ETHICS COMMITTEES AT WORK
a1 Paul B. Hofmann, Dr. P.H., is with Provenance
Health Partners, Moraga, California. He is a fellow of the American
College of Healthcare Executives, a member of its Leadership Advisory
Committee, and the College's consultant on healthcare management
Like some ethical dilemmas, this question has an obvious answer that
may not be right. On first reflection, it seems entirely unreasonable
and inappropriate to expect staff members to withhold supportive care.
Legally, a designated surrogate has the authority to refuse pain
medication on the patient's behalf, but is it ethically
defensible? A patient lacking decisionmaking capacity is crying out in
pain; can we really imagine just closing the door? What do we say to
other patients, visitors, and staff members, such as physicians,
nurses, housekeepers, and dietary workers, who might hear the patient?
Do we place a sign on the door, one noting that the surrogate has
refused, on behalf of the patient, to authorize the administration of
pain medication and that the hospital or nursing home must comply with
the surrogate's decision?