EthicsLab Essentials

As patients, surrogate decision makers, and clinicians discuss goals of care, questions arise regarding what interventions will physiologically work and what interventions will honor the patient’s values. Do Not Resuscitate Orders are one of the interventions frequently discussed. Our lead contributor on this episode, Mark Repenshek, Executive Director for Ethics & Mission at Hospital Sisters Health System, in Wisconsin is in conversation with guests to explore a number of ethical issues related to Do Not Resuscitate orders that include, but are not limited to: a) Patient/Surrogate desires for full resuscitation despite the intervention’s lack of efficacy in specific clinical circumstances, b) Consideration of partial codes as a “compromise” co-status, c) A physicians’ professional right to limit the use of resuscitation efforts in certain circumstances. The episode also introduces a new series within the EthicsLab Podcast called EthicsLab Essentials. This new series is designed to be an introductory series of modules to enrich ethics committee members.

Our guests in this episode are:

Dr. Jacqueline K. Yuen, MD, geriatrician, palliative care physician and medical educator. Dr. Yuen is now Assistant Clinical Professor, Department of Medicine at the University of Hong Kong

Dr. Michael Ruben, M.D., M.A., neurointensivist and clinical ethicist

Dr. Gregory Holt, M.D., Ph.D., pulmonary critical care physician at the University of Miami and VA Medical Center in Miami

As patients, surrogate decision makers, and clinicians discuss goals of care, questions arise regarding what interventions will physiologically work and what interventions will honor the patient’s values. Do Not Resuscitate Orders are one of the interventions frequently discussed. Our lead contributor on this episode, Mark Repenshek, Executive Director for Ethics & Mission at Hospital Sisters Health System, in Wisconsin is in conversation with guests to explore a number of ethical issues related to Do Not Resuscitate orders that include, but are not limited to: a) Patient/Surrogate desires for full resuscitation despite the intervention’s lack of efficacy in specific clinical circumstances, b) Consideration of partial codes as a “compromise” co-status, c) A physicians’ professional right to limit the use of resuscitation efforts in certain circumstances. The episode also introduces a new series within the EthicsLab Podcast called EthicsLab Essentials. This new series is designed to be an introductory series of modules to enrich ethics committee members.

Our guests in this episode are:

Dr. Jacqueline K. Yuen, MD, geriatrician, palliative care physician and medical educator. Dr. Yuen is now Assistant Clinical Professor, Department of Medicine at the University of Hong Kong

Dr. Michael Ruben, M.D., M.A., neurointensivist and clinical ethicist

Dr. Gregory Holt, M.D., Ph.D., pulmonary critical care physician at the University of Miami and VA Medical Center in Miami

Have you ever experienced an event, a situation or a decision where you felt that your professional integrity had been compromised? It may have occurred because of something you did, something someone else did or simply a number of events that lined up in a way that made you feel that you were between a rock and hard place. In that moment you probably experienced moral distress. In this episode, we look at moral distress in the health care environment. What are the clinical situations that cause moral distress to arise, what can be done to respond, can it be cured or is it a part of our moral life?

Our guests in this episode are:

Dr. Cynda Rushton, the Anne and George L. Bunting Professor of Clinical Ethics in the Berman Institute of Bioethics and the School of Nursing at Johns Hopkins University

Dr. M. Sara Rosenthal, Ph.D., Professor and Founding Director, Program for Bioethics, Departments of Internal Medicine, Pediatrics and Behavioral Science Chair, Hospital Ethics Committee, University of Kentucky and co-creator of the Moral Distress Education Project

Dr. Beth Lown, Chief Medical Officer of the Schwartz Center for Compassionate Healthcare

Resources referenced in this episode:

The Schwartz Center

The Moral Distress Education Project

The Boston Globe Magazine - Article by Ken Schwartz

Facilitated Ethics Conversations: A Novel Program for Managing Moral Distress in Bedside Nursing Staff

A Health System-wide Moral Distress Consultation Service: Development and Evaluation

Development and Testing of an Instrument to Measure Moral Distress in Healthcare Professionals

Have you ever experienced an event, a situation or a decision where you felt that your professional integrity had been compromised? It may have occurred because of something you did, something someone else did or simply a number of events that lined up in a way that made you feel that you were between a […]

Health care ethics committees help patients and clinicians with tough choice decisions. Within this work of clinical ethics consultation, what are practical tools being used to improve their competence and impact? In this episode, our guests present such practical tools that help health care ethics committee members become more competent, become more aware of gaps and trends, and have more impact on improving the care and health experience of patients.

