Tag: ethics consultation

Bioethics Blogs

Ethics Committees Should Have Standards in Preparing New Members

Guest Post: Danish Zaidi and Jennifer Kesselheim
Paper: Assessment of orientation practices for ethics consultation at Harvard Medical School-affiliated hospitals

Ethics advisory committees (EACs), or clinical ethics committees, fulfill an important role in hospitals, providing ethics consultation, contributing to hospital-wide policies, and educating staff on ethical dimensions of medical practice. Our study built upon a central question: what qualifies one to serve on these sorts of committees? It’s a question with added relevance to us as authors: Danish Zaidi was part of the inaugural class of the Harvard Medical School Master of Bioethics program and Jennifer Kesselheim is an EAC co-chair and the founding director of the Harvard Medical School Master of Medical Sciences (MMSc) in Medical Education program. We studied how EACs recruit and educate members of their committees. In particular, what orientation practices were use in educating new members of EACs and how did members perceive confidence were member in fulfilling their duties on the other end of their “orientation”?

In recent years, the American Society for Bioethics & Humanities (ASBH) has made efforts to improve and standardize practices in ethics consultation across medical institutions. The ASBH has published two foundational books regarding ethics consultation and recently their Board of Directors approved the development of a healthcare ethics consultation (HCEC) certification program. Such efforts allude to a desire for standards in ethics consultation. As such, we turned to the ASBH Core Competencies in Healthcare Ethics Consultation to identify areas that we felt committee members should have familiarity with, using these competencies as metrics to develop our survey instrument.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

End-of-Life Healthcare Sessions at ASBH 2017

The 2017 ASBH
conference
 in October 2017 includes over 400 workshops, panels, and
papers in bioethics and the health humanities.  Here are ones that pertain
to end-of-life issues.


THURSDAY, OCTOBER 19


THU 1:30 pm:  End-of-Life Care and Decision-Making in the ICU – Limited
English Proficiency as a Predictor of Disparities (Amelia Barwise)


Importance: Navigating choices in predominantly English-speaking care settings
can present practical and ethical challenges for patients with limited English
proficiency (LEP). Decision-making in the ICU is especially difficult and may
be associated with disparities in health care utilization and outcomes in critical
care. 


Objective: To determine if code status, advance directives, decisions to limit
life support, and end-of-life decision-making were different for ICU patients
with LEP compared to English-proficient patients. 


Methods: Retrospective cohort study of adult ICU patients from
5/31/2011-6/1/2014. 779 (2.8%) of our cohort of 27,523 had LEP. 


Results: When adjusted for severity of illness, age, sex, education, and
insurance status, patients with LEP were less likely to change their code
status from full code to do not resuscitate (DNR) during ICU admission (OR,
0.62; 95% CI, 0.46-0.82; p


Conclusion: Patients with LEP had significant differences and disparities in
end-of-life decision-making. Interventions to facilitate informed
decision-making for those with LEP is a crucial component of care for this
group.


THU 1:30 pm:  “But She’ll Die if You Don’t!”: Understanding and
Communicating Risks at the End of Life (Janet Malek)


Clinicians sometimes decline to offer interventions even if their refusal will
result in an earlier death for their patients. For example, a nephrologist may
decide against initiating hemodialysis despite a patient’s rising creatinine
levels if death is expected within weeks even with dialysis.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Authorship and Pets

The International Committee of Medical Journal Editors is an
influential group that, as expected, takes publication and authorship very
seriously.  They have issued the most
generally accepted definition of the criteria for authorship of scientific
publications. They list these criteria very clearly and unambiguously on their website.
These criteria are:

“The ICMJE
recommends that authorship be based on the following 4 criteria:

  •            Substantial
    contributions to the conception or design of the work; or the acquisition,
    analysis, or interpretation of data for the work; AND

  •          Drafting the
    work or revising it critically for important intellectual content; AND
  •           Final
    approval of the version to be published; AND
  •          Agreement to
    be accountable for all aspects of the work in ensuring that questions related
    to the accuracy or integrity of any part of the work are appropriately
    investigated and resolved. “
  • They go on to say “All those designated as authors
    should meet all four criteria for authorship, and all who meet the four
    criteria should be identified as authors.” There does not seem to leave much
    doubt as to their meaning. The practise of guest authorship, including authors
    with non-substantive contributions by virtue of their position was once common
    but is now considered inappropriate. However, no simple set of guidelines can
    address all possible circumstances. Which raises the point I am addressing in
    this blog: What about pets?

    An important paper
    on atomic behaviour published in Physical Reviews by Jack Hetherington and
    F.D.C.

