HEALTH DECISIONS
A Publication of the Vermont Ethics Network
( 64 Main St. , Room 25, Montpelier , VT 05602-2951
Telephone: 802 828-2909, Fax: 802 828-6558
Email: VEN@vtethicsnetwork.org , Website: http://www.vtethicsnetwork.org
Vol. 14 No. 1 September 2007
VEN Survey Shows Variation in AD Interpretation
New Organization Gives Voice To Vermonters Facing Difficult Medical Decisions
ADVANCE DIRECTIVE WEEK set for September 24-29.
Dr. Colin Murray Parkes, Hospice Pioneer, to appear in Burlington October 3
VSNA October 24-25 Conference to address Ethical Issues in Nursing Care
New Resource: The Bioethics Program at Union College
VENnotes
Editor’s Note: To print this newsletter go to the File menu of your browser and click “Print”.VEN Survey Shows Variation in AD Interpretation
The Vermont Ethics Network was fortunate to have the services of MPH student intern Ruofan Yao, from the Dartmouth Medical School’s Center for Evaluative and Clinical Sciences in the Spring semester of 2007. He conducted a survey of doctors and other health professionals in rural areas of Vermont and New Hampshire to see if there was a variation in interpretation of hypothetical situations involving patients with Advance Directives that were either silent or generally directive about such issues as tube feeding and other life sustaining procedures. The topic was suggested by impressions and anecdotal information that the individual state laws would have a bearing on interpretation. What Mr. Yao discovered from the over 50 responses, mostly from physicians, was that there was as likely to be variation among clinician interpretation within a region as across state borders. Another finding was that although the NH law was quite clear about not giving authority to withhold or withdraw feeding tubes if there was no specific direction in the AD, clinicians usually weighed the circumstances and the general nature of the statements in these documents as guiding decisions that needed to be made. While clinicians on both sides of the border were generally familiar with their own state’s law about Advance Directives (over 90%), fewer than one in five was aware of the provisions of the neighbor state’s law.
Variations in specificity can have a large impact on treatment decisions. People who have specific feelings about having or not having feeding tubes in place under certain circumstances would be well advised to express this in their ADs. Even if one is ambivalent but wants one’s agent to be able to make such a choice, that should be indicated on the document as well, particularly if treatment might be provided in a New Hampshire hospital. Otherwise the agent will not have such authority.
Those wanting a copy of Mr. Yao’s paper may contact the VEN office to receive either an emailed or hard copy.
New Organization Gives Voice To Vermonters Facing Difficult Medical Decisions
Vermont patients and families facing life-threatening and serious chronic illness have a new resource to help them through the difficult process of deciding what kind of medical care is right for them. V.O.I.C.E.S., the Vermont Organization for Informed Choices, Education, and Support, is a statewide non-profit network of medical professionals, facilitators, knowledgeable laypeople and trained volunteers that offers seriously ill patients and those close to them the time, focused attention and continuity of support that hospitals and providers often cannot. V.O.I.C.E.S.’ mission is to give patients and their families the information and support resources they need to make care choices that are thoroughly informed and grounded in the their own needs and values.
Initially, V.O.I.C.E.S. will focus its efforts on bringing 1-on-1 decision guidance to patients across the state using evidence-based decision aid tools and in-person or telephone-based support. Neutral but supportive facilitators will help them to understand the nature of the decisional tasks before them, clarify their informational needs, recognize the roles of the various participants in the process and identify the values that matter most to them in choosing among the medical options. They will also offer information about how to approach decision-making, how to communicate questions, values and goals effectively and how to navigate in a medical environment that may be completely foreign. Family members and surrogate decision-makers will be supported as well. Longer term, V.O.I.C.E.S. plans to make available a 24/7 decision support “hotline” and other services.
For more information, contact Gerhild Bjornson, PhD, MD, MSc at (802) 862-8626. email: gerhildbjornson@yahoo.com , or Cathy Suskin at (802)279-0855 or by emailing her at cathy@suskin.com .
To TopADVANCE DIRECTIVE WEEK set for September 24-29.
