EthicsLab

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 and Becket Gremmels. This episode was recorded on Friday March 20, 2020.

Our guests in this episode include:

Dr. Ken Iserson, Professor Emeritus of Emergency Medicine at The University of Arizona, Medical Director (Emeritus) of the Southern Arizona Rescue Association (search & rescue), a Supervisory Physician with Arizona’s Disaster Medical Assistance Team (AZ-1), and a member of the American Red Cross disaster response team.

Becket Gremmels, System Director of Ethics for CHRISTUS Health based in Irving, Texas. CHRISTUS Health can be found in 60 US cities and is comprised of 60 hospitals and long-term care facilities, as well as 175 clinics and outpatient centers.

Additional resources relating to or referenced in this episode:

Improvised Medicine: Providing Care in Extreme Environments, Ken Iserson

Joint Statement on Multiple Patients Per Ventilator

Must I Respond If My Health Is at Risk, Ken Iserson

Triage in Medicine, Part II-Underlying Values and Principles, John Moskop and Ken Iserson

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 on these issues. One, who was an undocumented person and who later became a physician in the United States, and the other is the healthcare leader who supported her journey.

Our guests in this episode include:

Mark G. Kuczewski, PhD, is the Fr. Michael I. English, S.J., Professor of Medical Ethics and also Director of the Neiswanger Institute for Bioethics and Health Policy at Loyola University, Chicago

Dr Johana Mejias-Beck, internal medicine pediatrics specialist, currently at the University of Missouri, Kansas…and one of the first undocumented students to attend the first medical school in the country to accept applicants with DACA status.

Additional resources relating to or referenced in this episode:

Limbo Really Exists: Undocumented Youth at Risk, Mark Kuczewski, Johana Mejias-Beck, Amy Blair, and Matthew Fitz

Treating Fear: Sanctuary Doctoring, Loyola University Chicago - Neiswanger Institute

As we look back on 2019 and forward to 2020, our guests are editors of key healthcare ethics journals with an international readership:

Gregory E. Kaebnick, Editor, The Hastings Center Report

Leslie LeBlanc, Managing Editor, Journal of Clinical Ethics

Nate Hibner, Primary Editor, Health Care Ethics USA and Director of Ethics at the Catholic Health Association of the United States

What are the issues in health care ethics that are impacting ethics committees, health systems, public policy and patients over the past year? What issues do they expect to continue and emerge within the next year? What are they hearing from authors and readers? What key articles published in their journals published in the last year might they recommend to you, our listeners? We explore these questions and more in this episode of EthicsLab.

Additional resources relating to or referenced in this episode:

Of Slide Rules and Stethoscopes: AI and the Future of Doctoring, Robert D. Truog

Patient as Gift, Lydia Dugdale

Changing the Question, Daniel Brudney

The Inner Life of Ethicists: The Importance of Cultivating an Interior Life, Paul J. Waddell

Ethics and Medical Standards of Care: Hysterectomy, Tubal Ligation or Salpingectomy?. Sr. Patricia Talone and Amy Warner

Health disparities and health outcomes for African Americans, is egregious… A 2019 report identified that African American Adults, compared to non-Hispanic white adults, are:

44% More likely to die from stroke

20% more likely to have asthma

40% more likely to die from breast cancer

25% more likely to die from heart disease

52% more likely to die from cervical cancer

23% more likely to be obese

72% more likely to be diabetic

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 Smith, professor at the Duke Divinity School and associate faculty with the Trent Center for Bioethics, Humanities, and History of Medicine at Duke University School of Medicine.

Dr Farr Curlin, Josiah C. Trent Professor of Medical Humanities in the Trent Center for Bioethics, Humanities and History of Medicine, and Co-Director of the Theology Medicine, and Culture Initiative at Duke Divinity School.

Claretta Dupree, Chair of the Academy of Fellows at the Center for Bioethics and Human Dignity at Trinity International University, Deerfield, Illinois.

Additional resources relating to or referenced in this episode:

Center for Practical Bioethics, Richard Payne, MD

Palliative Care in the African American Community

Perceptual Contributions to Racial Bias in Pain Recognition

Racial Bias in Pain Assessment and Treatment Recommendations, and False Beliefs About Biological Differences Between Blacks and Whites

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). Our three guests are working together on bioethical projects to spread the awareness of U=U.

Our guests in this episode include:

Jamie Crist, JD, MA a Clinical Ethics Fellow at the Baylor College of Medicine, Houston Texas and doing clinical ethics consultation at Houston Methodist Hospital. Jamie has a JD and Masters in Bioethics at Case Western University.

Nicole Meredyth, MD, is a clinical ethics fellow at Weil Cornell Medicine in New York Presbyterian Hospital. She is also completing her surgical residency at Weil Cornell University.

Nekee Pandya, MD; is a clinical ethics fellow at Weil Cornell Hospital and also a hospitalist at that hospital.

