Santa Clara University

Through writing about her own experience with her father's death, Lisa Krieger, reporter for the San Jose Mercury News, began research for a set of articles about the cost of dying and moral choices at the end of life, published in 2012.  This month, Kreiger visited Santa Clara University in a talk sponsored by the Ethics Center and Commonwealth Club, Silicon Valley.  You can listen to the podcast of her presentation here.

San Jose Mercury News reporter Lisa Krieger reflects on the cost of dying and the ethical issues that raises in a presentation Tuesday, May 14, noon, in the Arts & Sciences Building on the Santa Clara University campus.  In a series of powerful articles in the last year, Krieger both documented the immense financial costs associated with her father's final illness and showed how such costs are impacting end-of-life care throughout our health care system as a whole.  

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A university student must decide whether to ignore his flu symptoms in order to take part in a group presentation.  Is it worse to let down his presentation partners or to expose others to his germs?  

This case study was written by Sarah Ludwig, and SCU student and Honzel Fellow at the Ethics Center.  Honzel Fellowships focus on medical ethics and are supported by the Honzel Family Foundation.

President and Chief Executive Officer of the Catholic Health Association of the United States Carol Keehan, S.J., will discuss ethical issues facing Catholic health care providers at a talk Oct. 17, 7 p.m., in the St. Clare Room of the Santa Clara University Learning Commons. 

With flu season almost upon us, the Ethics Center offers a timely resource: Ethical Issues in Dealing with Influenza. The material, including cases, commentaries, and practical tools, addresses both pandemic and seasonal outbreaks.  Topics covered include vaccine rationing, quarantine, and triage.

Photo by Jason Rogers [CC-BY-2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons

The best preparation for a career in medicine may be a degree in the humanities. That suggestion by author Abraham Verghese, this year's DeNardo lecturer at SCU, will be the focus of a panel discussion today at noon in the Wiegand Center. The panelists are all highly regarded SCU faculty who work closely with students pursuing careers in health care.

-- Stephen Carroll, SCU English Department

-- Steven Fedder, SCU Chemistry and Pre-Health Advisor

-- Lawrence Nelson, SCU Philosophy

This event is being done in coordination with the DeNardo Lecture Committee.

Santa Clara University students are invited to apply for 2012-2013 health care ethics internships, sponsored by the Markkula Center for Applied Ethics.  The internship is a year-long program that brings undergrads into local hospitals and hospices to learn first-hand about the ethical issues arising in medical care.  Students shadow doctors, nurses, chaplains, and others who work in patient care.  In addition to learning more about medical ethics, they have an opportunity to see what it would be like to work in the health care field.  Applications are due April 13

The impact of health care reform on hospitals was the focus of a presentation by Center Executive Director Kirk O. Hanson to the 2012 Premier Governance Education Conference held Jan. 30 - Feb. 1 in Miami Beach.

Hanson focused on the ethical implications of reform for hospitals as business organizations.  Among the considerations he addressed were:

• Clear organizational ethics goals – ethical behavior toward all stakeholders; honest reporting; control unethical behavior
• Concern for Conflicts of Interest
• Greater responsibility for competence and integrity of staff and partners
• Adequate policies and procedures to manage incentives to violate
• Concern for understanding and adherence to ethical norms throughout organization

Periodically, visitors to our Web site send us fascinating questions. While we can't respond to each one, this question from a nurse raised an issue we think may of general interest. The answer is by bioethicist Margaret R. McLean, the Center's associate director.

Q: Where can I find information about a physician's refusal to honor a patient's repeated request for hospice? The request was repeatedly denied until she changed doctors. We are looking for ways to change this and advocate for others who are being refused.

A: Your question intrigued me, partly because anecdotal evidence would indicate that the situation you describe is far from rare. However, I have no clear answer. I brought your case to two colleagues—one an elder law attorney and the other a hospice chaplain. They both found it an interesting question for which they, too, had no answer.

Whereas one would hope that a physician would follow the directions given by his/her patient, this is not always the case, as you know. There are legitimate reasons for physician's refusal, e.g., what the patient is requesting is not medically indicated; what the patient is requesting may be medically indicated but the physician (or other health care professional) refuses for reasons of conscience.

In such cases, once it is established that an impasse has been reached, the physician should make every effort to transfer care to another physician who is willing to comply with the patient's wishes. In the acute care setting, communication between physician and patient could be facilitated by the Ethics Committee, which could provide the opportunity for value identification and conversation about goals of care. In the case that you present, the burden fell on the patient to change doctors. I believe that the right outcome was achieved, but the burden was misplaced.

Here's where your desire to advocate on behalf of patients facing similar circumstances becomes vitally important to good patient care. It certainly helps to have someone—or, better yet, more than one—on the care team advocate for the patient's best interest, in this case, a transfer to hospice care. If this is in an acute care setting, then I would involve the Ethics Committee as well.

I have seen cases in which there has been a long-term relationship between the physician and patient, and the physician has a hard time "letting go." I have also seen cases in which a particular physician will never refer to hospice, a very unfortunate state of affairs. In such cases, ethics asks us to follow the patient's best interest and articulated goals of care, and facilitate a transfer of care to a physician who will comply with the patient's wishes and complete the hospice referral.

In 2002, a Wisconsin pharmacist declined to fill a prescription for birth control pills because, as a Catholic, he said to do so would violate his religous beliefs.  He also refused to refer or transfer the prescription. 

That incident forms the basis of a case study by Center Bioethics Director Margaret McLean, exploring the rights and responsibilities of medical professionals who do not wish to be involved in lawful and standard treatments that violate their personal consciences. 

She delivered the case at a recent conference, The Spark of Conscience Inflames Debate, which examined conscientious refusals in health care.