1. Residents: Healers in the making
Thalia Arawi, PhD
Clinical Bioethicist
Director, Salim El-Hoss Bioethics & Professionalism Program
Vice-Chair, Medical Center Ethics Committee
Faculty of Medicine

2. Welcome! Welcome to Residency!
Being part of this profession entails ethical and professional obligations (Dr. Zeineldine addressed you on this)
In part, this requires learning to “think ethically” through self-reflection, alone and with others
At AUBMC we are committed to Patient Centered Care.
Any resident and attending who fails to do that fails in professionalism and betrays his/her profession.

3. Plan
Few words about what patients think of physicians. Food for thought
MCEC: Bioethics in direct relation to Patient Care
Final words

4. A study assessing the public perception regarding physicians in Lebanon revealed the following:
The physician traits most desired by the public were found to be: moral traits (41%), interpersonal traits (36%), scientific traits (19%) and other (4%).
The most unwanted traits/behaviours were a lack of interpersonal traits (57%), a lack of moral traits (40%) and a lack of scientific skills (3%).

5. Sample Traits Not Desired Desired Inhumane Negligent
Does not admit mistakes
Dishonest
Hurried
Does not discuss with patients
Unfriendly
Treats patients as a number or case
Disrespectful
Arrogant:
Does not respect appointments
High-handed
Treat patients as inferior
Pretentious
Annoyed with questions
Does not listen to patients
Humane
Honest
Ethical
Not materialistic
Compassionate
Humble
God fearing
Explains thoroughly
Good listener
Respects patients
Has good interpersonal skills
Gives time to patients
Caring
Patient
Smiles
Is not haughty
Not Desired
Desired

6. We all need to start thinking…
Regression in moral development and empathy in residents as they progress through medical school is RAMPANT.
You can guard against it by emulating good role models and self-reflection.
How not to fall prey to the dehumanization of medicine?
Invasion of Money into Medicine
Physicians became the service providers
Patients became “clients”
Doctors can now make a lot of money (regardless of how)
The profession began attracting the “wrong” kind of person
The Hidden Curriculum: everything matters (how you dress, talk, communicate, examine, treat, etc.)

7. "As I look into the future, I think we will undoubtedly be a much more divided profession than we are now. We will not have again an ethic which will bind all of us," There will be "those who choose to follow the moral imperative--the high ground--and those who become purely businessmen and entrepreneurs."
It is YOUR CALL!
E. D. Pellegrino, Previous Chairman of the President's Council on Bioethics

8. Being a “good physician”
Healthcare Practitioner (ST) or Healer?
YOUR CHOICE
Is much more than following rules and principles
It is about what kind of person you are and want to become
Rules and Principles taught
Becoming process (will, mind, heart)
Doing the right thing when NO ONE IS LOOKING!

9. SHBPP-AUBFM HUMANISM AND PROFESIONALISM AWARD, 2012
Dr. Darwish

10. SHBPP-AUBFM HUMANISM AND PROFESIONALISM AWARD, 2013
Dr. Costa

11. SHBPP-AUBFM HUMANISM AND PROFESIONALISM AWARD, 2014
Residents Graduation Ceremony
June 10, 2014

12. You have all taken Bioethics
I will not repeat what you already know
MCEC

14. AUBMC-MCEC

15. MCEC Handbook

16. MCEC Handbook

17. What is a Clinical Ethics Committee?
Final treatment decisions are made between the attending physician and patient or surrogate-decision maker.
Group of professionals who meet to consider and discuss the ethical aspects of clinical care within the hospital.
It gives opinions or recommendations.

18. Education Policy Functions of the MCEC Case Consultation
facilitates educational opportunities for health care professionals, patients, and their families.
provides consultative services regarding ethical issues pertaining to a specific patient.
discussions and evaluations of policies and procedures having ethical implications.
MCEC
Case Consultation
Policy
Case Consultation

19. Members represent Diverse medical depts.
Other departments (such as nursing, social services)
Religious views
Hospital administration
Lawyer
Bioethicist
Community
Members bring experience and expertise from their areas.

20. Common Ethical Issues Withholding or withdrawing treatment
Do Not Attempt Resuscitation orders (DNR/AND)
Identification of patient’s representative
Medical futility
Informed consent
Aborting a fetus with malformation
Determining decision-making capacity
Palliative care issues
Conflict resolution
Perinatal & neonatal issues
Other

21. The “Ashley Treatment”..5’
The “Ashley Treatment”..
Ethics Committee recommended the Ashely Treatment

22. Born 1997 with static encephalopathy (permanent brain damage) of unknown etiology
Breathes on her own but unable to raise head up, sit up, hold and object, walk, talk, must be tube fed
2003 Signs of puberty
2004 received “Ashley Treatment”
High doses of estrogen to halt growth
Hysterectomy Breast bud removal

24. Was this right? At least two points:
Ethics is part and parcel of patient care (medicine)
Discussion and decisions cannot be made at a distance
Who should decide?
Who should be involved when making the decisions?
The fact is that the decision created a great deal of controversy.
But it was done in good faith.

25. The average hospital ethics committee receives 3 requests for case consultation per year

26. AUBMC Medical Center Ethics Committee (MCEC)
From 2005 to March 2012, only 5 cases were referred to the medical center Ethics committee for recommendation.

27. Av. 2-3 hrs.

28. 2013-2014 TO DATE- 32 bedside ethics consultations Called for by:
Attending physicians
Residents
Nurses
Patients
Satisfied Pts and Phys.

29. Patch Adams Last Speech

30. Our Lives are Dedicated to Yours!
Loaded term… we are responsible/accountable for it

31. A note.. The elderly
Often older people are treated with less enthusiasm, care and dedication
“They are old”
What you owe to the child, the adult, you owe to them, even more.

32. Good Luck in entering yet another learning phase.. As physicians
Remember:
Do not judge others from your own perspective. Keep an open mind, develop a bird’s eye view of things. You will be surprised what you will discover.
You are now residents. Med students are not your subordinates. They are what you have been just a few days ago and they are the future you. Be kind to them and help them learn as you learn. Be a role model.
Medicine is about team work. Nurses, Physiotherapists, etc. are educated healthcare professionals and members of the healthcare team. Without them, there is no patient centered care.
The patient is your “partner”, your “teacher”, not your “tool”.

33. RESPICE FINEM, for you too are mortal.
The patient “has” a disease, he/she “is” not a disease.
The patient has a name like yours, which is not a room number nor ends with something like “-itis”.
Residents and physicians often suffer from a chronic iatrogenic disease called Egotitis. The only proven remedy to this illness is humility and remembering your own finitude and mortality.
The reputation of a lifetime may be determined by the conduct of a single moment.
RESPICE FINEM, for you too are mortal.

34. Questions?