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Making decisions about life-changing or life-ending situations can create conflict among families, patients and health care professionals. Physicians, nurses, social workers and bioethics committee members often experience moral distress when faced with difficult bioethical choices. A statewide network called a “community of practice” is providing training and practical tools to support professionals as they work through challenging medical situations.
The Arizona Bioethics Network in collaboration with St. Luke’s Health Initiatives, Arizona State University, and several other partners, is hosting its second annual conference, to help teach practical ethics consultation and decision-making skills. The conference is called “Ethics at The Bedside: Making the Hard Decisions” and participants will interact with experts to discuss difficult issues such as stopping feeding for incompetent patients, palliative care versus extreme life-saving measures, and family conflicts arising from end-of-life care. Also, the conference will once again feature a unique ASU innovation.
“Instead of just having a case study on paper, we dramatize the case and develop them as video vignettes,” said Jason Scott Robert, an associate professor in ASU School of Life Sciences and professor in the university’s Lincoln Center for Applied Ethics. “We will show a few minutes of the story and then pause, ask questions and discuss the issues. Then we do it again for the next scene as the situation unfolds in real time.”
Kathleen O’Connor, an ASU doctoral student, and Greg Loeben, a collaborator and associate professor from Midwestern University, wrote two fictional scripts that mimic real cases. These stories are featured in the videos. In the first vignette, written by Loeben, a patient is effectively at the end of her life and the only useful medical intervention would be comfort care. Yet the patient’s family demands that everything possible must be done for their loved one. The second video, authored by O’Connor, highlights the common problem of patients in long-term care being sent back and forth between an emergency room and a nursing home. A lack of communication about the patient’s end-of-life wishes adds to the stress.
According to Robert, the point of the vignettes is to spark conversation.
“So we can ask at the end of each vignette, ‘How might this situation have been avoided? What lessons can we learn for the patient care team, for the clinical ethics consult team, for family and patient education?’ We want to present ways we can be more preventive rather than just reactive in the future,” Robert said. With Robert’s leadership and ASU’s support, the bioethics network expects to produce ten of these video vignettes each year to create a library of bioethics resources for the community.
This summer, the network will be transferring from St. Luke’s Health Initiatives to become a joint initiative with ASU. As of July 1, 2012, Robert will become the director of this collaborative effort.
Robert, a professor of bioethics in life sciences and Lincoln Professor of Ethics in Biotechnology and Medicine, said the network conferences have initially focused on the clinical ethics setting. However, they hope to expand their topics into public and population health ethics, as well as research ethics. In addition, the bioethics network wants to connect with more medical professionals throughout Arizona.
“Hopefully we can work with the residency programs, allied health programs, and the health services units working with local Native American tribes,” Robert said. “We want to be able to share best practices between institutions. We’ve got a big vision moving forward to really bring bioethics, whatever that might be, to the state of Arizona and bring the state of Arizona into the conversation about this intersection of values and biological and biomedical science.”
The conference takes place from 8 a.m. to 5 p.m., April 20, at the Fiesta Inn Resort and Conference Center in Tempe.
Arizona State University has the only bioethics program in the country that is based in a School of Life Sciences. The university’s master of arts, master of science, and doctorate programs in bioethics are growing and the Lincoln Center for Applied Ethics, a transdisciplinary unit in the College of Liberal Arts and Sciences, is developing several bioethics certificates.