Tag: social workers

Bioethics News

Elder Abuse: ERs Learn How To Protect A Vulnerable Population

August 28, 2017

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Abuse often leads to depression and medical problems in older patients — even death within a year of an abusive incident.

Yet, those subjected to emotional, physical or financial abuse too often remain silent. Identifying victims and intervening poses challenges for doctors and nurses.

Because visits to the emergency room may be the only time an older adult leaves the house, staff in the ER can be a first line of defense, said Tony Rosen, founder and lead investigator of the Vulnerable Elder Protection Team (VEPT), a program launched in April at the New York-Presbyterian Hospital/Weill Cornell Medical Center ER.

The most common kinds of elder abuse are emotional and financial, Rosen said, and usually when one form of abuse exists, so do others. According to a New York study, as few as 1 in 24 cases of abuse against residents age 60 and older were reported to authorities.

The VEPT program — initially funded by a small grant from The John A. Hartford Foundation (a Kaiser Health News funder) and now fully funded by the Fan Fox and Leslie R. Samuels Foundation — includes Presbyterian Hospital emergency physicians Tony Rosen, Mary Mulcare and Michael Stern. These three doctors and two social workers take turns being on call to respond to signs of elder abuse. Also available when needed are psychiatrists, legal and ethical advisers, radiologists, geriatricians and security and patient-services personnel.

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KHN

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

Charlie Gard: Three Issues That Did Not Make Social Media

by Ann Mongoven, Ph.D., MPH

All hearts go out to the Gard family in this time of grief for their son, Charlie.

The legal wrangling over Charlie’s care became a political football–unfortunately, about many things having little to do with Charlie.

Despite the involvement of Pope Francis, this was not a case about abortion rights or the sanctity of human life. Catholic tradition warns both that quality-of-life arguments can dehumanize the disabled, and that unduly burdensome medical care can become assaultive. There is no “Catholic” view of the case, and Catholic moral theologians disagree about it.

Despite the involvement of Donald Trump, this was not a case about the relative merits of the U.K. National Health Service (NHS) versus other health systems. It was not a case of utilitarian ethics pitted against duty-based ethics or love. The NHS provided extremely expensive intensive care for Charlie for most of his life, and British courts governed cases related to his care solely by a “best interest of the child” standard– amidst heated disagreement between Charlie’s parents and doctors about his interests. The European Court of Human Rights backed the British court decision.

The case did address questions about who should decide when parents and doctors disagree about a child’s medical interest. But contrary to some portrayals in the American press, it neither changed conventional parameters for addressing those questions, nor exposed major differences in legal reasoning used to address them in the U.K. and the U.S.  Both countries appeal to “best interest” standards for resolution, and both reject an absolutist interpretation of parental rights.

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

Advance Care Planning and End of Life (ACPEL) Conference

The program for the 2017 Advance Care Planning and End of Life (ACPEL) Conference in Banff is now available.


Pre-Conference Sessions (Part 1)
Session 1: CRIO 
1. How do people with disabilities perceive advance care planning – Robin Gray, University of Calgary


2. Differences in survey methodology of two Advance Care Planning survey polls conducted in Alberta, Canada – Sunita Ghosh, Alberta Health Services-CancerControl


3. Efficacy of Advance Care Planning and Goals of Care Designations Discussions: A Randomized Controlled Trial and Video Intervention – Maureen Douglas, University of Alberta
  
4. Identification of indicators to monitor successful implementation of Advance Care Planning policies: a modified Delphi study – Patricia Biondo, University of Calgary

5. The economics of advance care planning, Konrad Fassbender, University of Alberta; Covenant Health

Session 2: Health Care Consent, Advance Care Planning, and Goals of Care: The Challenge to Get It Right in Ontario

Health Care Consent, Advance Care Planning, and Goals of Care: The Challenge to Get It Right in Ontario – Tara Walton, Ontario Palliative Care Network Secretariat

Session 3: How to Invite Clinicians to Initiate ACP

1. How to Invite Clinicians to Initiate ACP to Residents, Patients, and Family Carers? – Luc Deliens  
  
2. Development of a complex intervention to support the initiation of advance care planning by general practitioners in patients at risk of deteriorating or dying: a phase 0-1 study – Aline De Vleminck, Free University of Brussels & Ghent University

Pre-Conference Sessions (Part 2)

Session 1: Faith Based Workshop

Inviting the voice of Spirituality within the conversation of Advanced Care Planning – Thomas Butler, Bon Secours Health System Inc.

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 News

What Social Workers Need to Know about Surrogacy

December 15, 2016

(The Guardian) – The fact is that social care agencies can and do get drawn in. They may get cases referred during the surrogate’s pregnancy because of concerns about her exploitation or the arrangements for the child. They may become involved if family difficulties later develop – in either the “new” family or the surrogate’s own family, or if parents separate. They may see any of the parties via mental health services. Care workers must be well informed if they are to recognise the human rights and social work principles that need to be respected in order to practise safely and ethically.

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 Ethics of Climate Change Activism: Fear vs. Reality

Image via NASA

STUDENT VOICES

By: Chelsea Zantay

This essay is in response to the Carnegie Council for Ethics in International Affairs video clip “Global Ethics Forum: Ethics Matter: A Conversation with Bill McKibben.”  

