Services & Initiatives
The Program in Medicine and Human Values is dedicated to patients, bioethics education, furthering research in bioethics, and scholarship. Our services and initiatives are designed around these four components.
Ethics Consultation Services
Ethics consultation service for individual patient care
The heart of the Program is the ethics consultation service. Ethics consultations can be requested by anyone involved in a patient's care.
The Program works closely with hospital and system administrators to develop ethics policies that serve our patients and staff. For information on internal (Sutter facility) policies, please contact the administration office at the specific facility in which you have interest. You may also send an email to firstname.lastname@example.org.
The Program also works on projects that inform policy with other facilities and as a component of our research activities.
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. The Program uses a specially designed instrument to assess current ethical health care practices as a baseline for setting goals and developing quality improvement plans.
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. We now conduct the survey biannually in the Sutter hospitals located in San Francisco, Marin, Sonoma, and Lake Counties.
For more information on ethics quality initiatives, please contact Dr. Linda Hummel.
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Our bioethics education component 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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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. This study concluded in February 2010 and the results are now available in the Journal of Critical Care Medicine: April 2014 - Volume 42 - Issue 4 - p 824-830.
- Seeking to Reduce Nonbeneficial Treatment in the ICU: An Exploratory Trial of Proactive Ethics Intervention
Moral Values 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 have ten years of data and continue to collect more. For more information, email email@example.com.
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. Opens new window
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Bioethics programs are situated almost exclusively in schools of medicine, university teaching hospitals, and large health management organizations. It is rare to find a program located in a community hospital setting. Our program is one of those rare examples and, as such, faces particular and unique challenges.
The extensive body of scholarship that constitutes modern Bioethics must be translated into information and advice useful to patients and practitioners as they navigate difficult decisions. This requires skilled scholars and bioethicists, professionals capable of communicating with patients and doctors, and able to provide ongoing education to the vast variety of practitioners serving patients in the community hospital.
These functions require constant and flexible planning and consume extensive resources as reimbursement for Bioethics consultation services is not currently available.
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