EthicsLab

Chaplaincy and spiritual care are essential components of healthcare, addressing the physical, spiritual, mental, and social aspects of a person’s life. Providing spiritual support to patients, families, and staff during times of illness, crisis, or loss acknowledges the human element and the challenges faced in healthcare. Chaplains play a crucial role in offering emotional and spiritual guidance while respecting diverse religious beliefs and values. They also navigate unique ethical dilemmas inherent to their profession.

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One of the most difficult problems facing hospitals and health systems today is scarcity of key medical resources. Unfortunately, blood product shortages are not uncommon, and they present significant challenges for patient care. Our guests in this episode developed a specific set of recommendations and a protocol for their hospitals to deal with these situations. They’ve also worked to establish a standard approach across their geographic region, which a lot of locations have not really been able to accomplish. We hope their insights and work can inform other ethicists, hospitals and cities looking to develop similar protocols.

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According to the United States Centers for Disease Control and Prevention, more than 46 million, or 15% of all Americans live in rural areas. And, as more attention is given to meeting the health needs of this population, a significant gap in health between rural and urban Americans has emerged.  

Rural Americans are more likely to die from heart disease, cancer, unintentional injury, chronic respiratory disease, and stroke than their urban counterparts. Unintentional injury deaths are approximately 50 percent higher in rural areas, partly due to greater risk of death from motor vehicle crashes and opioid overdoses. 

These challenges underscore the important role that critical access hospitals play in helping to address these disparities. But what are the ethical considerations that should be looked at when caring for rural communities? In this episode, our guests offer their perspective and expertise on this important topic. 

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When you hear the phrase quality of life, what comes to mind? Having dinner with family, learning a language, watching a movie with friends? Or, does the image of a patient struggling to perform basic tasks such as bathing or getting dressed, or someone who is reliant on a ventilator to breathe come to mind? Despite its inherently subjective and multifaceted nature, quality of life is a term that is widely used in healthcare, particularly for making critical decisions that have life-altering consequences. It is a complex construct that encompasses a wide range of factors that affect a person’s overall sense of well-being, including their physical health, emotional state, social connections, and financial stability.

In this all new in-depth episode of EthicsLab, with our guests we explore how the concept of quality of life is used in medical decision making and shed light on the challenges this brings, especially to those in the disability community. We offer several solutions to how these challenges can be overcome.

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In our two part series, we have been unpacking how health care ethics committees, ethics programs, and health care ethics consultants provide guidance to patients, their families and clinicians in hospitals and health care delivery sites. In this second episode, we focus on data that demonstrates the impact of ethics consultation. Our guests look to deepen the effectiveness of this service to all involved in health decision making.

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This episode was recorded on multiple dates in mid 2021.

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It is not unusual for tough choice decisions to be made in health care. In those situations, what help can patients, their families or the clinical team receive? Health care ethics committees and health care ethics consultants provide guidance to patients, their families and clinicians in hospitals and health care delivery sites across the United States and throughout the world. According to the American Society of Bioethics and Humanities, “The goal of ethics consultation is to “improve health care outcomes through the identification, analysis and resolution of ethical issues in health care institutions,” How might better access to these resources be made more available. How might their impact be assessed?

In this first episode, of a two part series, our guests explore the impact that ethics consultation has in the continuum of care, and dive deeper into just how big of an impact this service can have in clinical care.

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This episode was recorded on multiple dates in mid 2021.

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What type of influence should physicians, nurses and patients have on tough choice healthcare decisions? Clinicians want to offer their experience and their competence, so should they be neutral and simply support patient decisions? What type of influence would be helpful and what type would be inappropriate, coercive, or biased? In this episode, our guests explore these questions and a behavioral economics tool called “nudging”. Nudges are subtle changes to the design, framing of information, and decision options that can influence behaviors. These subtle changes, stemming from decision psychology, enable clinicians to inform patients of their options, while at the same time, being very intentional about avoiding manipulation of patient decisions.

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This episode was recorded in December 2021.

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Drug shortages in health care occur for many reasons and have negative impacts. According to the US Food and Drug Administration, “a high percentage of drug shortages have been, and continue to be, sterile injectables, including chemotherapy, anesthesia and other acute drugs”. And, even though drug shortages have declined in recent years, a significant number of shortages are still active and continue to negatively impact patient care. In this episode, we interview national experts who have focused their professional attention on this issue.

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This episode was recorded in February 2021.

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Image Credit: Pavel_Chag, via Getty Images, found via promarket.org.

In March 2020, the coronavirus pandemic created a devastating impact within and outside the United States. COVID-19 made us painfully aware of systemic racism in healthcare with the allocation of scarce resources for vulnerable populations. In May 2020, the murder of George Floyd by a police officer brought the continued injustice of systemic racism into sharp focus for many Americans. The nation’s focus on confronting systemic racism highlighted foundational questions of bias against people of color in public health ethics and bioethics regarding providing fair and equitable responses to the coronavirus pandemic. Specifically, one example was the SOFA score tool, a proposed unbiased method to fairly allocate scarce resources like ventilators, was shown to be less likely to allocate resources to people of color compared to white Americans. In this podcast, we learn from experts why our resource allocation methods fail to be fair and equitable and how we can work towards an equitable approach to scarce resource allocation in particular and bioethics in general.

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Jaime Konerman-Sease, our graduate intern at EthicsLab in 2020 and 2021, will be interviewing our guests. Jaime is completing her PhD in Healthcare Ethics and Theology at Saint Louis University.

This episode was recorded on February 5, 2021.

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Image Credit: Equality vs. Equity – by the Interaction Institute for Social Change | Artist: Angus Maguire.” Image Found: interactioninstitute.org and peacecorps.gov

If primary health care professionals are to serve and accompany the transgender community well, what would that look like? What would need our attention? What approaches have proved helpful and supportive? What would accompaniment require from health care professionals? Our guests today are either health professionals who are transgender or who have devoted their professional lives to serving the transgender community.

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This episode was recorded on multiple dates in 2019 and 2020.

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