It is anticipated that Governor Douglas will be signing a Proclamation designating the week of September 24-29 as “Advance Directive Week in Vermont”. The text of the Proclamation that will be available once the Governor has signed it is expected to emphasize the importance of the newly available Vermont Advance Directive Registry managed through the Vermont Department of Health. VEN has a grant from VDH to assist in local promotional activities and workshops explaining the Registry and its benefits. Already a number of sessions have been planned for this Fall at libraries, senior centers and other locations. Available since February of 2007, the latest count of the number who have registered (as of August 17) is 570. To assist in promoting this service a brochure is being developed jointly by VEN and VDH that should be available by the end of September. Information is also available on the Vermont Advance Directive Registry website at the Dept. of Health: www.healthvermont.gov/vadr
To set up local workshops or information sessions on Advance Directives and use of the Registry, contact VEN at (802) 828-2909. A one-hour video presentation of a workshop led by John Campbell, VEN’s executive director, at the Montpelier Senior Center on June 14, 2007 is available for loan to groups that want to use this format in place of a “live” presentation. If this is the preferred format, it is recommended that other helpers be present for at least a half hour following the workshop to answer questions or give one-on-one help and support to people who want to do their Advance Directives there. If there is a program already set up in your area (see the list at the end of this newsletter) you may wish to attend one of these.
Dr. Colin Murray Parkes, Hospice Pioneer, to appear in Burlington October 3
A community presentation by internationally renowned bereavement scholar Colin Murray Parkes, OBE, MD, FRCPsych, followed by a panel discussion "Loss in Our Community: Reflection, Response and Renewal," moderated by Robert Macauley, MD, Medical Director of Clinical Ethics at Fletcher Allen Health Care and the University of Vermont College of Medicine. Doubletree Hotel, South Burlington 7 p.m. Presented by the Madison-Deane Initiative of the VNA in partnership with Fletcher Allen Health Care and the University of Vermont. The event is free and open to the public. For more information, please call 860-4419 or visit www.vnacares.org . (See VENnotes for training conference the next day.)VSNA October 24-25 Conference to address Ethical Issues in Nursing Care
The Vermont State Nurses Association (VSNA) has announced their program for a two day conference at the Capitol Plaza Hotel in Montpelier on October 24-25, 2007: “Ethical Issues and Quality of Care in Today’s Health Environment”. The conference will begin with a free evening presentation co-sponsored by the VSNA and the Vermont Medical Society at 7 pm on October 24 at the Capitol Plaza in Montpelier by Vermont journalist and author Steve Kiernan entitled: “Vermont’s Next Mission, Better End of Life Care.” The all-day Program on the 25th will begin with registration at 7:30 am followed by a keynote address by Dr. Ira Byock, Director of Palliative Care at Dartmouth Hitchcock Medical Center. He will also participate in a session of small group discussions on Ethical Questions. The afternoon will offer four breakout sessions: The ANA Code of Ethics, How to Protect Your License When Ethical Issues Arise, The National Database of Nursing Quality Indicators, and Ethical Issues in Elder Care. A registration form is available at: www.vsna-inc.org or, for more information, call (802) 851-8886 or 1-800-540-9390.New Resource: The Bioethics Program at Union College
Union Graduate College in Schenectady, NY has announced a new distance learning and joint degree program. The following notice was received from Joanne Fitzgerald, VP for Enrollment Management:
Union Graduate College and the Mount Sinai School of Medicine (NYC) Form THE BIOETHICS PROGRAM
On February 26, 2007, the Boards of Trustees of Mount Sinai School of Medicine in New York City approved a partnership with Union Graduate College to jointly offer degrees and certificates in The Bioethics Program. The joint degree program will officially be known as The Union Graduate College-Mount Sinai School of Medicine Bioethics Program, but it may be abbreviated as The Bioethics Program. The Bioethics Program's mission is to provide quality professional graduate education in bioethics for those unable to participate in campus-based programs because of the demands of work or obstacles of distance. The dual degree programs in law, philosophy, and social work offered by Union Graduate College with Albany Law School, The University at Albany/SUNY and the School of Social Welfare/SUNY will continue to be offered by The BioethicsProgram.
For additional information on The Bioethics Program, contact Ann Nolte, Assistant Director, at bioethics@union.edu or 518-388-8045.
