April 2, 1999

In an environment like the MGH, situations can arise that present challenging ethical dilemmas – ones that don't always have easy, clear-cut solutions. Whether dealing with patients, their families, research participants or even other employees, MGHers may be faced with difficult questions like the following:

• What should clinicians do if the parents of a critically-ill infant disagree about keeping their child on life support?

• How should medical staff counsel a 17-year-old patient with lymphoma who doesn't want chemotherapy, despite his parents' wishes?

• How should a caregiver approach a pregnant patient who is abusing substances harmful to her fetus?

Several resources exist at the MGH to help staff, patients, families and students work through some of these dilemmas. Case-by-case consultation on specific issues is provided by specially designated committees and individuals, who represent a variety of disciplines throughout the hospital (see table below).

To educate staff and increase awareness, nursing ethics "rounds" take place regularly on the patient care units. Other committees, like the MGH Ethics Task Force and the Patient Care Services Ethics in Clinical Practice Committee, although they do not offer consultation services, meet to discuss ethical issues and seek administrative, policy-oriented and educational solutions to problems. One such initiative includes the Ethics Forum series, sponsored by the Ethics Task Force, which provides an opportunity for staff and students to discuss ethical issues.

"Ask the Ethicist" will be the topic of the next forum April 7, 4:30 to 6 pm, in the Ether Dome. A panel will discuss possible dilemmas, demonstrating how "ethicists" think on their feet in difficult situations. Questions, which should preserve patient confidentiality, will be taken directly from the audience and also may be submitted in advance to the forum's moderator Alex Flather-Morgan, MD, by fax at 6-6878, in-house mail to Bulfinch 148, or e-mail to flathermo@helix.mgh.harvard.edu. To receive regular announcements about upcoming forums throughout the MGH, Partners and Harvard Medical School communities, send e-mail to npliner@partners.org.

Basic information about such ethical issues as informed consent, advance directives, life sustaining treatment and patient confidentiality can be found in the MGH Administrative Policies and Procedures and the Clinical Policies and Procedures manuals. These resources are available on the MGH homepage, which is accessible through Partners workstations or at http://www.mgh.harvard.edu.

Listed below are some of the committees and individuals at the MGH who can help staff and patients deal with challenging medical ethics issues.

• Optimum Care Committee – end-of-life issues
  Edwin Cassem, MD; 6-2988

• Pediatric Bioethics Committee – pediatric issues
  I. David Todres, MD; 4-4380

• OB/GYN Ethics Committee  – assisted reproduction issues
  George Richardson, MD; 6-3001

• Palliative Care Service – palliative care/end-of-life issues
  J. Andrew Billings, MD; 4-9197

• Chaplaincy – religion and spirituality issues
  Sister Sheila Hammond and Rev. Mary Martha Thiel; 6-2220

• Patient Care Assessment Committee  – quality of care issues
  Cyrus Hopkins, MD; 6-2036

• Human Research Committee – research ethics
  Research Affairs; 6-3493

• Office of Patient Advocacy – patient care issues
  Sally Millar, RN; 6-3370

• AIDS Clinic – AIDS issues
  Ben Davis, MD, and Sandy McLaughlin, MSW; 4-0050

• Patient Care Services Ethics in Clinical Practice Committee – discussion and facilitation of hospital policy and education;
  Patricia Lally, RN, and Regina Ferraro Doherty, MS, OTR/L; 4-5001, voice mailbox 136-4446.

• Ethics Task Force – discussion and facilitation of hospital policy and education;  Cyrus Hopkins, MD, and Alex Flather-Morgan, MD; 6-2036 or 6-3734

© 1999 Massachusetts General Hospital.