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Post Integrating Ethics into Palliative Care
Author: UTMCKPallCare
Date: May 18, 2012 2:19 pm
We are fortunate to have a full-time bioethicist at our medical center. Our Palliative Care service has a good working rapport with her and value her services. While we are working out our "boundary issues", on the whole, having a bioethicist at our facility is proving to be a wonderful resource. We have worked towards making her an adjunct member of the Palliative Care service and are formalizing this relationship. There does seem to be an air of reluctance on the part of many physicians in regard to having the bioethicist role quite visible, somewhat akin to seeing her as the "ethics police". Has anyone else charted these waters, or have any suggestions on how to facilitate a culture change? We think having an ethicist is positive and hope others will, as well.
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Re:Integrating Ethics into Palliative Care (by sjcrump on 05/23/2012)
Dear UTMKC pallcare,

I am a physician-bioethicist and would be happy to engage your center on team dynamics and formation/roles with a bioethicist. Please contact Joyce Crump at the PCLC at UAB if you are interested.

In general, there is a danger in IDTs to think that another discipline or credentialed person will bring value or expertise automatically. This can be the case but it does not necessarily follow. Whether a bioethicist or a nurse or physician -- the credential does not make the value but the person. In the specific case of a bioethicist it will be important that the bioethicist is seen as someone with expertise in wrestling with ethical dilemmas and not as the 'ethics police.' I have known bioethicists that do act as the ethics police and work with the false assumption that all in ethics is settled; however, this is more the exception than the rule. Most clinical bioethicists will clearly know accepted law and hospital and community standards but allow for much disagreement with other issues (issues that lack moral concensus in our pluralistic society). Overall -- I applaud the addition of a bioethicist to the palliative team. Palliative teams are often master communicators and compassionate. However, they don't necessarily have the experience or knowledge of certain ethical dilemmas. A bioethicist can add tremendous value to the team. The appropriate approach by the bioethicist will be required for success and the team needs to expect some storming, forming, and norming. Conflict in a team is normal. How we deal with that conflict defines the health of a team. I hope this helps - please contact us if we can help further.

Posted on behalf of Ryan R. Nash, MD, MA
Assistant Professor and UAB Director of the
Palliative Care Leadership Center
Director of Ethics Education
UAB School of Medicine
Chair of Clinical Ethics
UAB Medicine

Sandra Joyce Crump, Program Manager
UAB Center for Palliative and Supportive Care

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