage Face-to-Face Meetings Be Educated on Logistics of Discharge

QUESTIONS kbenton@hospicesavannah.org 912-667-7527 THANK YOU QUESTIONS kbenton@hospicesavannah.org 912-667-7527