OBJECTIVE: The vast majority of physicians frequently faces ethical dilemmas and feels overwhelmed as a result. Those at Boston Medical Center are no exception. Various studies show more adept handling of ethical issues can improve the quality of care and patient safety by reducing moral distress of physicians and fostering better patient-physician relationship. The method of Preventive Ethics, which actively identifies recurrent themes and underlying systematic issues among ethics consultations, is more effective than the traditional, case-by-case approach in reducing the number of ethical conflicts. The purpose of this study is to identify common themes prompting ethics consultations and any hotspots among recurrent ethical dilemmas at Boston Medical Center by using the Armstrong Clinical Ethics Coding System.
METHODS: A total of 32 ethics consultations handled by the BMC Ethics Committee between October 2010 and April 2013 were reviewed. Each consultation was coded using the Armstrong Clinical Ethics Coding System. The data was analyzed to identify the types of ethical dilemma that are most prevalent at BMC. The consultations involving the most frequently occurring issues were evaluated further to expose common themes among these cases and potential underlying systematic failures.
RESULT: "Clinical Candidacy or Risk / Benefit Analysis" (6.25%), "Concern About Decision Maker Choices" (14.6%) and "Futility / Inappropriate or Nonbeneficial Treatment" (13.5%) were the most prevalent types of ethical issues at BMC. Not only are these three frequently occurring, they also have a very high tendency to occur simultaneously. Further analysis of consultations involving these three issues revealed that at BMC, there are frequent instances of conflict, in which family members serving as healthcare proxies disagreed with physicians in deciding the best interest of patients with severe ailments, ultimately precipitating ethics consultations.
DISCUSSION: Comparison with similar retrospective studies previously carried out at other institutions suggests that consultation involving the issue of futility may be more frequently occurring at BMC, which might be coming from unique systematic problems. Several interventions such as improved policies or educational training in physician-family communication should be considered.
CONCLUSION: According to the principles of Preventive Ethics, the issue of physician-healthcare proxy conflict regarding patient futility should be issue to be addressed at BMC. The Armstrong Clinical Ethics Coding System can serve as a much needed standard documentation format for ethics consultations, which would open up the possibility of more detailed future studies
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/15629 |
| Date | 12 March 2016 |
| Creators | Naito, Tatsuhiko |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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