March 6, 2009

Forum takes on care providers’ tough questions

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Joseph Fanning, Ph.D., left, and Jeffrey Bishop, M.D., from the Center for Biomedical Ethics and Society, lead a discussion during a recent Schwartz Center Rounds at the Vanderbilt-Ingram Cancer Center. (photo by Mary Donaldson)

Forum takes on care providers’ tough questions

When is it time to offer a patient palliative care and a supportive transition to death and when should you fight for every moment of life? How do you support family members as they help make these decisions, and what happens when the medical team disagrees with those choices?

These are some of the questions posed to medical caregivers during the regular Schwartz Center Rounds held at the Vanderbilt-Ingram Cancer Center.

The Kenneth B. Schwartz Center, based in Boston, started the Schwartz Center Rounds at Massachusetts General Hospital in 1997. Currently, those rounds are held at more than 125 sites in 26 states, including VICC.

They offer an open and relaxed forum where physicians, nurses, chaplains and other caregivers have the opportunity to discuss and reflect upon the difficult social and emotional issues of patient care.

The meetings can provide a comforting hand to caregivers who need emotional support.
During a recent Schwartz Center Round at VICC, presenters Jeffrey Bishop, M.D., and Joseph Fanning, Ph.D., from the Center for Biomedical Ethics and Society, posed the question, when is enough, enough?

They told the audience about two cases — one in which an unresponsive patient with multiple chronic illnesses was being kept alive with the help of a ventilator. While the care team believed it was time to remove the ventilator, a relative disagreed. In the absence of an advance directive from the patient, it was difficult to come to a resolution. The second case involved a physician and nurses who believed additional procedures for a patient were advised, but the patient's brother disagreed. In both cases, the religious beliefs of the family played a role in the final decision.

Lillian Strahine, a chaplain in the Department of Pastoral Care, said she often works with families on the definition of healing.

“Sometimes healing isn't recovery,” Strahine said. “Healing can be peace, and that comes in many different forms, including death sometimes.”

Arnold Malcolm, M.D., associate professor of Radiation Oncology and medical director for Vanderbilt's Schwartz Center Rounds, believes medical schools don't spend enough time preparing students for the emotional and ethical decisions they must make on a daily basis.

“As medical professionals we tend to focus on diagnosis and treatment for patients, but there is a whole long-distance run between curing the patient and the end of the illness,” said Malcolm. “My concern is that we can forget about that. The end of the race may not be when they leave the hospital. The race is about taking care of that patient to the end.”

The Schwartz Center Rounds are open to all caregivers and are held the third Wednesday of the month, from September through May. The schedule is posted on the Medical Center's online calendar at or contact Cindy Tinker at 322-7459.