Two recent presentations at the 2016 Annual Meeting of the American Society for Bioethics and Humanities in Washington, DC – offered within just a couple of hours of each other – had a similar theme but approached the issue from different angles. The first presentation was a case review by David Kappel, MD, a surgeon at the University of West Virginia, and Valerie Satkoske, MSW, PhD, a bioethics professor at the University of West Virginia Center for Bioethics and Health Law. The case involved a 75-year-old-man admitted for surgery. Unfortunately, following the surgery, he was delirious. The delirium continued for several days. He had to be restrained and fed with a nasogastric tube. The situation was very upsetting to his family; they were completely taken aback by this complication. The delirium was so unexpected and surprising that the family wondered whether or not the patient would have agreed to the surgery if he had fully understood that the extended delirium might result. The title of this presentation was: “You Should Have Told Me! Struggling to Meet the Spirit of Informed Consent.” As one can imagine, the presenters asked if information about the possibility of an extended delirium should have be included as a part of the informed consent process. The delirium was not part of the patient’s and family’s expectations. Of course, even with a more extensive, informed consent process, the family still may have not been fully prepared to deal with the complication anyway. Perhaps the answer turns more on the likelihood of the complication arising in this patient’s case given the particulars and context? Some complications are more probable than others given the circumstances?
The second presentation, titled “I Never Promised You a Rose Garden: On the Necessity of Not Meeting Expectations Regarding Clinical Ethics Consultation,” was given by Virginia L. Bartlett, PhD, and Stuart G. Finder, PhD, of Cedars-Sinai Medical Center. This presentation too dealt with expectations: the expectations those who ask for a clinical ethics consultation might have of clinical ethics consultants. The presenters suggested that the expectations might range from “ethics policeman” to “ethics superhero.” The presentation ended with the relatively unsatisfactory mechanisms available to evaluate the effectiveness or helpfulness of clinical ethics consultation services interventions. From the presentation, it was clear that clinical ethics consultants should be prepared for not meeting expectations of those who request assistance.
Regardless, both presentations highlight how important it is for clinicians – whether physicians or surgeons directly caring for patients or clinical ethics consultants offering advice or recommendations to colleagues or patients or families – to understand stakeholder expectations as well as they can. With doctors and nurses it may be a bit easier: mostly likely the patient wants to be restored to health or a baseline with the least discomfort and minimal aggravation. With clinical ethics consultation services, the expectations are often not this clear. Moreover, with both clinical medicine and clinical ethics consultation service interventions, there are complications and unintended consequences. One cannot always fully anticipate which way a case may turn, or which word or phrase at a particular moment may result in a worse situation rather than a better situation.
For good or ill, there is no informed consent equivalent for clinical ethics consultation services when stakeholders ask for a consultation. The various stakeholders – when they request a clinical ethics consultation – may or may not know exactly what they are asking for anyway. But, most likely, what they are asking for is help with a very troublesome or thorny issue that has ethical implications or dimensions. In this respect, clinical ethics consultants perhaps should worry less about meeting expectations than other clinicians, since the goals of clinical ethics consultation services often times are much less clear – at least when the consultation is requested – than restoring the patient’s health or previous baseline with the least discomfort and minimal aggravation. However, may always be better for the clinical ethics consultant to ask, “How do you think we can help?” and try to set or reset expectations as well as one can at the beginning of the process.
The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.
If you only paid attention to popular media, you’d think cancers primarily strike young people. Here’s a picture from a medical journal contrasting media coverage of cancer to actual occurrence of cancer in younger and older people:
by Craig Klugman, Ph.D.
BioethicsTV is an special section of bioethics.net that looks at the ethical issues raised in television medical dramas
Code Black (season 2, episode 3) revolved around a bus crash. The team captain, a promising athlete, has a crushed leg and requires a leg amputation. His father initially refuses to consent, stating that he can’t destroy his son’s dreams. He later tells the doctor that he is okay with the needed surgery but he can’t be the one to make the decision. He does not want to be to person who decided that his son’s dreams would end with the loss of his leg.…
Also speaking are
- Margaret Battin
- Alan Meisel
- Michele Bratcher Goodwin
- Mary Crossley
- Marshall Kap
- Paul Lombardo
- Erin Fuse Brown
- Dean Karampelas
- Sylvia B. Caley
- Samantha R. Johnson
In recognition of the 40th anniversary of the landmark case, In Re Quinlan, Georgia State University Law Review’s 2016-17 Symposium will explore the state of end-of-life decision-making in the United States from 9 a.m. to 4:45 p.m. Friday, Nov. 11.
Quinlan was the first major judicial decision to hold that life-sustaining medical treatments may be discontinued, even when the patient lacks capacity. Experts in law, medicine and bioethics will discuss how law and science have evolved and how those changes impact patients’ and surrogates’ decisions.
Through this symposium, Georgia State Law Review seeks to initiate a legal but accessible conversation regarding these emerging, important questions and produce scholarly articles that will serve as a foundation for future conversations. The symposium features four panels and a keynote speaker during lunch.
The symposium has been approved for (5) general CLE credits, one (1) professionalism credit, and one (1) ethics credit. Admission is $30 plus the cost of any additional CLE/professionalism credits.* The Center for Law, Health & Society is co-sponsoring this event.