Ethics Facilitation
This presentation is the property of its rightful owner.
Sponsored Links
1 / 25

Ethics Facilitation Part 1 Philip Boyle, Ph.D. Vice President, Mission & Ethics CHE.ORG/ETHICS PowerPoint PPT Presentation


  • 79 Views
  • Uploaded on
  • Presentation posted in: General

Ethics Facilitation Part 1 Philip Boyle, Ph.D. Vice President, Mission & Ethics www.CHE.ORG/ETHICS. Etiquette. Press * 6 to mute; Press # 6 to unmute Keep your phone on mute unless you are dialoging with the presenter Never place phone on hold

Download Presentation

Ethics Facilitation Part 1 Philip Boyle, Ph.D. Vice President, Mission & Ethics CHE.ORG/ETHICS

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Ethics facilitation part 1 philip boyle ph d vice president mission ethics che org ethics

Ethics Facilitation

Part 1

Philip Boyle, Ph.D.

Vice President, Mission & Ethics

www.CHE.ORG/ETHICS


Etiquette

Etiquette

  • Press * 6 to mute;

  • Press # 6 to unmute

  • Keep your phone on mute unless you are dialoging with the presenter

  • Never place phone on hold

  • If you do not want to be called on please check the red mood button on the lower left of screen


Goals for today s conversation

Goals for today’s conversation

  • House keeping & review of course

  • Part 1: The nature of ethics facilitation

  • Part 2: Responsibilities of those engaging in ethics facilitation

  • The nature of ethics

  • The nature of ethics facilitation

  • Are you tracking your self- understanding?


Who is providing consultations

Who is providing consultations?

  • ASBH study

  • 35,000 are involved in 15,000 annually

    • 36% MDs

    • 30% RN

    • 11% LSW

    • 10% Chaplains

    • 10% Administration


Ethics facilitation part 1 philip boyle ph d vice president mission ethics che org ethics

  • The nature of ethics

  • The nature of ethics mechanisms

    • Promoting appropriate moral agency

  • Distinctions

    • Consultation

    • Facilitation

    • Mediation


Ethics facilitation part 1 philip boyle ph d vice president mission ethics che org ethics

Case

  • 82-yr-old found disoriented at home unattended, septic, breathing problems

  • Placed on vent

  • 3 day woman requests to be extubated

  • MD refuses—”Its assisted suicide”

  • Ethic facilitation identifies her rights under the law


What is healthcare ethics consultation

What is healthcare ethics consultation?

  • A service provided by individual or groups to help patients, families, surrogates, healthcare providers to address uncertainty or conflict regarding value-laden issues.


What s the goal of facilitation

What’s the goal of facilitation?

  • “The proper role of ethics consultation is to advocate for an unbiased robust process and not to privilege the needs and agenda of any one part.” ASBH, 2007


Commonly performed tasks

Commonly performed tasks

  • Navigating clinical setting

  • Gathering information

  • Evaluating, interpreting, and analyzing info

  • Facilitating meetings, understanding each perspective, assessing options for moral acceptability

  • Promoting ethically acceptable plan of action

  • Implementing quality assurance measures


Qualified facilitation model

“Qualified facilitation model”

  • Identify and analyze nature of value uncertainty

    • Gather relevant data

    • Clarify relevant conceptual issues

    • Clarify related normative issues

    • Help identify range of morally acceptable options

  • Resolve value uncertainty by building consensus

    • Ensure concerned parties have voices heard

    • Assist in clarifying values

    • Help build morally acceptable share commitment


Core competencies

Core competencies

  • Skills of ethical assessment

    • Identify the nature of the value uncertainty

    • Analyze the value uncertainty

  • Process and interpersonal skills


Developing skills

Developing skills

  • Apprentice model

  • Simulation model

  • Opportunities to practice

  • Method to evaluate performance

  • Feedback on performance


The consultation

The consultation

Ability to facilitate meetings

  • Introducing oneself properly, explaining what an ethics consultation is and what a person taking the lead does, the purpose and limitation of the consultation and his or her recommendations, and the relationship between the ethics consultation mechanism and institution.

  • Ensure that all relevant parties have been invited and encouraged to participate.

