IME Virtual Seminar 8th Sept
Join us for a thought-provoking hour of ethics as we explore some more areas of current thinking in the latest in our series of Virtual Seminars. Our confirmed speakers for this session are Liz Dzeng and Rashmi Mehta who will present their recent peer-reviewed abstracts.
Liz Dzeng (Associate Professor of Medicine and Sociology, University of California, San Francisco (UCSF); Senior Research Fellow, Cicely Saunders Institute, Kings College London): How Neoliberalism Influences Institutional Ethics and Culture around Non-Beneficial Life-Sustaining Treatments Near the End of Life in the United States
Rashmi Mehta (Clinical Research Fellow (OOPR), Neonatal Medicine/ Paediatric Neurology, Sheffield Children’s Hospital; Member of RCPCH EDI Reference Group; Co-organiser/Co-director Soft Landing-International Medical Graduate Hub; PRAM (Paediatric Research Across Midlands) Communication Lead): Ethical Dilemma Posed by Geographical Movement of Roma Community
Session to be chaired by Chantal Patel, Lecturer in Health Law and Ethics, Swansea University
Information regarding how to join the online event will be sent to you in advance of the meeting following successful registration
Abstracts
How Neoliberalism Influences Institutional Ethics and Culture around Non-Beneficial Life-Sustaining Treatments Near the End of Life in the United States
Background: Potentially non-beneficial life-sustaining treatments (LST) near the end of life have the potential to create ethical tensions. Systems-level contexts such as neoliberalism, characterized by free-market capitalism, which encourages a culture of consumerisation and unlimited choice, may play a role in the persistence of potentially non-beneficial LST near the end of life.
Objective: The objective of this study is to understand the macro-sociological factors that encourage potentially non-beneficial LST.
Methods: We conducted 114 semi-structured in-depth interviews with clinicians and administrators at two American hospitals in the West Coast rated by the Dartmouth Atlas as high-intensity and one as low-intensity for aggressiveness of end-of-life care. Transcripts were analyzed using thematic analysis.
Findings: Interviews reveal different practice patterns around high intensity care, which reflect different institutional support structures that mitigate the influences of neoliberalism. Stronger systems-level support structures at the low-intensity hospital appear to support clinicians in making decisions in a patient’s best interest (beneficence) that modulate the intensity of end-of-life care. The high-intensity hospital was characterized by a prioritisation of an unreflective reverence to patient autonomy; extreme deference towards consumerisation; clinician powerlessness to act ethically; a focus on metrics and in particular, patient satisfaction, sometimes at the expense of good medical practices; and the coopting of ethics committees into a regulatory body, all of which encourages clinical momentum towards potentially non-beneficial LST.
Conclusions: These results suggest that neoliberal ideology might shape organizational ethics and culture in ways that may have implications for ethical care around potentially non-beneficial LST. Understanding how macro-sociological phenomena influence clinical practices and behaviors have the potential to inform the development of systems-level interventions to mitigate potentially non-beneficial LST near the end of life.
Ethical Dilemma Posed by Geographical Movement of Roma Community
Case history: A late preterm infant of young non-consanguineous homozygous Roma parents was born with antenatal diagnosis of TMEM70-gene mutation. TMEM70-gene mutation is associated with mitochondrial complex-V deficiency leading to encephalocardiomyopathy, a life limiting condition. At antenatal counselling, a mutual decision was undertaken to offer palliation. However, after baby’s birth, parents wished for full treatment and admission to Neonatal Intensive Care Unit (NICU).
Ethical dilemma: We live in a diverse multicultural society as global citizens, sharing health care services. As part of the ‘geographical movement’ Roma Gypsies bring in their own beliefs and cultures. Would ideas and beliefs around the ‘end of life (EOL) care’, which they trusted and practiced, change as they migrate? Particularly relevant to the Roma community, conflicts making palliative care discussions challenging are, lack of autonomy and decision-making power. (Roman G et al 2014).
However, was it ethical to offer intensive care to baby, who otherwise has life limiting condition? In this particular case, approach solely based on ‘Teleology’ – rightness or wrongness based on the good or bad consequences or ‘Deontology’ – based on moral duties, would be difficult. This could be better explained using concept of ‘Communitarian Ethics’- influence of community on the individuals and values based on traditions and culture. (Brannan S et al 2012).
Outcome: Parents’ wishes were honoured, and baby was admitted to NICU. Parents’ along with their family, often need time in making decisions towards ‘EOL care’. Respecting parents’ cultural beliefs and recognition that in certain communities’ concept of palliation is not well established, is of paramount importance. Repeated conversations over a period of time builds trusting relationship. At the heart of these conversations, one should keep the best interests of the baby. Baby was supported with nasogastric-tube feeding, however baby died on third day of life.
FREE for IME members (ensure you are signed in when booking to claim discount) — £5 for non-IME members
Registration now open