By ALVIN REINER
---- — ELIZABETHTOWN — An uninsured farmer was diagnosed with life-threatening cardiac issues and did not want to burden his family financially.
So he declined treatment and did not want his wife to know.
That was a mock case mulled by the Elizabethtown Community Hospital Ethics Committee recently.
Should the physician ignore the man’s wishes and call the wife, opening the door for further discussion on treatments that might save the farmer’s life?
It was a complex issue, involving the privacy of the patient through the American Health Insurance Portability and Accountability Act and other matters, and the committee discussed it at length.
David Scaglione, an attorney for the Ethics Committee, observed that, had the case involved a child, “your job is in his best interest, even though he might not want you to tell.
“However, a case like this is a tougher call. If the client is being stupid, should you go along with him?”
The committee came up with several recommendations, but, ultimately, it was up to the doctor to make the final determination.
At a California assisted-living facility not long ago, a staff member refused to give CPR to a woman who had collapsed and subsequently died.
The 911 dispatcher pleaded with the caller to render assistance, but the staffer complied with the protocol of the establishment.
Though the convening of an ethics committee certainly wasn’t an option as that unfolded, the tragic incident cast a spotlight on ethics and health care.
The purpose of the ECH committee is the analysis of ethical questions that arise.
“There are many people who are not aware that there is this forum,” ECH Director of Quality Denise Plano said.
“We have to be an advocate for the patient and be proactive. We have to maintain confidentiality but also must try to get the patient to have treatment.
“I tell staff, ‘If it doesn’t feel right, make sure the outcomes for the patient are in the best interest.’”
Often, there’s concern about patients who have diminished capacity to participate in decision-making. The committee attempts to provide recommendations for support and counsel for those responsible for that person’s care.
It is not intended as a legal course of action.
The Ethics Committee meets two or three times a year, though if there is an issue, it will convene as quickly as possible.
“We try to have a diverse group of community members to get different perspectives,” ECH Director of Facilities and Support Services Matthew Nolan said at the start of a recent meeting.
“Most of us don’t have patient contact.”
The committee is made up of nine members: the hospital’s chief nursing officer, the public-relations director, a clergy person, a physician, an attorney, Office for the Aging and Horace Nye Nursing Home representatives, a case manager and the ECH facilities director.
Anyone who is close to the patient or the situation is generally excused.
It was emphasized several times during the meeting that the committee is not intended to create policy or deal with complaints but rather to provide guidance in assisting the concerned party in making a decision.
Upon presentation of a case, the group must consider facts, emotion and logic in tackling questions regarding treatment, life support and other socially driven ethical dilemmas.
Often among the considerations are the societal imbedded ideas that a doctor should do everything possible to keep the patient alive and, at times, the family’s insistence that God will intervene.
Rarely are finances a prime consideration.
“Often, there’s not a well-defined line between the use of aggressive treatment that’s not warranted — meaning it won’t restore or preserve someone’s health — and one that is warranted,” an ECH statement said.
In evaluating a case, ethics committees generally discuss the relevant facts, concerns, values and preferences for each party, conflicts among the values, options, best choices, reasons for the concern and how to prevent the issue in the future.
“We put together options, but ultimately let them hash it out,” ECH Director of Community Relations Jane Hooper said.
“Often, when someone comes to an ethics committee, they want support, and when outsiders come to the same conclusion, it would be helpful.
“What we say is not carved in stone; it’s just what we can offer,” she continued. “We try to give well-thought-out suggestions, which we come to with a consensus.
“Sometimes, it’s just the need for support and reassurance.”
For additional information, contact Hooper at 873-3003.
Email Alvin Reiner: email@example.com