It was back to basics for the Bermuda Hospitals Board (BHB) when a visiting expert on medical ethics was in Bermuda to talk about creating good relationships between medical staff, patients and families.

Dr Christy Simpson, Head of the Department of Bioethics, in the Faculty of Medicine at Dalhousie University in Halifax, Nova Scotia, Canada was here for Medical Ethics Awareness Week held earlier this month. The theme of the week was ‘back to basics’. She did training with the BHB Medical Ethics Committee and gave lectures to various medical professionals including staff from the Mid Atlantic Wellness Institute (MWI).

“At MWI we focused on establishing trust and hope, and how important these things are to having good relations with patients and families,” she said. “Sometimes trust is hard to come by.”

BHB Psychiatrist Dr Chantelle Simmons said one of the ethical challenges for mental health professionals was balancing the mentally ill individual’s right to make their own decisions, with public safety.

“That is probably the issue we spend the most time thinking through,” she said. “Often times it is not black and white. The Mental Health Act does provide a form for involuntary admission if they are a danger to society, but the problem is that that takes away the individual’s autonomy. It is a decision not taken lightly.”

She said another issue was confidentiality.

“We are quite attentive to this,” she said. “It is quite a sensitive area for many people. If someone says to us, ‘I don’t want to inform my father or partner that I am here MWI’, I will respect that. If someone calls and says they want information we will get written permission from the patient first, before we talk to them.”

Dr Simpson said it might feel harsh to the person’s family, but it helped doctors to establish that sense of trust with the patient.

Dr Simmons said, if the patient posed a threat to someone in the community then that person would be informed.

She said she wanted the public to know that the Medical Ethics Committee at the BHB had been relaunched and was a resource for patients, their families and medical professionals.

“It is there to provide input during these difficult decisions,” she said. “The other day, one of the staff members said she didn’t realise the committee was still in existence.”

The committees also aims to take a role when it came to policymaking. They have an ‘end of life’, subcommittee dealing with issues related to the terminally ill.

Dr Simpson has written several papers and essays on the topic of ethics and the terminally ill including “Considering Hope in the Context of Palliative Care in the ICU. In End of Life Care in the ICU: From advanced disease to bereavement” published by Oxford University Press in 2010.

She has been exploring and writing thoughtfully about the role of hope in healthcare including the topics of addressing how healthcare providers can or should respond in moral ways to the emotions of others. She has been involved in the development and use of a conceptual framework to critique and constructively reformulate existing notions of ‘false hope’.

“A lot of doctors wonder, how do I tell the truth to a patient when I know the truth will be devastating,” she said. “They ask: how do I work with a patient if they don’t trust me. There are a series of questions around end of life issues. There are questions about hope such as what does it mean for healthcare providers to be in a role where people are looking to them for hope.

“I think more and more we are on the side of trying to tell the truth and being more open about the statistics, but recognising that every patient follows their own path. I think a number of physicians have really improved around sharing that information and being more engaged and asking patients how much they want to know. They might ask the patient: what are you most concerned about? They might ask if the patient is worried about pain? The doctor might say: ‘what is the most important thing I should do for you’.”

To contact the BHB Medical Ethics Committee with a question of concern you can either approach your healthcare provider, or leave a message at 291-HOPE.