EthicsLab

Offering a composite picture of someone with a drug addiction is not easy. It is not specific to gender, age, income, education, ethnicity, or geography. In this second episode on addiction and medically supervised injection rooms, we go to Melbourne Australia and speak to health care leaders there, on their experience with these programs. Again, these programs aim to a) respond to the addiction health issues of those who are dependent on injection drugs, and b) respond to the broader public health impact of addiction on a community, such as a high amount of drug overdose or the transmission of infectious disease through the sharing of infected needles.

Our guests in this episode include:

Dr Yvonne Benomo, Director of the Department of Addiction Medicine at St Vincent Hospital in Melbourne, Australia and Associate Professor at the Department of Medicine University of Melbourne

Dan Fleming, Group Manager of Ethics and Formation at St Vincent’s Health Australia, Fellow in the Law, Health and Justice Research Center in the University of Technology Sydney, Adjunct Lecturer and the Institute for Ethics and Society at the University of Notre Dame, Australia

This episode was recorded on November 18, 2019

Additional resources relating to or referenced in this episode:

ITQ - Might We Celebrate A Small Step, by Daniel J. Fleming

Harm reduction programs like needle exchange programs or medically supervised injection sites aim to a) respond to the addiction health issues of those who are dependent on injection drugs, and b) respond to the broader public health impact of addiction on a community such as a high amount of drug overdose or the transmission of infectious disease through the sharing of infected needles. These harm reduction programs are having an impact, but some have questioned whether such programs inappropriately cooperate with drug abuse. Our two guests today will offer us insight into that question and the impactful experience of two such harm reduction programs at Providence Health Care in Vancouver, British Columbia, Canada.

Our guests in this episode include:

Scott Harrison, Director for Urban Health, Indigenous Health, Substance Use, Maternity and Neonatal Intensive Care at Providence Health Care

Christopher DeBono, Vice President of Mission, People and Ethics also at Providence Health Care

This episode was recorded on January 23, 2020

Additional resources relating to or referenced in this episode:

Assessing the Ethical Issues in "Safe Injection" Sites by Carol Bayley, and Fr. Charles Bouchard

Catholic Ethicists on HIV/AIDS Prevention, by James Keenan

Catholic Participation in Needle- and Syringe-Exchange Programs for Injection-Drug Users: An Ethical Analysis, by Daniel Sulmasy

Safe Injection Sites: A Moral Reflection, by Steven Bozza and Jeffrey Berger

Today, tough choice healthcare ethics dilemmas are discussed by patients, their loved ones and health care professionals. These discussions are about the care and treatment plan of the patient based on their values. Most often these discussions and decisions have been held in person. As healthcare moves to virtual care, especially in our current COVID19 environment, what would virtual ethics discussions or consultations look like? What would be important to pay attention to? Our guests today have offered such virtual ethics discussions on tough choice decisions with patients.

Our guests in this episode include:

Cristie Cole-Horsburgh, lawyer and staff ethicist with the Cleveland Clinic, Center for Bioethics

Dr. Mahwish Ahmad, physician and transplant ethicist with the Cleveland Clinic, Center for Bioethics

This episode was recorded on March 4, 2020

Resources referenced in this episode:

Cleveland Clinic Center for Bioethics Virtual Ethics Consultation

On March 11, the World Health Organization (WHO) declared COVID-19 a pandemic, pointing to the over 118,000 cases of the coronavirus illness in over 110 countries and territories around the world and the sustained risk of further global spread. To discuss some of the ethical issues regarding COVID-19 we are joined by Dr. Ken Iserson […]

Street Medicine is local and international. In this second episode on Street Medicine we hear about health care leaders in Portland, Oregon responding to the needs in their community. The challenge? Nationally, Oregon has the fourth highest rate of homelessness and the second highest rate of families without shelter. In recent years Portland’s chronic homelessness has increased at twice the national rate. The homeless population is growing older, more disabled, and is on the streets for longer periods of time. The homeless in any community face stigma, social isolation, and loss of relationships. They suffer a disproportionate burden of illness and premature death. The life expectancy of a homeless person is 47 years.  The healthcare leaders collaborating in the Portland Street Medicine program are working to shape a different future.

Our guests in this episode include:

Dr. Dan Bissell, emergency physician and co-founder and executive director of Portland Street Medicine

Drew Grabham, social worker and board member of Portland Street Medicine

This episode was recorded on April 10, 2020

Resources referenced in this episode:

Portland Street Medicine

We hear many stories these days about immigration. Certainly, healthcare workers see undocumented individuals in Emergency Rooms or clinics. What is that experience like of being undocumented and needing healthcare? What would be helpful for clinicians to know? Does healthcare ethics have something to say on this topic? Today we hear from two healthcare leaders […]

Health disparities and health outcomes for African Americans, is egregious… Regarding pain medication, a 2019 published article offered that the pain of African Americans is systematically under-diagnosed and under-treated Our guests today will offer stories and discuss insights on end of life care in the African American community. Our guests in this episode include: Patrick […]

New research findings regarding HIV status will impact how we understand and practice disclosure of HIV status of patients… specifically whether or not to disclose a sick patients’ HIV serostatus to their family or partner. The new research demonstrates that when an HIV-positive person sticks to their treatment, their HIV is undetectable and untransmittable (U=U). […]

A 2019 White House Report tells us that half a million people are homeless each night in the UnitedStates.In 1992, Dr. Jim Withers began doing street rounds in Pittsburgh, Pennsylvania, bringing medical care to the homeless. Since that time the Street Medicine Institute he founded has grown to become international organization. In 2015, CNN named Dr Withers as one of their “Top Ten Heroes.” How might healthcare best include and serve people living without any shelter?

This episode was recorded on March 16, 2020

Resources referenced in this episode:

The Street Medicine Institute

American College of Physicians - Dr. James S. Withers, MD, FACP, on 26 years of treating the homeless and living by the motto, "Go to the people."

CNN -Top 10 CNN Hero Dr. Jim Withers

COVID19 has caused all of us to prepare and it has also demanded something from us. We hear many stories of the technical and resource preparation. In this episode we speak with three physicians from California and Washington state about their preparation and what it has demanded from them. We hear people in frontier territory wanting to offer their best. Some might even call this the crafting of virtue.

Our guests in this episode include:

Dr. Bethany Kapp, dual boarded in Emergency Medicine and Palliative Medicine, CHI Franciscan, Tacoma, WA

Dr. Mojdeh Talebian, pulmonologist and ICU physician, System Medical Director Critical Care, Director ICU & Pulmonary Services, Sequoia Hospital Redwood City, CA

Dr. Anita Chandrasena, pulmonologist, Chief Medical Officer, Northern California Division-Bay Area, CommonSpirit Health, Redwood City, CA

Three physicians, responding to COVID19… and diving deep.

This episode was recorded on April 1st, 2020