Ethics director offers guidance along health care paths

Photo Caption: Birgitta N. Sujdak Mackiewicz is the first director of ethics at OSF Saint Francis Medical Center in Peoria.

By: By Jennifer Willems

Working in a hospital always seemed to be in Birgitta N. Sujdak Mackiewicz’s future, although serving as the first director of ethics at OSF Saint Francis Medical Center in Peoria wasn’t something she could foresee as a high school student in Jacksonville, Fla.

Her goal then was to enter medical school, but she discovered that the intricacies of chemistry weren’t as life giving as the challenge of ethics — specifically health care ethics.

“I recognized that it was a way of serving the human person in medicine, but in a different fashion — and in no less of an important fashion,” Sujdak Mackiewicz told The Catholic Post.

“I am still able to be involved in medicine and learn about medicine,” she explained. “And when you look at a medical ethics problem, often it’s not just the philosophical or ethical aspects that inform the problem. There are medical facts that have to be taken into consideration.”

She started learning those facts at Randolph-Macon Woman’s College in Lynchburg, Va., where she earned a bachelor’s degree in philosophy and American studies in 1998. She continued her studies at Michigan State University, where she received a master’s degree in philosophy.

Sujdak Mackiewicz is currently writing her dissertation for a doctorate in health care ethics from the St. Louis University Department for Health Care Ethics, and hopes to be finished by May 2010.

While she has only been director of ethics at OSF Saint Francis since 2007, she is no stranger to the facility or Peoria. Sujdak Mackiewicz was an ethics intern at OSF Saint Francis in the summer of 2005 and served as an ethics fellow in 2006.

In addition, she is an adjunct professor at the Saint Francis College of Nursing.

Sujdak Mackiewicz is using all of this training to do three things as director of ethics at OSF Saint Francis: case consultations, education, and policy development and review.

“Education is formal and informal — to medical residents, to students at the College of Nursing, on the floors, at rounds,” she said. “Some is at the bedside, some is in an auditorium. There are lots of different ways that happens.”

Sujdak Mackiewicz said that when she receives requests for ethics consultations, for example, she tries to educate all involved so they feel they have the necessary resources to address problems now and in the future.

“They’re always welcome to call, of course, but at least this gives them tools to work through some of these issues and perhaps, in some instances, to recognize ethical issues where they may not have seen them before,” she told The Post.

In terms of policy development, Sujdak Mackiewicz said OSF Saint Francis, like all Catholic hospitals, relies to a great extent on the Ethical and Religious Directives for Catholic Health Care Services. This document was developed by the U.S. Conference of Catholic Bishops’ Committee on Doctrine.

“That’s our starting point and we go from there,” she said, explaining that she helped to review and write the OSF Saint Francis policies regarding patient rights and organizational ethics. This covers advance directive policies, informed consent and research, among other things.

What most people think of when they hear the term “medical ethics,” however, is what happens in the third part of her job: case consultations.

“Our consultation service here at the hospital is available 24 hours a day, seven days a week. It has been in existence for some time,” according to Sujdak Mackiewicz, who said anyone can request an ethics consultation.

She handles calls the majority of the time, and works closely with Dr. Gerald McShane, who chairs the OSF Saint Francis Ethics Committee and is president of the OSF Medical Group.

In addition, the ethics consultants work closely as members of the interdisciplinary team.

Ethics consultations are not an indication that someone has done something wrong, Sujdak Mackiewicz emphasized.

“An ethics consultation is meant to be a resource to our staff, to our patients and to our families,” she said. “We want to identify issues and concerns and really promote resolution of an issue by respectful listening, asking questions and trying to get all the parties around the table to work through all the different ethical issues, the diverse opinions and points of view, and provide a greater opportunity for internal conversation.”

Sometimes requests are made by families who need more information about a patient’s care or church teaching, or by the medical staff when they are concerned about a decision the patient or the family is making, she said.

In other cases, families are struggling with difficult treatment decisions on which the church does not provide explicit guidance, she told The Post.

“A moral dilemma is not a choice between a right and a wrong. That’s not a dilemma,” Sujdak Mackiewicz said. “It’s a choice between two paths — both of which have things that are beneficial, both of which may have risks or consequences to them.”

She said the church asks people in these situations to look at both the benefits and the burdens of treatment and then make a prudential judgment.

“That’s where the education piece comes in, too,” Sujdak Mackiewicz said. “We want to educate the staff about the values that are guiding us as a hospital and facilitate communication between staff, between staff and families, and between patients and families.”

She added that not every consultation is huge: “Sometimes it’s just clarifying hospital policy.”

Above all, ethics consultations should improve patient care, Sujdak Mackiewicz said.

While it can be difficult and challenging work, Sujdak Mackiewicz calls it “rewarding.”

An Oblate with the Community of St. John in Princeville, she sees what she does as a vocation.

“I wouldn’t make the sacrifices I’ve made in my life — the time to do the education, the money to do the education, the time I spend away from my husband, Darin, and son, John, the phone calls at 3:30 in the morning — I wouldn’t make those sacrifices if I didn’t believe what I was doing was important to the service of the church, to the service of humanity.”

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