GARY — What do local hospitals do if a patient refuses lifesaving care?
It turns out the facilities have staff members dedicated to handling such ethically charged decisions.
Two of those employees spoke at a conference Wednesday at Indiana University Northwest about medical and biological ethics. The forum coincided with the inaugural World Bioethics Day, an initiative of the United Nations, as well as IUN’s common campus book for 2016-17, “The Immortal Life of Henrietta Lacks,” about a poor black tobacco farmer whose cells were taken without her knowledge for use in medical research.
Jana Lacera, director of the institutional review board and bioethics for Community Healthcare System, gave the example of a Jehovah’s Witness who declined a lifesaving blood transfusion because it went against his religion. The patient’s family said he had received blood before, had mental health issues and that Jehovah’s Witness was just his “religion of the month.” The physician wanted to administer blood, too.
Ultimately, Lacera said, patients have the final say. “We as a health care team have to honor their decisions,” she said.
If the hospital deems the patient capable of decision-making, Lacera said, all it can do is inform him or her of the available treatment options and consequences of foregoing care. While physicians can withdraw from the case, they can’t go against the patient’s wishes.
But sometimes a patient is in coma or on life support. In that case, if the person doesn’t have an advanced directive or assigned health care representative, it’s up to the family as to what happens next (if the individual has no family, there are volunteer advocates who can get involved).
And loved ones aren’t always on the same page. Linda Kraiko, interim chief nursing officer for Franciscan Health Dyer, Hammond and Munster, relayed the case of six siblings who split, 50-50, on whether to take their mother off life support.
Kraiko consulted with the hospital attorney, who advised her that a majority would have to rule. She and the medical staff returned to the family and further explained the options on the table and their mother’s medical outlook. Eventually five of the six siblings agreed to take her off life support.
“What would have happened if we remained 3-3?” Kraiko asked. “That’s why it’s good to have an advanced directive from the patient ... or have one person to make those decisions.”
She noted that the Franciscan Physician Network now has a palliative care representative who works with patients in physician officers to develop advanced directives before they end up in the hospital.
Anya Matwijkiw, professor of ethics and human rights at IUN, noted that bioethics is a newly recognized concept, one that emerged after World War II. During the Holocaust, the Nazis performed numerous medical experiments on prisoners, where, for instance, they tested the body’s capacity to endure pain, cold and high altitudes. “After the second world war, the model was ‘never again’ in the human rights corridor,” she said.
However, Gianluca Di Muzio, an IUN professor philosophy, pointed out that abortion was being debated in ancient times, though not always, as it is now, over the rights of the fetus. He said some Greek and Roman philosophers supported abortion for population control, while others railed against women who used it to maintain their looks or hide affairs.
Marc Rodwin, the keynote speaker and a law professor at Boston’s Suffolk University, said another ethical concern in the medical field is when a doctor has a conflict of interest, usually of the financial variety.
He gave the example of a physician that buys an ownership in a local physical therapy practice. The more referrals the doctor makes, the more money he earns.
“Conflict of interest can cause physicians to use the wrong kind of services, overuse services or underuse services,” he said.
He noted that bioethics has traditionally consisted of four major tenets: letting patients decide their own treatment, avoiding harm, doing good and being just. But, he added: “Avoiding conflict of interest should be added to the key principles of bioethics.”