ࡱ> NRdO)!M CPowerPoint Document(SummaryInformation(DxDocumentSummaryInformation8pB  !"#$%&'()*+,-./0123456789:;<=>?@AMEFGHIJKLOx6( / 00DArialngsRoman2 wp+jDGaramondRoman2 wp+j DTimes New Roman2 wp+j0DWingdingsRoman2 wp+j `0.  @n?" dd@  @@`` ( j,,>>  ()  () ()5  HH()   ()HH,,>>HH** 5,,>>    ()HH        0AA@8ʚ;ʚ;g4_d_d4pppp@ <4ddddP0Pgp g4_d_d4pppp@ <4!d!dP0Pgp<4BdBdP0Pgp0___PPT10 h___PPT2001D<4X ? %O  =)Ethics Consultation*MNuts and bolts Jay Baruch, MD Chairperson, Ethics Committee Memorial HospitalN?)Roles: Hospital Ethics Committees (HECs) **$#|Education HEC members Hospital staff Residents and students Community--outreach Policy formation and review Consultation*** B F, F-Ethics consultation--Overview-Goals Models Assessment Consultation PitfallsWhat is an ethical dilemma? Genuine conflict of moral belief, perspective, or position. No consensus on what is right and good Conflict of valuesGoals of ethics consultation,Clarification Identify nature or source of moral problem. Provide  safe space for multiple parties to reflect on their own deeply held moral beliefs as well as the beliefs of others involved in case. Moral community in hierarchical hospital structure Ethical discourse is discursive promote dialogue Point of view Multiple voices ,+ HGoals of ethics consultation (con t)Raise questions Placing the issues within an ethical framework Provide a forum for discussion with a larger, and varied, group of people. HECs are not necessarily decision-making bodies Ultimately, decisions made between clinicians and patients/families *0Ep !The ethical expertise controversyHow do we define expertise? Training in philosophy or medical ethics? Practical wisdom (phronesis) and character Sensitivity, insightfulness, intelligence Certification? Give impression of special standing as decision-maker Risk displacing patients and clinicians Consultation skills Lifting questions ask, and not necessarily answer Justifying judgments ZUZ*ZZ_ZZGZZU*  _  GX  HECs--representationDSomeone with formal medical ethics training Disciplinary diversity Physicians, nurses, ancillary care, hospital administration, community representation, clergy Members Formal experience with medical ethics not as important as interest and his/her particular perspectives and skills. Education Orientation of new members xC^C^t' Ethics consultation--models#Ethics consultant or consultation team (3-4 people) Pro Easier to get together in timely fashion Efficiency Open, personal discussion may be easier with small groups Con Limited perspective Full committee Pro Diverse perspectives Con Impractical Intimidating to patients/families Tribunal 4PPnPPPPPPP8PP4n  9 Ethics consultation--assessmentrIs there an ethical problem? Need to have all medical facts Who is asking for the consult? Who else should you be talking with? Examine issues to see if problem for HEC Miscommunication, team squabbles, education Consider keeping records of initial assessment Avoid  hallway consultations Singular point-of-view ZZ,ZMZZZ,M LEthics consultation assessment (con t)''& cReview chart Visit bedside of patient Patient the subject, not object Avoid medical problem solving(&>&> NEthics consultation overview of process((&dWho has access to HEC? Should patients be notified of consult? Documentation Case review The consult FEthics consultation process (con t)Who has access to HEC? Policy of open access Acknowledges exceptions include in policy. Should patients be notified of consult? Patients or surrogates should be notified Reasons for consultation Explanation of process Invitation to participate If exceptions, clearly note in hospital policy, (i.e, consults that don t directly involve patients-- team issues.) tZBZ(ZZZB( FEthics consultation process (con t)Documentation Must keep records of consults General consensus: in medical record Accountability, communication, quality improvement Patients notified of recommendations if patient involvement Case review Process and outcomes Inform policy development within institution Quality improvement Target areas for education committee/institution Feedback from participants consultation effective? ZCZ4Z=Z ZZZC4=   >Ethics consultation the consult)Introductions Sign-in sheet Remind attendees of confidentiality Describe case: much of ethical work done Solicit information about case from stake-holders Allow time for questions Keep conversation on track State ethical issues Discuss options Summarize recommendations and justifications for them*P*)Potential pitfalls in ethics consultationAvoid temptation to rush to judgment Not giving equal consideration to all the stake-holders Not involving all committee members The authoritarian voice Tone of tribunal, with HEC as judges  Fixing problem rather than  exploration.  Conflicts of interestsPower of ethics committee Confidentiality Members not clinicians Personal/professional relationships with parties involved in case Relationship to institution N*_*_Review and final thoughts8Ethics consultation is a  practice HEC improves by working through cases Gather as much information as possible Consider range of moral perspectives at stake Clarify issues: heightened awareness of conflict Can t medicate people from deeply held beliefs Outsider status: Fight urge to act as MD and/or RN Transparency is vital  A successful ethics consult is a thoughtful, responsible, and defensible process. Z/sx,, ` e(HH(dh   ` 3333ff3` 3333f33ff3` "3333̙ff3` Kf3̙` &e̙3g3f` f333̙po7` ___f3̙;/f9` ff3Lm` ff3LmNLm>?" dd@*?nAd@q<nAqFLK#M n?" dd@   @@``PR    M`2p>> `(  ` ` H2? ?" `} ֤ T Click to edit Master title style! !< ` H`2? ?" ` ֤ RClick to edit Master text styles Second level Third level Fourth level Fifth level!     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