As recently reported in American Medical News, Washington Hospital Center began a pilot program for residents working in the intensive care unit – an ethics checklist. The program was implemented after a realization that checklists seemed to have helped in surgery and infection control. "Hospitals implementing the WHO checklist cut deaths after surgery by 46% and surgical complications by 36%. Director of WHO Safe Surgery Saves Lives initiative recommends integrating ethics issues." We have reproduced the ethical checklist in its entirety:
Clinical Ethics Patient Assessment
Add relevant ethical issues to progress notes and report on rounds
- Patients wishes unclear/refusal of treatment
- Questionable capacity to consent to, or refuse, treatment
- Disagreement involving relatives/surrogates/caregivers
- End-of-life (advance directive/power of attorney, do not resuscitate/allow natural death, withdraw/withhold Rx)
- Confidentiality/disclosure issue
- Resource or fairness issue
- Other (please note)
- No notable ethical issues
The idea is "fantastic," said John J. Lynch, MD, chair of the Washington Hospital Centers bioethics committee. "This is a brief list that raises the really important questions that residents and other physicians need to be clear about. It makes eminent sense."
The ethics checklist will be considered at the Loyola University Chicago Stritch School of Medicine, said Kayhan Parsi, PhD, a clinical ethicist who directs the Neiswanger Institute for Bioethics and Health Policy graduate program there.
"What the checklist does, in my mind, is it more formally integrates ethics into the care of patients so it really just becomes part of the culture," Parsi said. "It actually standardizes care so everyone gets treated in a similar fashion."
Dr. David Warriner, a physician in South Yorkshire, England, is so enthusiastic about the checklist concept that he had an ink stamp made of it so that he can quickly add it to patients charts.
"The list stimulates doctors to think laterally, concerning themselves with the patient, the relatives and their future, not just their temperature, blood tests or scan results," Dr. Warriner said.
Some skeptics of the ethical checklist believe that ethical issues should be integrated into existing checklists, while others believe that checklists receive too much hype and dont think they will change behavior.
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