Clinical Ethical Summary

After reviewing our standards, I then met with Margo Bykonen, our Chief Nursing Officer and Chair of the Swedish Ethics Committee. Ethics and palliative care are two of Margo’s passions. When I asked if she was available to meet and discuss their role at Swedish she quickly responded and set up a meeting. Margo shared that there are two services the Ethics Committee provides at Swedish: consultations by the Ethics Sub-Council and formal reviews by the Ethics Committee. Both groups use the Jonsen model for clinical ethical decision making and base decisions on the hospitals mission, vision, and values. These groups cover all Swedish campuses except Edmonds and cover our Women, Children, and Adult patient populations.
The Ethics Sub-council …show more content…
Autonomy is defined as, “the quality or state of being self-governing” (Miriam-webster.com, 2016). When patients lack decision making capacity and are no longer considered autonomous, surrogate decision makers then have legal authority to make healthcare decisions for the patient (Bartlett & Finder, 2016). For adult inpatients in the intensive care units, only 3-4% of decisions to withhold or withdrawal care were made by the patients themselves; the remaining decisions were made by surrogate caregivers using the standard of substituted judgment (Shapiro, 2007). A meta-analysis found that the overall accuracy of prediction of surrogate decision makers was only 68%, leaving significant room for discrepancies (Shapiro, 2007). Factors that affect surrogate decision making include: a living will, extent of discussion regarding patient preferences and values, education on diagnosis, prognosis, provider recommendations, perceptions of quality of life, surrogate values and biases, financial burdens, and medical or bureaucratic deadlines (Gordon, 2014; Phillipsen, Murray, Wood, Bell-Hawkins, & Setlow, 2013; Shapiro,