Center for Biomedical Ethics
APRIL 6 , 2006– "Court-Appointed Guardians: Strangers at the Bedside?"
DECEMBER 1, 2005 – "Suffering and Justice" – Selected topics from the American Society for Bioethics and Humanities meeting
• Abu Ghraib and Guantanamo: Medical Professionalism, Dual Loyalty and Human Rights
• Conceptions of Justice: International Considerations Related to Basic Rights to Healthcare/National Considerations Related to Investment in Public Health
• Justice and Quality of Life – A New Model of Caring About and Caring for Patients with Dementia
• Just Responses to Sterilization Requests by Guardians of the Cognitively Disabled
Objectives of this session:
Click here for Dr. Tom Bledsoe's Powerpoint presentation.
NOVEMBER 3 , 2005 – "Dissent on Informed Consent: Socio-Philosophical Aspects of Japanese Efforts to Forge an Alternative Path in Bioethics"
The Center for Biomedical Ethics and the Ocean State Ethics Network welcomed Professor William LaFleur, a Senior Fellow and Professor of Japanese Culture and Bioethics in the Center for Bioethics at UPenn. Professor LaFleur has extensively written and researched the Japanese approach to medical ethics, which often contrasts strongly with our own. Resistant to the American insistence that patient autonomy requires that medical decisions be made by individuals, some Japanese bioethicists are trying to articulate a "family based" approach. How this plays out in decisions about therapy selection, organ transplantation, and the use of stored tissue was analyzed at this early evening lecture.
SEPTEMBER 22 , 2005 "No Place Left To Go...Ethical Dilemmas in R.I. Free Clinic"
A panel discussion moderated by Jay Baruch, MD
1) Understand how R.I. Free Clinic is different than community health centers.
2) Analyze how lacking health insurance can have non-health related consequences.
3) Understand the challenges faced by caregivers who offer free care.
4) Discuss strategies to ensure access and high-quality care to the community of uninsured persons when resources are limited.
Consider that free access doesn't imply open access. Can we identify justifiable criteria relevant to the decision of who gets the appointment? What is meant by "medical need"? Can a fair decision be made in the face of overwhelming need?
MAY 19 , 2005 "Does DNR Disqualify You From an ICU Bed?"
A panel discussion moderated by William J. Kirkpatrick, LICSW. Case presentation by Vadim Fayngersh, MD. Guest panelists: Thomas Bledsoe, MD; Achal Dhupa, MD; Michael Felder, DO; and Mitchell M. Levy, MD.
Objectives of this session:
1) Discuss how code status impacts one's "right" to ICU admission.
Dr. Barbara Bridgman Perkins, author of The Medical Delivery Business: Health Reform, Childbirth and the Economic Order, led a provocative discussion to examine where and how the profession of medicine fits into the business of medicine.
APRIL 20, 2005 "Living with Grief: Ethical Dilemmas at the End of Life "
Co-sponsored by the Center for Biomedical Ethics, the Lifespan Comprehensive Cancer Center, and the Rhode Island Hospital Ethics Committee
Satellite teleconference & local panel discussion
DECEMBER 2 , 2004 "Flu Vaccine Triage: Who Really Needs It? Who Gets It? How to Decide?"
A panel discussion, moderated by Dr. Jay Baruch
Consider: Presently, the current flu vaccine shortage is a serious health issue on a national and statewide level. There will not be enough vaccine to cover those population groups considered to be highest priority and most in need. For certain high-risk populations, the flu can be potentially lethal. For others, the flu can lead to a serious illness that results in lost time from work and school, and compromises vital family routines.
The shortage of flu vaccine has raised many important issues concerning the uncomfortable topic of bedside rationing. This symposium will provide an open forum for the discussion of this sensitive topic. What is the role of the flu vaccine? How are we defining burdens and benefits when it comes to the disease and the vaccine? What criteria should be considered relevant when deciding whether a patient does or does not get vaccinated and why? Who should make these decisions? How can we make this allocation process fair, justifiable, consistent, and transparent?
