Media release 25 March 2019 | What happens when a person refuses life-saving treatment? How should clinicians talk to patients about limiting care when active treatment is not clearly indicated?
These are some of the thorny questions regularly faced by Counties Manukau Health’s Clinical Ethics Advisory Committee (CEAC).
Comprised of 19 members across a range of disciplines including medical, nursing and allied health staff members from various clinical specialities and ethnic backgrounds, legal advisors and an ethicist, the committee is chaired by Chief Medical Officer Gloria Johnson.
It meets every two months, although it can meet urgently if required, Dr Johnson says.
In a hospital serving a population of more than 500,000, there are plenty of occasions where staff are required to consider ethical issues.
“What DHB clinical ethics advisory committees are about is clinical practice and how we deliver our services and some of the broader ethical issues that come up as part of operating a health service,” she says, noting this is a different function to the nationally mandated independent ethics committees designed to oversee clinical research.
Recently, the committee discussed a case of a patient, who had declined the treatment programme her clinical team advised but presented repeatedly requiring acute life-saving interventions, which might have been avoided if she had accepted the other treatments offered. After a robust discussion, the committee acknowledged the need to respect the patient’s informed decision, although it was recommended the patient be assigned a dedicated consultant and that the patient’s GP, religious advisors and a case worker from her own cultural group be more actively included in her care plan.
Another scenario recently brought to the committee was how to respond to a request from a vendor to use a CM Health clinician to promote equipment being provided to Middlemore Hospital at a discounted rate.
“The outcome of that was that the service went back to the vendor and said ‘No, we are not comfortable with this and we think you should give us a good price anyway,’” Dr Johnson says.
This is a good example of ethics as they relate to procurement and the DHB’s relationship with a key vendor, she says.
The Amber Care Bundle, a communication and planning tool to manage the care of hospital patients who are facing an uncertain recovery, has also been a recent topic on the Clinical Ethics Advisory Committee Agenda.
“We invited the lead (of the Amber Care Bundle) to come and talk about some of the ethical issues involved in having conversations with patients and their families around decisions to limit care when active treatment is not clearly indicated.”
Dr Johnson says the committee also considers questions relating to how decisions are made about access to unusual, unorthodox or expensive treatments, given a limited funding pool for a large population.
“There’s not necessarily a black and white answer but what you have to do is make sure you’ve considered all the relevant factors, and presenting that information back to the patient is sometimes helpful.”
Dr Johnson says it is important that people are aware the committee exists to help.
“In a situation where there are significant differences of opinion and there may be a level of discomfort on an issue, it is always available to meet.”