Ethics for Lunch: Decision Making for Incapacitated Patients with and without Surrogates
525 N. Wolfe Street
Baltimore, MD 21205
The Johns Hopkins Hospital Ethics Committee &
The Johns Hopkins Berman Institute of Bioethics
Lunch will be provided. RSVPs are not required, please email Anna Adelman with any questions
PANELISTS
Moderator
Mark T. Hughes, MD, MA
Panelists
Nasreen Bahreman, PhD, MSN
Caitlin McGeehan, RN, BSN
Mollie Selmanoff, LCSW-C, CCM
Amy Shane, JD
H.G. is a 65-year-old woman with a history of HIV/AIDS, Hepatitis C, and emphysema with bullous changes noted on CT scan and on chronic supplemental oxygen 2 liters by nasal cannula. She is admitted with hypoxic respiratory failure requiring High Flow Nasal Cannula oxygen in the setting of COVID-19 infection. She is admitted to the Medical Intensive Crae Unit due to concerns for developing Adult Respiratory Distress syndrome (ARDS). She lacks decision-making capacity and does not have an advance directive. A surrogate decision maker needs to be found to make decisions about mechanical ventilation and cardiopulmonary resuscitation.
In this Ethics for Lunch, we will explore how decisions to start, withhold, or withdraw life-sustaining treatments are made depending on what kind of legally authorized healthcare decision maker (LAHD) is designated to make decision on behalf of a patient. We will also explore a proposal currently before the Maryland legislature to have a hospital-based committee make surrogate decisions when no family or friends are available to serve as LAHD.
Objectives
- Discuss the different kinds of legally authorized healthcare decision maker.
- Differentiate decisions that can be made by a health acre agent compared to a surrogate decision maker.
- Explain the guardianship process
- Define a certifying condition and why it matters in Maryland for making decisions to withhold or withdraw life-sustaining treatment.
- Describe the proposal for an interdisciplinary hospital surrogate committee for incapacitated, unrepresented patients.