Beyond the Diagnosis: Ethics Rounds Treat the Whole Person
by Patricia Allen '13 M.A.
The facts of the case are catastrophic, unthinkable: Ahead-on collision causes a young woman to suffer a severe traumatic brain injury; signs indicate impending brain death; the ventilator will be removed because of infection risk. The distraught family considers the insertion of a tracheostomy tube to maintain life support for an extended period. Without an advance directive, the patient’s wishes about end-of-life care are unknown. Hard questions must be faced, and the family relies on the doctors for guidance.
Bioethicist Peter A. Clark, S.J., professor of theology and health services and director of SJU’s Institute for Catholic Bioethics, is training Mercy Health System residents to provide all of the information patients and their families need to ensure the best possible outcome in critical circumstances. A staff bioethicist at Mercy, Father Clark pioneered weekly ethics teaching rounds for the health care system’s four acute care facilities in 2008.
Fr. Clark says the southeastern Pa. Mercy system is the only Catholic teaching hospital that conducts weekly ethics teaching rounds. He and his colleagues on the interdisciplinary ethics team facilitate discussions with residents that are related to the ethics of each case, often at the patient’s bedside. These meetings are different from daily medical teaching rounds held by attending physicians that discuss patients’ physical disorders.
“Ethics is about actions and their consequences,” says Fr. Clark. “As medical professionals, it’s up to us to make sure that a patient or their family understands all of the ramifications of a treatment course. It’s also our responsibility to train medical residents to consider each case in all of its human complexity.”
Rather than being fixated solely on medical challenges, Fr. Clark says it’s essential for residents to understand that the person lying in the hospital bed is much more than a body with an illness that needs to be fixed or managed. “Residents must consider the person beyond their diagnosis,” he says. “We want them to learn to treat, and care for, the whole person.”
For instance, he explains, if like the young woman described on the previous page, a patient is on life support with no hope of reviving, and the family is leaning toward approving a tracheostomy, the team helps the resident examine the consequences of this action during the ethics round.
“Among other questions, we’d ask the resident if the family understands the differences between coma and a minimally conscious state, permanent unconsciousness, and brain death,” says Fr. Clark. “And as difficult as this is for a family to comprehend, we’d ask if they understand that there is no chance their loved one will awaken some day, and that she will be placed permanently in a vent-dependent nursing facility.”
Ethics teaching rounds train residents to understand the importance of communicating to patients and families, not just the right information, but all of the information, in the most sensitive and humane manner possible. “So that consent to treatment is truly informed,” Fr. Clark says.
Saint Joseph’s pre-med and graduate health care ethics students have shadowed Fr. Clark and his colleagues during ethics rounds since the program’s inception. Aspiring physician and chemical biology major David J. Temme ’16 says the experience made him certain that he wants to pursue a career in medicine.
“Working alongside medical professionals while attending ethics rounds provided me with real-time exposure to the hospital environment,” he says. “I came to admire the amount of thoughtfulness and compassion that these people displayed for their patients, which has instilled in me the desire and passion to do the same for my patients, once I am a physician.”