Every day, hospital case managers must make decisions — large and small — that affect the lives of their patients. Some of these are ethical decisions — what the case manager “ought” to do in a given situation. Since many decisions must be made quickly, hospital case managers should consider their ethics and plan ahead rather than reacting solely in the moment.
Clinicians must be careful about imposing medical staff priorities over patients’ priorities. Making presumptions is dangerous. Ethicists can help by explaining the provider’s responsibility to offer accurate information.
Parties clash regarding comfort levels and how aggressive treatment should be. The lack of advance directives for so many patients exacerbates the problem. Nurses and other colleagues can join the conversations to assist or outright substitute for physicians who are unwilling or unable to engage deeply.
Consider psychological, biological, spiritual, and social factors, and the role they play in understanding illness and healthcare delivery. Using this model, clinical ethicists can encourage dialogue between healthcare professionals caring for seriously ill patients.
Hospitals could put a policy in writing to make clear the obligation of staff to follow a patient’s previously expressed decisions and the obligation of the surrogate to make the decision the patient would want, not the decision the surrogate would want.
Leaders working in case management are under unforgiving time limits, pressures, and resource constraints that make decision-making difficult. The challenge relates to the way healthcare is moving and the speed with which change is occurring within organizations as they continue to change, form partnerships, and other issues.
Most patients learn about the the option of left ventricular assist devices when they are facing the possibility of death. Emotion is high, and biases of cognition are prevalent. These issues pose challenges to ethical decision-making and informed consent.
Ethicists are seeing increasing numbers of consults involving extracorporeal membrane oxygenation (ECMO), the most aggressive life-sustaining technology available. With ECMO, which is currently offered by about 250 U.S. hospitals, some patients are saved who would otherwise die.