Our guests in this episode include:

Becket Gremmels, PhD, System Director of Ethics, Mission Integration Department. CHRISTUS Health

Katherine Wasson, PhD, MPH, Associate Professor, Neiswanger Institute for Bioethics, Stritch School of Medicine, Loyola University Chicago

Mark Repenshek, PhD, Executive Director, Ethics & Mission, HSHS Eastern/Western Wisconsin Division, Door County Medical Center

Laura J. Bishop, Ph.D, Associate Teaching Professor and Academic Program Manager, Kennedy Institute of Ethics, Georgetown University

Additional Resources in this Episode: 

10 Week Free Online Introduction to Bioethics (presented by Laura Bishop)

Ethics Tracker Screenshots (presented by Becket Gremmels)

REDCap Software  (presented by Becket Gremmels)

The ACES Project: Online Clinical Ethics Consultation Skills Assessment (presented by Katherine Wasson)

HCEUSA Dashboard Article 2012 (presented by Mark Repenshek)

Dashboard 2011 Data (presented by Mark Repenshek)

One of the challenging areas in clinical practice today is wanting to honor patient wishes but not being clear on the competency or capacity level a patient with dementia or behavioral health issues. In this episode we explore different challenging situations that ask: a) What is the best assessment of capacity? b) What level of risk should be supported? c) How might health care professionals approach these situations at a deeper human level? Our guests, who are national experts in this area and will offer insight and practical consideration and approaches to the questions list above and others.

Our guests in this episode include:

Sherri Boggs, Quality, Patient Safety & Education Manager, Our Lady of Peace Hospital

Dr. Stephen Post, international speaker, best selling author and the Director for the Center for Medical Humanities, Compassionate Care, and Bioethics at Stony Brook University

Dr. Paul S. Appelbaum, New York State Psychiatric Institute and Columbia University Department of Psychiatry

Dr. Ali Abbas Asghar-Ali, Michael E. DeBakey VA Medical Center

Sessions are monitored on a monthly basis by CME office and content confirmed to be evidence based and without bias. Secondly, the CME Program Director and CME Coordinator reviewed and approved all material prior to the educational activity being approved to confirm that the educational activity was evidenced based. Peer reviewed journals and other literature are used, as applicable during discussions.

References for Further Study:

Kontos, N., Freudenreich, O., & Querques, J. (2013). Beyond capacity: identifying ethical dilemmas underlying capacity evaluation requests. Psychosomatics, 54(2), 103-110

Calcedo-Barba, A., Fructuoso, A., Raga, J. M., Paz, S., MSd, C., & Pons, E. V. (2020). Evidence on the capacity of severe mental disorder patients to make well-founded decisions about their healthcare: a meta-review (Doctoral dissertation, Universidad Anáhuac, México)

Kelly, B. D. (2017). The Assisted Decision-Making (Capacity) Act 2015: what it is and why it matters. Irish Journal of Medical Science (1971-), 186(2), 351-356

Ganzini, Linda, Ladislav Volicer, William A. Nelson, Ellen Fox, and Arthur R. Derse. "Ten myths about decision-making capacity." Journal of the American Medical Directors Association 6, no. 3 (2005): S100-S104

Finch, J. (2019). Assessing mental capacity and making decisions. British Journal of Neuroscience Nursing, 15(4), 187-189

One of the challenging areas in clinical practice today is wanting to honor patient wishes but not being clear on the competency or capacity level a patient with dementia or behavioral health issues. In this episode we explore different challenging situations that ask: a) What is the best assessment of capacity? b) What level of risk should be supported? c) How might health care professionals approach these situations at a deeper human level? Our guests, who are national experts in this area and will offer insight and practical consideration and approaches to the questions list above and others.

