UCLA Ethics Center Can Guide in Making Difficult Decisions

A child needs a life-saving blood transfusion but her parents’ religious beliefs prohibit the procedure. A massive heart attack strikes a patient. If he survives, he faces severe disabilities for the remainder of his life. Nothing on record suggests his desire for extraordinary measures to possibly prolong his life and it is not known if he has any family members to help in the dilemma. Unfortunately, scenarios like these are not uncommon and most likely many of us will be involved in some aspect of this type of decision making, either professionally, personally or both.

How do we choose which patients will receive the newest treatments? Must economic factors, information technologies and genetic breakthroughs jeopardize the doctor-patient-family relationship and impede optimal bedside care for patients? Where is the balance if ethical issues become obstacles to technological development and medical advancement?

Ethical conflicts such as these and others challenge healthcare professionals, patients and their families in many and often surprising ways. In an academic hospital environment like ours, where critically ill patients often require complex testing and care from multiple specialists, ethical issues can be especially difficult to understand, much less resolve. Yet, addressing these issues as they arise is a vital component of UCLA’s dedication to providing patients with the best healthcare experience possible.

The UCLA Healthcare Ethics Center was created to help staff, patients and the community at large cope with and, whenever possible, resolve these ethical issues through education, research and consultation. “This center, in a context of medical advancement, economic constraints and patient need, provides resources to explore and develop potential solutions to some of the problems facing our society today,” says Katherine Brown-Saltzman, UCLA clinical nurse specialist and palliative care specialist. “We aim to have a positive impact on patients here at UCLA, and elsewhere.” Margaret Cunningham, UCLA associate director, adds that local community hospitals and healthcare institutions that may not have robust ethics resources upon which to rely are also welcome to access the center.

Medical advancements, the explosion of information availability, and economic pressures have created unprecedented ethical issues in healthcare and end-of-life care.

“Hospitals, including UCLA Medical Center, that develop and provide cutting-edge medicine need a mechanism to balance complicated medical and ethical issues” says Neil Wenger, MD, the center’s director. “Academic medical centers often confront complex life and death questions. We must help patients and their families through the process of negotiating difficult ethical decisions. This center builds on our ethics consultation service by sharing innovative research, providing opportunities for creative policy development and enhancing the knowledge and activities of doctors, nurses, social workers, chaplains and medical students in addressing ethical issues at the patients’ bedside.”

How can the Ethics Center be most useful to you?

The Ethics Center is available for discussion and advice at all times. Consultation often focuses on end-of-life care issues but is not limited to those concerns. Ethical discussions on topics such as moral distress, organizational issues, distribution of limited resources, symptom management, professional boundaries and conflicts of interest may also be addressed. Some consultation requests are brought to the full Ethics Committee for consideration. Anyone can request an ethics consultation by simply paging ‘ETHIC’ (38442).

The Ethics Center provides education for the UCLA Healthcare System. The noontime Ethics Lecture series provides a forum for UCLA Healthcare System employees and others to explore a variety of issues that enlighten, enhance awareness and foster discussion. The Ethics Center is poised to contribute to the ethical discussion or specific education in your area.

New on the UCLA ethics scene this year is the establishment of a post-doctoral Clinical Ethics Fellowship and a Nursing Ethics Institute. A fellow in clinical ethics will contribute to ethics consultation within the UCLA Healthcare system. Six nurses will participate in the Nursing Ethics Institute to explore ethical issues.