Transparency And Ethics In End Of Life Care [Interview][Transcript]

Dawn_Ann_Farnin_Healthcare_Ethicist
Guest: Dawn Ann Farnin
Presenter: Neal Howard
Guest Bio: Dawn Ann Farnin is a Health Care Ethicist located in Orange County, CA. She earned a Master of Science degree in Health Care Ethics from Creighton University School of Medicine with a discipline in end of life care. She currently works in her community in an effort to introduce and implement Ethical standards of care related to transitional treatment of terminally ill patients.

Segment overview: Dawn Ann Farnin discusses transparency and honesty as important aspects of smooth transitional health care.



Transcription

Health Professional Radio

Neal Howard: Hello and welcome to Health Professional Radio. I’m your host Neal Howard, so glad that you could join us again today. In studio today we’re talking with returning guest Dawn Ann Farnin, a Health Care Ethicist working in Orange County California. And she’s working in her neighborhood to introduce and implement ethical standards of care related to transitional treatment of terminally ill patients. How are you doing today Dawn Ann?

Dawn Ann Farnin: Good. How are you Neal?

N: I’m doing very well. Thank you so much for returning to talk with us again.

D: It’s great to be here again.

N: Great. When you were here in another segment, we talked a little bit about your role as a Health Care Ethicist. Many of our listeners may not have heard that segment, so I’d like to once again find out what exactly is your role as a health care ethicist?

D: Well what I tell people I do is I help them morally negotiate and facilitate conversation that deal with ethical dilemmas or moral dilemmas related to healthcare situations that they might be and related to end of life care and treatment.

N: When we’re talking about moral dilemmas, ethical dilemmas sometimes morality is skewed when it comes to the point of view of the healthcare provider versus the point of view of the terminally ill patient versus the point of view the family of the terminally ill patient. It seems to be a soup of complication when it comes to morality. Morality being related to belief in what is right and what is wrong. Sometimes when morality is skewed and damage has been done and one might determine that this damage is morally wrong, what steps can be taken to repair the damage if that is even possible? When it comes to end of life care in someone’s for lack of a better term putting their foot in their mouth or totally turning their back on someone once they realize they’re terminal.

D: Well it’s an excellent question and I spent quite a bit of time discussing that because mistakes are made in medicine and mistakes are made in healthcare. And listen, all of us understand that, it’s just the way the world runs. The problem I have as an ethicist is that in the healthcare profession those mistakes are not discussed. They’re discussed behind the walls of hospitals but they’re not discussed with a lot of transparency. And I take issue with that because to me in order to have better communication, have a better healthcare system, have better healthcare outcomes just to improve the entire healthcare system there has to be more transparency. So when these mistakes occur and they can be anywhere from a small mistake to a large mistake, I believe they need to be disclosed and discussed with the person it happened to – the family or the care givers or the people around them and the treatment team. So instead of just the treatment team talking about it behind closed doors, I believe the person who has been wronged needs to be involved in that conversation. And I think what becomes very confusing is because we live in a very litigious world, so that I understand. Everybody sues for the littlest, and tiniest, and stupidest thing, that it’s actually even annoying to me because it jams the legal system for more important issues that I believe are issues such as these. Now when people are either hurt or permanently disabled or actually killed accidentally, not intentionally I don’t think any physician or health care professional will ever take a life intentionally. But it happens, because it happened to me and my family. And moral repair deals with the whole idea of making amends and there’s been several books written about it. One of my favorite authors is Margaret Walker and she wrote a book about “Moral Repair.” And basically what it is, is that in order to be able to say just “I’m sorry” you have to acknowledge what has occurred. So there has to be a conversation about “Okay this did happened” so you have to, you want to validate what happened. And then you want to make amends by being able to not, you can’t always go back and fix it like you said. But being able to say “I’m sorry” or have a conversation about “We made a mistake.” Being able to admit in morally what went wrong not intentionally, but to be able to just listen to the pain and maybe suffering that this person or persons or whatever the situation might call for, has been through. And a lot of people, in hospitals risk management a big department, I’ve worked with hospitals a long time – it’s a big department. And so they manage risk from a point of view of numbers and money, so it’s very impersonal.

N: You know when we’re talking about being able to admit a mistake and at the same time as you said living in a very litigious world. Now you’ve got the mistake, you’ve got the looming specter of legal ramifications and you also have a mixture of world view. Is it ethical to put your employer as a hospital staff in such a position and can you as an ethicist kind of smooth the way or help that process without everyone feeling the shrapnel or possible shrapnel?

D: I do believe that. Most hospitals have health ethics committees that meet monthly or some meet weekly and they discuss ethical issues related to hospital cases and that’s wonderful. And so it teaches some healthcare professionals in certain situations how to handle them better next time. That’s great too but there are certain situations and I’ll give you one that’s personal to me and I’m only giving personal examples because I don’t want to give anything out that’s confidential.

N: Understood.

