Excellence Every Day Portal - A focus on ethics

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.

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ethics in clinical practice

Quick links: Advance Care Planning | Glossary of Ethics Terms
Policies & Procedures | Professional Codes of Ethics | Resources at MGH

available in English and
many other languages

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
Know Your Choices: A Guide for Patients with
Serious Advancing Illness
The Massachusetts Department of Public Health created this guide to support patients and their family members with important information about healthcare choices, especially when facing a serious illness.
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://fivewishes.org/ - 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.

"Planning in Advance for Your Health Care" is a patient education document that can be ordered through the Allied Group in English (#84669) or Spanish (#84669Sp) or printed from the Partners Handbook.

** Produced by the MGH PCS Ethics in Clinical Practice Committee and the Maxwell & Eleanor Blum Patient and Family Learning Center.

National Health Care Decisions Day
Caring Headlines 2018

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. On the Toolbar, click "Patient Ed," then click on topic "Senior Health" or "End of Life" to download and print various forms and resources for patients or families who express interest.
(internal access only - one-time free registration required)

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CURRENT TOPICS IN ETHICS

Don't want 'heroic measures' as part of your end-of-life care? Have the converstation - STAT
article written by MGH physician Allison Bond, read article.

National Health Care Decisions Day: Annual Advance Care Planning Information Booth—Caring Headlines (June 2018)

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

Archived items

Palliative Care and Hospice Care
Palliative care is an approach to patient care, not reserved exclusively for end of life, which focuses on optimizing physical, emotional, and psychological care and comfort by effectively managing symptoms associated with progressive disease. Hospice Care also provides palliative care that primarily focuses on optimizing care and comfort at the end of life. Both employ an interdisciplinary team of physicians, nurses, social workers, chaplains, pharmacists, psychologists and other health care workers to relieve suffering related to disease as much as possible in all areas of a patient’s life.
- Hospice vs. Palliative Care (National Caregivers Library)
- Sherman, D. W., & Cheon, J. (2012). Palliative care: A paradigm of care responsive to the demands for healthcare reform in America. Nursing Economics, 30 (3), 153-162, 166.
- Kovner, C. T., Lusk, E., & Selander, N. M. (2012). ‘Affordable’ death in the United States: An action plan based on lessons learned from the Nursing Economics special issue. Nursing Economics, 30 (3), 179-184.
- McHugh, M.E., Arnold, J., & Buschman, P. R. (2012). Nurses leading the response to the crisis of palliative care for vulnerable populations. Nursing Economics, 30 (3), 140-147.
- National Consensus Project for Quality Palliative Care: Clinical Practice Guidelines for Quality Palliative Care, 2nd ed. (2009). Pittsburg, PA. ISBN# 978-1-934654-11-8.
Bedside Manner: Conversations With Patients About Death
National Public Radio (May 6, 2013)

“This is TALK OF THE NATION. I'm Neal Conan, in Washington. All of us prefer to be told the truth - at least, we say we do - even when the diagnosis is terminal. And doctors believe they have an obligation to deliver bad news except that often, they don't. In a survey of nearly 2,000 physicians by the Mongan Institute for Health Policy at Massachusetts General Hospital, a majority said they believe they should never lie to a patient and yet more than half delivered a rosier prognosis than warranted, and 10 percent outright lied.

Telling somebody they're about to die isn't easy, of course, and it's no easier having what's sometimes called "the conversation" with their loved ones. Doctors, is there one of these conversations that's stayed with you? Tell us about a talk that helped shape how you talk with your patients and their families about death.”

Click here to read the full transcript
Goals of care at the end of life.
Proc (Bayl Univ Med Cent). Apr 2001; 14(2): 134–137. Marvin J. Stone, MD

All people have goals and hopes and enjoy having control over their lives. Over time, each person develops a very personal sense of what brings greatest meaning and value and adds most to his or her quality of life. People in the hospital often feel that they are losing control. As their illness progresses, their goals and hopes may change. It is the physician's role to communicate with the patient and family, clarify their goals and priorities, and develop a plan of care based on this information. Regular reassessment of goals and priorities ensures that patient, family, physician, and health care team are working together to maximize the patient's quality of life.

Click here to read full article
- Bioethics and the Dogma of “Brain Death” by Franklin G. Miller and Robert D. Truog (Feb. 3, 2014)
- Texas court orders brain-dead pregnant woman off life support—Los Angeles Times (1/24/14)
- MGH Policy on Brain Death (based on Massachusetts State Law)
- The Hastings Center has released new guidelines for End Of Life Care that are sure to be an interesting read. Click here to view.
- A New Look at Living Wills—Wall Street Journal (6/8/12)
- Authorities perplexed by drug shortage spike—Reuters (10/14/11)
- Current Drug Shortages —US Food and Drug Administration
- SICU hosts very special ethics rounds - Caring Headlines (1/7/10)

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.

Resources for clinicians caring for patients in vulnerable populations
click here

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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.

Palliative Care: Sedation for Intractable Distress of a Dying Patient Using Continuous Intravenous Infusion of Pentobarbital or Propofol & Benzodiazepine Continuous Infusion for Severe Distress of a Patient with a Life-Threatening Illness

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PROFESSIONAL CODES OF ETHICS

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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_logo The 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 4/15/19

MGHfC Pediatric Ethics Consults (internal access only)

MGHfC Pediatric Ethics Consults
(internal access only)