Ethics in healthcare
A culture of doing what's right.
Ethics in patient careBecause you have your own views, values and religious beliefs, you may have questions or concerns about the ethical implications of recommendations for your treatment and care. You may need more information about your options for diagnosing and treating your illness. You or your family members may even disagree with those recommendations. Geisinger's Ethics Advice and Consultation Service is staffed by experts who are trained to help you and your family understand your choices and resolve concerns or conflicts about your care.
Ethics in improving healthcare
Geisinger aspires to be a learning health care system, organized around the drive to learn and improve care continuously. In a learning health care system, learning initiatives—from quality improvement and innovation to clinical trials, comparative effectiveness studies and other forms of research—are closely integrated with the delivery of care. The aim is to learn and improve care continuously. In striving to achieve this goal, patients play key roles—from providing feedback on their experience of care to serving as advisors and as co-investigators. Information about Geisinger’s efforts to engage patients more broadly and more deeply in learning is available here.
Geisinger's Ethics Advice and Consultation ServiceWhat should be done to ensure that the care for this patient is both right and good? (Right means that both evidence and clinical experience indicate that the care will be effective; good means that the care is aligned with the patient’s wishes—and with the integrity of clinicians.) This is the ethical question that should be asked –and answered—in caring for every Geisinger patient.
In some circumstances, however, it may be difficult to answer this ethical question. There may be questions or disagreements within the health care team about the most effective treatment. There may be conflicts within a patient’s family about the best course of care for their loved one. And sometimes conflict arises between the patient or the patient’s family and the health care team. In situations like these, it may be helpful to seek guidance from individuals with expertise in clinical ethics—individuals who are educated and trained to facilitate the resolution of ethical conflicts and questions in patient care. It may be helpful to contact Geisinger’s Clinical Ethics Advice and Consultation Service.
What is the Clinical Ethics Advice and Consultation Service?
Geisinger’s Clinical Ethics Advice and Consultation Service provides help to patients, their families, and their clinicians whenever difficult ethical questions or concerns arise or when assistance is needed in improving communication—within families or between clinicians and patients and their families.
The Service can offer informal advice on a confidential basis or it can provide a more formal intervention, including the facilitation of meetings that bring together patients, their families, and their clinicians. The Service’s recommendations are intended to advise and facilitate—but not replace—decision making by patients, families and their clinicians.
When is the Clinical Ethics Advice and Consultation Service available?
The Clinical Ethics Advice and Consultation Service is staffed by individuals with specialized education and training in clinical ethics and in conflict mediation and resolution. The Service is staffed 24 hours a day, seven days a week, and is available throughout the Geisinger.
Who can contact the Clinical Ethics Advice and Consultation Service and how?
Anyone—a patient, a family member, a nurse, social worker, physician, or chaplain—involved in the care of a patient can seek and get help from the Clinical Ethics Advice and Consultation Service.
To contact the Service, please page 4192 or call 570-556-4713. In addition, physicians or advance practitioners at any Geisinger hospital may also order a clinical ethics consultation through EPIC.
For additional information, please feel free to contact:
Daniel Davis, PhD, director of the Clinical Ethics Advice and Consultation Service, at firstname.lastname@example.org or 570-214-7340.
Daniel J. Hoegen, MSW, clinical ethicist, at email@example.com or 570-814-4185.
Shannon Getchey, senior administrative assistant, at firstname.lastname@example.org or 570-214-4887.
Geisinger’s Research Ethics Advice and Consultation ServiceEthical questions and challenges also arise in the context of research. To learn more about Geisinger’s Research Ethics Advice and Consultation Service, please follow this link.
Geisinger’s Hospital Ethics Committees
As healthcare and healthcare decision making have become more complex, the potential for ethical uncertainty and conflict has increased. For more than four decades, hospital ethics committees have offered an important forum for dialogue, reflection, and help—to patients and their loved ones, to the clinicians who care for them, and to organizational leaders in need of ethical expertise and advice.
At every Geisinger hospital, an ethics committee has been established and now meets routinely (usually on a monthly or quarterly basis). In membership, the committees strive to represent the full range of health care professionals (from physicians and nurses to clinical social workers and respiratory therapists), as well as the major hospital units (from the emergency department to the labor/delivery suite and the intensive care unit). They also include, as members, representatives of their surrounding communities.
Geisinger’s hospital ethics committees pursue several aims:
- They educate themselves about fundamental as well as emerging issues in clinical and organizational ethics
- They plan and provide ethics educational programs for their colleagues
- They develop and revise system-wide policies on, for example, withholding and withdrawing life-sustaining treatment, determining death, medical futility, conscientious objection and other topics
- They critically review formal clinical ethics consultations to ensure quality
- And they contribute to ethics quality improvement initiatives at their respective hospitals and throughout Geisinger’s clinical enterprise
Some of the committees’ most important work occurs beyond their monthly meetings as their members go about the performance of their day-to-day clinical duties. That work consists in members’ efforts to serve as ethics resources for their colleagues as well as for patients and their loved ones—helping to identify and address needs for education or consultation, for policy revisions or development, or for systemic solutions to entrenched problems. In brief, hospital ethics committees and their members work to open up and sustain what can best be described as moral space: a place and a time for analyzing, reflecting upon and tackling the ethical challenges inherent in the care of patients.
Public Education and Outreach
For patients at the end of life, high quality care can be a difficult goal to achieve. All too often, patients with serious, advanced illness do not think ahead about their preferences for care and treatment, nor do they communicate their wishes to their loved ones. The results can be unwanted treatment that does little to benefit patients—treatment that can prolong and complicate the dying process.
In the context of serious illness, thinking ahead about care and treatment, understanding what is and is not effective, and clarifying values and preferences are all aspects of advance care planning. And advance care planning is most effective when a patient’s loved ones understand the treatments that will and will not be helpful—and understand and respect the patient’s preferences and wishes for care.
To promote awareness of the importance of family conversations about end of life care, the Hospital Ethics Committee at Geisinger Medical Center has developed a public education program—It’s a Family Matter: Living with Advanced Illness, Dying Well, and the Importance of Talking About It with Family. This 40-minute program includes helpful information about chronic disease, about the challenges of high quality care at the end of life, and about family conversations about end of life wishes. It culminates in a brief overview of the family discussion guide developed by the Conversation Project, which is dedicated to helping people talk about end of life wishes. [For more information on this project, which works in collaboration with the Institute for Healthcare Improvement, see www.theconversationproject.org. Copies of the discussion guide are also available from this site.]
It's a Family Matter has been presented, free of charge, to nearly fifty groups across the geographical area that Geisinger serves—most of them churches and civic groups. To schedule a presentation for your organization or group, please contact Shannon Getchey at email@example.com or 570-214-4887.