    The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

    Bioethics Blogs

    Authorship and Pets

    The International Committee of Medical Journal Editors is an
    influential group that, as expected, takes publication and authorship very
    seriously.  They have issued the most
    generally accepted definition of the criteria for authorship of scientific
    publications. They list these criteria very clearly and unambiguously on their website.
    These criteria are:

    “The ICMJE
    recommends that authorship be based on the following 4 criteria:

      Substantial
    contributions to the conception or design of the work; or the acquisition,
    analysis, or interpretation of data for the work; AND

      Drafting the
    work or revising it critically for important intellectual content; AN

      Final
    approval of the version to be published; AND

      Agreement to
    be accountable for all aspects of the work in ensuring that questions related
    to the accuracy or integrity of any part of the work are appropriately investigated and resolved. “

    They go on to say “All those designated as authors
    should meet all four criteria for authorship, and all who meet the four
    criteria should be identified as authors.” There does not seem to leave much
    doubt as to their meaning. The practise of guest authorship, including authors
    with non-substantive contributions by virtue of their position was once common
    but is now considered inappropriate. However, no simple set of guidelines can
    address all possible circumstances. Which raises the point I am addressing in
    this blog: What about pets?

    An important paper
    on atomic behaviour published in Physical Reviews by Jack Hetherington and
    F.D.C. Willard is the object of this question.

    The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

    Bioethics Blogs

    Certification for Health Care Ethics Consultants: An Update

    At its April 2017 meeting, the American Society for Bioethics and Humanities (ASBH) Board of Directors considered the final reports of the Healthcare Ethics Consultation (HCEC) Certification Task Force that was appointed in July 2016.


    On the basis of the role delineation study and needs assessment conducted by the task force, the board approved in concept the development of a voluntary, professional certification program to validate the professional knowledge and professional legitimacy of individual healthcare ethics consultants.


    The next steps are to refine the competencies, structure, charges, and budget for the group of volunteer leaders that will lead this effort. The board anticipates opening a call for applications after its July meeting and making appointments in September.

    The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

    Bioethics Blogs

    Fertility preservation for transgender individuals

    The field of oncofertility emerged to preserve the fertility
    of cancer patients whose treatment might render them as infertile or sterile.
    Today, the field of fertility preservation has expanded to other patient
    populations whose medical treatment may affect their fertility. One such
    population is transgender individuals undergoing gender affirming treatments.
    Although research on transgender individuals is limited overall and in
    particular regarding issues surrounding reproduction, transgender individuals
    are interested in biological reproduction. Because various gender affirming
    treatments will permanently affect their fertility, such as hormonal treatment
    and surgical removal of the gonads, it is important for transgender individuals
    to be offered fertility preservation before they start these treatments.

    There are, however, some factors that may make fertility
    preservation difficult or less attractive of an option for transgender
    individuals. Healthcare professionals offering fertility preservation should be
    aware of these factors so they can help mitigate them. Here I will discuss two
    of them.

    First, undergoing fertility preservation treatment can be
    stressful for both transgender and cisgender people, but there are some unique
    challenges for transgender individuals. Individuals with gender dysphoria may
    find it particularly difficult to undergo procedures involving anatomy that is
    discordant with their identity. For example, transgender women who are asked to
    retrieve sperm via masturbation may find this request exacerbates their gender
    dysphoria and may not be possible to do. Transgender men who are asked to
    undergo vaginal ultrasounds may find this psychologically traumatic. In
    recognizing how fertility preservation treatment can be particularly difficult
    for transgender individuals, healthcare professionals should be prepared to
    find ways to alleviate these difficulties, such as by offering surgical methods
    of sperm retrieval for transgender women and sedating transgender men during
    vaginal ultrasounds.

    The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

    Bioethics Blogs

    Fertility preservation for transgender individuals

    The field of oncofertility emerged to preserve the fertility
    of cancer patients whose treatment might render them as infertile or sterile.
    Today, the field of fertility preservation has expanded to other patient
    populations whose medical treatment may affect their fertility. One such
    population is transgender individuals undergoing gender affirming treatments.
    Although research on transgender individuals is limited overall and in
    particular regarding issues surrounding reproduction, transgender individuals
    are interested in biological reproduction. Because various gender affirming
    treatments will permanently affect their fertility, such as hormonal treatment
    and surgical removal of the gonads, it is important for transgender individuals
    to be offered fertility preservation before they start these treatments.

    There are, however, some factors that may make fertility
    preservation difficult or less attractive of an option for transgender
    individuals. Healthcare professionals offering fertility preservation should be
    aware of these factors so they can help mitigate them. Here I will discuss two
    of them.