Often when a problem is too big or too scary we throw up our hands and announce that “there is nothing we can do” to solve it.  Admittedly, climate change feels like one of those problems.  It seems like a quagmire of depressing facts and statistics.  It is now scientific fact that the polar ice caps are melting, our oceans are rising and becoming more acidic, and if we do not curb our consumption of fossil fuels, our planet will be rendered unlivable.  The plethora of disturbing information on climate change is enough to cause anyone to have a sleepless night or make them wish they had never heard the truth about our warming planet.  However, ostriches with their heads buried in the sand do not get much done, and once you know some truth, you cannot un-know it.  And so the question at hand is not “is climate change happening?” for that question has been answered in the affirmative (although climate change deniers would like to see this issue removed from our national political discourse).  The question right now is “what are we going to do about it, if anything?”

Bill McKibben, environmental scientist and founder of 350.org, has spent his career writing about climate change and mobilizing communities as an activist for the cause. 

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

Let’s Talk About Wishes, Values, and Beliefs

Angel Petropanagos reflects on her experiences asking dialysis outpatients questions about healthcare wishes, values, and beliefs.

__________________________________________

I want to tell you about one of the most rewarding ethics projects I’ve been involved with. Over the past few months, I’ve been speaking with dialysis outpatients about what they want, what’s important to them, and what they believe. I’ve been asking them about who they want as their substitute decision-maker if they lose the capacity to consent to treatment, and whether they have or would like to have a living will (or a Power of Attorney for Personal Care). I’ve been asking them if they have any wishes related to receiving Cardio Pulmonary Resuscitation if their heart stops. I’ve also been asking them how they feel about their dialysis treatment. With these types of extremely challenging personal and moral questions I’m getting to know a lot about these patients.

Most of these conversations have happened at the bedside while outpatients have been receiving their dialysis treatment. Often, when I have asked patients these questions, they have smiled at me, paused to reflect, or just laughed. Some patients have told me that they had never thought about their healthcare wishes before. Others have told me that they were glad that someone was finally asking them about their wishes.

These conversations are part of an ethics quality improvement project called ChELO (Checklist to meet Ethical and Legal Obligations). Ethics quality improvement is a novel approach to clinical ethics that aims to improve quality of care. Improved quality of care means giving patients care that they want and can benefit from.

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

LECTURE: Rebalancing Empowerment and Protection: Evolving Legal Frameworks for Impaired Capacity

Thursday 8 December 2016, 18:00 – 19:00

UCL Gustave Tuck Lecture Theatre, Wilkins Building, Gower Street, London WC1E 6BT

Speaker: Professor Mary Donnelly (University College Cork)
Chair: TBC
Accreditation: This event is accredited with 1 CPD hour with the SRA and BSB

Admission: Free, Registration required (here)

 

The past decade has seen a notable evolution in the normative context for law’s response to people with impaired capacity. Driven by a range of factors, including greater recognition of human rights (perhaps most notably through the Convention on the Rights of Persons with Disabilities) and better empirical understandings, a rhetoric of inclusion and empowerment has replaced traditional approaches centred on control and protection.  Law reform projects in various jurisdictions (Australia, Canada, Ireland, Northern Ireland) have attempted to develop legislative frameworks to give effect to these emerging norms. Yet there is also another narrative. Concerns are expressed (perhaps most commonly by frontline professionals: healthcare professionals, lawyers, social workers and sometimes by family members of people with impaired capacity) that something important may be lost where there is a devaluation of protective norms. There is also a dissonance between the abstract ideals of human rights on the one hand and on the other, the complex corporeal, economic, family, phenomenological and social context within which people with impaired capacity, and those who care for/about them, live.

Tensions between empowerment and protection norms and between abstract, rights-based and contextual, evidence-based policy drivers are inevitable by-products of law’s evolution and they play a necessary role in the development of the law in this area.

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 Care for Older People in Long-term Care Facilities – International Conference

This conference (March 31st-April 1, 2017 in Kraków, Poland) is focused on the issue of improving end-of-life quality of care in long-term care facilities (LTCFs) across Europe with a special focus on the Polish context. 

The conference is targeted at healthcare and social workers, nursing staff as well as managers of LTCFs. Through presentations and workshops the conference participants will be familiar with the latest guidelines of care principles and tools for implementation and execution of a high-quality end-of-life care. 

The conference is organized as the part of the PACE project – Comparing the effectiveness of Palliative Care for Older People in long-term care facilities in Europe which overall aim is to develop tools to assist practitioners and policy- and decision-makers to make evidence-based decisions regarding best end-of-life care.  

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

Health Care Decision Making for Unbefriended, Incapacitated Adults: A Value-Committed Policy Transfer Analysis

Despite the scope and prevalence of the problem, there is not much literature
addressing the problem of incapacitated unrepresented patients.  One new 21-page article nicely summarized the issues.

This article then zeroes in to assess two innovative approaches.  Texas permits clergy to serve as default surrogates.  Florida permits social workers.

The authors write:  “These mechanisms allow for surrogate or proxy consent for medical treatment not otherwise covered by emergency consent procedures. Moreover, this mechanism supports timely health care decisions for patients who otherwise are subject to institutional ad hoc approaches to consent for non-emergent treatment or judicial processes such as guardianship or emergency treatment orders.”

“Although of benefit to the patient, default surrogate or proxy mechanisms for unbefriended, incapacitated patients carry implicit benefits in the form of economic gains to health care organizations that come from facilitating timely health care decisions. These gains may come in the form of expediting  hospital discharges. . . .  In essence, the mechanisms to facilitate health care decision making for unbefriended, incapacitated patents function as a double-edged sword: vulnerable patients benefit from a health care agent to facilitate medical care decision making and entities (e.g., for-profit hospitals, state resources) realize economic gains from alternatives to guardianship.”

“Therefore, it is imperative to acknowledge these competing interests when surrogate and proxy health care decision makers for unbefriended, incapacitated adults are selected such that competing interests are  minimized.”

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.