Ethics Presentation

Medical Ethics: 

Medical Ethics And the work of the HealthCare Ethics Committee

Ethics: 

Ethics Ethics is a branch of philosophy that studies the nature of and the justification for principles governing right conduct Bio-Ethics is field of study concerned with the ethics and philosophical implications of certain biological and medical procedures, technologies, and treatments, as organ transplants, genetic engineering, and care of the terminally ill. Ref. Furrow, Barry R. Sandra H. Johnson. Bioethics: Health Care and Ethics. West Publishing Co. St. Paul. MN 1991

Landmark Cases: 

Landmark Cases 1947 The Nuremberg Code (Informed Consent; research ethics) 1973 Dax Cowart (informed consent) 1977 Karen Ann Quinlan( Living Will) 1990 & 1991 Nancy Cruzan(Health Care Directives, Health Care Power Of Attorney, US Patient Self-Determination Act 1990) 1990 Janet Adkins(Jack Kevorkian’s first assisted suicide; suicide vs.-withdrawal) Terri Schiavo (Importance of Advanced Directives)

Karen Ann Quinlan: 

Karen Ann Quinlan Hospitalized in 1975 Vent-dependent Parents asked to have vent removed Removed after a 1976 US Supreme Court decision

Nancy Cruzan: 

Nancy Cruzan In 1983 resuscitated after a car accident and became feeding tube dependent Parents said she would not have wanted to exist in this way and asked to have tube removed. 1990 US Supreme Court ruled in favor of parent’s request

Why Ethics Committees?: 

Why Ethics Committees? Developments in medical technology Genesis early 1990’s Result of Quinlan and Cruzan case JCAHO required ; dispute , mediating/resolve mechanism –does not have to be a committee Use of committee is not required; recommendations are not mandatory

Ethics Committee Functions: 

Ethics Committee Functions Education Policy Consultation

Ethics Committee Members: 

Ethics Committee Members Medical Staff Nursing Staff Administration Legal Services Social Services Pastoral Care Community Ethicist

Four Moral Principles Approach to Healthcare Ethics: 

Four Moral Principles Approach to Healthcare Ethics Autonomy Beneficence Justice Non - maleficence Other Values and Principles Confidentiality Honest / Integrity Competence Dignity

Ethical dilemma: 

Ethical dilemma Medical indicators and patient or family preferences conflict, prohibiting the achievement of goals of medicine People may have different understanding of the principle involved and the implication for a particular medical decision

Patient Self Determination: 

Patient Self Determination Became NC law in 1990 Requires that written information be provided concerning an individuals right under state law to make decisions concerning medical care. Right to accept or refuse medical treatment Right to formulate advance directives

Informed Consent Model: 

Informed Consent Model The right to informed consent/informed refusal of treatment endures despite a patient’s loss of decision making capacity. Living Wills HCPAs (Healthcare Power of Attorney) DPAs (Durable Power of Attorney) Portable DNR (Do Not Resuscitate), DNAR MOST (Medical Orders for Scope of Treatment) Surrogate decision makers

Advance Directives: 

Advance Directives Whatever you want re: health care let physician and family know Does not specifically require involvement of legal system Can be handled by notary public

Living Will: 

Living Will Limited to when death is imminent Covers ventilation, artificial nutrition and hydration, other treatments Notarization only

Health Care Power of Attorney: 

Health Care Power of Attorney Designated person Control of your healthcare decision if you are unable/incapacitated only Notarization only If no designee, fall to next of kin

DNR/DNAR: 

DNR/DNAR “Do-not-resuscitate” or “Do not attempt Resuscitation” Covers your desires in the event of cardiac arrest Initiated by patient or family-discussion with physician Goldenrod form-portable DNR for NC

DNR/DNAR: 

DNR/DNAR Does not mean we stop medical treatment Continue to provide care to patient Patients and family need emotional support No such thing as a slow code Modified codes: give specific directions for modification i.e. do not intubate etc. Patient/or family can change DNR status @ any time