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

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

3. The Burden of Technology Has Increased and Autonomy is Threatened

4. 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”

5. 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,

6. 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

7. 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

8. 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

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

10. 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

11. 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.

12. 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

13. 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

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