Raising Problems Before Offering Solutions

Rosemary Flanigan

November 12, 2009

At the risk of being thought insane—or hopelessly naïve—I propose to you the following scenario: What if, PRE-healthcare reform activities in Congress, there had been a “softening up” series of discussions across the nation, through all sorts of media, to raise the problems BEFORE we started offering “solutions”?

That is the program I think we could do in Kansas City around the issues involved in pandemic preparedness. Missouri-wide, from a consortium of 4-5 ethics centers, a draft document has been prepared based on four fundamental ethical values: fairness, respect, solidarity, limiting harm.

If we were to get people to think about fairness (allocating healthcare resources fairly with a special concern for the most vulnerable), respect (each person must know that they will always be cared for and will be treated with dignity), in solidarity (each individual must consider the needs of others, not just family and loved ones but also to the community), and limiting harm (acknowledging that healthcare professionals will do as much good as possible while limiting harm resulting from the scarcity of resources), then we might have some reasonable discourse.

I know no better way to encourage such thinking than with small groups of people wrestling with broad moral values. THEN, begin to get specific.

ANY EXPERIENCE with this sort of thing in your part of the world????

End of Life Debate Continues

Even though the House passed health reform legislation specifies counseling wouldn't force patients to limit efforts to keep them alive, and even with the support of the American Medical Association, AARP and others, suspicion has lingered.

Links:

Few Americans make end-of-life wishes known, Associated Press, November 11, 2009

End of Life Scare II, podcast, John CarneyVP for Aging and End of LifeCenter for Practical Bioethics, August 28, 2009 13 minutes 45 seconds

The End of Life Scare, podcast, Myra Christopher, President/CEO, Center for Practical Bioethics
August 3, 2009 14 minutes 44 seconds

Assessing Quality of Ethics Case Consults

Rosemary Flanigan
September 25, 2009

I feel so fortunate to have you conscientious discussion-groupers when I have a vexing question—and I am vexed by the first article in the recent Cambridge Quarterly.

George Agich is the guest editor for the issue on "Consultation: Time for Assessment and Evaluation." My query is about assessing the quality of our case consults.

I have been helping to drive our ethics committee at Carondelet Health for 19 years and the only specific “quality assessment” we have conducted is through the self-assessment tool prepared by the Consortium.

On Case consultation, there are 11 questions:

Who may ask for a consult?
Questions about the screening process
What happens to a case that is “screened out”?
How is the consult addressed (individual? a few members? the whole?)
Response time
Required consents
Who else is involved?
How documented
How reported and to whom?
Written procedures?
Have we reviewed Core Competencies?

But how ought we to assess the quality of the consult? Do any of you have a specific time to do it? A tool to use?

It’s as if I’ve neglected something very important.

HELP! HELP!

Is healthcare an American "right?"

Art Caplan thinks so in a column on MSNBC.com. But a survey shows around 55% disagree with the good doctor Caplan.

Dr. Caplan believes health reform can be pushed through by the well-intended Obama administration by answering one single, fairly simple ethics question: Is health care a right that every American should have?

What do you think? Find links to Dr. Caplan column and the online survey below.

Links:

Details, schmetails: Think big on health care, Arthur Caplan, Ph.D., msnbc.com, June 26, 2009

Online survey click here.

The Values of Health Reform

Rosemary Flanigan
June 29, 2009

The new Hastings Center REPORT is focused on health reform, from the perspective of VALUES. (“Connecting American Values with Health Reform”)

Notice the “health,” not “healthcare.”

Erika Blacksher, formerly of the Center and now with Hastings Center, sees “Health” as the value at stake—healthCARE is ”but one determinant of health, and by some measures it is a relatively minor one.”

It’s an interesting way to get people to focus on reform:

Bruce Jennings writes on LIBERTY; Paul Menzel on JUSTICE AND FAIRNESS in mandating universal participation; Jim Sabin on RESPONSIBILITY (in which he contrasts Joey Starrett and Shane the cowboy in the movie); William Sage on SOLIDARITY (it is good to hear talk of “public good” in this economic downturn time); Dan Callahan on MEDICAL PROGRESS (and its unintended consequences—Dan is still beating that drum); Lawrence Gostin on PRIVACY (and how the prevailing model fails to protect it); Ed Pellegrino on PHYSICIAN INTEGRITY (what else?); Frank Davidoff on QUALITY, and Marc Roberts on EFFICIENCY.

I’ll be telling you some of my thoughts. Overall, I like anchoring reform in something besides economics. More later—unless one or other of you has read the issue and want to get a headstart. THANKS.