Monday, July 4, 2005
Internal Logic, Operation of an Ethics Committee
The July 4th N.Y. Times had a good piece on the hospital ethics committee at New York's Montefiore Medical Center in the Bronx. Although the committee's activities were described in a semi-breathless, gee-whiz style, Montefiore's approach seems mostly consistent with the five committees on which I currently serve (2 as co-chair). Among the observations offered up by the author:
- Montefiore's program uses the tools of mediation, common in business and divorce but relatively new to medicine. At the bedside, grown children and their parents can regress to childhood battles. Hope can overcome scientific probability. In such situations, says Nancy Neveloff Dubler, the director of bioethics at Montefiore and the founder of the program, "Getting to a common place is 95 percent cutting through conflict and 5 percent applying the rules of bioethics." The important thing, she said, is to avoid the disputes that can arise from poor communication between members of the medical team and family members, and to defuse tense situations with straight talk and empathy.
- A living will does not cover everything.
The Montefiore style seems to exclude family decision makers at critical junctures and to be, to that extent, paternalistic, but it's hard to tell if that's an accurate impression or just the way the story was written. [tm]