2025 Colorado Healthcare Ethics Forum Annual Conference

Assessing decision-making capacity in healthcare requires a nuanced understanding of both ethical principles and clinical criteria. This talk explores how to evaluate a patient’s ability to make decisions by examining their reasoning, particularly when they choose to decline treatment, based on their understanding of the situation. Participants will learn how to assess this reasoning in the context of the patient’s personal values, either directly or through surrogates, and how to ensure that these values are respected in decision-making. The session will also address common biases and systemic barriers that may unintentionally undermine patient autonomy. Additionally, strategies for supporting patients in making informed decisions—especially when surrogate decision-makers are involved—will be discussed, ensuring that both the patient’s reasoning and values are at the forefront of the decision-making process. By the end, participants will gain practical tools to balance ethical considerations and enhance patient autonomy in complex situations.

Objectives:

1. Define and apply key ethical and clinical criteria for assessing decision-making capacity in healthcare settings.
2. Identify common biases and systemic barriers that may unintentionally undermine patient autonomy in capacity assessments.
3. Develop strategies to support and enhance patient autonomy while navigating ethical complexities in surrogate decision-making. 

Providing competent and efficient ethics consultation demonstrates a commitment to an ethical culture as well as a just culture and aligns with the standards for a high reliable organization. When patient care conferences, goals of care conversations, etc. create a space for a patient and the professional to authentically engage in shared decision-making, especially earlier in an in-patient hospitalization, adverse patient outcomes (e.g. excess length of stay) are mitigated. All too often, we hold numerous and, seemingly, redundant conversations with patients (or their decision-maker) that leave physicians and nurses feeling as though their professional expertise was disregarded as much as leave patients and families feeling as though their fears, hopes, wishes were disregarded. Indefinite boundaries are established, moral distress ensues, and teams call risk or legal for what can be done to remove a decision-maker or if we are obligated to honor a request. Often ethics consultants opine in the patient’s chart or with the requester but what is needed is a skilled, hospitable, and authentic conversation. This workshop will share some of the best practices acquired over numerous consult services and encourage participants to actively engage in role play using not-so-complex cases to practice these skills.  

Explain three classic understandings of ethics consultation requests. Identify possible conflict situations that can divide patients, families, physicians, and other caregivers, compromise patient care, and lead to moral distress. Articulate recommendations for responding to requests for nonbeneficial treatment.

Caring for individuals with dementia requires a shift in mindset and an ethical commitment to honoring the person’s autonomy. This session will explore innovative communication strategies that respect the person’s voice, even when memory and decision-making abilities are impaired. Participants will learn practical approaches to fostering autonomy while navigating how individuals with dementia express their needs, preferences, and emotions in the present moment.
We will discuss how to balance the need to keep individuals safe while respecting their autonomy and sense of agency. We will discuss how to navigate situations where safety concerns arise without unnecessarily restricting personal choice or independence. By integrating these compassionate and ethically grounded strategies, healthcare providers can enhance wellbeing, dignity, and connection for those living with dementia.

The presentation will include 30 minutes of content followed by 20 minutes for questions and discussion. Attendees will leave with actionable insights and ethical strategies to empower autonomy and wellbeing for people living with dementia.

Program Objectives: 1. Develop Ethical Communication Strategies: Participants will learn simple communication techniques that respect the dignity of individuals with dementia, ensuring ethical, compassionate interactions and wellbeing.
2. Balance Autonomy and Safety: Participants will understand how to ethically balance the need for patient and staff safety while respecting the individual’s autonomy in healthcare settings.
3. Develop Ethical Communication for Treatment Decisions: Participants will learn strategies for involving individuals with dementia in treatment decisions, to help ensure their values and preferences are respected.

Emily and Erin will review Colorado’s state statute on who can determine medical decision-making capacity, and the limitations that imposes. They will then discuss how the UCHealth system evaluates and captures patient's capacity, prior to their intervention and how they have altered this process to better align with patient autonomy. Their conversation will inspire thoughts on how to apply patient-centered assessment and advocacy through multi-disciplinary team collaboration at your own work setting.

-Define Capacity per CO State Statute and how that applies within the healthcare setting -Describe UCHealth’s former and now current way of capturing patient decision making capacity -Evaluate patient-centered capacity assessments in your own setting

This program will be a workshop with a 30-minute discussion followed by a breakout session where individuals will draft a decision aid for a given case scenario.

Objectives:
1) Gain an Understanding of Some of the Evidence that Guides the Development of a Decision Aid 2) Attempt to Draft a First Version of a Decision Aid 3) Explore and Discuss the Challenges of Too Much vs. Too Little Information in Shared Decision Making

Presentation by Chet Seward, Colorado Medical Society. More details coming soon!

Wrap up of day one education session.

Welcome and introductions.

Shared decision making (SDM) is difficult to implement in mental health practice, but it remains an ethical ideal for motivating therapeutic capacity in patient-clinician relationships; this discrepancy warrants attention from clinical and ethical perspectives. This presentation explores what some clinicians see as obstacles to even attempting SDM with patients with psychiatric disabilities. I identify 4 such obstacles: a patient’s lack of decision-making capacity, a patient’s poor insight, a health care professional’s therapeutic pessimism or personal dislike, and a patient’s or health care professional’s conflicting recovery orientations or goals of care. I argue that each obstacle could be overcome in many cases and that health care professionals, patients, and their caregivers should remain dedicated to attempting SDM in mental health practice.

Objectives:

1. Describe common barriers to shared decision-making in psychiatric care.
2. Analyze how barriers to shared decision-making can be overcome.
3. Discuss ways to understand and enable agency in psychiatric care.

Dr. Guidry-Grimes will be speaking virtually from a conference in Switzerland.

This session will focus on applying and adapting advance care planning approaches to meet the care planning needs of persons with dementia and their families of choice.

Objectives:
1) describe advance care planning approaches for a general population
2) outline key adaptations for persons living with dementia, including assessment of capacity and considerations for supportive decision making
3) practice eliciting values and preferences, including in the context of dementia

Join Elizabeth Moran, Executive Director at The Arc of Colorado, to learn more about Colorado's Supported Decision-making (SDM) Agreement law, what SMD is, and isn't, and 5 things you can do RIGHT NOW to be a part of meaningful systems change that honors dignity of choice and supporting an individual's will and preference. This session will provide a 2024 guardianship-to-supported decision-making case study, with ample time for Q&A and participant discussion.  

Session objectives:

1. Identify less-restrictive alternatives to guardianship/conservatorship.
2. Have a basic understanding of generally recognized best practices of Supported Decision-Making and related agreements.
3. Identify up to 5 things (tools or action steps) they can take RIGHT NOW to incorporate SDM into their practice.

We will discuss and examine the proxy decision-making process, including finding, working with, and terminating a proxy decision-maker, focusing on the related ethical issues. In addition, we will discuss and examine non-proxy surrogate decision-makers and the ethical issues therein.

Objectives:

1. Learn how to conduct a proxy decision-maker appointment process.
2. Learn how to effectively communicate with family members and patients about the process and procedures in both proxy and surrogate decision-makers.

Conference wrap-up. This session will cover the key points covered during the day.