7:15am – 8:00am
Conference Registration & Networking Breakfast
8:00am – 8:15am
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
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
- 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
- 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
7:15am – 8:00am
8:00am – 8:15am
8:15am – 9:00am
Dealing with Parents Who Make Decisions Without Having Their Child’s Best Interest in Mind
Parents have the authority and responsibility to make medical decisions on behalf of their children. However, when parental decision making is not in the best interest of the child, clinical practitioners have an ethical and legal duty to challenge parents to advocate for the best interests of their patient, particularly when dealing with critically ill children. Topics to be discussed include the following:
- Examples of decisions which can place a child at harm
- Leveraging strategic post-acute positioning to maximize bundled payments
- Should children be involved in medical decisions regardless of the wishes of their parents?
- Circumstances where minors can make medical decisions for themselves
- The Charlie Gard Case
- Providing hope with the use of experimental treatments
- Ability of patients to purchase whichever treatments they can afford
- Must governments play a regulatory role in protecting patients, regardless of the patient’s desire or ability to pay?
9:00am – 9:45am
Ethical Issues Related to the Care of Nursing Home Patients in the Emergency Room
Medical emergencies are inevitable in most nursing home settings causing patients to be brought to the emergency room. These patients provide unique medical and ethical challenges for emergency room practitioners as they may not have all the pertinent information required to make the proper medical assessment. As such, prompt clinical decisions are needed which may challenge certain ethical principles for which there is not always an easy answer. This session will focus on the many factors considered when deciding on the proper care for nursing home residents (desired level of care, fear of patients passing away in the nursing home, advance directives and potential cost savings) as well as methods for emergency room practitioners to properly deal with these patients.
9:45am – 10:15am
Morning Networking & Refreshments Break
10:15am – 11:00am
Understanding Palliative and Hospice Care - Pushing Patients into Ineffective Treatments
There are a wide range of medical issues and ethical dilemmas that arise in the provision of palliative and hospice care of patients for which it is determined that a cure is impossible. A good understanding of medical ethics will impact a health professional’s decision making for these patients. Regardless of financial constraints, patients should be fully aware that palliative care and hospice alternatives are available, including the possibility that the reduction of pain and suffering may reduce the patient's life.
Multidisciplinary interventions should be sought including specialty consultation, hospice care, pastoral support, family counseling, and other modalities. Patients near the end of life must continue to receive emotional support, comfort care, adequate pain control, respect for patient autonomy, and good communication.
11:00am – 11:45am
The Ethical Dilemma of Balancing Pain Management and Prescription Drug Addiction
Doctors have struggled to find the proper balance between treating pain while avoiding addiction with their patients. While physicians have an ethical obligation to relieve their patient’s pain, they also need to be cognizant of limiting preventable harm when prescribing pain medication. Since prescription drug addiction has become a rapidly growing problem, doctors are reluctant to prescribe narcotic painkillers fearing that the patients will develop an irreversible addiction to the drugs. This may lead to pain treatment being managed sub-optimally. This session will discuss best practices to achieve an ethical balance for opioid prescribing practices while applying the ethical principles of beneficence, respect for autonomy and justice.
Ethical Issues Concerning the Relationship Between Medical Practitioners and the Pharmaceutical Industry
Both medical practitioners and the pharmaceutical industry work towards the treatment of disease and research directed towards improvements in treatment. While their goals are often similar, they also conflict since medical practitioners answer to patients and pharmaceutical companies answer to shareholders. Associations between the pharmaceutical industry and doctors may compromise a health care provider’s professional objectivity and integrity or undermine their fundamental ethical commitment to putting the interests of their patients first. The information the pharmaceutical reps present or gifts provided will most likely bias clinicians in favor of the drug or equipment that is being promoted. This session will review the ethical risks of compromising relationships with patients when dealing with outside market forces, such as physician’s financial interests, insurance and pharmaceutical companies as well as outline strategies to avoid such conflicts of interests.