Who can help isolated seniors with dementia or cognitive impairments to make decisions about their care? What are the complicated ethical issues that doctors face in aiding their patients to die? When it comes to medical treatment what does “do no harm” mean? These are just some of the thorny questions that have been raised by the San Francisco city-wide Bioethics Forum convened by Seniors At Home.
As a leader in the field, Seniors At Home brings local experts together to discuss the tough ethical issues that arise in senior and palliative care. Seniors At Home, part of JFCS, is known for providing the most innovative and thoughtful care to clients throughout the Bay Area, and the Bioethics Forum helps to make that possible.
So what is Bioethics?
Bioethics is the application of ethics to the field of medicine and healthcare. The philosophical questions asked are typically linked to the ethical dilemmas that emerge with advances in medicine. For example, “What is the ‘right’ thing to do in this situation?” is a common question asked in bioethics, and often there are no black and white answers.
The Bioethics Forum
The San Francisco Bioethics Forum is a quarterly gathering of professionals that began over 15 years ago. The forum serves as an important place for professionals to come together, present cases and questions, and discuss the difficult issues that arise from working with clients who are un-befriended, sick, or have little capacity to make their own decisions.
Redwing Keyssar, RN, Director of Palliative Care, at Seniors At Home says, “The purpose of this forum is to have the time and space to discuss tough ethical issues. It gives us all context to our work and helps us give better care to our clients. As experts in different fields we get to share ideas and strategies together, to help understand what it means to ‘do no harm.’”
Forum members come from UCSF Medical Center, Kaiser Permanente, Laguna Honda Hospital, Adult Protective Services, the Probate Court, Fiduciaries, and many senior service organizations, and work in an array of fields including: geriatric medicine, palliative care, home care, end of life care, and assisted living. Participants include doctors, lawyers, social workers, therapists, case workers and psychologists, along with graduate students and others interested in delving into the complicated issues which arise when people are facing serious life transitions, illness, cognitive impairment, and/or death and dying.
One of the San Francisco Bioethics Forum organizers, Eileen Goldman, LCSW, notes that Albert R. Jonson, PhD—the well-known biomedical ethicist and author—attended meetings when the group was first organizing, and provided support and education to the group regarding the bioethics model of inquiry. The structure and the ethical framework that Jonson shared still inform many of the meeting discussions. The principles considered when discussing client issues are: autonomy, beneficence (action that is done for the benefit of others), nonmaleficence (do no harm), and justice.
Aid in Dying
The topic of the most recent Bioethics Forum was “Aid in Dying”. On this evening, five group members gave short presentations on one aspect of assisted suicide: family/caregiver concerns, medical implications, psychosocial concerns, spiritual implications, and a case example. Goldman says, “In our meetings we often find that we want to start solving problems right away and we jump right to strategy. We are training ourselves to slow down and examine the ethical issues rather than the practical problem solving.”
A robust and often existential discussion about what is a “good” death brought many interesting insights and perspectives. Dr. Patrick Arbore from the Center for Elderly Suicide and Prevention, Institute of Aging, said, “Talking about these issues with peers can be really challenging.” He, and many other participants, expressed their appreciation for the time and space to examine such a profound subject in a thoughtful and non-judgmental way.
If you are a professional interested in learning more about Seniors At Home’s Bioethics Forum contact Traci Dobronravova at tracid@jfcs.org.
