Dartmouth-Hitchcock Medical Center physicians and nurses discussed bioethics and palliative care during the 30th biannual conference of the New Hampshire-Vermont Hospital Ethics Committee Network on Monday. The conference, which was held at DHMC, included attendees from hospitals across the Northeast.
"What we tried to do today is to explore some of the boundaries between clinical ethics and palliative care," said James Bernat, chair of the DHMC bioethics committee and president of the New Hampshire-Vermont Hospital Ethics Committee Network. "We don't really have the answer yet."
Clinical ethics consultations involve giving "advice upon request to provide information, analysis or assistance for the resolution of a clinical ethical conflict," Bernat, who is also a neurologist at DHMC and a Dartmouth Medical School neurology professor, said.
Clinical ethics consultants do not investigate misconduct, he said in an interview, but work to evaluate the best form of medical care for a patient. End-of-life issues like the termination of life support prompt 74 percent of ethics consultations, Bernat said.
Ethics consultants do not, in most cases, have the authority to decide the outcome of an ethical dilemma, Bernat said, but instead serve as mediators among physicians, patients and patients' families. Some medical professionals disapprove of ethics consults because they believe physicians should have primary responsibility in deciding a patient's treatment, Bernat said.
Marie Bakitas, an anesthesiology professor at DMS and a member of the palliative care department at DHMC, spoke about the benefits of palliative care. Doctors involved with palliative care aim to understand patients' goals and help patients live comfortably, often in end-of-life situations, Bakitas said.
The American Hospital Association defines palliative care as medical care that addresses the symptoms of patients with advanced disease, and supportive care, including counseling, for patients and their families, Bakitas said.
"You can't determine what's right or wrong to do until you determine what the patient and family goals are," Eva Zivitz, palliative care program coordinator at Rutland Regional Medical Center in Rutland, Vt., said in a question and answer session following the lectures. "That's where palliative care can help, as opposed to ethics."
Palliative care often reduces costs by limiting procedures to symptom alleviation, making resources available for patients with treatable conditions, Bakitas said.
Diane Palac, a physician at DHMC who specializes in palliative medicine, also highlighted situations in which an ethics committee consult, palliative care consult or both may be appropriate.
Bernat began the New Hampshire-Vermont Hospital Ethics Committee Network 15 years ago when he became chair of DHMC's bioethics committee, he said. The network aims to share the ethics knowledge and experience available at DHMC with health care professionals at other local level hospitals, Bernat said in the interview.
