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An Interdisciplinary Ethics Panel Approach to End-of-Life Decision Making for Unbefriended Nursing Home Residents
Howard J Finger1, Cheryl A Dury2, Giorgio R Sansone3
1Attending Physician in the Department of Medicine at Coler Rehabilitation and Nursing Care Center in Roosevelt Island, New York USA. howard.finger@nychhc.org.
The Journal of Clinical Ethics
|June 22, 2022
Summary
An Interdisciplinary Ethics Panel (IEP) approach improved advance-care planning and palliative care for nursing home residents with life-limiting illnesses. This ethical framework supports quality of life for vulnerable populations at end-of-life.
Area of Science:
- Medical Ethics
- Geriatric Care
- Palliative Medicine
Background:
- Ethical decision-making for unbefriended nursing home residents with advanced life-limiting illnesses presents significant challenges.
- Optimizing quality of life and avoiding non-beneficial treatments are critical at the end of life.
- Lack of decisional capacity and surrogate decision-makers complicates care planning for this vulnerable population.
Purpose of the Study:
- To evaluate the efficacy of an Interdisciplinary Ethics Panel (IEP) approach in end-of-life decision-making for unbefriended nursing home residents.
- To assess the impact of a nine-step algorithm designed to guide ethical decisions for this population.
- To determine if the IEP approach promotes advance-care planning and palliative care.
Main Methods:
- A retrospective review of three quality-of-care initiatives (June 2016-February 2020) at a New York City public nursing home.
- Application of a nine-step algorithm by an Interdisciplinary Ethics Panel (IEP) for end-of-life decision-making.
- Analysis of outcomes including advance-care planning rates and palliative care enrollment, including during the COVID-19 pandemic.
Main Results:
- The IEP approach successfully promoted advance-care planning and the endorsement of palliative measures to enhance quality of life.
- Application of the IEP during the COVID-19 pandemic for residents with surrogates also improved advance-care planning rates.
- The initiative led to increased enrollment in the Palliative Care Program.
Conclusions:
- The novel Interdisciplinary Ethics Panel (IEP) approach, guided by a nine-step algorithm, is effective in improving end-of-life care for nursing home residents.
- This ethical framework supports advance-care planning and palliative care, optimizing quality of life for vulnerable populations.
- The IEP model demonstrates potential for broader application in similar healthcare settings after careful assessment.
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