Evan G DeRenzo

Howard County General Hospital, Columbia, Maryland, United States

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Publications (22)32.1 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: In May 2011, the clinical ethics group of the Center for Ethics at Washington Hospital Center launched a 40-hour, three and one-half day Clinical Ethics Immersion Course. Created to address gaps in training in the practice of clinical ethics, the course is for those who now practice clinical ethics and for those who teach bioethics but who do not, or who rarely, have the opportunity to be in a clinical setting. "Immersion" refers to a high-intensity clinical ethics experience in a busy, urban, acute care hospital. During the Immersion Course, participants join clinical ethicists on working rounds in intensive care units and trauma service. Participants engage in a videotaped role-play conversation with an actor. Each simulated session reflects a practical, realistic clinical ethics case consultation scenario. Participants also review patients' charts, and have small group discussions on selected clinical ethics topics. As ethics consultation requests come into the center, Immersion Course participants accompany clinical ethicists on consultations. Specific to this pilot, because participants' evaluations and course faculty impressions were positive, the Center for Ethics will conduct the course twice each year. We look forward to improving the pilot and establishing the Immersion Course as one step towards addressing the gap in training opportunities in clinical ethics.
    The Journal of clinical ethics 01/2012; 23(2):139-46. · 0.47 Impact Factor
  • Evan G DeRenzo, Jack Schwartz
    The Journal of clinical ethics 01/2011; 22(1):95. · 0.47 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This paper presents the behavioral interview model that we developed to formalize our hiring practices when we, most recently, needed to hire a new clinical ethicist to join our staff at the Center for Ethics at Washington Hospital Center.
    HEC Forum 03/2010; 22(1):51-63.
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    ABSTRACT: Curbside ethics consultations occur when an ethics consultant provides guidance to a party who seeks assistance over ethical concerns in a case, without the consultant involving other stakeholders, conducting his or her own comprehensive review of the case, or writing a chart note. Some have argued that curbside consultation is problematic because the consultant, in focusing on a single narrative offered by the party seeking advice, necessarily fails to account for the full range of moral perspectives. Their concern is that any guidance offered by the ethics consultant will privilege and empower one party's viewpoint over-and to the exclusion of-other stakeholders. This could lead to serious harms, such as the ethicist being reduced to a means to an end for a clinician seeking to achieve his or her own preferred outcome, the ethicist denying the broader array of stakeholders input in the process, or the ethicist providing wrongheaded or biased advice, posing dangers to the ethical quality of decision-making. Although these concerns are important and must be addressed, we suggest that they are manageable. This paper proposes using conflict coaching, a practice developed within the discipline of conflict management, to mitigate the risks posed by curbside consultation, and thereby create new "spaces" for moral discourse in the care of patients. Thinking of curbside consultations as an opportunity for "clinical ethics conflict coaching" can more fully integrate ethics committee members into the daily ethics of patient care and reduce the frequency of ethically harmful outcomes.
    HEC Forum 03/2010; 22(1):41-9.
  • Evan G DeRenzo, Jack Schwartz
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    ABSTRACT: Excellence in the care of hospital patients, particularly those in an intensive care unit, reflects esprit de corps among the care team. Esprit de corps depends on a delicate balance; each clinician must preserve a sense of personal responsibility for "my" patient and yet participate in the collaborative work essential to the care of "our" patient. A harmful imbalance occurs when a physician demands total control of the decision-making process, especially concerning end-of-life treatment options. Although emotional factors may push a physician to claim decision-making exclusivity, compounded by a legal framework that overemphasizes individual responsibility, esprit de corps can be preserved through timely communication among clinicians and a recognition that optimal care for "my" patient requires effective team practice.
    The Journal of clinical ethics 01/2010; 21(3):232-7. · 0.47 Impact Factor
  • HEC Forum 10/2009; 21(4):341-9.
  • The Journal of clinical ethics 02/2009; 20(1):34-6; author reply 41-3. · 0.47 Impact Factor
  • Evan G DeRenzo
    The Journal of clinical ethics 02/2009; 20(1):90-7. · 0.47 Impact Factor
  • Evan G DeRenzo
    The Journal of clinical ethics 02/2009; 20(2):168-71. · 0.47 Impact Factor
  • Jeffrey T Berger, Evan G DeRenzo, Jack Schwartz
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    ABSTRACT: The care of adult patients without decision-making abilities is a routine part of medical practice. Decisions for these patients are typically made by surrogates according to a process governed by a hierarchy of 3 distinct decision-making standards: patients' known wishes, substituted judgments, and best interests. Although this framework offers some guidance, it does not readily incorporate many important considerations of patients and families and does not account for the ways in which many patients and surrogates prefer to make decisions. In this article, the authors review the research on surrogate decision making, compare it with normative standards, and offer ways in which the 2 can be reconciled for the patient's benefit.
    Annals of internal medicine 08/2008; 149(1):48-53. · 13.98 Impact Factor
  • Evan G Derenzo, Nneka Mokwunye, John J Lynch
    HEC Forum 01/2007; 18(4):319-31.
  • Cambridge Quarterly of Healthcare Ethics 03/2006; 15(02):207 - 215. · 0.85 Impact Factor
  • Evan G DeRenzo
    The Journal of clinical ethics 02/2006; 17(3):275-88. · 0.47 Impact Factor
  • Cambridge Quarterly of Healthcare Ethics 02/2006; 15(2):207-15. · 0.85 Impact Factor
  • Evan G DeRenzo
    [Show abstract] [Hide abstract]
