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Ethical Considerations and Challenges in Elderly Patients

Course Description | Faculty | Accreditation | General Information

Course Description

Acknowledgement: This module is supported by a grant from the Donald Reynolds Foundation.

This activity meets the criteria of the Massachusetts Board of Registration in Medicine for 2 credits of Risk Management Study. This includes 2 Credits of End-of-Life Care Studies.

Please check your individual state licensing board requirements before claiming these credits.



Ethical issues are common among hospitalized elders and represent a clinical challenge for many physicians and trainees. This web-based, interactive virtual patient program aims to educate clinicians regarding some of the most common ethical issues including the role of surrogate decision makers, feeding issues in advanced dementia, and issues underlying the futility debate. The first case of this module addresses the issue of substituted judgment in an 83 year old gentleman without a legally designated surrogate decision maker. The learner will gain understanding regarding the principles of substituted judgment and the role of the surrogate decision maker. In the second case, feeding issues in advanced dementia are addressed. The learner will learn about treatment options for feeding issues in the population and the associated advantages and disadvantages of each option. In addition, they will gain an understanding of the barriers to providing palliative care to patients with advanced dementia. The third case explores the basic theories underlying the futility debate. Learns will come to understand the rights of patients and families who desire to continue aggressive care even when the medical team does not feel it is beneficial in addition to understanding the rights of healthcare providers when faced with providing medical treatments they believe are harmful or ineffective. Questions are interspersed within the text of each case and video feedback is provided to reinforce main concepts. At the completion of each case, an expert provides a teaching summary. References are provided with links to PubMed.

Original Release: 11/7/2008
Most Recent Update: 7/16/2013
Termination Date: 7/16/2016

NUMBER OF CREDIT HOURS: The Harvard Medical School designates this enduring material for a maximum of 2 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This course should take approximately 2 hours to complete.

COST: $40.00 for the average learner. Participants living in emerging nations receive a 50% discount or can register for free. See our International Pricing Page for details.

OVERALL LEARNING OBJECTIVES:

  1. The learner will understand the principle of substituted judgment.
  2. The learner will understand the role of a surrogate decision maker (e.g., health care proxy).
  3. The learner will understand the benefits and limitations of a living will.
  4. The learner will understand the epidemiology and natural history of advanced dementia.
  5. The learner will understand the treatment options for feeding problems and the associated advantages and disadvantages of each option.
  6. The learner will understand the barriers to providing palliative care to patients with advanced dementia.
  7. The learner will understand the basic theories underlying the futility debate.
  8. The learner will understand the rights of patients and families who desire to continue aggressive care even when the medical team does not feel it is beneficial.

CLINICAL LEARNING OBJECTIVES:

  1. The learner will demonstrate knowledge regarding the role of surrogate decision makers.
  2. The learner will be able to council families regarding feeding issues in patients with advanced dementia.
  3. The learner will demonstrate knowledge regarding the rights of physicians and other healthcare providers when faced with providing medical treatments they believe are harmful or ineffective.

METHOD OF PARTICIPATION:

Registrants participate in the learning process by answering interactive multiple choice questions that are dispersed throughout the case presentation. You must answer a question correctly in order to continue through the course. If you answer a question incorrectly, you will be prompted to try again.

In order to earn credit, physicians must complete the entire educational activity before the termination date (see above). Non-physicians may register for the course but are not eligible for AMA PRA Category 1 Credits™. Instead, non-physicians will earn a certificate of participation after successfully completing the course before its termination date.

COMBINATION OF MEDIA USED:

This internet enduring material is a case-based, interactive presentation comprised mainly of text, interactive questions, and images. A variety of media, including video clips, audio clips, and Flash animation, may be presented. Links to any necessary plugins are provided when necessary, but no plugins are required for general use of the CME website, and you may skip the multimedia presentation(s) within the course if you choose.

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Faculty
ANGELA CATIC, MD
Course Director
Dr. Angela Catic, a geriatric clinician educator at Beth Israel Deaconess Medical School and Harvard Medical School, is the recipient of a Hartford Center for Excellence Research Fellowship Award and two Geriatric Academic Career Awards. She utilized these awards to develop multidisciplinary educational programs regarding the safety of elders during acute hospitalization. Particular areas of focus include pain management; delirium prevention and management; successful care transitions; and appropriate care of elders with advanced dementia.

Dr. Catic also co-directs ECHO-AGE, a tele-medicine educational program which trains long term care providers in the management of elders with dementia and associated behavioral issues. She holds a number of leadership roles including directing the Harvard Geriatric Medicine Fellowship program, leading the fourth year Harvard Medical School geriatric elective, and directing the educational component of the geriatric elective for internal medicine residents at Beth Israel Deaconess Medical Center.

