Supporting ethical decision making and clinical practice
Given the vulnerability of patients and the complexity of health care today, ethical concerns will be presented to nurses practicing in the Penn health system. Resources to support ethical decision making and mitigate moral distress are organized through the three hospital-based ethics committees. These committees are charged with staff education, policy development and clinical ethics consultation. The clinical ethics consultation service provides a forum to assist patients, families and staff with addressing their ethical concerns.
Experienced clinicians who are prepared to provide ethics consultation are an important resource in our care setting. Clinical ethics consults are submitted from staff members, patients and family members for:
- Patients faced with myriad treatment options that may sustain life yet have significant burden.
- A family member assuming responsibility for health care decision-making for a loved one who is unable to speak for her/himself.
- Nurses and physicians using new knowledge, skills and technologies to extend life may at times ask, Are we doing the right thing?
Witnessing the suffering of aggressive treatment when outcomes are uncertain places a significant burden on direct caregivers. Patients may express their doubts to their bedside nurse about continuing with chemotherapy, dialysis or surgery with an uncertain outcome. Family members ask staff, what decision would you make if you were faced with a similar situation?
Ethics consultants have advanced education in ethics and bring a formal process to helping patients, families and staff members identify all the care options that can be ethically supported as well as mediate when conflicts arise. Authority for decision-making always remains with the patient or their legally authorized surrogate in consultation with the medical care team.
Interdisciplinary Ethics Committees at Our Hospitals
Each of the three entities at Penn Medicine has their own interdisciplinary ethics committee where nurses provide leadership.
Hospital of the University of Pennsylvania (HUP)
A nurse and a physician both of whom hold the Master of Bioethics degree from the University of Pennsylvania, co chair the HUP Ethics Committee and provide leadership for ongoing ethics education for HUP staff. With the leadership of the nurse ethicist, Mary K. Walton, MSN, MBE, RN nurses are active committee members and assist with ethics education and policy development. Nurse members of the ethics committee assist with the planning of Schwartz Center Rounds and organize unit based ethics conversations and journal club programs. Nurses interested in developing their knowledge and skills in the field of clinical ethics are encouraged to join the committee.
Penn Presbyterian Medical Center (PPMC)
The PPMC ethics committee is available for consultation by pager at all times, and its intranet site contains staff education and resources for nurses. Membership includes a strong nursing component, and a nurse is often part of the three-co-chair leadership. The committee frequently visits patient care units to hear and discuss ethical concerns by staff.
Pennsylvania Hospital (PAH)
At PAH, Janet Creely, RN, CPSO, CCM, CPHQ, director of patient safety, co-chairs the ethics committee with Michael Buckley, MD, CMO and chair of the Department of Medicine.