It’s not surprising that such a futuristic conference as "Ethics and Mental Health Practice in the Age of Information Technology" was held in one of America’s most futuristic hospitals, the Dartmouth-Hitchcock Medical Center in Lebanon, N.H.

The seven-year-old hospital, designed by the Boston architectural firm of Shepley, Bulfinch, Richardson, and Abbott, looks like a lavish, multistoried shopping mall at the entrance. Light flows down from a skylight in the roof over the multifloored common area and bathes it with sunshine and warmth. Flanking the common area on the main floor are various departments—EEG lab, renal dialysis, occupational medicine, CT scanning, and so forth. The common area on the main floor also contains several restaurants, a bank, a book store, a gift shop, as well as several futuristic centers titled the "Chaplaincy" and the "Center for Shared Decision Making."

The latter is especially interesting and apparently the first such center in the United States. It was set up a year ago to help patients participate in medical-treatment decisions that physicians have traditionally made alone or that are not black-or-white, say, in the appropriate treatment for prostate cancer, low back pain, uterine fibroids, breast cancer, or mild high blood pressure.

First, physicians refer patients to the center. The patients can then view videos and read booklets having to do with their treatment options and receive counseling from the program director for the center, Virginia Beggs, M.Sc., a family nurse practitioner. As Beggs told Psychiatric News, "I try to find out what piece of making a decision is giving them difficulty and direct them back to their provider for information, to the library for information, or to their family—it depends on what they need."

After patients have decided what treatment they prefer, they can then contact their physician. Being able to participate in treatment decisions, patients report, gives them a sense of empowerment and helps them heal after treatment.

So far some 100 physicians have referred patients to the center. Help is free. The center was made possible in part through a grant from Blue Cross-Blue Shield of New Hampshire.

Both patients and physicians have indicated that they would also like the center to offer families help in making end-of-life decisions, such as whether to use a feeding tube or not. A psychiatrist at the Dartmouth-Hitchcock Medical Center, Robert Santulli, M.D., has applied for a grant to make this kind of counseling possible.—J.A.T.