Why Didn’t They Call a Clinical Ethicist?
By Trudi Galblum - Marketing, Communications, and Grant Writing
Okay. I admit it. I watch network medical dramas. They help me relax.
Like most of these shows, much of the action in Fox’s “Doc” revolves around cases. A case that recently caught my attention involved a gay couple and an outdated advance directive.
The Wrong Proxy
The patient, Matt, was in critical condition and couldn’t speak for himself. The options were risk-free radiation therapy, which would buy Matt a few unpleasant years, and a risky surgery, which could lead to a complete recovery.
The attending physician notices that Matt’s proxy is not his current partner, Nathan, but his ex-husband of 16 years, Grant. Apparently, Matt never changed his advance directive when he and Grant divorced. Nevertheless, Grant still has legal authority over Matt’s treatment.
Nathan believes Matt wouldn’t want to live a few unpleasant years and asks for the surgery. However, Grant decides to go with the safer radiation therapy. Dr. Michael Hamda, the hospital’s Chief Medical Officer, is called to resolve this dicey ethical situation.
The Issues
And that’s where I went whoa, hold on, wait a minute!
ISSUE #1 – Why are the clinicians in this major medical institution calling on their CMO to resolve an ethics issue? What qualifies the CMO to decide a matter like this? Does Dr. Hamda have any training in bioethics?
ISSUE #2 – Dr. Hamda talks to Nathan and Grant individually to figure out who has Matt’s best interests at heart. Dr. Hamda believes Nathan when he promises to take care of his partner even in sickness, so Dr. Hamda approves the surgery which, lo and behold, is successful!
What if the surgery wasn’t successful? A CMO has the authority to override an advance directive. But husband Grant could have a strong medical malpractice case for having done so. Should a CMO put themselves, and the entire hospital, at that much risk? Based only on the promise of a family member?
Who You Gonna Call?
The whole thing made me want to yell: DON’T YOU HAVE A CLINICAL ETHICIST ON YOUR TEAM?
Someone with the training and background to work with patients, families and medical teams to help clinicians identify the best treatment options, to provide an additional set of eyes complementing the oversight of clinicians, risk managers and technicians, and to ensure that the care being delivered is to the highest ethical standards?
Unfortunately, at far too many healthcare institutions, the answer is no.
At the Center for Practical Bioethics, our bioethicists frequently encounter cases like Matt’s.
Dr. Hamda and his clinicians could avoid a lot of potential problems in the future if they call the Center for Practical Bioethics to provide clinical ethics consultations.
