Course information

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. Learners 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.
OVERALL LEARNING OBJECTIVES:

• The learner will understand the principle of substituted judgment.
• The learner will understand the role of a surrogate decision maker (e.g., health care proxy).
• The learner will understand the benefits and limitations of a living will.
• The learner will understand the epidemiology and natural history of advanced dementia.
• The learner will understand the treatment options for feeding problems and the associated advantages and disadvantages of each option.
• The learner will understand the barriers to providing palliative care to patients with advanced dementia.
• The learner will understand the basic theories underlying the futility debate.
• 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:
• The learner will demonstrate knowledge regarding the role of surrogate decision makers.
• The learner will be able to council families regarding feeding issues in patients with advanced dementia.
• 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.

Throughout her career thus far, Dr. Botts has demonstrated an ongoing commitment to geriatric medical education. Following her internal medicine residency at the Beth Israel Deaconess Medical Center, Dr. Botts completed a geriatric medicine fellowship at Harvard Medical School. She is currently active as a geriatrician at the Beth Israel Deaconess Medical Center and is an Instructor in Medicine at Harvard. Dr. Botts is the recipient of a Hartford Center for Excellence Research Fellowship Award and Geriatric Academic Career Award. Her teaching interests include the development, implementation, and management of an inpatient geriatric pain management curriculum for interdisciplinary housestaff and nurses. In addition, she has been selected as a Rabkin Fellow for the 2008-2009 academic year.