To TopVENnotes
Upcoming events around the State include the following (in addition to those already mentioned):
Sept. 5 - AD workshop including information about the new VT Advance Directive Registry at the Blake Memorial Library in E. Corinth. Participants will view a DVD of VEN Exec. Dir. John Campbell’s presentation to an earlier workshop in Montpelier in June. For more information, call Marie at the Library at (802) 439-5338.
Sept. 15 (Saturday) – SEVCOA “Caregivers Conference” in Springfield, VT at the Nolan Murray Center from 9 AM to 1 PM will feature a midmorning workshop on ADs and the VADR led by John Campbell and Dr. Ray Walker.
Sept. 24 - ADVANCE DIRECTIVE FAIR at RRMC in Rutland (Leahy Conference Center) from 1 – 4 pm is free and open to the public and includes one on one assistance provided by hospital social workers.
Sept. 25 - Staff AD awareness day at CVMC (materials and consultation provided to all shifts during the day in the hospital cafeteria); followup day is planned for October 2.
Sept. 27 – Brownell Public Library 6 Lincoln St. in Essex Jct. - AD workshop led by John Campbell and volunteers at 3 PM. For more information call (802) 878-6955
Sept. 27 - Rawson Memorial Library in Jericho – AD workshop 6:30 pm
Oct. 2 - Winooski Senior Center - Noon AD workshop led by John C. and vols.
Oct. 3 - Georgia Public Library - AD workshop 2pm For more info call Sue at 524-4643.
Oct. 3 - Dr. Colin Murray Parkes at the Doubletree in S. Burlington – 7 PM. (see next item)
Oct. 4 - MDI Conference: “Teachable Moments: Companioning Children and Teens through Loss and Grief” - Wyndham Hotel, Burlington – 7:30am –3:40pm featuring Dr. Parkes and four other faculty presenters. Registration information: Call Sue Leonard at MDI (VNA) at 1-866-293-8200 or register online at www.vna-vermont.org
Oct. 4 - Platt Memorial Library – Shoreham – AD workshop at 4 pm For more information call Renee at 897-2647.
Oct. 6 - Aging in Place Health Fair… Montpelier Senior Center 9-3pm featuring many exhibitors, door prizes and a special table on the VT AD Registry.
Oct. 22 – Rural Ethics Network Fall Meeting at DHMC from 10 – Noon. Agenda being developed but will include discussion of shared decision making and other patient and family support in critical care situations. (Other suggestions – contact VEN). Note this precedes the Biannual DHMC meeting of the NH/VT Hospital Ethics Committee Network and will be in Auditorium E at the DHMC Conference Center.
Oct. 24-25 - VSNA Conference on Ethics and Quality Care (see HD article).Last year VEN printed the “Long Form” version of the Advance Directive that is the complete version in the Vermont Dept. of Health Rules (also on the VDH and VEN websites) but there has been little interest on the part of health organizations or others in ordering multiple copies. To reduce our inventory, we are going to make boxes of 180 forms available from now until October 1, 2007 at the low one-time price of $50 per box plus $10 shipping. If you interested in ordering one give us a call at 828-2909. Individual mailed copies of the Long Form will still be provided at $2 apiece. For other forms that address specific situations or the needs of specific populations, visit the VDH website at www.healthvermont.gov/vadr
Check out website for up to date calendar listings. www.vtethicsnetwork.org
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Health Decision and VEN InformationBOARD OF DIRECTORS: Patrick McCoy, chair; M.Teena Flood; Cathy Frank, Judy Cohen, RN PhD; Betsy Davis, RN MPH; Christine Graham, Marilyn J. Hart, MD; Robert Johnson; Steve LaRose; Daria Mason; Rev. Denise Niemira, MD; Robert Opel; Louise Rauh; Kevin Veller
HONORARY BOARD MEMBERS: Arnold Golodetz, MD; Michelle Champoux; James L. Bernat, MD; Jean Mallary; Marge Trautz
STAFF: John Campbell, Executive Director; Jim Mullally, Staff Assistant
Health Decisions is a publication of the Vermont Ethics Network, Inc., a non-profit, tax-exempt organization
dedicated to promoting public dialogue about ethical issues and choices in health care.Vermont Ethics Network
64 Main St., Room 25
Montpelier, VT 05602-2951
Telephone: 802 828-2909, Fax: 802 828-6558
Email: VEN@vtethicsnetwork.org
Website: www.vtethicsnetwork.org
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