Center for Bioethics Offers Guidance, Education
Formalizing education of ethics in medicine for residents is part of the year-old Center for Bioethics’ mission.
Muriel Gillick, MD, director of education for the center, is creating consistent, didactic education in residency programs. “We focus on issues that residents have encountered and that are upsetting and distressing to them,” Gillick said.
For example, a patient comes in to the hospital with an advance directive saying she does not want a certain treatment, but her daughter, who is with her, wants her mother to have the treatment. The mother cannot speak for herself, and her care team is put in the position of dealing with an emotional daughter who believes she is doing what is best for her mother. New residents grapple with questions of ethics in such cases, and the educational sessions serve as a forum to discuss these cases.
Gillick has helped the departments of Medicine, Surgery and Neurology create regular educational sessions for residents, which vary from formal case discussions to sessions in a lecture and discussion format. This coming academic year, Gillick will work with the OB/GYN and Anesthesia residency programs. The Center for Bioethics’ plan is to work with different departments each year until all are reached, but departments are welcome to contact Gillick at any time if they would like guidance and input.
The center also offers unit-based rounds. The format of these rounds can vary from informal discussions among nurses to sit-down, multidisciplinary rounds about a specific case, depending on the needs of the unit. “Unit-based rounds are done at the request of someone in the leadership group on the unit,” Martha Jurchak, PhD, RN, director of the Ethics Service, said. Themes of these rounds include disclosure, managing decisional conflict with family members, identifying surrogate decision-makers and managing disagreements on the treatment team.
Another type of education is discussion following a difficult case at the request of clinicians on the case. “Emotions often get stirred up about what’s the right thing to do or what’s good for the patient. These feelings have to be worked through so providers can digest emotionally what has happened,” Jurchak said.
Education is one piece of the Center for Bioethics’ mission, which also includes research and patient care. This tripartite mission makes the BWH center unique, as many other hospitals focus solely on the clinical side of ethics.
In addition to strengthening its educational outreach and research, including establishing an Ethics Fellowship, the center continues to assist clinicians with its consultation service. In the last year, the consultation service has reviewed many cases, including a patient refusing an emergency C-section; setting limits with a patient requesting excessive pain medication; posthumous sperm retrieval; parents requesting discontinuing life support for a newborn with an unclear prognosis; decision-making for a severely disfigured burn victim; and a family’s request for non-beneficial treatment.
“The consultation service functions as an advisory service, providing recommendations to care providers and helping them sort through ethical problems,” said Lisa Lehmann, MD, PhD, MSc, director of the Center for Bioethics. “We help them think about things in different ways and come up with alternative solutions.”
The consultation service, available around the clock at page ID# 18590, is one way the Center for Bioethics is advancing the thinking about ethics hospital-wide.
The center’s multidisciplinary 30-member Ethics Committee reviews cases from the consultation service and develops policies on practices with ethical components, such as do not resuscitate orders and organ donation. The committee also is interested in hearing from staff who want to reflect on ethics issues from challenging clinical cases for an educational purpose.
For more information on the Center for Bioethics, e-mail Lisa Lehmann, or visit www.brighamandwomens.org/ethics/about.aspx