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204 VVVVVVVVVVV The Hospital Ethics Committee Solving Medical Dilemmas NATALIE R. HANNON An eighty-three-year-old comatose woman, Mrs. J., came in to our hospital with a very poor prognosis. Although she was comatose, the staff became extremely attached to her. They were so attached that in the two months she was in the hospital, her skin never broke down and she never developed any bedsores. Her family, who lived in a distant state, would occasionally call to find out how she was doing. After two months, her daughter came to visit. The next day she brought in a living will signed by her mother. Mrs. J. had stated that if she had no hope of recovery and could no longer function, she would want to discontinue all treatment, including all food and water. The staff was very upset: “How could this daughter, who had not visited her mother for two months, take her parent off food and water?” Should the hospital discontinue all treatment, including nutrition and hydration? This was an ethical dilemma. There was no right or wrong answer. Both yes and no were morally acceptable. The case went to the Hospital Ethics Committee, a standing committee that serves to clarify such dilemmas and offers recommendations to resolve them. The hospital, from which I retired a few years ago, is in New York’s inner city. Although not a major trauma center, it has an extraordinarily busy emergency room, which handles over one hundred thousand cases annually, including stab wounds, asthma, complications from diabetes, AIDS, and every other imaginable illness. The patient population is diverse, with Latinos from various countries, Western Africans, and African Americans. The staff is even more diverse, with ninety-eight different languages spoken. The hospital’s Ethics Committee is made up of physicians, nursing staff, a social worker, an administrator, a chaplain, and a member of the community , who was also a chaplain. I also sat on the committee. I was the director of training and staff development, responsible for all nonclinical training at the hospital. I have my doctorate in sociology and have received certificates in bioethics training from Georgetown University and a program conducted jointly by Montefiore Hospital (a major tertiary hospital in New York City) and Columbia University. The objective of the committee is to understand and clarify the medical dilemmas faced at the hospital, most of which are presented by the advanced technology, such as ventilators and feeding tubes, which keeps people from dying. After sorting out the issues by interviewing the parties involved in a particular case, including the physician, the nursing staff, the patient and the patient’s family, the committee comes up with a recommendation. The committee met with Mrs. J.’s daughter, who explained that she had wanted to visit but could not afford to take off from work and also had needed to save for a plane ticket. She had not sent the living will to the hospital because she wanted to see her mother before her mother died. We met with the physician in charge of the case, who stated that there was almost no chance that the woman would ever come out of her coma. We decided that the hospital should follow the patient’s wishes as stated in her living will. We then met with the staff to tell them of our recommendation and offered to move the woman to a different unit. The staff refused this offer and said that they would take care of the woman until she died. This was a relatively “easy” case since we knew what the patient’s wishes were and the likelihood that Mrs. J. would ever recover was extremely small. Other cases were more difficult, particularly when the wishes of the patient were unknown. During the seven years I sat on the Ethics Committee, many ethical dilemmas were raised, such as: Should life-saving treatment be given when the patient does not want it? Should the hospital discontinue artificial nutrition and hydration if requested to do so by the patient or the patient’s health-care proxy? Should treatment be continued when it is futile? Should treatment be withdrawn although it may cause the patient’s death? Should a patient be told the prognosis, even if the family is opposed to the physician doing so? Fifty years ago there was no need for ethics committees. Without advanced surgical techniques, advanced intensive care units (ICU’s), the THE HOSPITAL ETHICS...

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