PROGRAM SUMMARY: clinicians function under uncertainty in many ways, especially when decisions must be made for incompetent patients in extraordinary or end-of life treatment situations. Traditionally, clinicians and immediate family members have made such decisions, but surely with trepidation. But for all the recent emphasis on advance directives, many patients have not provided sufficient prior guidance, either in the form of living wills, or by designating a surrogate. Family members can add to the uncertainty by not having had sufficient prior discussions with the patient to base decisions on, and by being overwhelmed by grief and the complexity of the medical situation; not seldom, their connection with the patient may be less than ideal, if not estranged. Finally, uncertainty currently exists as to what relevant legal guidance and prohibition is in this area, and clinicians often end up quite unsure as to how to proceed.
This program aims at decreasing such uncertainty by addressing the following issues: (1) what do we know, and not know, about the nature and accuracy of surrogate decision making from the large body of empirical literature that recent research has produced? Mary Ann Meeker, a nurse of varied clinical experience, including hospice nursing, will share the results of her own research into this literature, both as to its insights and gaps. (2) what is the social and legal background to surrogate decision making at the end of life, especially in New York State? Jack Freer, a physician-ethicist, will review the legal and social history and current situation of such decision making, including a review of relevant NYS legal cases and legislation toward clarifying what is clear, or murky, or problematic in this area, as well as addressing how clinicians might proceed in the interim; And (3) Jonatha Moreno, a philosopher-bioethicist, will then step back and array the ethical issues and options regarding such decision making, and offer a decision making process that can assist clinicians and families to comfortably proceed in such situations.
PROGRAM
8:30AM: Registration
9:00-9:10 Case Presentation
9:10-10:00 AM: Mary Ann Meeker, R.N./ The University at Buffalo
"Surrogate Decision-making at the End of Life: Insights from and Gaps within the Empirical Literature"
10:00-10:10 AM: Continental Breakfast
10:10-11:00 AM Jack Freer, M.D./ The University at Buffalo
"Surrogate Decisions in NY State: Is a social and legal consensus possible and how do we proceed in the interim?"
11:10-12:00 AM Jonathan Moreno, Ph.D./ University of Virginia
The Patrick and Edna Romanell Annual Lecture
on Philosophical Issues in Medicine and health Care
"Deciding for Others Together: Moral Consensus in the Midst of Uncertainty"
12:00-12:15: Conference Closing Remarks
Each lecture will be followed by a Q&A session. Physicians, nurses, social workers and other allied health professionals are encouraged to attend, as are attorneys, and health care management personnel. Lay persons are also invited.
The UB School of Medicine and Biomedical Sciences is accredited by the Accreditation Council for CME to sponsor CME for physicians. UB designates this program for up to 3 hours in Category 1 credit towards the AMA's Physician Recognition Award. Each ph ysician should claim only the actual time he/she spends in the educational activity.
The conference will be free of charge, including the continental breakfast. Please, however, RSVP to Ms. Norma Hoffman (VA Medical Center) at 862-8530 if you will be attending with your name, affiliation and phone number, so we can est imate for the continental breakfast. For further info, call Ms. Hoffman or beep Stephen Wear at 460-2943.
Sponsored by the Center for Clinical Ethics and Humanities in Health Care, University at Buffalo, The Center for Hospice and Palliative Care, and a generous grant from Professor Patrick Romanell and Mrs. Edna Romanell.