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The Hospital Ethics Committee
While attending a lunch hour presentation at the Sturgeon General Hospital in St. Albert I was struck by two things.
First and foremost I was struck by the caring, dedication and compassion of the staff and volunteers at the Sturgeon. I have been a member of the Ethics Committee at this hospital since 2007 so I am intimately familiar with the commitment and expertise of my fellow committee members. Over the years, we have tackled some sensitive and important issues. The average person has very little appreciation of the depth of service performed at a public health institution such as this. For example, a few years ago there was a threat of a virus that would seriously impact a large number of people. Our ethics committee, which is composed of volunteer members from outside the hospital and hospital staff who take on this extra duty voluntarily, tackled this issue well in advance of the virus outbreak (which ended up being a very minor issue). We had a plan in place to deal with the allocation of resources and treatment of new arrivals should the outbreak exceed our ability to respond.
At the recent noon hour seminar I was able to meet several of the other hospital staff. These people are currently working under a very stressful environment as the province of Alberta deals with deficits and cutbacks. In spite of that, all the staff members I met continued to speak highly of our healthcare system and were dedicated to providing the best healthcare possible with the highest level of ethics. We are indeed fortunate to live in an area with such a wonderful healthcare system populated by so many top-notch dedicated people.
Second, I was struck by the impact a lack of planning, legal documents and family consensus can have on the treatment of those in the healthcare system. Difficult ethical issues arise when a patient has not taken the time to let their wishes be known. Patients will communicate their preferences to hospital staff such as a desire to avoid intubation or chest compressions. They will then fail to communicate this to family members who will push for these procedures when the patient is no longer able to speak for themselves. Clearly placing your position on difficult medical issues increases the likelihood your family will follow your wishes. Assuming that all family members know what to do and will do what is “right” is a recipe for conflict. The definition of “right” is very subjective. Make sure family members know specifically your definition and get them to acknowledge they will follow your directions.
Health care institutions across Alberta are moving to a “goals of care” model. I am proud to report that the Sturgeon Hospital was one of the first to adopt this new model. The traditional model was simply choosing between resuscitate or do not resuscitate (DNR). Under the new model there are nine different levels of care ranging from “do everything possible” to comfort measures only. If you are in hospital or anyone you know is in hospital make sure the medical professionals assist in completing the goals of care. When you are discharged take this with you and tape or magnetize it to your fridge so it is readily available and can follow you through the healthcare system.
The final step is to make sure you have a Personal Directive in place. This is a legal document where you appoint someone to make personal care decisions on your behalf. This is a powerful document so make sure you are comfortable with the person you choose. It extends well beyond medical care to include all issues of personal care. Major areas such as where you will live, who you will socialize with and whether you will pursue any vocational or employment activities are typically included in the powers. Many people attempt to do their own Personal Directive and end up with a flawed document. For example, the most recent homemade document I reviewed mentioned medical decisions only so the family members now have to apply for a court order so they can make decisions regarding accommodation.
Many people will name more than one person as their agent. This can create a lot of confusion and indecision. Medical professionals and other caregivers want to know the name of one person they can turn to for a final decision. Appointing one person at a time with the second and third person named as an alternate is preferable. While I am all for family consultation and consensus my experience is it works best when one person is named as the final authority.
Galbraith Law has extensive experience in preparing Personal Directives. Please contact us to book an appointment to complete this document and the two companion documents, a Will and an Enduring Power of Attorney. Most times, we can complete a Will, Power of Attorney and Personal Directive in one office visit.