Dr Danielle Ko1,2, Sharon Feldman1,2, Katheryn Hall1,2, A/Prof. Rosalind McDougall1
1University Of Melbourne, Australia, 2Austin Health, Melbourne, Australia
Biography:
Dr Danielle Ko trained as a lawyer and GP in Australia before completing fellowships in both medical ethics and palliative medicine in Boston, USA. Danielle is a palliative care consultant at Austin Health, and the Clinical Ethics Lead for the institution. Danielle’s area of expertise is in the intersection of medicine, law and clinical ethics as it relates to everyday clinical practice as well as at the end of life.
A/Prof Rosalind McDougall is a bioethicist with expertise in the ethical challenges faced by health professionals. She is a teaching and research academic at the University of Melbourne, with appointments in the School of Population and Global Health and the Department of Surgery.
Abstract:
Since the COVID-19 pandemic, attention to elective (or planned) surgery waiting lists has been increasingly urgent and sustained. While the ethical challenge of prioritising patients for planned surgeries is extensively discussed at a policy or system level, less attention has been paid to ethical practice at the individual clinician level. This project worked to fill that gap, exploring the ethical challenges faced by surgeons, surgical liaison nurses and surgical leadership practising in one network of hospitals in metropolitan Melbourne, Australia. The project was conducted by the hospital’s clinical ethics unit as part of an elective surgery reform initiative. We aimed to articulate and share clinicians’ ethical challenges, as a way of increasing awareness and ethical conversation within units and the hospital network. Through iterative discussions with eighteen key staff members, we identified many ethical challenges faced by clinicians working in the context of long waiting lists for planned surgery. These arose across various stages of the patient’s journey, from referral to the scheduling of the procedure. Challenges included the perceived unfairness of patients bypassing outpatient clinics via the private system, inconsistencies in process including application of categories, and patient deterioration between consent for surgery and the procedure itself. We produced a map organising these challenges along the six stages of the surgical patient journey. The map of challenges shows that clinicians administer “the system” and bear witness to its failings, with some experiencing significant moral distress along the way.