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END-OF-LIFE CARE/MEDICAL ETHICS

BWH: ETHICS SERVICE
Director: Lynn Peterson, M.D.
Assistant Director: Martha Jurchak, RN, PhD
(617)732-8590; beeper 18590 for emergencies

The BWH Ethics Service provides multidisciplinary ethics consultation for patients and caregivers, and is available 24 hours/day, 7 days/week. The purpose of a consultation is to clarify the ethical issues, suggest further information that could be helpful and provide recommendations to the caregivers, patient and family. Consultation involves an initial meeting between the ethics consultant and the caregiver teams. The consult team will then meet with the patient and family, as well as the caregivers whenever possible. In many instances the case will be presented to the full Ethics Committee and the caregivers will be invited to participate in the presentation.

Issues for which consultation will be helpful include:

· disagreement among caregivers
· questionable level of competence for a medical decision
· conflict between family members
· seeking inappropriate level of care (question of futility)
· refusing life-saving care
· questions about the meaning or application of hospital policy
· questionable limits on care by a third party payer
· assistance in identifying a proxy
· questions about the interpretation of legal precedent in new cases

The Ethics Service also organizes conferences for hospital units or teams of caregivers on a regular or ad hoc basis to discuss ethical issues that arise in the course of delivering patient care. Such a conference can be set up by calling the Ethics Service. The Ethics Service Web site (www.partners.org/ethics) provides more information.

MGH: PALLIATIVE CARE SERVICE
Director: Andrew Billings, M.D.
Founders’ House, Room 600; 724-9197; fax 724-8693

The Palliative Care Service provides comprehensive, coordinated multidisciplinary consultation and primary care services for patients with life-threatening or terminal illnesses and for their families. The Service assists patients who seek to live as fully and comfortably as possible in the face of an active, progressive, far advanced disease such as cancer, AIDS, late-stage heart or lung conditions, kidney or liver failure and/or neurological problems (e.g., dementia, amyotrophic lateral sclerosis, multiple sclerosis, multiple strokes).

Services include:

· pain and symptom control
· psychosocial and spiritual support for patients and their families (including special attention to young children facing parental or sibling loss) and bereavement follow-up
· planning and coordination of home care, hospice care and other alternatives to acute hospital care
· assistance with advance care planning and decisions about the goals and methods of care
· general medical management

These services are available 24 hours/day, 7 days/week and are provided by a specially trained core multidisciplinary team which includes a physician, nurse specialist, social worker and chaplain, as well as consultants from a variety of other units. Patients are seen in the office, in-hospital and in the Spaulding Rehabilitation Hospital, as well as in homes and nursing homes in selected nearby communities.

The Service also offers a variety of educational opportunities for students and graduates in the health professions and attempts to design patient/family care plans that facilitate ongoing participation and learning by House Officers and other primary care clinicians. House Officers may also take a role in our active research program in end-of-life care.

The MGH Optimum Care Committee may also be called to provide clinical consultations, as described above for the BWH Ethics Service.