Health Ethics Conference stresses medical ethics

Bioethics committee chairman provides new ethical plan for doctors.

By Garrett Bergquist

Published Oct. 10, 2008

Doctors followed the Hippocratic Oath for 3,000 years, but the modern world seems to have turned its back on it.

The MU Center for Health Ethics addressed this issue with a lecture Thursday night at the Reynolds Alumni Center as part of the fourth annual MU Health Ethics Conference. The conference, which continues until Saturday, will feature several workshops to help train health care professionals to deal with situations involving difficult decisions about patients, including disruptive patients.

On Thursday night, Edmund Pellegrino, chairman of the President's Advisory Council on Bioethics, said physicians have strayed from the principles of the Hippocratic oath, which saw medicine as a service, not a job. In recent decades, Pellegrino noted an increasing focus on profit and negotiability.

"Medicine is at its heart a moral profession," Pellegrino said, noting the Hippocratic oath's emphasis on beneficence and benevolence.

Pellegrino said medicine's biggest problem is the prevalence of business ethics in modern medicine. He also said he saw a decline in personal accountability since the 1960s, saying everyone blames the system for a physician's ethical shortfalls instead of the specific doctor. Pellegrino drew a line between health care and medical care, adding that health care refers to the business side of medicine.

"I speak of medical care, the immediate care of those who are ill," he said.

Pellegrino said the increased involvement of patients in determining how they will be treated is an excellent development, but he added it has gone too far, to the point where patients are trying to get care they do not need.

Pellegrino said it is not possible or advisable for physicians to go back to the Hippocratic oath as it is. Instead, he advocated adhering to traditional ethics and reinforcing them with modern internal morality. What does not change, he said, are the patient's predicament, the physician's promise of competence in the patient's interest and a technically correct and morally good act of healing.

Members of MU's medical community will explore the points raised by Pellegrino in workshops Friday and Saturday as they put themselves in a variety of ethical simulations. Dilemmas vary between specialties.

Occupational therapists face primarily organizational ethics questions because of the pressure to do more with less, said Lea Brandt, occupational therapy assistant.

Brandt said many Americans lack health literacy, meaning they are unaware of the health resources available to them.

"Because we live in a pluralistic society, we see value conflicts between health care professionals and the people they serve," Brandt said.

Since occupational therapy focuses on the patient's autonomy, occupational therapists often face a difficult decision as to who should be driving the care plan. Brandt said better communication could resolve these issues. Better communication also means the client is more likely to follow through on their intended care plan. This can reduce the chance of a patient refusing potentially beneficial treatment.

"By increasing communication with patients and truly listening to them, health care professionals can avoid conflicts that may lead to legal action," Brandt said.

The situation is different for long-term care providers. Adjunct professor Don Reynolds said difficult patients get a disproportionate amount of attention in situations such as at nursing homes. The behavior of these patients is rarely deliberate but rather a result of what they are going through.

"The staff sometimes spends a disproportionately large amount of their time on a very small group of people," Reynolds said.

During his lecture Thursday night, Pellegrino said character is what matters most in medicine. He also said the youth of today can redefine medical ethics.

"Let's not blame the young for what has happened," he said. "Let's inspire them."