    First, undergoing fertility preservation treatment can be
    stressful for both transgender and cisgender people, but there are some unique
    challenges for transgender individuals. Individuals with gender dysphoria may
    find it particularly difficult to undergo procedures involving anatomy that is
    discordant with their identity. For example, transgender women who are asked to
    retrieve sperm via masturbation may find this request exacerbates their gender
    dysphoria and may not be possible to do. Transgender men who are asked to
    undergo vaginal ultrasounds may find this psychologically traumatic. In
    recognizing how fertility preservation treatment can be particularly difficult
    for transgender individuals, healthcare professionals should be prepared to
    find ways to alleviate these difficulties, such as by offering surgical methods
    of sperm retrieval for transgender women and sedating transgender men during
    vaginal ultrasounds.

    The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

    Bioethics Blogs

    The Crisis of Our Era: Can we find a way to talk about it?

    So much of the fate of our planet, the human race, and all of God’s creatures depends on humans having an objective, causal understanding of the pressing problems we face and then, on that basis, developing some reasonably effective practical means by which those threats can be ameliorated—it’s called, using human intelligence and being connected to reality, at least reality with a small “r”, as in empirical reality. Just think of the causes of threats such as climate change, transmittable diseases and drug resistant viruses, gun violence, drug abuse, hunger, unemployment, poverty, lack of healthcare coverage, and on and on. Without reasonably sound knowledge of the causes of these threat humans are rendered helpless and vulnerable. And even with sound knowledge, without a practical, yes political, means, in the form of sound public policy, of collective action, to ameliorate them, we are cannot take meaningful action, and are still rendered helpless and vulnerable. Currently, in the United States there is vast disagreement not only over how best to formulate policy solutions to some our most pressing problems, there is often no agreement over how to understand the problem or even whether or not a problem exists. Climate change and gun control are two prominent examples. 

    The fact that climate change is real and greatly accelerated by human activity is a fact about which there is clear scientific evidence. Practically all scientific societies, science academies, and governmental and intergovernmental agencies, are in complete agreement, which means the evidence for this empirical claim being true is about as compelling as anything we know about the natural phenomena.

    The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

    Bioethics Blogs

    The Crisis of Our Era: Can we find a way to talk about it?

    So much of the fate of our planet, the human race, and all of God’s creatures depends on humans having an objective, causal understanding of the pressing problems we face and then, on that basis, developing some reasonably effective practical means by which those threats can be ameliorated—it’s called, using human intelligence and being connected to reality, at least reality with a small “r”, as in empirical reality. Just think of the causes of threats such as climate change, transmittable diseases and drug resistant viruses, gun violence, drug abuse, hunger, unemployment, poverty, lack of healthcare coverage, and on and on. Without reasonably sound knowledge of the causes of these threat humans are rendered helpless and vulnerable. And even with sound knowledge, without a practical, yes political, means, in the form of sound public policy, of collective action, to ameliorate them, we are cannot take meaningful action, and are still rendered helpless and vulnerable. Currently, in the United States there is vast disagreement not only over how best to formulate policy solutions to some our most pressing problems, there is often no agreement over how to understand the problem or even whether or not a problem exists. Climate change and gun control are two prominent examples. 

    The fact that climate change is real and greatly accelerated by human activity is a fact about which there is clear scientific evidence. Practically all scientific societies, science academies, and governmental and intergovernmental agencies, are in complete agreement, which means the evidence for this empirical claim being true is about as compelling as anything we know about the natural phenomena.

    The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

    Bioethics Blogs

    Case-Based Study Guide for Addressing Patient-Centered Ethical Issues in Health Care

    The American Society for Bioethics and Humanities (ASBH) announces the publication of A Case-Based Study Guide for Addressing Patient-Centered Ethical Issues in Health Care.


    Authored by the ASBH Clinical Ethics Consultation Affairs Committee, this 160-page study guide provides an unfolding approach to 12 cases—9 involving adult patients, 3 involving minors—on various topics in clinical ethics. The presentation of these complex cases mimics the way that they evolve incrementally in the clinical setting: Patient and family narratives are interwoven with skills-based, reflective study questions that encourage critical thinking on the part of ethics consultants, ethics committee members, students, and other healthcare professionals.


    All healthcare professionals and students seeking to build their competencies, from the basic skills used to address common ethical issues to advanced consultative skills that can be used to address complex ethical concerns, will find this resource useful. 


    Included are tips related to communication and decision making in medicine, including strategies for guiding fruitful patient interviews, elucidating patients’ or surrogates’ concerns or perspectives, and conducting family meetings. 

    The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.