Ethics and Quality and Potential

One thing I am watching in my field is the tie-in to Quality (with a capital Q). Several years ago, a mentor of mine made this connection evident for me. There is a clear link between a mindful environment, with ethical and moral space, and Quality Improvement (yes, that sentence was 90% buzz-word). This is to say that diminishing moral distress (generally, know what the right thing to do is, but being unable to it) increases the frequency of good care experiences. My mentor got Lean Six Sigma certified because, it appears, “quality” is more than a descriptive term—it’s an approach to assess problems and to facilitate change.

Once I got clued-in, I began seeing the link everywhere. The Veteran Affairs Hospitals and clinical ethics programs are doing wonderful things (too lengthy to describe) and creating evidence. You see, high-level health-care people like evidence and measures and metrics, which has always been an area where clinical ethics has traditionally had problems producing. I love the VA because it has lots of potential, and does really good work: it’s actually very hard not to like and sets the standard in the field. The call now is for everyone else to catch-up, or even better yet, to innovate. That’s what my team has been working hard on, though we at times look back on what’s come before for inspiration.

I guess the link-in for up-and-coming JDs would be QI that exists in legal fields. Looking at QI as a meta-analysis by practitioners (at my hospital, most QI analysts are RNs) to improve the delivery of service, are there opportunities in this field for lawyers (I am sure there are) that can be taken advantage of? The underlying point I suppose I am making is that this is one approach to finding fulfilling work.

Continue ReadingEthics and Quality and Potential

Springtime for Daubert: Insights From the EDWBA Panel

In late January the “tort reform” package imposed the staid Daubert rules on the Wisconsin Rules of Evidence. Now it’s spring, although the weather feels a lot like January, and we must get serious about what to do with this gift that the judiciary did not want. The new rules require that expert testimony be based on demonstrably reliable methods and principles. To be determined is whether Wisconsin will be a “strict” or a “lax” Daubert jurisdiction — whatever that is. It is worth noting that the first wave of Wisconsin Daubert cases, which will likely set the mold for what follows, are also those that least interested the tort reformers, namely, criminal cases and “chapter 980” sexually violent offender cases.

Right now, however, we are in a state of nature, legally speaking. Case law under the relevancy test, the current standard, is of little avail. And while the new rules are copied from the federal rules, state courts are not bound by federal precedent (yes, that includes Daubert itself!). Last week alone I spoke at two conferences, one a large, attentive gathering of state judges in Elkhart Lake and the other an even larger, equally engaged joint convocation of state prosecutors, public defenders, and private defense counsel here at Eckstein Hall. There is a clamor for answers and a discernable unease about what to do.

Continue ReadingSpringtime for Daubert: Insights From the EDWBA Panel

Drugs and Long-Term Care

Video is now available here from the Elder’s Advisor‘s fine conference last month on drugs and long-term care.  Here is the description of the conference:

For this symposium, we bring together a variety of practitioners and academics to speak on current topics about the use of pharmaceuticals for residents of long-term care facilities. Our speakers will address the impact of regulatory requirements on the timely delivery of medications to residents in long-term care facilities. They will discuss the impact of consumer choice and cost on the drug markets. They will also consider the implications of the medicalization of aging as a disease rather than treating aging as a natural process. Finally, we will close with a discussion of the legal, ethical, and medical concerns surrounding the ability of long-term care residents and their decision-makers to refuse medications and treatment.

I learned a great deal from the portions of the conference I attended — much of it rather disquieting — and I would recommend the video to anyone with a professional or personal interest in the way that drugs are administered in long-term care facilities.

Continue ReadingDrugs and Long-Term Care