Bedside Consultation and Ethical Issues
It wasn't that long ago that the spectre of 'death panels' was raised by some attempting to discourage supp0rt of the Affordable Care Act, now signed into law. We thought we would present the explanation of what a bedside consultation from California's Stanford Hospital could make available to a patient's family as well as guidelines from the Montefiore Bioethics Consultation staff in New York City.
"The Ethics Committee of the Stanford Hospital and Clinics provides a medical ethics consult service for the hospital and clinics. Anyone may request a consult — physicians, nurses, allied health care professionals, staff, patients or their families. Ethics consults usually involve a situation where patient care is impacted by conflicts in values between and/or among patients, families, and treatment providers. The issues involved in ethics consultations have included such matters as differences of opinion about whether to stop aggressive end-of-life treatment and switch a patient to palliative care only, whether psychiatric patients can refuse surgery or medical treatment, uncertainty about who can best serve as surrogate decision maker for an unconscious patient, disagreements among family members about the treatment choices for an incompetent patient, demands for treatment that are considered futile by physicians, doubts about what treatments are in the best interests of the patient, uncertainty about treatment choices that are based on religious or cultural imperatives, the extent to which non-medical facts and circumstances impact a decision to offer organ transplant for a particular patient, whether a patient is being made to suffer unnecessarily by reducing or withdrawing pain medication, and how to best protect a patient from the harmful acts of a close family member. Ethics consults consist of a process whereby facts are gathered from all relevant persons, values are elucidated and prioritized, and recommendations made so as to honor as much as possible the priority of values. In most cases, ethics consults involve a multidisciplinary team of persons from the ethics committee led by a member trained and/or experienced in medical ethics theory and consult management.Another example of Bioethical Consultation Services is that of Montefiore Hospital in New York City:
The Bioethics Consultation Service at Montefiore helps patients, families and health professionals address difficult decisions about patient treatment. Healthcare decisions depend not only on medical information but also on the patient’s religious, moral values and other preferences. These difficult decisions can stir up strong emotions, especially when not all those who are concerned about a patient agree about the best plan. Our Bioethics Consultation Service team listens to the voices of different participants, helps clarify values and works toward consensus and the resolution of conflict while respecting the different values of those involved.
We accept requests for consultation from anyone involved in the care of a particular patient, including patients and family members. Our services are free.
Issues Addressed by the Bioethics Consultation Service
Bioethics involves the analysis of moral and ethical issues that arise in the healthcare setting. Our trained consultants help people deal with issues like these:
- Who should make decisions for patients who cannot decide for themselves or communicate their wishes?
- What should patients do if suggested treatments are in conflict with the beliefs of their religion or culture?
- What should happen when there is strong disagreement or uncertainty about what is best for a patient?
- What should patients consider in agreeing to or in refusing treatment?
- When should life-prolonging treatments, such as feeding tubes or breathing machines, be started, continued or stopped?
How We Help
The key to making wise decisions at crucial times is focusing on what is best for the patient. As simple as that sounds, the best course of action is not always clear. A bioethics consultation is designed to help patients, family members, healthcare proxy agents and caregivers clarify issues and reach those decisions. Support may include:
- Meetings with our Bioethics Consultants who can counsel and guide the patient and family members through the decision-making process
- Educational materials that increase the patient/family’s knowledge about healthcare decision making
- Help in resolving issues related to advance directives, such as a living will
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