Objectives of the session:
SEPTEMBER 23, 2004 "Testing the Limits: Ethics in the Hospice Unit"
An open case discussion, moderated by Dr. Jay Baruch and Dr. Thomas Bledsoe.
Case for consideration: A middle age male is admitted to Hospice with a primary diagnosis of ALS. He lives with his wife and minor child, who is extremely close to the patient. The patient has expressed suicidal ideations since he came on to the hospice service. The hospice team in this case is primarily the RN, MSW, and CNA. The patient verbalized to the MSW that he would tolerate the disease progression to a certain point before taking his own life. This was communicated to the interdisciplinary team on several occasions at their weekly meetings. A psychiatric evaluation was performed, clearing him of any type of clinical depression. The patient's family is aware of his wishes. The patient's wife sought counseling and supports her husband's decision.
Objectives of the session:
A brief clip of the film "Dax's Case" was shown. Several members of the Ocean State Ethics Network board then addressed ethical questions raised by the film and the actual burn case presented. Presenters included William Kirkpatrick, LICSW; Mary Brunell, EdD, RN; Dr. Michael Felder; Dr. Stephen Mernoff, and Dr. Jay Baruch.Click here for a copy of the case handout and questions discussed.
Click here for Bill Kirkpatrick's Powerpoint presentation on surrogate decision making.
Click here for Dr. Stephen Mernoff's Powerpoint presentation on surrogate decision making.
Objectives of the session:
The panel included Cynthia Padula, PhD, RN, CS; Lynn Pasquerella, PhD, and Sheri Smith, PhD. This public forum explored the complex dynamic between doctors and nurses, how their roles inform their perception and reaction to ethical problems, and strategies to address and hopefully improve this infrequently talked about issue.
DECEMBER 4, 2003 "Dead or Dead Enough"
A panel on organ donation, in conjunction with the New England Organ Bank, who wanted to promote non-heart-beat cadaver donation (NHBCD) in Rhode Island. Cardiac death may appear straight forward, but when tied to organ donation poses many areas for ethical inquiry. For example, after what minimal interval from the moment the heart stops can death be declared? Does that equal death of brain tissue? Can end-of-life care, withdrawal of medical treatment, and respect for the dying be separated from the organ procurement process? What constitutes valid consent? What is the role of ethics committees in hospital NHBCD protocols? Dr. Stephen Mernoff, Medical Director, Neurorehabilitation Program, Rehabilitation Hospital of Rhode Island gave a thorough review of brain death criteria. Then, Paul E. Morrissey, MD, Assistant Medical Director, New England Organ Bank, and chief of transplantation surgery at Rhode Island Hospital spoke on organ transplantation in R.I.
OCTOBER 2, 2003 "Medical Futility: Clarity or Confusion?"
The term "futility" is difficult to define, yet evokes strong emotional responses from clinicians and their families. Futility often doesn't represent differences in medical judgment, but differences in values.
JUNE 26, 2003 "Ethics Consultation: Nuts and Bolts"
Dr. Jay Baruch gave a talk which provided a brief, general overview on the process of ethics consultation. Issues discussed included the aim of clinical ethics consultation, the nature of "ethics expertise," the essential elements of ethics consultations, the different models of ethics consultation, and potential pitfalls that can undermind an ethics consult. Following the talk, representatives from three ethics committees presented cases that came before their respective HECs. We discussed why a consultation went well and why it may have gone poorly.
Bill Kirkpatrick, Director of Clinical Social Work for Lifespan Academic Medical Center, presented preliminary results from his "Ethics Committee Benchmarking Project." This project surveyed HECs of fourteen hospitals in Rhode Island and Massachusetts. His work provided information about particular strengths and needs of HECs in the region, and gave the evolving ethics network a cogent approach to curriculum development that would most benefit network members.
MARCH 31, 2003 "Barriers to Advance Directives"
The lack or inadequacy of advanced directives seemed to be a common problem across the state. The panelists drew three different perspectives on this rich issue. They included Maureen Glynn, Assistant Attorney General, Dr. Joan Teno, Professor of Community Health and Medicine and a principal investigator in the SUPPORT trial, and Mary Callahan-Cimini, Executive Director, Aging 2000.