D: But with my father, he ended up that he went in for knee surgery, he was supposed to be out within a day and ended up being in a hospital eight weeks having four surgeries and all this different specialist and nobody was talking to anybody and nobody was giving me answers and it was very frustrating. And he went into cardiac arrest and died five minutes before I arrived, and everybody stopped talking to me, and then they put a monitory on the hospital that nobody could talk to me. And so I couldn’t go there and get any answers or ask any questions. And 1 hospital, they’re called ‘hospitalists’ told me that “He probably left this earth because he missed your mom so much.” And I found that very insulting because first of all he didn’t know me, he didn’t know my family he knew nothing about me and he’s making an assumption and giving an answer that I found actually unbelievable.

N: It was silly. It was kind of silly hearing it, it was a very silly and insensitive statement to make such a judgment call as you say without knowing anything about the family or the person. I mean had your father come to grips with the loss of your mother, he didn’t know that. He had no idea.

D: No and what’s ironic about it was that my father fought all the time. And so they had a very acrimonious marriage, so if you knew anything about me or my family at all, that would be so far from the truth. But I guess the reason I give that example is because my first thought was not “I want to sue this hospital” and I think that’s what hospitals and healthcare professionals believe. Their first thought is “Oh shoot, this person is gonna sue.” And I understand that there are people that do that. But there’s also a lot of people I spoken with, who just want to hear somebody tell them the truth because I think that ethics is a lot about truth telling. And I do believe that healthcare professionals owe patients the truth. And if the truth is “Your dad died because somebody nipped his lung and he went into cardiac arrest, we’re sorry about what happened.” That’s all I wanted to hear, I wanted them to be accountable for their actions and I wanted somebody to stand up and say it was their fault and that they were sorry. The last thing on my mind was taking anybody to court because that’s a long drawn out process. It just didn’t cross my mind, I just wanted some compassion and I think that’s what most people want. So with “moral repair” it’s not as complicated as people think because if you take the litigious part out of it and there’s always gonna be some aspect to that because there are people that sue and a lot of times it’s for small reason or for reasons that are valid. There’s also a huge gap in between that people need to be validated and heard that there was this mistake made and that there is more transparency, and that however it happened or and whoever did it is sorry.

N: Uh huh. That there is a little bit of remorse for having made the mistake at least.

D: Yes. And … the people that I’ve spoken with that have gone through what I went through with my dad with malpractice is they just want an explanation. I mean I had actually hired an outside medical examiner to do an autopsy because they would not discuss his death. And so it took me over a year just to get the medical records and it just became a big mess and afterwards I just gave up on it, after I found out that it was egregious malpractice I thought to myself this is taking up so much of my life and sucking so much of my energy and I had so much anger because nobody would talk about it, I mean they could save all of that by just stating at the time, sitting you down in a room and at the time you’re in that moment of truthfulness and realness and just having that conversation of saying “This is what happened and we’re sorry. We made a mistake.” And I think they’d be very surprised with the reactions of most people. I just don’t think those people would head straight to court.

N: Now as we wrap up Dawn Ann, I’d like to ask you about your company DAF Health Care Proxy Facilitation. When did you start that company?

D: Well I started the company after I received my Masters in 2011. While I was going thru school I have this idea that people needed to hear a lot of this information that they didn’t know and that healthcare is such a giant. I thought this should be health care ethic should surround health care in every aspect, in every institution, in every healthcare professional. And so I thought when I received my masters degree that I would be hired by hospital within weeks and they just don’t hire them, they don’t have them, they use them occasionally maybe for consults but they want to keep all of that information in-house and that’s where a lot of these moral issues come into play because there isn’t enough transparency. If there was more sharing of information, there would be less issues and less litigious matters related directly to heathcare cases.

N: And I think that is important to point out that it’s not only sharing the information but it’s how the information is shared that can have the facility avoid a legal bombshell and offer some understanding in the way that the information is delivered. Sometimes delivering information isn’t as cut-and-dry as we think it is. It’s not what you say it, it’s how you say it. Do you believe that’s true in cases such as this?

D: Oh absolutely. And I don’t think that healthcare professionals are taught that in medical school and I do believe that they should have a course on empathy, on being compassionate. I know that they’re overloaded as being in medical school, with a courses that they take. But I do believe that using certain words and terms and being able to even hold somebody’s hand or look them straight in the eye, that’s one of the other issues is eye contact. It’s just being in a moment of being truthful and to take the oath or pledge that I will always be truthful with my patient regardless. And I believe that most healthcare professionals do that but when it comes down to like you mentioned earlier, that they report to their institution, is it taken out of their hands? Sometimes it is. And so it has to come from top down too so the transparency has to be revamped in my opinion. And that’s really what I’m trying to do is get these institutions to realize that what they think is gonna happen is not necessarily the truth.

N: Right, some absolute great information. We’ve been in studio today talking with Dawn Ann Farnin, returning guest who’s a Health Care Ethicist focused on ethical standards of care related to transitional treatment of terminally ill patients. And we’ve been here talking about some of the moral issues that healthcare providers and patients face as they approach end of life. We also have been talking about the importance of transparency. We hear a lot of about transparency in the media as it relates to politics and elections and what not but transparency and honesty and morality is just as important in healthcare. You’ve been listening to Health Professional Radio. I’m your host Neal Howard. Transcripts and audio of this program are available at hpr.fm and also at healthprofessionalradio.om.au. And you can also subscribe to our podcast on iTunes. It’s been great having you here with us again today Dawn Ann.

D: Thanks Neal.

N: Thank you so much.