 Who decides? An ethics case consult for Terri Schiavo. What lessons might we take away as palliative care clinicians or ethics consultants?
I might summarize as follows: As has been widely discussed elsewhere, the importance
of advance directives, designation of proxy decision makers, and nuanced discussions
with those potential proxies is of utmost importance--even for young adults.
Be as clear as possible about diagnosis and prognosis. Rely on those with the
greatest expertise and the least potential conflict of interest. Be honest about
the limits of medical certainty and the diagnostic and prognostic possibilities.
Separate reality from what loved ones or special interest advocates might wish
were the reality. Efforts to resolve disputes among families or between families
and care providers ought to remain private, and focus on the patient at hand
rather than broader social or political agendas. Ethics committees or independent
mediators work toward "win-win" outcomes and may help avoid the polarized,
"winner-take-all" approach of litigation. Medical facts are not value-free
and do not add up to a universally agreed-upon conclusion in the manner of a
mathematical equation, but are viewed and interpreted through the lens of each
participant's perspective. In the space of this essay, I can offer only a brief
nod to the field of narrative ethics, but the interested reader will find a
rich body of literature regarding this concept on which to base his or her own
ethical conclusions regarding this case. Vandekieft G. Am J Hosp Palliat Care.
2005 May-Jun;22(3):175-7. |
| Department of Pain Medicine and Palliative Care Beth Israel Medical Center, New York City ©2005 Continuum Health Partners, Inc. www.stoppain.org/palliative_care |
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