On February 14th, Professor Joy L. Delman participated in a conference at the UC San Diego Medical School discussing bioethical issues in medical cases in an Ethics Panel for the fourth year medical students. Professor Delman serves as a member of the UC San Diego Health System Ethics Committee. The conference is held every year for graduating medical students.
The conference was titled “From Principles to Practice,” and the other panelists included Mary Devereaux, Ph.D., Director, Biomedical Ethics Seminars, Assistant Director, Research Ethics Program & San Diego Research Ethics Consortium Department of Pathology UCSD, Angela M. Vieira General Counsel Rady Children's Hospital and Health Center and Janice F Mulligan, Esq, Mulligan & Banham.
The conference was moderated by Lynnette Cederquist, M.D., Clinical Professor UCSD, Chair, Ethics Committee UCSD Health System. Also present but not pictured was Belinda Hein, class of 1989, Director, Risk Management, Director, Interpreter Services, UC San Diego Health System.
The panelists presented and discussed a variety of actual cases involving a wide range of bioethical issues, including questions of autonomy and decision making when a patient requests termination or refusal of treatment that will result in the patient’s death.
Legal issues of capacity, right to privacy, and informed consent were reviewed with the medical students. Questions from the students raised issues of when those wishes could be exercised by a surrogate making those decisions of behalf of the patient, when depression and pain relief might affect that decision making, and who is the best position to determine whether the patient has decision making capacity.
The panel reviewed procedures for patients to provide advance directives for health care, as well as to appoint surrogates to exercise those wishes on their behalf should they become incapacitated.
Other cases discussed by the panel addressed issues of managing non-terminally ill patients with severe injuries and no hope of recovery. The panel delved into policies and ethical matters concerning non-beneficial and futile care. The importance of clear, frank, compassionate, and direct communication with family members was discussed. Members of the panel stressed the importance of documentation, not only for treatment purposes, but also in the event of litigation. Withdrawal of treatment in various situations was addressed, as were recent cases involving patients who were declared brain dead but who were kept on ventilators. Definitions of death, and the meaning of life-support versus organ support were reviewed. The importance of making those distinctions clear to the families and to the public is an issue that is quite topical in light of those recent cases. The medical students participated actively in the discussion, raising many questions about actual cases they had. The conference was lively and very well attended.