Monday, March 30, 2009

24th Annual Clarke Family Medical Ethics Conference

On March 27th-29th, 2009, approximately one hundred doctors, nurses, medical students, medical ethicists, and Notre Dame undergraduates came together for our 24th annual Notre Dame Medical Ethics conference. As usual, the Notre Dame Alumni Association joined the Center in sponsoring the conference, which took place on campus at the Center for Continuing Education in McKenna Hall. The conference is designed to serve current and future medical professionals, providing them with an opportunity to join with others to reflect thoughtfully on the often complex ethical questions and problems that arise in medicine. Among medical ethics conferences, our conference is distinctive in encouraging theologically-informed discussions and in placing emphasis on small-group discussions of physician-submitted cases.

The first session of our conference dealt with challenges associated with finding a workable, accurate, medical definition of death. As the discussed cases made apparent, both which definition is chosen and who is deemed to have the authority to choose will have serious practical consequences for issues such as organ donation eligibility as well as treatment continuance and cessation. Two of the discussed cases also brought out some practical difficulties associated with applying the now widely-accepted brain-death criterion of death: for one class of persons—newborns—very rarely are physicians able to verify brain death.

On the first evening of the conference, we held our annual J. Philip Clarke Family lecture, a lecture open not only to our conference attendees but also to the Notre Dame, St. Mary’s, and greater South Bend communities. This year’s speaker was Edmund Pellegrino , M.D., Professor Emeritus of Medicine and Medical Ethics at the Center for Bioethics at Georgetown University Medical Center. This was Dr. Pellegrino’s third time giving the Clarke Lecture, and the title of his address was “A Moral Foundation for the Helping Professions: Medicine, Law, Ministry, and Teaching.”

Following the Clarke lecture, Dr. Pellegrino participated in a book signing for two recently-published books: The Philosophy of Medicine Reborn: A Pellegrino Reader, which was published in the Center’s book series, and Medical Ethics at Notre Dame: The J. Philip Clarke Family Lectures 1988-1999, a collection of the first twelve Clarke lectures with responses. During the third session, participants tackled problems of obtaining informed consent. Physicians discussed both what is required for full and proper informed consent and who is capable of giving true consent. They considered whether doctors are obligated to volunteer information about which hospitals and doctors can provide patients with the best treatment. The participants also discussed tough cases of consent to treatment involving minors and the very poor participating in medical research for pay.

For the fourth session of our conference, we welcomed Notre Dame Economics Professor Bill Evans, who gave detailed assessments of both the current state of the United States health care system and President Obama’s proposals for health care reform. At the request of several conference attendees, the slides from Prof. Evans’ lecture are available online at the Center’s website.

In the fifth session, “Medicine and Money,” participants considered problems that have arisen in the health care delivery system as hospitals, governments, and individuals have tried to deal with the realities of limited financial resources. One of the most provocative cases involved hospitals, including at least one Catholic facility, that have resorted to deporting indigent,
uninsured immigrants in an effort to balance their budgets.

On Saturday afternoon, participants had a choice of attending one of three panel discussions. The topics for these discussions were: the recent document from the Vatican’s Congregation for the Doctrine of the Faith, Dignitas Personae, a document on a series of recommended changes to resident duty hours that the ACGME (the organization that accredits medical schools in the U.S.) is now considering; and the appropriate response of health care professionals when they conflict with their colleagues on when and how to prescribe pain medication. dimensions of science and technology.

On Sunday morning, we had our usual “roundtable discussion,” a wrap-up session in which participants are invited to raise questions for all present to consider. These questions can be on topics discussed in previous conference sessions or on entirely new topics. Some of the most memorable discussions in this year’s roundtable were prompted by physicians seeking advice on how to handle some of the tough cases they had encountered in their own practices.

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