Ethics Mentors: Impacting Patients and Families to Make Ethics Matter Stephanie Van Slyke, BA, RN, CCRN

60% of people say that making sure their family is not burdened by tough decisions is “extremely important” 56% have not communicated their end-of-life wishes Source: Survey of Californians by the California HealthCare Foundation (2012) 70% of people say they prefer to die at home 70% die in a hospital, nursing home, or long-term care facility Source: Centers for Disease Control (2005) Consider the facts There’s a big gap between what people say they want and what actually happens.

80% of people say that if seriously ill, they would want to talk to their doctor about end-of-life care 7% report having had an end-of-life conversation with their doctor Source: Survey of Californians by the California HealthCare Foundation (2012) 82% of people say it’s important to put their wishes in writing 23% have actually done it Source: Survey of Californians by the California HealthCare Foundation (2012)

Principles of Bio-Medical Ethics Autonomy Non-Maleficence Beneficence Justice

The right to refuse or accept treatment Autonomy Self Rule: The Patient decides what is done to/for him to her self Must consider capacity

DO NO HARM! Non- Maleficence Considered a duty Conduct based on moral or legal obligations

State or Quality of Doing Good Beneficence Doing the most good for the most people Can be considered subjective Prevent harm from occurring to others

Equals must be treated equally Justice Distribution of Resources Can have some application problems

What would YOU do Scenario: Over several days, your pt consistently voices ambivalence re current treatments, which are painful & non-productive to the pt. You witness a complete reversal of behavior when the physician is in the room & future tx plans are mapped out. When the physician leaves the room, the pt confides in you that he doesn’t want to disappoint his physician but he really would rather not continue treatment. What do you do? What ethical principals, if any, would you cite as being in conflict?

Crucial Conversations! Break into groups