Services & Initiatives
The Program in Medicine & Human Values is dedicated to patients, bioethics education, furthering research in bioethics, and policy development. Are services and initiative are designed within these four areas.
Ethics Consultation Services
The main activity of the Program is our ethics consultation service. Ethics consultations can be requested by anyone involved in a patient's care. For more information on ethics consultations, see
ethics consultation information.
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Bioethics Education
Our bioethics education programming is comprised of an internship program, a fellowship, a clinical rotation for residents, graduate medical education, continuing education, international collaboration and scholarship, and public outreach.
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Ethics Quality
Improving the quality of health care practices requires not only improving scientific, technical, and service quality, but also ethics quality. It requires assuring that clinical and management practices are consistent with widely accepted ethics standards, norms, and expectations. California Pacific uses the Staff Ethics Survey to help assess current ethical health care practices as a baseline for setting goals and developing quality improvement plans. It is designed to capture staff perceptions about their own and others’ routine practices, their knowledge of concepts in health care ethics and of California Pacific policies related to ethical health care practices, as well as their views about how well the hospital supports ethical health care practices.
PMHV developed the Staff Ethics Survey based on materials from the National Center for Ethics in Health Care, Veteran’s Health Administration and the American Medical Association. We piloted the Staff Ethics Survey in 2005 and our first full-scale survey was conducted in January 2011. In September, we conducted the survey at Sutter Lakeside Hospital.
The Staff Ethics Survey measures ethical health care practices in each of seven core health care ethics areas: overall health care ethics environment, communication, shared decision making, end-of-life care, privacy and confidentiality, professionalism, and resource allocation. These areas represent key areas in which hospitals encounter ethical problems unique to health care. Hence, using the survey results, our hospital can analyze the degree to which our practices are perceived as consistent with good quality ethical health care practices in each of the seven areas. We can identify areas that need improvement or areas where further investigation is needed.
The Staff Ethics Survey and resulting quality improvement efforts have the potential to refocus our hospital‘s approach to ethics in health care from a case-by-case operation in which various aspects of ethics are handled in a disjointed fashion, into a systems-oriented, comprehensive approach. It moves ethics out of ethics committees and into collaborative relationships that cut across the organization. Its comprehensive approach to ethics encompasses the full range of ethics content areas, and both rules- and values-based approaches to ethics. This practical, structured, systems-oriented, results-driven approach is designed to translate theory into practice and make ethics an integral part of what goes on at California Pacific every day.
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Research
Proactive Ethics Intervention
In 2006, our visiting scholar, Dr. Larry Schneiderman from UC San Diego proposed a study of “proactive ethics intervention.” Proactive ethics intervention is a service provided by the hospital, with the patient’s consent, in which a clinical ethicist evaluates a patient’s case after some ‘trigger’ indicates that there may be some manifest or latent ethical issues involved. For us, this trigger is a stay of five days or longer in the ICU (the goal of care in the ICU, with the exception of transplant patients, is to get you in, well and out as quickly as possible); possibly indicating a poor prognosis.
This study, concluded in February 2010, investigated whether or not proactive ethics intervention has any affect on patient satisfaction, provider satisfaction, and length of stay. We wish to thank the William Randolph Hearst Foundation, the Wallace Alexander Gerbode Foundation, and all of our donors for making this important research possible.
Moral Reasoning in Medicine
In response to a body of research that suggests that development of moral reasoning plateaus at a certain point in individuals, we aimed to develop an instrument that refuted this argument. We hypothesized that instruments used in measuring moral reasoning were systematically flawed. The instruments that have been developed; the Defining Issues Test (DIT), the Sociomoral Reflection Measure (SRM) and the Moral Judgment Interview (MJI); have largely produced data that showed no developmental change in moral reasoning by medical students over the course of time. But what if these findings do not accurately represent the real processes of moral reasoning? What is there is something unique about doctors? In stark contrast to these conclusions, there has been a small amount of research by J. R. Rest and S. P. McNeel that has shown some rather significant developmental change while using these instruments in liberal arts undergraduates as a result of their education and teaching methodology they received. All of these instruments are based on Lawrence Kohlberg’s “Stages of Moral Development.” We’ve got ten years of data and are still collecting. For more information, email
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Policy Development
Commercialism in Medicine
In 2004 and 2005, we brought together a group of leading bioethicists to San Francisco to discuss the ways in which commercialism has changed the practice of medicine. Drs. Jonathan Moreno (University of Virginia), Larry Churchill (Vanderbilt University), Joe Fins (Cornell University, New York Presbyterian Hospital), Mark Siegler (University of Chicago), Jacob Needleman (San Francisco State University) and Rosamund Rhodes (Mt. Sinai Medical Center) spent two days discussing the issues. The papers have been published in volume 16, issue 4, of the Cambridge Quarterly of Healthcare Ethics (Fall 2007). For the full text articles, please visit Cambridge Journals Online.
Click here to view the table of contents of the Fall 2007 issue.
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