California Pacific Currents 2003
Encouraging the Discussion of Medicine and Ethics
William Andereck, MD, Maurice Kanbar
Imagine that you have been admitted to the hospital with heart failure. While you are being treated, you have a stroke. You are transferred to the intensive care unit (ICU) and are placed on a breathing machine. Because of the breathing tube, you cannot speak and slip in and out of consciousness.
Many of us find it hard to think of ourselves in this situation. As a result, we might not have executed an “advance directive,” a document in which instructions about our health care are specified—if and when we cannot speak for ourselves. Without an advance directive, physicians, as well as family members, could be completely uncertain about our wishes.
Situations like this emphasize the importance of executing advance directives and having discussions about these issues with family members and physicians from whom we receive care. This scenario provokes difficult questions: What would my doctor do? How will he or she make
a crucial decision without knowledge of my wishes? How do physicians learn the necessary skills to manage illness when confronted with issues that cross the boundaries of medical and scientific knowledge into the realm of ethics, values, beliefs, and even morality?
California Pacific medical staff, hospital administrators, nurses, residents, and fellows have had assistance in coming to grips with these issues. William Andereck, MD, Chair of the Medical Center’s Ethics Committee and a respected medical staff member, has long championed the understanding of medical ethics for all hospital staff. He took a keen interest in California Pacific’s graduate medical education programs and has provided its educators and their charges with training in the field of medical ethics, as well as an immediate setting in which staff can discuss patients’ care.
Wednesday mornings, Dr. Andereck can be found conducting rounds in one of California Pacific’s ICUs. These sessions encourage participants to hear the varying perspectives of the health care team, to listen to families’ subtle messages, and, above all, to explore the values their medical decisions represent. This approach does not devalue the importance of medical and scientific knowledge but enriches it, as well as medical decision making, with principles from other disciplines.
Dr. Andereck has an ally in his friend and patient, Maurice Kanbar. Mr. Kanbar, a supporter of California Pacific Medical Center and of many San Francisco charitable organizations, established the Kanbar Fellowship in Ethics in 2001 with a generous gift of $250,000. This was followed in 2003 with another gift of $500,000. Dr. Andereck is using these funds to establish the Program in Medicine and Human Values. Development is currently focused on defining the mission of the program with the assistance of a group of leading ethics scholars. One thing is certain: Whatever its specific mission, the Program in Medicine and Human Values will be driven by the need to offer patients not only the best medical care possible but the respect and dignity that all humans deserve.
And Mr. Kanbar? In addition to supporting the Ethics Program, he has also contributed $5.5 million to establish the Kanbar Cardiac Center, a new and technologically advanced cardiac service currently under construction at the Medical Center’s Pacific Campus. Mr. Kanbar is helping California Pacific offer the best of both worlds— high tech cardiac care in an environment that is highly responsive to patients’ and families’ wishes and needs.