Navigating Hospital Policies: The Clinical Ethicist's Role in Bridging Variability in Substance and Application

Abstract: Myriad institutional policies play a critical role in shaping high-stakes patient care decisions, yet significant differences may exist in policy substance and procedure across institutions, and in application within institutions, raising significant ethical concerns. What is the clinical ethicist’s role in addressing such variation? This panel of clinical ethics program directors from several academic centers in the northeast will explore the ethics of such variability in policy, using policies addressing potentially inappropriate treatment (PIT) and/or “futility” as a case example. Drawing from their experience engaging with patient-facing policies, they will lead attendees in a dynamic discussion about their perspectives and approaches. They will examine key areas of distinction across institutions (including definitions of PIT/“futility” and how this is assessed, stakeholder involvement, and conflict resolution processes), along with challenges related to intra-institutional differences (including clinician-level and patient-level variations in application). The panel also will address practical challenges in applying and implementing PIT/“futility” policies across different hospitals that sit in close geographic proximity, as well as within multi-hospital systems. Special attention will be given to whether it is ethically justifiable for hospitals to adopt different approaches based on their institutional cultures or the unique patient populations they serve (e.g., pediatrics, uninsured patients). Additionally, the session will explore the recently revised Health and Human Services anti-disability discrimination regulations and potential implications for institutional PIT/“futility” policies. Ultimately, presenters will raise provocative questions about the ethical challenges related to policy variability and present recommendations for navigating this complex area of clinical ethics practice.

Keywords: organizational policy, potentially inappropriate treatment, clinical ethics