The Ethics Forum at WMC

Check-in
Wyoming Medical Center strives to provide quality care within an ethics framework.  Or mission is “to support the rights of patients, families, and care givers to plan and guide the decision-making process concerning their care and to ensure that ethical care will be provided in a manner respectful of their wishes, values and dignity.” 

Basic ethical principles include:

patient autonomy - respect for the individual
beneficence - obligation to help
non-maleficence - obligation to do no harm
fidelity - professional obligations
integrity - contracting, promise keeping
justice - equals shall be treated equally
reparation - the duty to make up a wrong
veracity - truth telling
voluntariness - informed consent

When ethical issues arise, the WMC Ethics Forum may be consulted for assistance.  Whether a formal consult with the ethics team, care providers and patient/family, or an informal consult where any team member can provide insight, the WMC Ethics Forum is available to help.  The Forum is made up of Clinical Staff, Chaplains, Physicians, Social Workers, and community members.  The intent for the Ethics Forum is to provide a resource and support for patients, families and or staff when ethical dilemmas arise.  The Forum does not make treatment recommendations.

To contact the Ethics Forum, call the nursing administrative office at 577-2713.

Characteristics of Ethical Dilemmas
Healthcare is a complex system, involving life and death issues everyday.  Dilemmas arise when parties are not in agreement with the care or direction of care.  The conflict may arise between the patient and family, the family and the physician, the physician and the care giver staff, or any combination of the above.  The following ten statements better define the characteristics of ethical dilemmas:

1. The choice is between equally undesirable alternative.
2. Real choice exists between possible courses of action.
3. The people involved place a significantly different value judgment on possible action or on the consequences of actions.
4. data alone will not help resolve the dilemma
5. “Answers” to the ethical dilemmas come from a number of disciplines.
6. Actions taken in an ethical dilemma will result in unfavorable outcomes and/or constitute a breach of one’s duty to another person.
7. The choices made in an ethical dilemma have far reaching effects on our perception of human beings and definition of personhood, our relationships and people and society as a whole.
8. Any ethical decision involves the allocation and expenditure of resources which are finite.
9. Ethical dilemmas are not solvable, but rather, resolvable.
10. There is not ‘right’ or ‘wrong’ when dealing with two equally unfavorable actions.

Ethics Problem Solving Process
When an ethics consultation is requested, the team utilizes a standardized process to help with discernment of the situation.  A standardized process helps by identifying the key players and the perspectives of each.  This provides the foundation to get to the issues while maintaining objectivity.  The steps are as follows:

1. Identify the players and their values
   • Name the referral source
   • Identify the players and ethical perspective
   1. patient
   2. physician
   3. nursing
   4. administration
   5. guardian/parent
   6. family
2. Identify the true ethical issues
   • Identify areas of true conflict-attempt to discern the primary opposing ethical values to describe the dilemma
     1. patient/physician
     2. nurse/physician
   • identify areas of perceived  conflict (differing viewpoint)
     1. nurse/physician
     2. physician/administration
     3. patient/staff
3. Processing the ethical dilemma
   • acknowledge personal conscience
     1. ethical choices are personal choices
     2. The Ethics Forum provides a normative baseline
   • develop the ethical solution road map
     1. non-biased identification of ethical questions
     2. normative prioritization of ethical choices
     3. non-judgmental reporting of ethical problems