Using Goals of Care Conversations to Build Ethics Competency

"Literature indicates that 99% of clinicians believe that timely Goals of Care (GOC) conversations are important. However, only 11% of patients report having had GOC conversations with their providers throughout the trajectory of their disease. Congruent to this, it is reported that only 41% of patients feel that they have received care consistent with their preferences. One can therefore deduct that there is a great ethical gap in how patients are approached by healthcare providers, especially respecting their autonomous decision-making. As a concept, GOC refers to discussing patients’ therapy intend, which is informed by the patients’ hope, fears, information preferences, presumed minimally acceptable quality of life, and expectations for their future. Therefore it needs to be an explicit conversation which is personalized to each patient’s context and circumstances. Within these conceptual ideas there are a myriad of ethical values which needs to be addressed. The author will explain how a Goals of Care initiative was started at the hospital where the author is a clinical ethicist and how these interactions with various members of the care team have been used to build ethics competencies of all the members of the care team. This innovative approach has been applauded by the participants for making ethics practical and applicable. The structure of the talk will focus on basic literature review, discussion on initiative (how it was set up), challenges, lessons learnt, value in ethics competency development. "

Developing Organisational Diversity Statements through Dialogical Clinical Ethics Support: The Role of the Clinical Ethicist

"In increasingly pluralist societies, stakeholders in healthcare do not always share a common moral perspective on health, wellbeing or good care. Growing cultural, religious, and sexual diversity among both patients and healthcare professionals (HCPs) require healthcare organizations to address these differences and to engage in inclusive and equitable practices. Addressing diversity, however, comes with inherent moral challenges. For example, regarding how to deal with healthcare disparities between minoritized and majoritized patients. Additionally, increasing diversity in the workforce means that HCPs moral perspectives on ‘good care’ are diversifying. Developing diversity statements is an important strategy for healthcare organizations to define their normative ideas, values, and approaches to both care and diversity. To tackle concerns of exclusion and power differences, and to ensure that these statements reflect a common ground among HCPs, healthcare organizations ought to develop diversity statements in an inclusive and participatory way. Clinical ethics support (CES) services and interventions such as Socratic Dialogues can be employed to help healthcare organizations to do so. In this presentation, we (1) argue for taking a participatory approach when supporting healthcare organisations in developing diversity statements, (2) report both on the content and the process of developing a diversity statement through CES and Socratic Dialogues, and (3) maintain that CES that supports processes of joint reflection and learning among stakeholders can be used in such an approach. We will use a case example from practice to illustrate our point. We conclude with several recommendations regarding a participatory CES approach for developing diversity statements. "

Resuscitating Patient Rights during the Pandemic: COVID-19 and the Risk of Resurgent Paternalism

The COVID-19 Pandemic a stress test for clinical medicine and medical ethics, with a confluence over questions of the proportionality of resuscitation. Drawing upon his experience as a clinical ethicist during the surge in New York City during the Spring of 2020, the author considers how attitudes regarding resuscitation have evolved since the inception of do-not-resuscitate (DNR) orders decades ago. Sharing a personal narrative about a DNR quandry he encountered as a medical intern, the author considers the balance of patient rights versus clinical discretion, warning about the risk of resurgent physician paternalism dressed up in the guise of a public health crisis.

Counter-Transference and the Clinical Ethics Encounter: What, Why, and How We Feel During Consultations

One of the more draining aspects of being a clinical ethicist is dealing with the emotions of patients, family members, as well as healthcare providers. Generally, by the time a clinical ethicist is called into a case, stress levels are running high, patience is low, and interpersonal communication is strained. Management of this emotional burden of clinical ethics is an underexamined aspect of the profession and academic literature. The emotional nature of doing clinical ethics consultation may be better addressed by utilizing concepts and tools from clinical psychology. Management of countertransference, the natural emotional reaction by the therapist toward the patient, is a widely discussed topic in the psychotherapeutic literature. This concept can be adapted to the clinical ethics encounter by broadening it beyond the patient-therapist relationship to refer to the ethics consultant's emotional response toward the patient, the family, or other members the healthcare team. Further, it may aid the consultant because a recognition of the source and nature of these reactions can help maintain ‘critical distance’ and minimize bias in the same way that a psychologist maintains neutrality in psychotherapy. This paper will offer suggestions on how to manage these emotional responses and their burden in the clinical ethics encounter, drawing upon techniques and strategies recommended in the psychotherapeutic literature. Using these techniques may improve consultation outcomes and reduce the emotional burden on the clinical ethicist.