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    Bioethics at the Bedside:
    Tackling Tough Ethical Questions

    Melissa Sitter at home in St. Helena two years after her husband’s passing from melanoma. “The bioethicists in the Program in Medicine & Human Values helped Tom die a death of great dignity, in my arms, just as he wished.”
    “I have given you the power to make these decisions. Use it.” These were Melissa Sitter’s instructions from her husband when he was hospitalized with end-stage melanoma.
    “I felt that Tom had given me such a terrifying responsibility,” says Mrs. Sitter now, more than two years after his death. “How do you know which is the right moment? You’re grieving, you’re overwhelmed, and there is so much medical information to consider. Thank goodness one of the nurses mentioned the possibility of an ethics consultation.”

    The Program in Medicine & Human Values provides clinical ethics consultations at Sutter Health’s hospitals in Santa Rosa, Lakeside, Novato, and at California Pacific Medical Center in San Francisco. The program is unusual in that the bioethicists speak directly to the patient if possible, to the family, and to the doctors and nurses involved in the patient's care. The bioethicists’ goal is to help providers and family members make the health care decisions that the patient would make if he or she were capable of doing so.

    It is a sign of medicine’s success that the need for bioethics consultations is growing: We are all living longer, even with serious diseases such as cancer. And for stroke patients or those with other neurological disorders, it is vital to have a process that will help determine the ethical appropriateness of medical treatments to be provided to the patient. Finally, each patient has different health care goals and a unique cultural context for determining those goals. An ethics consultation takes into account the patient's wishes, the physicians’ and nurses’ professional values, and the accepted moral standards of the community.

    “We support the treatment of each patient with respect, dignity, and the appropriate care.” – William Andereck, M.D., co-founder of the Program in Medicine & Human Values

    William Andereck, M.D., co-founder of the Program in Medicine & Human Values (left) with Bioethicist Ruchika Mishra, Ph.D.
    Thomas Sitter was no longer able to speak for himself, but he’d made his wishes very clear to his wife Melissa. William Andereck, M.D., and Ruchika Mishra, Ph.D., from the program directed a process that allowed each member of the care team, plus the Sitters’ children, to recognize that Tom had passed the point of heroic medical measures. “It’s a very profound job they have of lovingly guiding people towards dying well,” says Mrs. Sitter. “Because of them, my husband died a death of great dignity, in my arms, just as he wished.”

    Mrs. Sitter lives in St. Helena, and is particularly pleased that the program is expanding its reach to her local hospitals. “Access to this program could be, possibly, the best thing in our last moments of life,” she says. Recent cases at several Sutter West Bay hospitals have providers echoing that sentiment. Siri Nelson, chief administrative officer at Sutter Lakeside, says, “The bioethics team at CPMC consults with us frequently and helps us wade through sometimes very muddy water.” And Deborah Levin, a social worker at Novato Community Hospital, agrees: “The CPMC bioethicist and the ethics committee at Novato provided great support and a framework for us to think through an ethical dilemma.” The program has recently hired a second bioethicist, David Campbell, Ph.D., to staff Sutter Health’s West Bay hospitals.

    Bioethicist Ruchika Mishra, Ph.D. counsels a family member in making health care decisions on behalf of a loved one.
    The program’s work with individual patients is grounded in research and scholarship. Through publications and seminars, the program has had a hand in educating an entire generation of bioethicists, and continues to be a leader in establishing the best practices in new areas, such as those arising from the rapidly developing field of neuroethics. Ultimately, all of this work comes back to the same goal: to provide individualized advice in ethically challenging situations, and to help the entire care team treat each patient with respect, dignity and the appropriate care.

    The care provided by the Program in Medicine & Human Values is not reimbursed by insurance. The program has been sustained by our philanthropic partners ever since the visionary gift that brought the program into being. For more information about how your charitable investment can make a difference to your local Sutter Health hospital and possibly qualify for a 2014 matching grant from Sutter Health, please contact us.

    San Francisco and Bay Area
    CPMC Foundation

    Marin County
    Novato Community Hospital Fund Development Office

    Sonoma County
    Sutter Medical Center of Santa Rosa and Sutter Pacific Medical Foundation Fund Development Office

    Lake County
    Sutter Lakeside Hospital Foundation