Bioethics and Palliative Care
Bioethicists work with clinicians to improve care outcomes by addressing ethical dilemmas arising from the patient care process. This involves clinical ethics consultations and a palliative ethic of care.
Clinical Ethics Consultation is designed to assist patients, families, and healthcare professionals in identifying, analyzing, and resolving these ethical dilemmas and issues. Clinical ethics consultation focuses on clinician-patient communication including communicating bad news and disclosing medical errors, improving patient safety, and reducing medical errors and their impact. This is because the fulcrum of the clinician-patient relationship is communication. Effective communication that is clear, accurate, and timely is a prerequisite for improving patient outcomes and satisfaction, decreasing risk exposure, and providing quality patient care.
Clinical ethics consultation addresses issues such as: when there is a difficult decision to make that presents a challenge to the patient or clinician; when the values of patients and practitioners conflict; when a patient lacks the capacity to make decisions; when there is uncertainty about who should decide on the patient’s behalf; when a family requests to withhold information from the patient; when it is unclear whether the burdens of treatment are worth the expected benefits; when families request care that a patient has refused; resolving end-of-life issues; and other ethical issues that can arise during the management of patients. There is strong evidence that ethics consultations can: reduce the length of stay in care facilities; reduce lawsuits; improve the quality of care; resolve conflicts
between providers and patients; and save the organization money. The duties of a bioethicist also include providing ethical guidance and counsel; ethical decision-making; conflict/dispute resolution; research ethics; ethical considerations that arise from an organizational perspective; and mentoring the development and implementation of ethics education programs for clinicians, staff, patients,
families, and hospital community.
With most ethics consults being on end-of-life issues, and my expertise in difficult conservations such as breaking bad news end-of-life (EOL) conversations, I provide a palliative ethic of care for patients in need of palliative care and/or end-of-life care and their families. A palliative ethic of care focuses on developing a set of patient and physician goals for improving quality of life, resolving end-of-life issues, and treating dying patients. This is important because a structured approach to end-of-life decision-making significantly improves the quality of care for patients with terminal illnesses.
End-of-life decision-making is regularly problematic for many clinicians. It is a process requiring clear and consistent communication delivered in a compassionate way by clinicians to patients and/or their families. Helping dying patients and their families come to terms with death and making the appropriate decisions is vital. The result is that patients “die well” meaning they die maintaining or regaining a sense of emotional well-being, and a sense of integration and reconciliation with loved ones. Patients who are prepared in this way can bring closure to their relationships with their loved ones and die peacefully. Such patients and their relations are more satisfied with the care they receive and less likely to sue organizations.
CLINICAL ETHICS CONSULTATIONS
When to seek an Ethics consult:
- When there is a difficult decision to make that presents a challenge to the patient or healthcare worker.
- When the values of patients and practitioners conflict
- When a patient lacks the capacity to make decisions
- When there is uncertainty about who should decide on the patient’s behalf
- When a family requests to withhold information from the patient
- When it is unclear whether the burdens of treatment are worth the expected benefits
- When families request care that a patient has refused
Difficult Case Scenarios Requiring Ethics Consultation
Beginning of life decisions
- Reproductive technology
- Medical interruption of pregnancy
- Neonatal Resuscitation
- Withholding or withdrawing treatment
- Controlling pain and suffering
- Decision-making on medically futile or inappropriate care
- Improving the quality of life
- Resolving end-of-life issues
- Treating dying patients
- Refusing treatment
- Demanding treatment
- Privacy and confidentiality
- Advance directives
- Ability to participate in medical decisions
- Deciding for incapacitated patients
- Blood transfusions
- ICU beds
Who can request an ethics consult?
· Social workers
· Anyone involved in the patient’s care
For ethics consultation, call Dr. Ama Edwin on 0206301163
Intercom line: 12213