1. Program in Clinical Ethics

2. Goals Who we are What we do What we can do for you

3. What is Ethics? Moral philosophy--systematic endeavor to understand and justify moral concepts Legal ≠ Ethical Disciplined reflection on moral ambiguity Jonsen, Albert. The New Medicine and the Old Ethics. Cambridge: Harvard University Press, 1990.

4. What is Bioethics? “The systematic study of the moral dimensions--including moral vision, decisions, conduct and policies--of the life sciences and health care, employing a variety of ethical methodologies in an interdisciplinary setting.” Reich, Warren. The Encyclopedia of Bioethics. New York: Simon Schuster Macmillan, 1995, p. xxxi.

5. Who are Medical Ethicists? Ethics Committees –RNs, JDs, chaplains, case managers, social workers, MDs. PhDs Who teaches students / residents? –Philosophers, attorneys, internists, neurologists, pathologists, social workers, nurses... surgeons

6. At UMHS Interdisciplinary committees founded in late 1970s, early 1980s –Addressed technological interventions at the beginning and end of life Pediatric Ethics Committee Adult Ethics Committee

7. Role of Ethics Committees Provide Clinical Ethics Consultation Provide Ethics Education Work on Hospital Policies

8. Program Rollout As of January 2016, The Program in Clinical Ethics has become a new core program within the Center for Bioethics and Social Sciences in Medicine (CBSSM). The Adult and Pediatric Ethics Committees continue to report to OCA and retain their current structure and function, but are nested within CBSSM.

9. Program Aims This Program is designed to nurture a culture of ethical excellence at UMHS, and to provide an academic home for these endeavors. The Aims of this Program are to: –Streamline clinical ethics consultation –Assist with ethics-related policy development –Organize and administer structured educational programs in clinical ethics across UMHS –Coordinate empiric research with relevance to clinical ethics

10. Clinical Ethicist The person you can call and rely on for help dealing with ethical issues and questions.

11. Ethics Faculty Individuals with significant additional training in ethics that are available to: –Help with ethical dilemmas –Give lectures, lead discussions, help debrief –Round on your unit to discuss thorny issues

12. Clinical Ethics Consultation UMHS encourages the importance of quality and a comprehensive approach in all aspects of a patient’s care. The Joint Commission mandates access to a system to manage ethical dilemmas arising in clinical practice The Medical Staff Bylaws as well as government and accreditation standards, require such a service.

13. When to Call for an Ethics Consult Patients, families and staff may face difficult choices and questions they need to talk about, particularly when it is unclear what may be the “right” thing to do. Clinical ethics consultants facilitate communication among patients, their families and the treatment team to assist in making appropriate choices when difficult decisions need to be made.

14. Access and Availability of Ethics Consultation Ethicist always on-call Accessible 24/7/365 Available to all providers, staff, patients, families and surrogates Anyone can request a consult Inpatient and outpatient areas Adults and pediatrics Hospital campus and off-site locations

15. How to Request a Consult 24/7/365 availability via paging web site Monday – Friday 8am to 5pm: call 734-615-1379, ask for on-call ethicist to be paged After hours and weekends: call 734-639-6267, ask for on- call ethicist to be paged MiChart ethics consult (inpatients only), please page ethicist on call after writing consult order To remain anonymous use paging system or ethics hotline 734-615-1379 (do not place consult in MiChart)

16. How the Process Works Clinical ethics consultants on call will review the patient's medical situation and help to articulate the ethical question. This will usually involve discussion with multiple stakeholders, family meetings. Consultant may offer suggestions about justifiable courses of action; consult placed in patient’s record. Final decisions are made by the patient, family and the health care team. Follow a case over time and/or across settings

17. What an Ethics Consultant Does –Identify sources of disagreement –Ensure that involved parties have their voices heard –Assist involved parties in clarifying their own values –Facilitate explicit, comprehensive deliberative process –Identify risks, benefits, goals of care –Negotiate workable compromise –Bring experience with similar issues to assist process, communication, and outcomes

18. What an Ethics Consultant Doesn’t Do –“Police” clinicians –Make moral judgments –Dictate choices or “take sides” –Supersede clinician-patient-family dynamic –Act as legal counsel

19. Preventative Ethics Round in ICUs / floors Sit in on case conferences or meetings Identify and/or help with moral issues in practice Identify potential conflicts before they become “dilemmas” Teach

20. Questions? Janice Firnjfirn@med.umich.edujfirn@med.umich.edu Andrew Shuman shumana@med.umich.edushumana@med.umich.edu Christian Vercler cvercler@med.umich.educvercler@med.umich.edu Ethics Line 734-615-1379