Story Posted: 2024-11-08
Bioethics seminar explores complex discharges
November 5, 2024 – The W.F. Mitchell Bioethics Seminar was held in Pylypchuk Hall with Katarina Lee-Ameduri, Director of Ethics for Reseau Compassion Network, presenting on, “Complex Patients and Discharges: What should we do when every option feels problematic?” Approximately 60 people attended the seminar in person in St. Paul’s Hospital’s Pylypchuk Hall, with over 200 more joining via Webex.
Lee-Ameduri began the presentation by highlighting four groups of patients that often have challenging discharge plans: (1) patients who lack decision-making capacity or have questionable decision-making capacity and wish to engage in risky choices; (2) patients who are unhoused or precariously housed; (3) patients who are using substances; and (4) patients who are non-participatory in their medical treatment. In many cases, patients will fall into more than one of these groups, which makes care planning all the more complicated.
To bring shape to these situations, Lee-Ameduri walked participants through a case study which she applied to the Beauchamps and Childress’ four principles of medical ethics: autonomy, beneficence, non-maleficence, and justice. She shared that what often makes these situations so complex is the tension within and among these principles. For example, a patient may be capable of making their own decisions in one moment, but not of following through on this decision in other moments. She also highlighted the “dignity of risk,” pointing out that there is a tension between paternalism and respect for the patient. “Dignity of risk is also going to be impacted by socio-economic determinants – or drivers – of health […] Something that I consider risky may seem very different for a person who has not had the advantages that I have had in life. They may tolerated a much higher form of risk than I will because my lens comes from a place of greater advantage.”
The presentation closed with a discussion of moral distress, i.e., the psychological response to morally challenging situations. Lee-Ameduri stressed two points that often lead to moral distress. “People are going to make choices based on so many things that I am not going to see […] We’re also not great at accepting that some people are palliative.” In these situations we often find ourselves in tension with our patients because we have a different vision for their health than they do. In these moments it is important to reach out for education and support to help us manage our moral distress.
The seminar was made possible by the W.F. Mitchell Endowment which is stewarded by the St. Paul’s Hospital Foundation. William F. Mitchell was a Saskatoon business man, who recognized the value of ethical reflection both in the business world and in health care. The recording of the seminar is available below.