March 26, 2012

Medical ethicist to discuss patient decision-making

by Pete Rosenbery

CARBONDALE, Ill. -- A leading medical ethicist will examine the pivotal role that health care providers play in a patient’s decision-making process during a lecture at Southern Illinois University Carbondale.

Rebecca Susan Dresser will present the 2012 John & Marsha Ryan Bioethicist-in-Residence lecture at the Southern Illinois University School of Law Center for Health Law and Policy.

Dresser will present “When Seriously Ill Patients Make Bad Treatment Decisions,” at 5 p.m., Wednesday, March 28, in the Hiram H. Lesar Law Building courtroom.  The lecture is free and the public is welcome to attend.

Media Advisory

Reporters, photographer and camera crews are welcome to cover the lecture. Dresser will be available to speak with the media at 4:30 p.m., March 28, prior to the lecture. To make arrangements for interviews or for more information on the lecture, contact Alicia Ruiz, the law school’s director of communications and outreach, at 618/453-8700.

Dresser is the Daniel Noyes Kirby Professor of Law and a Professor of Ethics in Medicine at Washington University in St. Louis.  She is also the editor of and contributor to “Malignant: Medical Ethicists Confront Cancer,” a book published earlier this month that looks at how medical ethics experts confronted the myriad of questions and decisions that arose during their own cancer treatment or that of a family member.

“We are so fortunate to have Professor Dresser serve as this year’s Ryan Bioethicist,” said Cynthia L. Fountaine, dean of the SIU School of Law.  “She is an incredibly accomplished scholar and teacher in the field of bioethics.  I expect that her public presentation, which looks at treatment decisions made by seriously ill patients, will be illuminating for a broad audience.  Everyone who treats, advises, or cares for people with a serious illness, as well as individuals who are or will be faced with their own treatment decisions, can learn from Dresser’s experience, which includes her own battle with cancer.”

In the book, Dresser, who has taught bioethics and related topics to law and medical students for nearly 30 years, recounts a decision she faced during cancer treatment six years ago.  She writes about a radiation treatment and intensive chemotherapy regimen that made eating difficult, and her desire to avoid a feeding tube.

When the feeding tube possibility arose, Dresser was already being subjected to many medical interventions.  She wanted to avoid yet another medical procedure that would intrude on her life and body.  But this treatment refusal was a bad choice on her part.  She lost a lot of weight, which further jeopardized her health.

Dresser finally agreed to the feeding tube after arriving at the cancer center in a very weakened condition and seeing the concern on the faces of medical staff and her family caregiver.

Dresser writes that respect for “patient autonomy is a major, if not the major, theme in bioethics.” Beginning in the 1970s, bioethicists promoted a “new model of shared decision-making” in which patients have more control over their treatment options.  While few want to return to “physician paternalism,” Dresser writes that this “new regime is imperfect as well.”

Dresser describes her treatment refusal as “an irrational medical choice.”  Irrational treatment choices come in forms that include refusing treatments that will likely prevent more serious complications, denying the severity of an illness, and harboring an unfounded fear of medical intervention.

Dresser writes that her own experience taught her “how poorly prepared I was for making important medical decisions.”  Among the lessons learned for patients, family caregivers and clinicians is that “patient autonomy can be a challenging business.”

“Even the most educated and savvy patients facing serious medical decisions may not be very good at applying their values and preferences to this new kind of choice,” she writes.  “Patients should recognize their lack of expertise and be more receptive than I was to what clinicians have to say.”  Patients also need to listen to what close friends and family say about their choices.

Dresser thinks that it is also important to remember that “medical decision-making occurs over time,” and that a medical decision made at one time can be revisited in many treatment situations.

Dresser believes that “respect for patient autonomy does not require outright acceptance of every patient choice, but not all clinicians realize this.”  Clinicians can confuse shared decision making with “a no-questions-asked approach,” she writes.

“For whatever reason, it seems … that the patient autonomy movement has had the unfortunate consequence of inhibiting fruitful conversation about the choices patients make,” she writes.

Law Professor W. Eugene Basanta, the Southern Illinois Healthcare Professor of Law, said the stress that seriously ill patients feel for themselves and those around them can impact their decisions.  It is important for health care providers to engage in meaningful dialogue, he said.

“Health care providers have a role in helping their patients clarify their goals, and understand what the implications of their decisions in relationship to their goals are,” he said.  “It’s the patient’s choice in patient-centered decision making.  But you want to help them make choices that are consistent with their goals and desires.”

Dresser earned her law degree from Harvard University. After law school she was awarded a National Institutes of Health fellowship in law and psychiatry, and worked with people teaching medical ethics.  She taught medical ethics at both Baylor College of Medicine and Case Western Reserve University before coming to Washington University, where she holds joint positions in the university’s medical and law schools.

This is the eighth bioethicist-in-residence lecture, and the sixth since John G. and Marsha C. Ryan endowed the visiting lecture series.

Founded in 2006, The John & Marsha Ryan Bioethicist-in-Residence supports an annual residence and lecture by a law or medicine ethics scholar for the SIU schools of law and medicine. The selected presenter visits classes at both schools and organizes interdisciplinary educational activities for students, residents and faculty. The presenter also interacts with students and offers a public lecture on the scholarship as it relates to law and medicine.

The lecture “is a very important part of our program,” Basanta said.  “If you look at the people we’ve had, there have been outstanding professionals from around the country here to meet with our students, faculty and public.”

It is also important that the bioethicist-in-residence also see the work at the University, the law school, and the medical school, Basanta said.

“It’s particularly appropriate they are in Carbondale and Springfield to see the full range of the medical and legal programs we offer,” he said.