Underwriting Ethics: The Foundation of Health Care
Imagine this situation: An 81-year-old man with a complex medical history, including congestive heart failure, dementia, and end-stage lung disease, has been admitted to the intensive care unit due to pneumonia. The medical team strongly believes that he will not recover, and there are no interventions that will reverse his decline. The patient lacks capacity to make decisions, and his family is adamant that his pneumonia and other conditions be treated aggressively. Is the medical team morally obligated to accept the family’s decision? What if there is disagree-ment among the family members? This is the kind of case study that Dr. Bill Nelson, an associate professor at the Geisel School of Medicine, likes presenting to medical students.
Bill, a national leader in health-care ethics, recently made a gift of real estate to the Geisel School to establish the Health Care Ethics Program Endowment. His is the first gift to what he hopes will become a robust fund to provide enduring support for “one of the core ingredients of medical education and training,” he says. “I don’t see ethics and humanities education as just window dressing,” says Bill. “A physician might be competent at treating a patient’s damaged heart muscle, for example, but how does he or she talk to a patient in a way that avoids paternalism, respects a patient’s autonomy, and engages them in shared decision-making? All those aspects of patient care are grounded on ethical principles.”
Students are eager for such training, too. Regular meetings and events hosted by Geisel’s ethics interest group, for which Bill is the faculty advisor, attract dozens of students from across Dartmouth, not just medical students.
Bill’s work also goes beyond individual patient-caregiver relationships to focus on ethics as the bedrock and guiding structure for health-care organizations and systems of care. In addition to teaching courses in Geisel’s MD program, at The Dartmouth Institute for Health Policy and Clinical Practice, and in Dartmouth’s Master’s in Health Care Delivery Science program, Bill is an ethics consultant for the American College of Healthcare Executives and the former Chief of Ethics Education for the Department of Veterans Affairs’ National Center for Ethics in Health Care. The VA even has an annual award named after Bill in honor of his 28 years of promoting health care ethics in the VA.
Bill hopes that the health care ethics fund at Geisel will enable the school to create “a recognized home for the teaching of ethics, so that we can further foster and formalize the integration of ethics and humanities into the overall curriculum for medical students.”
“Ethics is the foundation and framework for high-quality, high-value care,” he says. “It’s too important to leave to chance or to the mercy of fluctuating medical school budgets, now or in the future.”