Florida Health Care Professionals Explore Ethical Issues from AIDS to Zika

AIDS, cancer, climate change and the Zika virus are global problems with serious ethical considerations for Florida’s health care professionals. Accessing scarce medical resources, providing screening services for large populations and making end-of-life decisions add to the list of issues that continue to challenge if not bedevil contemporary health care systems.

A distinguished group of national clinicians, researchers and policymakers took a close look at these and related questions at “Florida Ethics: Debates, Decisions, Solutions,” an April 8 conference sponsored by the University of Miami Miller School of Medicine’s Institute for Bioethics and Health Policy and the Florida Bioethics Network (FBN).

“Our goal was to examine some of the thorniest ethical and legal issues facing our state’s health care professionals,” said institute Director Kenneth W. Goodman, Ph.D., who is also Director of the FBN and Co-Director of the university-wide UM Ethics Programs. “This was our 24th annual conference, and we always try to keep the program fresh and exciting.” The program is believed to be the oldest and largest community bioethics conference in the nation.

About 300 professionals and students from throughout Florida attended the conference, which was supported by a score of regional health care institutions led by UHealth and affiliated hospitals, the Jackson Health System and the Miami VA.

In her talk, “Climate Change and Bioethics,” a rare exploration of links between environmental ethics and bioethics, Robin N. Fiore, Ph.D., a voluntary faculty member at the institute, asked the question, “Are the benefits of industrialization and the burdens of climate change shared equitably?”

Citing the 2014 Intergovernmental Panel on Climate Change, she said the answer is no.

“Climate change will disproportionately affect the health of vulnerable populations – especially children, the elderly, and the poor,” she said. “So, the most vexing ethical issues connected with climate change are those of justice, fairness and equity.”

Adriane Gelpi, Ph.D., M.P.H., who is also on the faculty of the institute, as well as the Miami Institute for the Americas and the Department of Public Health Sciences, focused on Latin American populations in her presentation on “AIDS to Zika: Ethics of Setting Priorities in Public Health.”

Gelpi emphasized the importance of community engagement in setting health policy priorities.

“Although Zika represents a new threat to the region, past outbreaks of infectious diseases offer insights for public health ethics on how society should confront similar public health emergencies,” she said. “We now have an opportunity to do things better by engaging more stakeholders.”

Tracey L. Christner, Executive Director of Clearwater-based Empath Choices for Care, provided an update on prospective legislative support for adoption of Florida Physician Orders for Life Sustaining Treatment (POLST), part of a national initiative to improve end-of-life communication between physicians and patients. She said a statewide summit is being planned in Orlando this summer to develop a plan for the next session of the Legislature in 2017.

“The heart of the POLST paradigm is a structured conversation among patients, surrogates and health care providers about treatment options, potential outcomes, goals of care and patient values,” she said. “Since Florida has the largest proportion of people who are 65 years or older among the 50 states, it is an obvious candidate for POLST.” Indeed, UM and Jackson hospitals are among the first in Florida to adopt the POLST process.

Thaddeus Mason Pope, director of the Health Law Institute and professor at Mitchell Hamline School of Law in Minnesota, looked at a related question: “When May/Should/Must a Clinician Write a DNAR Order Without Patient or Surrogate Consent?” He said conflicts over Do Not Attempt Resuscitation (DNAR) orders are disturbingly common, and clinicians and surrogates should try to reach an agreement on the appropriateness of continuing life-sustaining medical treatment.

Speaking on “Cancer Care and Research in the 21st Century: Why Ethics Matters,” Otis Brawley, M.D., said the nation’s success in fighting cancer has not been shared equally throughout the country.

“There are disparities by race and socioeconomic status as well as disparities by state of residence,” said Brawley, who is chief medical officer at the American Cancer Society. “There is also an increasing need for evidence-based medical practice. For example, some screening tests make a profit for health care providers, but are less certain to benefit the patient.”

Ray Moseley, Ph.D., from the University of Florida College of Medicine’s Program in Bioethics, Law and Medical Professionalism and the founder of the Florida Bioethics Network, discussed the role of hospital-based ethics committees in his talk, “Proper Feeding and Watering of the American Ethics Committee.” He noted that ethics committees can play a key role as consultants in patient-related ethical and legal matters.

The UM-based Florida Bioethics Network is dedicated to the understanding and resolution of ethical and legal challenges arising in health care and biomedical research in Florida’s hospitals, hospices, nursing homes, managed care organizations and teaching institutions.

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