NYCLTCEN CLOSES 1999

WITH BEST-RATED CONFERENCE TO DATE!

Recently, organizational ethics and corporate compliance has been the topic of focus by such organizations as the Joint Commission on Accreditation of Health Care Organizations and the Department of Health and Human Services and on December 14th, the day prior to the threatened transit strike, the New York City Long-Term Care Ethics Network hosted a conference entitled Organizational Ethics and Moral Integrity: Whose Responsibility Are They? Organizational ethics covers more than simply legal compliance; it involves all the complicated ways in which decisions made by complex medical institutions delivering interdisciplinary care ultimately impact the lives of residents in long-term care facilities.

The objectives of the twelfth conference presented by the Ethics Network and co-sponsored by Fordham University Graduate School of Social Service, Ross Products Division•Abbott Laboratories, and The Journal of Clinical Ethics were to explore the importance of organizational ethics in long-term care, to explain organizational ethics as a practical and critical concern for staff in all areas, and to assist ethics committees to deal with new educational, policy-making, and case consultation responsibilities in the area of organizational ethics.

Dr. Carol Taylor delivered the keynote address entitled Organizational Ethics: Practical Considerations. Dr. Taylor is an ethicist and the Senior Research Scholar, Center for Clinical Bioethics and Kennedy Institute of Ethics and an Assistant Professor of Nursing at Georgetown University. She lectures and writes on various issues in healthcare ethics and serves as an ethics consultant to systems and professional organizations. Her keynote address was cited by the conference attendees as one of the highlights of the conference and a summary can be found in this newsletter.

A plenary session entitled Organizational Ethics from the Boiler Room to the Board Room: Creating Moral Space in the Workplace followed. Catherine Seeley, MA, Director of Bereavement Services, and former co-chair of the Patients' Rights and Organizational Ethics Committee, Calvary Hospital, Bronx, New York, discussed the work that was being done at Calvary Hospital and mentioned that an article is being published in The Journal of Clinical Ethics. The article, which can be found in volume 10 of the Fall 1999 edition of the Journal, is called Integrated Ethics: Synecdoche in Healthcare. Volume 10 is a special issue that is devoted to the topic of organizational ethics and a list of the articles appearing in this journal can be found on the NYCLTCEN website at: www.angelfire.com/on/ NYCLTCethicsnetwork/jce.html.

Concluding the conference was a multidisciplinary panel discussion of four case vignettes involving organizational ethics issues. The moderator of the panel was Linda Farber Post, JD, BSN, MA, Bioethics Consultant, Division of Bioethics, Montefiore Medical Center, and Assistant Professor of Bioethics, Albert Einstein College of Medicine, Bronx, NY. The following panelists participated in the panel discussion: Bonnie Burke, LNHA, MS, Assistant Administrator, Frances Schervier Home and Hospital; Ann Callaghan, RN, CNAA, MA, Director of Nursing, Ozanam Hall Nursing Home; Mark J. Kator, President and Chief Executive Officer, Isabella Geriatric Center; Ann E. McDermott, CSW-R, BCD, CCM, Director of Social Services, and Chair of Ethics Committee, Isabella Geriatric Center; Jeffrey Nichols, MD, NYCLTCEN Co-Director, Medical Director, Cabrini Center for Nursing and Rehabilitation, and Chief of Geriatrics, Cabrini Medical Center; and Rabbi Harold Stern, Director of Spiritual Care, and Chairman of Bio-Ethics Committee, Daughters of Jacob Geriatric Center. Sincere thanks to all the speakers at the conference for helping to make the conference a success.

One of the more interesting case vignettes discussed by the panelists was:

Mr. P. was admitted to Pagan Memorial SNF two years ago after successful coronary bypass surgery. He is a long- standing insulin dependent diabetic with poor vision, two minor past strokes, and moderate memory impairment, which has been variably attributed to his vascular disease and the anesthesia. He is oriented to person and place but not time. He can walk up to three blocks with his cane. He requires SNF placement because of his poor judgment, his complex medical regimen including twice daily insulin injections which he is unable to administer himself, and his unstable cardiac status.

Mr. P. was a lifelong petty thief, with a history of multiple arrests (information not included on his PRI) using the funds to live in his SRO and drink to excess. He has no involved family. He greatly enjoys his brief walks in the neighborhood around the Home, asserting that when he can't got out he feels like he is back in prison. Staff originally encouraged these walks, from which he always returned without incident, until they began to notice all the new items in Mr. P's wardrobe, his abundant supply of magazines, snacks, small items of jewelry, etc. He now offers to sell many of these, some in their original wrappings, to visitors and staff.

Some staff feel the Home has a moral obligation to provide local merchants with Mr. P's picture and a warning about his habits. Others feel this is a violation of confidentiality. A few suggest Mr. P. should not be allowed to go outside of the grounds and others suggest this will just lead to an epidemic of missing objects in the Home.

What are the organizational ethics issues? If this were your case what would you do?

The conference was attended by 75 long-term care professionals and students from 41 different facilities, with people coming as far away as Philadelphia and Washington, DC. The conference managed to draw a very respectable audience despite the torrential rains on the 14th and the fact that the topic of the conference may have been viewed as one geared mostly for administrators, even though organizational ethics is everyone's business. As one of the NYCLTCEN board members said, "... it is very difficult to interest lower and middle level health care managers in the moral and ethical concerns of their respective work environments [because] ... they feel powerless to cause any kind of change at the upper ends of management and they have little energy left to learn about, proselytize, or implement the necessary changes in behavior and comportment a moral and ethical environment requires."

This conference received very favorable ratings with 91% of the conference attendees rating the keynote address as Excellent or Very Good; 97% rating the plenary session as Excellent, Very Good, or Good; and 94% rating the panel discussion as Excellent, Very Good, or Good. The overall rating for the last conference of 1999 was the Ethics Network's most highly rated conference to date with 91% rating it as Excellent, Very Good, or Good. Special thanks to the members of this particular conference's planning committee: The Rev. James Gardiner, SA, chair, Bart Collopy, PhD, Margaret Flint, JD, Beverly Lyons, PhD, RD, Paulette Sansone, PhD, CSW, and Susan Rosendahl-Masella, PhD. We also appreciate the assistance we received from Ms. Janet Mackel and Dr. Elaine Congress from Fordham University in helping to set up the conference.

If you were not able to attend the conference but are interested in obtaining some up-to-date information on organizational ethics, please log on to the NYCLTCEN website where you will find a reference list and some on-line articles. The NYCLTCEN homepage is at: https://www.angelfire.com/on/NYCLTCethics network/index.html

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