DISCLOSURE:
The commercial entities with which we have relationships do not produce, market, re-sell, or distribute health care goods or services relevant to the content I am planning, developing, presenting, or evaluating for the activity.



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Reviewers
LISA LEHMANN, M.D., Ph.D
Reviewer
Lisa Lehmann, M.D., Ph.D., M.Sc. is Director of the Center for Bioethics at Brigham and Women’s Hospital, Assistant Professor of Medicine at Harvard Medical School and Associate Physician at Brigham and Women’s Hospital. She received her BA from Cornell University where she studied philosophy and was a College Scholar. She studied Talmud at Midreshet Lindenbaum and Drisha Institute. She attended Johns Hopkins University School of Medicine and completed her training in internal medicine at Johns Hopkins Hospital. She received her Ph.D. in philosophy from Johns Hopkins University and a Masters of Science in clinical epidemiology from the Harvard School of Public Health.

Lisa is a primary care doctor at Brigham and Women’s Hospital and teaches medical ethics at Harvard Medical School. She is an active member of Brigham and Women’s Hospital Ethics Consultation Service and Ethics Committee. Her research is focused on empirical and philosophical analysis of contemporary ethical issues in medicine. She is interested in the moral determinants of medical decision-making and has focused on ethical issues in genetics, truth telling in medicine, religion and medicine, and research ethics.

DISCLOSURE:
Reported no relevant financial relationships with commercial entities



MELISSA MATTISON, MD
Reviewer
Melissa Mattison, MD is a Hospitalist specializing in Geriatrics at the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

DISCLOSURE:
Reported no relevant financial relationships with commercial entities



JULIE MORAN, DO
Reviewer
Dr. Moran is a staff geriatrician in the Division of Gerontology at Beth Israel Deaconess Medical Center and an Instructor of Medicine at Harvard Medical School. She works primarily in the outpatient setting, but frequently performs inpatient consultation services for acutely hospitalized elderly patients. A clinician educator, Dr. Moran’s interest is focused on the emerging field of aging and developmental disabilities. She has been awarded a Geriatric Academic Career Award to develop education programs serving this population.

DISCLOSURE:
Reported no relevant financial relationships with commercial entities



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Course Planners
SANJIV CHOPRA, MD
Planner
Dr. Sanjiv Chopra is Professor of Medicine at Harvard Medical School. He is also the the James Tullis Firm Chief in the Department of Medicine and a Senior Consultant in Hepatology at the Beth Israel Deaconess Medical Center, Boston. He served as Faculty Dean for Continuing Education at HMS for 12 years. Dr. Chopra has more than 150 publications and seven books to his credit. Dr. Chopra is Editor-in-Chief of the Hepatology Section of UpToDate, the most widely used electronic textbook in the world subscribed to by more than 850,000 physicians in 149 countries. He is also the recipient of numerous awards and accolades. For a complete bio, click here.

DISCLOSURE:
Reported no relevant financial relationships with commercial entities



ANDI LONG, EdM
Planner
Andi Long directs the Department of Continuing Education’s Distance Learning group, which offers a variety of online continuing medical education programs to health care professionals around the world. Andi develops strategies for new pilot programs and systematically rolls out new distance learning initiatives and has a leadership role in IT planning and other online processes for HMS DCE. She oversees the day-to-day operations of each distance learning activity and ensures ACCME compliance across all enduring programs. She has had the privilege of working with hundreds of Harvard Medical School Faculty members to develop high-quality, engaging online programs that physicians in more than 170 countries have taken part in. Andi earned her Ed.M. in Technology, Innovation, and Education from Harvard Graduate School of Education and graduated from Bridgewater State College with a degree in English. Her professional interests focus on teaching and learning with new technologies and online course development.

DISCLOSURE:
Reported no relevant financial relationships with commercial entities



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Accreditation

NUMBER OF CREDITS: 2 

The Harvard Medical School is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Harvard Medical School designates this enduring material for a maximum of 2 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This course should take approximately 2 hours to complete.

Within 2 weeks of completing the course, you will receive your certificate via email.

Click the image to view a sample of the certificate


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General Information

HARDWARE/SOFTWARE REQUIREMENTS

Computers
Any computer running Windows, Mac OS, or Unix machines are supported.


Internet Connection
Your computer should be configured to access the Internet. A high speed internet connection may be required to view some of the large multimedia files.

Browsers
Firefox or Internet Explorer 5.5 or higher are recommended. JavaScript and cookies must be enabled.

Plugins
Some of the multimedia resources in this course require Apple Quicktime, RealMedia, or a Flash player. You will be prompted to download the appropriate plugin when necessary. No plugins are required for general use of the CME website, and you may skip the multimedia presentation(s) within the course if you choose.


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