  • Ensure that all parties are introduced and explain their perspective roles

  • Explain the goals and process of meeting and what can be expected.

  • Elicit medical facts

  • Elicit views and values of principles regarding issue

  • Facilitate reflective listening, clarifications, summarizing interests.


The consultation1

The consultation

Ability to build moral consensus

  • Help individuals to critically analyze their underlying assumptions

  • Negotiate between competing moral views

  • Recognize possible areas of conflicts between personal moral views and one role in consultation


Practical considerations

Practical considerations

  • Focus on “interests” not arguments

  • Bioethics facilitator is not a judge!

    • No constraints on evidence

    • But some statements are more useful in resolution


Practical considerations1

Practical considerations

  • Summarizing—most critical aspect

    • Lets the parties know facilitator is listening

    • Lets the mediator test her understanding

    • Helps parties organize thoughts

    • Helps parties to hear what others are saying

    • Shows areas of common interest

    • Provides order to discussion

    • Lets facilitator remind parties of progress

    • Repeat in nondestructive language

    • End with question: “Have I missed anything?”


Practical considerations2

Practical considerations

  • Questioning

    • To obtain a broader view

    • To obtain information

    • To clarify abstract ideas/generalizations

    • To focus discussion

    • To introduce hypothetical

    • To generate new options

    • To encourage participation


Practical considerations3

Practical considerations

  • Generating movement

    • Asking problem solving questions

    • Reframing

    • Raising issues

    • Hearing proposals

    • Stroking

    • Allowing silence

    • Holding caucuses

    • Reality testing

    • Reversing roles

    • Normalizing


Practical considerations4

Practical considerations

  • Packaging proposals

    • Loss aversion

    • Reactive devaluation-leads parties to view the one proposing as “enemy”

    • Attribution theory—what really is motivating the one who is proposing

    • Holding caucuses and allowing facilitator can avoid these barriers


Limits to consensus

Limits to consensus

  • People do not give up political rights

    • Patient’s autonomy

    • Employees’ conscientious objection


Place of personal views

Place of personal views

  • Cannot remain value neutral

  • Do you offer your personal views?

  • How to attend to sociological power and authority?


Evaluation

Evaluation

  • Videotape simulations ad self-assess performance

  • Keep track of feedback

  • Conduct case conference to evaluate

  • Use existing check lists to see if pertinent information has been asked

  • Debrief parties


Evaluation1

Evaluation

  • http://www.meddean.luc.edu/depts/bioethics/online_masters/ethics%20consult/ethics_consult_eval.html

  • Q1: Does the ethics consultant do an adequate job of gathering the facts of he case from the physicians? What kinds of things must the ethics consultant gather in advance of facilitating a conference?

  • Q2: Does the ethics consultant give the physicians an adequate idea what they might expect from an ethics case consultation, in general, and in this case, in particular?

  • II. The Case Conference

  • Q3: Does the ethics consultant do an adequate job of introducing himself and explaining what he does or what the goal of the conference is? Should he have said anything else?

  • Q4: Does the case conference result in the patient’s surrogate decision maker, understanding the medical facts of the case adequately?   


Ethics facilitation part 1 philip boyle ph d vice president mission ethics che org ethics

  • Q5: Does the case conference result in the patient’s attending physician understanding the patient’s values and wishes adequately? Does he adequately understand the surrogate decision maker’s understanding of the situation?

  • Q6: Does the ethics consultant do a reasonable job of “supporting” the surrogate decision maker through the conference? That is, does the consultant reinforce the notions that the surrogate’s understanding of the case is welcome in the discussion and that the patient’s legitimate rights will be respected?

  • Q7: Does the conference “flow” well or should the consultant have redirected it at points? If so, please be specific regarding when.

  • Q8: Does the consultant help to summarize and delineate the acceptable options? Is it clear what will happen next and how matters will proceed?

  • Q9: Are the options highlighted within ethically acceptable norms?


Conclusion

Conclusion

  • Bioethics Mediation: A Guide to Shaping Shared Solutions, Nancy Dubler and Carol Liebman, United Hosptial Fund, 2004.

  • Mediation Information Resource Websites

  • Http//www.meidate.com

  • http://www.crinfor.org/narrative_new _developments.cfm


  • Login