Cedars-Sinai Medical Center stands out among leading hospitals in Los Angeles because it offers a number of programs to support patients and connect them to potentially life-saving research. The center has comprehensive initiatives focused on a wide range of medical conditions, from Alzheimer’s disease to colon cancer. In addition to conducting scientific research, Cedar-Sinai is also a leader in related fields, including healthcare ethics.
The Center for Healthcare Ethics at Cedars-Sinai was established in 1995 and currently undertakes a number of programs to provide education and address the ethical issues that arise at the hospital. At its heart, the center is focused on dealing with these problems in the real-world, clinical setting, rather than discussing ethics in a more theoretical sense. The center has identified four primary activities: ethics consultations; education for faculty, staff, and students; involvement in institutional committees and task forces; and policy reformation.
Cedars-Sinai’s Clinical Ethics Consultation Services
The Center for Healthcare Ethics serves the clinical needs of the hospital through its Clinical Ethics Consultation Services, which are intended to promote moral decision making in the clinical setting. When patient care situations involve ethically ambiguous decisions, the consultation service helps participants discuss the issues involved. This step facilitates good communication and ensures that everyone has a thorough understanding of all options and what’s at stake. During these conversations, possible decisions, major alternatives, and likely outcomes are discussed. Ultimately, all participants are charged with identifying their ethical values and goals in the situation, in order to arrive at the best decision.
From a more basic standpoint, the consultation service works with each person involved in a patient’s care to explore his or her moral framework and see how it has an impact on healthcare decisions. By thinking about the larger moral framework, individuals can begin to see the specific issues involved in a particular situation and articulate why friction exists. The ethics team then helps each person identify possible resolutions that will resonate with all affected parties and lead to a solution that everyone can accept.
Virtually anyone in the hospital can request a meeting with the consultation service when they are facing an ethical dilemma, including physicians, nurses, social workers, other hospital staff, patients, their family members, and the patient’s legal representative. Common reasons for contacting the service include a patient’s refusal of treatment, end-of-life and qualify-of-life questions, conflicts between staff members, and the use of controversial treatments.
Opportunities for Ethics Education at Cedars-Sinai
Another primary goal of the Center for Healthcare Ethics is to provide education for hospital employees. Through education, the ethics team can raise awareness of important issues and promote greater sensitivity in patient care. The educational offerings at the center range from lectures and conferences to specific courses.
A monthly ethics seminar is open to all Cedars-Sinai staff. During these seminars, participants explore some of the most difficult questions related to patient care in a small, classroom setting. The seminars are designed to trigger self-reflection on the core values that underpin clinical healthcare. In addition, there is a monthly neonatology ethics session arranged for members of the Neonatal Intensive Care Unit (NICU). A bimonthly Surgical Intensive Care Unit Residents Clinical Ethics Conference helps residents consider relevant ethical issues while they work in that rotation. Another bimonthly offering is the Ethics Forum, which is open to all Cedars-Sinai staff. This event focuses mainly on issues that arise in daily practice, rather than outstanding cases.
The center also hosts a biweekly Intensive Care Unit Ethics Roundtable and sponsors courses for upper-level students at American Jewish University.
The Cedars-Sinai Bioethics Committee
Consisting of various medical staff from around the hospital and lay members, the Cedars-Sinai Bioethics Committee provides a multidisciplinary perspective on ethical concerns at the hospital. The committee is designed to advise on various matters according to the hospital’s specific rules and regulations. Members may help devise new parts of the Medical Staff Rules and Regulations, and Policy and Procedures documents. In addition, the committee often has conversations about the research and education being conducted at the facility to ensure that all initiatives adequately address ethical concerns. When necessary, the committee spearheads efforts to raise awareness about particular ethical issues by devising new programs and activities.
Ethics-Related Policies at Cedars-Sinai Medical Center
The policies designed in conjunction with the Bioethics Committee tackle a number of issues, include end-of-life care, resuscitation and do-not-resuscitate orders, determination of death, confidentiality, and withdrawal of life-sustaining treatments. One of the biggest issues currently facing the hospital involves advance directives. These documents provide instructions about the treatments a person wants to receive if he or she becomes incapacitated and unable to express an opinion.
Many ethical problems and concerns can be avoided when patients have advance directives, yet many people still do not take the time to sit down with their families and create one. The Center for Healthcare Ethics has worked diligently to create a comprehensive resource for learning about advance directives, how to make them, and what considerations are necessary. The team has also provided connections with third-party sources of information so that patients can get all the information they need to make the best decisions possible.