Day One 


7:15am – 8:00am

Conference Registration & Networking Breakfast


8:00am – 8:15am

Chairperson’s Remarks


8:15am – 9:00am

Optimizing the Roles and Functions of Hospital Ethics Committees

All US hospitals accredited by the Joint Commission for Accreditation of Hospital Organizations are required to have a mechanism for addressing ethical issues. As such, Hospital Ethics Committees have risen in response to a clinical need to address conflicts and uncertainties that arise in healthcare settings. Legal, regulatory and professional forces have also driven the development of ethics committees. This session will address the following:
-       The role of a Hospital Ethics Committee
-       Facilitating education about topical issues in clinical ethics, case consultation and policy development
-       How ethic consultants and ethic committees work with legal counsel, risk managers, compliance officers, administrators and others responsible for institutional policy and practices
-       Directives of the Joint Commission for Accreditation of Hospital Organization
-       Appropriate use of technology in dealing with patients’ rights, effects of changing healthcare providers and conflicting social values


9:00am – 9:45am

The Relationship between the Law and Ethical Issues

While laws are a critical tool for protecting and promoting the health of the public, their impact on individuals and communities often have conflicting consequences for patients. Legislation impacts the way healthcare can be delivered to patients. However, it is not always in the best interest of each patient. Since every case is unique, court decisions on resuscitation, withholding/withdrawing, POLST and informed consent are often controversial as there is never a one size fits all solution. Medical practitioners need to understand the current legal landscape to properly deal with patients and their families. Fear of lawsuits, anecdotal reports of court rulings, misunderstanding of the law, and anxieties about legal implications of actions cause physicians to overemphasize the importance of law in the resolution of ethical issues. Topics to be discussed include:


9:45am – 10:15am

Morning Networking & Refreshment Break


10:15am – 11:00am

Advance Directives: Avoiding Liability and Patient Safety Risks in the ED

Advance directives are usually written to avoid prolonging an inevitable, often painful or non-sentient dying process. However, they can also be used to instruct surrogates and the patient’s medical team to “do everything,” whenever possible. Physicians are most familiar with the do-not-resuscitate (DNR) order, normally initiated in hospitals, nursing homes and hospices. Often, physicians working in the emergency department are not aware of predetermined documentation or discussions regarding end of life care. These situations present complicated medical, legal and ethical dilemmas. This session will discuss the importance of advance directives and confusion concerning the validity of nonstandard DNR orders as well as strategies to prevent such confusion, promote safety and minimize institutional and provider risk.


11:00am – 11:45am

Breaching Patient Confidentiality & Information Sharing

Medical professionals are legally and ethically obligated to protect the confidentiality of their patients unless such disclosure is required or permitted by law. For clinicians, unauthorized breach of a patient’s confidentiality can result in lawsuits and adverse actions by state licensing boards or professional organizations. However, there may be situations where it is necessary to question whether-or-not to maintain confidentiality when the safety of others or public health is threatened.
Additionally, medical professionals are using personal mobile devices and electronic mail to communicate and collaborate on patient matters. However, many forms of communication are not HIPAA compliant since copies of messages or Electronic Health Records are left on servers which are not in the control of a healthcare organization. Often, healthcare professionals do not know or understand that such forms of communication and electronic storage could be breaking the Health Insurance Portability and Accountability Act's privacy rule. To address ethical considerations to protect patient’s confidentiality rights this section will discuss:
-       Breaching Confidentiality to protect others
-       Improving medical education about the importance of confidentiality and the need for greater care and attention in the management and handling of clinical information
-       Implementing a system where access to and the use of PHI is monitored
-       Messaging solutions for Healthcare Organizations


11:45am – 12:45pm



12:45pm – 1:30pm

End of Life Issues – When and How to Talk to Patients and Their Family

End of life discussions must go beyond the singular focus of resuscitation. Such discussions should address a large array of concerns shared by both patients and their families. Good practitioner communication should include understanding prognosis, potential comfort care, adequate pain control, respect for patient autonomy and end of life goals. These discussions are particularly difficult when the patient is not capable of making decisions on their own and rely on family members to make choices for them. This session will discuss the ethical dilemmas practitioners face in these situations and present solutions for dealing with a patient’s family members.


1:30pm – 2:15pm

Medically Ineffective Treatment Decision Making: Patient Choice, Autonomy and Best Interests

Medically ineffective health care treatment can be defined as treatment that will neither prevent nor reduce the deterioration of the health of an individual or prevent the impending death of a patient. Healthcare decisions can become complex when families and providers disagree about the benefits of such treatment. This session will discuss the following situations in relation to medically ineffective treatment:
-       The ethics of “forced treatment” (e.g. use of restraints, psychiatric treatment, care for patients with eating disorders)
-       Pain management – over and under treatment
-       When families want to continue treatment, but doctors decline to comply
-       Providers recommending unnecessary treatments when there is no value for the patient
-       Care decisions for unrepresented patients, those without decision making capacity or surrogate decision makers


2:15pm – 2:45pm

Afternoon Networking & Refreshments Break


2:45pm – 3:45pm

Panel: Complexity and Ethical Decisions Along the Continuum/Spectrum of Care

Throughout the continuum of care, individuals (both children and adults) and their families encounter multiple points of decision making where clinical choices, patient safety, institutional policy and legal parameters intersect.   Clinical healthcare professionals, legal counsel, administrators, risk managers and other team members work collaboratively, and often creatively, at these decision points to balance the clinical needs of patients with respect for patient’s preferences and within the protective constraints of institutional policy and state law.

This panel will address care decisions for individuals who may be moving between places of care (long term care facilities, home, hospitals, outpatient facilities, etc.) and the questions encountered around the scope of practice, safety, and adequacy of discharge plans.
-       Long stay patients who are medically ready for discharge
-       Refusal of possible placement options
-       Access to appropriate care facilities


3:45pm – 4:30pm

End of Life Decision Making for Compromised or Incompetent Patients

Many patients develop diminished mental competence to make medical decisions towards the end of their life. For patients with mental illnesses, that can interfere with their insight into their health or with their decision making, physicians have obligations to assess their capacity in order to evaluate their ability to make a particular health care decision at a particular point in time. The focus of this program is to demonstrate how to assist patients and their surrogates in making decisions that offer the patient the greatest benefit. A variety of medical options at the end of life are considered, as well as issues regarding honest communication with the patient and family members, problem cases in applying advance directives, and how to respond to a patient’s psychological, social, and spiritual needs when recovery from illness is no longer achievable.


4:30pm – 5:15pm

End of Life Decision Making for Competent Patients

Patient choices for end of life care can pose difficulties for health care providers, especially when patients request assistance in hastening or causing their death. Patients have the right to make their own health care decisions, but these must be considered within the ethical and legal boundaries of the health professions. We discuss how to respond compassionately to requests to die, including issues regarding competency, the role of pain management in restoring a patient’s quality of life, and the need for psychological, social, and spiritual support systems.



End of Day One


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