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A focus on ethics
ADVANCE CARE PLANNING

The Advance Care Planning Process

Advance Care Planning (ACP) is a process that promotes autonomy for individuals so that their treatment preferences will be known and respected should they be in a situation where they are unable to speak for themselves. The Ethics in Clinical Practice Committee supports ACP initiatives.

  • Advance Directive & Health Care Proxy Internet Resources
  • Medical Orders for Life-Sustaining Treatment (MOLST) establishes a standardized method of communicating and documenting a patient’s preferences for life-sustaining treatments (i.e. CPR, dialysis treatments, having a breathing tube inserted, etc.) and is completed AFTER advance care planning discussions have occurred between the patient , family, and health care providers (i.e. physician, nurse practitioner). A MOLST form is not to be confused with an advance directive and does not take the place of an advance directive (i.e. Massachusetts Health Care Proxy). MOLST is appropriate for any patient irrespective of age with a serious medical illness that may include but not be limited to conditions such as a life-threatening injury, chronic and progressive disease such as dementia, or medical frailty. See the MOLST website for more information.

    Click here to see the MOLST website for more information.


    Click here to view sample form

  • Five Wishes Aging with Dignity
    Five Wishes is a living will that helps adults of all ages plan how they want to be cared for in case they become seriously ill. This document addresses the concepts of a health care agent, living will, and the issues of comfort, dignity, and reconciliation. It is available in 27 languages and Braille and can be obtained on-line or in print. Voicing My Choices: A Planning Guide for Adolescents & Young Adults and My Wishes are guides to help express and communicate preferences of seriously ill adolescents and children based on the Five Wishes. These documents are available at: https://www.agingwithdignity.org/five-wishes-resources.php - This link will bring to resources that are provided for children and adolescents; as well as translations in other languages.

 

Advance Care Planning Resources &
Information for Staff (internal access only)

Inpatient

Massachusetts Health Care Proxy
Every patient has a right to appoint a Health Care Agent according to state and federal law. Click here to see the MGH Advance Directive Policy.

  • Patient education brochures on "Advance Care Planning" and "Advance Directives" are available through Standard Register (#84669).

    The Massachusetts Health Care Proxy Form can be used by patients to appoint a competent adult they know and trust to be their Health Care Agent. For information,instructions, and the form in English and other languages,click here.
  • If your patient or their family's preferred language is other than English, always work with an MGH Medical Interpreter when you ask your patient about Advance Directives, or when you present information about Advance Directives. Call 6-6966 to schedule a medical interpreter.





Outpatient/Ambulatory Staff

Advance Care Planning and Mass. Health Care Proxy Forms can be found on the Primary Care Office Onsite (PCOI)web site. Click on "Patient Information" under the topics "Senior Health" or "End of Life." There are links to allow download and printing of HCP forms and the patient education brochures "Planning Advance for Your Health Care and "Preparing to be a Health Care Agent" for patients who express interest during a patient encounter.

 

 

 

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CURRENT TOPICS IN ETHICS

National Health Care Decisions Day: Annual Advance Care Planning Information BoothCaring Headlines (June 18, 2015)

FRONTLINE explores the intersection of life, death, medicine and what matters in the end
with Atul Gawande, MD
(Feb 10, 2015)

Organ Donors Who Need Kidneys Jump to Front of Transplant Line—Medscape

Will a New Kidney Allocation System Even the Playing Field?Medscape

Archived items

 

ETHICS RESOURCES @ MGH
FYI

Unit-based ethics rounds
Unit-based ethics rounds are an opportunity for clinicians of all disciplines in an patient care area to come together and freely discuss cases or topics of ethics concern. Clinicians from other areas are welcome to attend as guests but are asked to first contact the ethics rounds facilitator.
Click here to view a list of Unit-Based Ethics Rounds(internal access only)

Optimum Care Committee
MGH has an ethics committee to review and consult with staff about ethical issues regarding the care of adult patients at MGH. click here for more information

Pedi Ethics Committee
MGH has a Pediatric Ethics Committee to review and consult with staff about ethical issues regarding the care of children who are MGH patients.

MGHfC Pediatric Ethics Consults
(internal access only)

Ethics in Clinical Practice Committee
The Patient Care Services Ethics in Clinical Practice Committee is a interprofessional committee, formed to develop and implement strategies to support the integration of ethical judgment into professional practice and provide consultation at unit and organizational levels related to ethical issues in patient care.

Institutional Review Board (IRB)
MGH has an oversight committee for all research.

click here for more information
(internal access only)

The Vincent Reproductive Medicine & IVF Code of Ethics
The Vincent Reproductive Medicine and IVF Service understands and values the ethical dilemmas that arise as part of the extraordinary treatment that we provide.  Our approach to these issues are multifaceted and involve identifying the decision makers, collecting data and establishing the facts, identifying all medically appropriate options, evaluating options according to the values and principles involved, identifying the ethical conflicts and setting priorities, selecting the option that can be best justified, and reevaluating the decision after it is acted on.

 

 

 

 

 

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Ethics in Clinical Practice Committee

Meets:
1st Wednesday monthly
1pm - 3pm
Trustees Conference Room

 

 

 

 

 

POLICIES, PROCEDURES & GUIDELINES (internal access only)

MGH has many policies related to ethics that guide staff to assure best practices in providing ethically appropriate care to patients and families and support an ethical work environment.

PROFESSIONAL CODES OF ETHICS
EXTERNAL REVIEWERS

Joint Commission logo

The Joint Commission standards guide health care organizations towards having structures and processes in place that ensure that rights of individuals are met and that business practices are ethical. The standards focus on the identification of fundamental, overarching patient rights:

  • The right to effective communication
  • The right to participate in care decisions
  • The right to informed consent
  • The right to know care providers
  • The right to participate in end-of-life decisions
  • Individual rights of patients
  • Patient responsibilities

For more information, see The Joint Commission Hospital Manual, Rights and Responsibilities of Individuals (RI).

Magnet Recognition

Magnet_logoThe American Nurses Credentialing Center (ANCC) requires Magnet-designated organizations to track nationally-benchmarked nursing sensitive indicators (NSIs) to continually inform improvement efforts related enhance patient outcomes. Examples of NSIs include, but are not limited to: patient falls, hospital-acquired pressure ulcers, blood stream infections, ventilator-associated pneumonia, and restraint use.

 

 

 

 

GLOSSARY OF TERMS

There are many terms in healthcare that may be unfamiliar. Please click here to visit a Glossary of Terms that may be helpful. And please email any suggested additions.

This month's featured term: Health Care Proxy
This term refers to the form-not the person. The preferred form of advance directive in Massachusetts under Massachusetts General Laws Chapter 201D Health Care Proxies. The form appoints a health care agent (the person) to make health care decisions for the patient if he/she loses the capacity to make their own decisions. This legal document does not require an attorney to fill out. It must be signed in front of two adult witnesses who are not the appointed agent. In some states this document is called a Durable Power of Attorney for Health Care.

Ethics in Clinical Practice Committee — Glossary of Ethics Terms click here

Excellence Every Day represents an MGH commitment to providing the highest quality, safest care that meets or exceeds all standards set by the hospital and external organizations.

If you have questions or suggestions related to the EED portal, please contact Georgia Peirce at (617) 724-9865 or via email at gwpeirce@partners.org.

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updated 6/23/15

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