May 14, 2003
DFCI launches new consultation service tohelp patients and families resolve ethical issues
S. Joffe, MD, MPH
Going through cancer treatment — or learning about one's risk of developing the disease — often raises vexing questions: How aggressively should I be treated? Should I volunteer for a clinical trial that will advance science but may not help me? Whom should I designate to make medical decisions for me if I'm not able?
Sometimes, the answers are difficult to find, and those involved don't always agree.
That's why the Institute is launching a consultation service this month to help patients, family members, and staff address and resolve ethical questions around medical decision-making.
The service has been offered to Dana-Farber patients for the past five years, but it was handled by the ethics consult teams at Brigham and Women's Hospital and Children's Hospital Boston — working with the Institute's Ethics Advisory Committee.
"Our two partner hospitals have provided an excellent service," says DFCI Hospital Ethicist Steven Joffe, MD, MPH, of Pediatric Oncology. "But given our high volume of patients and the complexity of care given here, we felt the time had come to offer a more accessible service at Dana-Farber."
According to Joffe, the program will help members of the DFCI community grapple with such issues as genetic testing and end-of-life care, as well as consider personal values and religious and cultural traditions in medical decision making. Although ethics services are available at many inpatient hospitals nationally, he notes, they are less common in the outpatient setting.
Under the new system, patients, family members, or staff members may contact the service by calling the ethics hotline at (617) 632-5713 or the ethics pager at ext. 41817. (To page, first dial (617) 632-2337 from the outside or "3" from inside DFCI.) Callers can talk briefly with the contact person and discuss whether a formal consult is appropriate. If so, representatives of the clinical team, as well as the patient or family members, will meet with two people from DFCI's Ethics Advisory Committee and a representative from BWH or Children's. (The service will focus on patient-care issues, as DFCI has resources for other kinds of ethical concerns.)
L. Tracey, RN, PhD, AOCN
"We're not going to tell people what to do, but will offer recommendations for resolving issues," says Joffe, who co-chairs the advisory committee with Libby Tracey, RN, PhD, AOCN, of Nursing and Patient Care Services. "We'll try to facilitate communication and help the parties better understand each other." If appropriate, the ethics consultants will document their recommendations in patients' medical records.
The service represents just one part of the advisory committee's role. It also promotes Ethics Rounds at DFCI, which give medical and Nursing and Patient Care Services staff a chance to discuss such issues as the legal liability of researchers and approaches to medical errors. The committee also helps spread the word about ethics programs of interest and addresses organizational ethics issues, such as patient confidentiality and industry sponsorship of educational programs here.
