JULY 2003
Volume 27 No. 7

Emergency department expansion, renovation will enhance care

Leadership, teamwork pay off in successful trauma survey

Trauma program QI projects

Results of statewide hospital survey provide benchmarking data

New rules limiting residents' work hours will require increased efficiency

Lawyer and medical ethicist helps physicians, families navigate ethical dilemmas


Attorney and medical ethicist MARGARET EATON, who will step down this summer as co-chair of Stanford Hospital's ethics committee, is interested in the distinctions between ethics and the law - what is legal versus what is right.

Lawyer and medical ethicist helps physicians,
families navigate ethical dilemmas

When an ethical dilemma arises in patient care, everyone involved in the case wants to do the right thing. But determining what is "the right thing" can be difficult. A patient insists on receiving an expensive, invasive treatment his physician believes is futile, for example. Or a trauma patient is brought to the ED unconscious, with no relatives or caregivers to make decisions for him.

As a member of Stanford Hospital's ethics committee since 1992 and as its co-chair since 2001, medical ethicist and attorney Margaret Eaton has helped many Stanford physicians, patients and families sort out the competing values in these situations and come to resolution. The ethics committee does this through bedside consults, which can be requested by anyone - patients, families or clinicians.

Navigating the thorny questions of medical ethics is no easy task, Eaton says. "Many times, we're dealing with a polarized situation, where one party has demands the other can't meet. The split is intense."

To get a handle on the situation, the committee members conducting the consult gather information by speaking with all of the involved parties. They then identify and prioritize the values at stake and make recommendations on how to resolve the dilemma.

When a patient insists on an expensive treatment that's unlikely to provide benefit, for example, the value of respecting patients' autonomy conflicts with the value of maximizing limited medical resources to help the greatest number of people. Other values that come into play at bedside consults include health-care practitioners' duty to do no harm, their obligation to do what good they can, and ensuring patients' access to medical care.

The committee discusses cases in a structured way. Being objective is important, Eaton says, because "we can only help if we aren't emotionally involved." Impartiality is difficult for patients' families, however: "The emotional pitch gets so high. It's hard to be objective when someone you love is terminally ill."

SHC's ethics committee consists of about 30 members including physicians, nurses, social workers and chaplains. In addition to conducting bedside consults, it develops hospital policies and offers educational programs.

Eaton herself has taken a rather unusual path to the committee. After earning degrees in pharmacology and pharmacy in the Northeast, she taught these subjects for a few years at the University of Minnesota. She then worked at a start-up pharmaceutical company, where at one point she taught the company's lawyers the science of the business. Realizing that someone with both a pharmaceutical and legal background would be valuable, Eaton earned her law degree at the UC-Hastings College of Law and then joined a San Francisco law firm, where she represented pharmaceutical and medical-device companies in product-liability cases.

Though she found the work interesting, she found it difficult to work on cases after harm had occurred. In 1989, seeking to prevent patient harm in the first place, she came to work for the medical center at the university's Office of General Counsel.

Eaton joined SHC's ethics committee in 1992 and became co-chair in October 2001 at the suggestion of its then-chair, professor of medicine emeritus Ernle Young. She was fascinated with the difference between what is legal and what is right. Eaton is also a senior research scholar with the medical school's Center for Biomedical Ethics, where she studies and teaches business ethics in the biotech industry.

With the recent arrival of David Magnus as the Center for Biomedical Ethics' new director, Eaton will step down this summer as the committee's co-chair, though she will continue as a member. Magnus will become co-chair along with assistant professor of psychiatry Jose Maldonado, the other co-chair since 2001. "Margaret is a great person to work with," Maldonado says. "She's very conscientious and considerate of people."

Eaton will continue doing bedside consults and policy writing, in addition to her research on ethics and the law. "I'm interested in situations where the law would lead you to do X, but that doesn't seem to be the right thing to do," she said. "Sick patients often bring up situations that laws don't address."