Our guests in this episode include:

Sherri Boggs, Quality, Patient Safety & Education Manager, Our Lady of Peace Hospital

Dr. Stephen Post, international speaker, best selling author and the Director for the Center for Medical Humanities, Compassionate Care, and Bioethics at Stony Brook University

Dr. Paul S. Appelbaum, New York State Psychiatric Institute and Columbia University Department of Psychiatry

Dr. Ali Abbas Asghar-Ali, Michael E. DeBakey VA Medical Center

Sessions are monitored on a monthly basis by CME office and content confirmed to be evidence based and without bias. Secondly, the CME Program Director and CME Coordinator reviewed and approved all material prior to the educational activity being approved to confirm that the educational activity was evidenced based. Peer reviewed journals and other literature are used, as applicable during discussions.

References for Further Study:

Kontos, N., Freudenreich, O., & Querques, J. (2013). Beyond capacity: identifying ethical dilemmas underlying capacity evaluation requests. Psychosomatics, 54(2), 103-110

Calcedo-Barba, A., Fructuoso, A., Raga, J. M., Paz, S., MSd, C., & Pons, E. V. (2020). Evidence on the capacity of severe mental disorder patients to make well-founded decisions about their healthcare: a meta-review (Doctoral dissertation, Universidad Anáhuac, México)

Kelly, B. D. (2017). The Assisted Decision-Making (Capacity) Act 2015: what it is and why it matters. Irish Journal of Medical Science (1971-), 186(2), 351-356

Ganzini, Linda, Ladislav Volicer, William A. Nelson, Ellen Fox, and Arthur R. Derse. "Ten myths about decision-making capacity." Journal of the American Medical Directors Association 6, no. 3 (2005): S100-S104

Finch, J. (2019). Assessing mental capacity and making decisions. British Journal of Neuroscience Nursing, 15(4), 187-189

Health care professionals, patients and family members could all agree that patient wishes about their care are important and need to be respected. Why then, nationally, do only 30 percent of adults have an advance directive that documents those wishes? Given that statistic, how could the town of La Crosse, Wisconsin, achieve the surprising goal that 96% of people who die there have an advance directive or similar documentation…such a difference from the national average? Some wonder how to begin such a conversation while others ask what the best systems to put in place are? Yes, there are better tools, practices and systems that can help us.

Our guests in this episode include:

Bernard “Bud” Hammes, PhD, Executive Director, Respecting Choices, A Division of C-TAC Innovations

David Bailey, Physician ENT and Chief Medical Officer for Memorial Health in Lufkin, TX.

Kate (O’Rourke) DeBartolo, National Field Director, Institute for Healthcare Improvement at The Conversation Project

Suzanne Engelder, MSW, ASW, The Center for Advance Care Planning and Advocacy

Health care professionals, patients and family members could all agree that patient wishes about their care are important and need to be respected. Why then, nationally, do only 30 percent of adults have an advance directive that documents those wishes? Given that statistic, how could the town of La Crosse, Wisconsin, achieve the surprising goal […]

Are there better ways to build and support a culture of clinical ethics in healthcare? What might that look like? What has worked and how could the ideas and tools offered be implemented? In the late 1990’s the idea was proposed, why not marry the work being done in health care ethics with quality improvement methodology. Would this type of “Thinking Differently” help us get traction and improve the systems and initiatives that clinical ethics tries to accomplish? These are some of the questions and issues that our guests will wrestle with as well as offering concrete examples and even practical solutions being tested today.

Our guests in this episode include:

Mark Repenshek, Sr. Director of Ethics, Ascension Health

Bob Strickland, Sr. Vice President Performance Management, Catholic Health Initiatives

Bob Scheri, Vice President Mission Integration, CHI Memorial