    ABSTRACT: Kennedy Institute of Ethics Journal 15.2 (2005) 199-210 This article addresses the National Institutes of Health (NIH) employee conflict-of-interest (COI) policy that went into effect February 2005. It is not, however, merely an account of another poorly crafted government policy that cries out for revision. Instead, it is also a story about one of our nation's most important and prestigious institutions and its struggles to navigate the crosscurrents of scientific aspirations, power politics, public ambivalence toward capitalist economics in the biosciences, and the media's inclination to exaggerate problems and under report complicated facts. It is also a tale of greed, politics, purgatory, and redemption. The dramatic and abrupt change in the NIH COI policy demonstrates the difficulty of balancing the production of cutting-edge science with the demands for transparency resulting from work performed in the public interest on the public tab. It is an unhappy chapter in the life of a government agency that is also a national treasure. And, one hopes, it will be an example of how harmful and ill-conceived law can be revised and amended to advance national health and well-being. The new NIH COI employee policy, more accurately referred to as the Interim Final Rule (Federal Register 2005), is a sweeping set of prohibitions on activities and holdings to reduce the possibility that NIH employees will have any actual or apparent conflicts of interest. For the most part, the prohibitions are applied across-the-board—i.e., without distinction to employee category or function. The new policy includes prohibitions on outside activities, stock holdings, and awards. It prohibits all NIH employees from engaging in any compensated or uncompensated employment, including consulting, serving on advisory or other such boards, and compensated teaching, speaking, writing, or editing with certain kinds of entities. The first class of such entities is referred to as substantially affected organizations, defined as biotechnology, pharmaceutical, medical device companies, and others with similar interests. But these are not the only entities included in the prohibitions. Other organizations from which NIH employees now are cut off are hospitals, clinics, and other health care institutions; health, science, or health research-related professional associations and consumer and advocacy groups. Included also are educational institutions and not-for-profit independent research institutes that are, or were, recent NIH funding applicants, grantees, contractors, or cooperative research and development agreement (CRADA) partners. The only exemptions appear to be for health care institutions at which NIH employees provide clinical care and some forms of writing—e.g., an NIH physician who moonlights at her/his local hospital's emergency room or submits a manuscript to a peer-reviewed journal that receives only unrestricted funding from a prohibited entity. Prohibited and/or restricted holdings include stock in biotechnology, pharmaceutical, and medical device companies and others in research, development, or manufacture of medical devices, equipment, preparations, treatments, or products. The prohibitions apply to senior NIH employees; restrictions in the amount of such holdings apply to all remaining employees. Both apply to the spouses and minor children of NIH employees. If an NIH employee wins an award, the monetary allowance in most cases is limited to $200. In sum, the scope of this policy is vast, too vast to be reasonable. Too many employees are restricted in too many ways. Where appropriate restrictions have been placed on senior NIH employees, even these constructive aspects of the policy are overshadowed by the unfairness and destructiveness of other aspects. This policy far exceeds anything that could be considered sound. Fortunately, the policy has a built-in assessment process to begin at the end of the policy's first year of implementation. One can only hope that a fair and open evaluation will be conducted, the results of which surely must result in major revisions to what is now bad regulation. Although there had been increasing consideration of tightening restrictions on the conflicting interests of NIH employees for some time, the need became obvious and urgent in December 2003. In a 7 December, Los Angeles Times exposé...
    Kennedy Institute of Ethics journal 07/2005; 15(2):199-210. · 1.21 Impact Factor
  • The Journal of clinical ethics 02/2005; 16(2):144-50. · 0.47 Impact Factor
  • Evan G DeRenzo, Jack Schwartz, Stephen Selinger
    Maryland medicine: MM: a publication of MEDCHI, the Maryland State Medical Society 02/2004; 5(3):39-41.
  • Archives of Internal Medicine 07/2002; 162(11):1217-9. · 11.46 Impact Factor
  • Jeffrey T. Berger, Evan G. DeRenzo, Jack Schwartz
    [Show abstract] [Hide abstract]
    ABSTRACT: urrogates, usually family members, make decisions about health care for cognitively incapacitated patients. The process for making surrogate decisions is widely ac- cepted as following a hierarchy of standards: patients' known wishes, substituted judgments, and patients' best interests (1). This schema, developed several decades ago during an era of rapidly evolving individual and civil rights and rising consumer empowerment, reflects not only a Western notion of personhood, but individual self-deter- mination, which is especially pronounced in the culture of the United States. Over the years, these hierarchical stan- dards have become established as convention in bioethics and interwoven in federal and state law. Although these standards emphasize important values and provide a frame- work for decision makers, they are at substantial variance with a body of empirical research describing the ways in which patients and families actually make health decisions. This research suggests that many patients want their surro- gates to exercise considerable discretion in decision making and finds that families often use a less schematic approach. We outline differences between normative standards for decision making and empirical evidence of practice and offer clinicians ways in which the 2 can be reconciled for the patient's benefit. DECISION MAKING AND STANDARDS
  • Source
    D E Hoffmann, J Schwartz, E G DeRenzo
    DePaul journal of health care law 3(3-4):547-608.

Publication Stats

83 Citations
32.10 Total Impact Points

Institutions

  • 2010
    • Howard County General Hospital
      Columbia, Maryland, United States
  • 2005–2010
    • Washington Hospital Center
      Washington, Washington, D.C., United States
  • 2008
    • Stony Brook University
      • Department of Medicine
      Stony Brook, NY, United States
  • 2006
    • Johns Hopkins University
      Baltimore, Maryland, United States
    • Washington DC VA Medical Center
      Washington, Washington, D.C., United States
  • 2004
    • MedStar Health
      Baltimore, Maryland, United States