Additional resources relating to or referenced in this episode:

HIV Law and Policy

CDC HIV Treatment as Prevention

HIV viral load and transmissibility of HIV infection: undetectable equals untransmittable

Buildings in TriBeCa, New York City.

Urban Bioethics may be a new term for you. It is a field and focus in bioethics that points a critical lens on the extreme inequalities of health and access to medical, legal, and other resources that leave many urban dwellers and communities distinctly disadvantaged, disenfranchised, and vulnerable. What is this focus, its scope, its lens, its challenges…

Our guests today are from the Center for Urban Bioethics at Temple University in the Lewis Katz School of Medicine in Philadelphia.

Nora Jones, anthropologist, Associate Professor in Bioethics, and Associate Director of the Center.

Nicolle Strand, Assistant Director for Research at the Center, as well as Assistant Professor. Nicolle is a lawyer and bioethicist.

Providenza (or Enza) Rocco, also a lawyer and a social worker, Assistant Professor at the Center.

Additional resources relating to or referenced in this episode:

Center for Urban Bioethics

Urban Bioethics: Adapting Bioethics to the Urban Context

Setting the agenda for urban bioethics

Imagine you are a patient that is seriously ill and the standard clinical treatment is not working for you. You may want to try experimental drug products, still being investigated and not yet approved by the US Food and Drug Administration (the FDA)…what are your options? There are currently a couple of pathways: First, you could enroll as a participant in a controlled clinical research drug trial. These drug trials are reviewed by institutional research boards or IRBs. A key focus of an IRB is to review how well participants are being fully informed of the risks and benefits of the drug trial.

But maybe you don’t meet all the criteria and don’t qualify for the drug trial. Then, there are two other pathways you might pursue - the Food and Drug Administration has an expanded access program and now, there exists Federal “Right to Try” legislation that was signed into law by President Trump in May of 2018. Both pathways are attempting to create more access and also navigate between ensuring patient safety and the ability of a patient with a life-threatening condition to have access to not yet approved approaches by the FDA. This change begs the question, “What level of patient safety is appropriate and what is unhelpful bureaucracy?” What are the risks and benefits of these different approaches to increasing patient access?

Ashley Snyder, our Summer intern at EthicsLab in 2019, will be interviewing our guests. Ashley completed her Masters in Public Health in Epidemiology at the Colorado School of Public Health, University of Colorado and in the Fall will be pursuing her PhD in Public Health at the University of Utah.

Our guests in this episode include:

Carolyn Chapman, faculty affiliate of the Division of Medical Ethics in the Department of Population Health in the NYU School of Medicine

Kelly McBride Folkers, Senior Research Associate at the Division of Medical Ethics in the NYU School of Medicine at NYU Langone Health, and a member of the Working Group on Compassionate Use and Pre-approval access

Additional resources relating to or referenced in this episode:

NYU Langone Health, Division of Medical Ethics Working Group on Compassionate Use & Preapproval Access

The Hastings Center Report, Federal Right to Try: Where Is It Going? by Kelly Folkers, Carolyn Chapman and Barbara Redman

U.S. FDA, Expanded Access

The Goldwater Institute, The Right to Try

Are you a graduate or post graduate student interested in the EthicsLab Podcast intern program? If so, contact us here.

Brain death is a fundamental ethical topic that is complex and often fraught with emotion. As ethics committees are faced with considerations involving brain death, these cases are often those that stick with professionals the most. Our lead contributor in this episode Becket Gremmels, System Director of Ethics at CHRISTUS Health in Irving TX is in conversation with two nationally recognized ethicists who explore the complexities and challenges surrounding this foundational ethical concept.

Our guests in this episode include:

Dr. Alexander M. Capron, University Professor, Vice Dean for Faculty and Academic Affairs, Scott H. Bice Chair in Healthcare Law, Policy and Ethics, Professor of Law and Medicine, Keck School of Medicine, Co-Director, Pacific Center for Health Policy and Ethics at the University of Southern California

Dr. Michael Rubin, neurointensivist and clinical ethicist in the department of neurology and neurotherapeutics in the Peter O'Donnell Jr. Brain Institute at the UT Southwestern Medical Center

Why would the question of whether to provide food and water to a patient come up at all? One might assume it is always helpful and never harmful to offer nutrition and hydration to patients. Is that accurate? When might it be appropriate or not appropriate? Our lead contributor in this episode is Alan Sanders, Vice President of Ethics Integration and Strategy at Trinity Health is in conversation with guests in this episode to explore a number of ethical issues related to providing nutrition and hydration to patients who cannot feed themselves.

Our guests in this episode include:

Dr. George J. Giokas M.D., Director of Palliative Care, Palliative Care Partners, Inpatient Palliative Care Consult Service, Ellis Hospital

Fr. John J. Raphael, SSJ, Catholic Chaplain and Staff Chaplain at Saint Thomas West Hospital in Nashville, TN

Those who work on responding to the ethical issues and decisions that arise in healthcare realize that we are invited into the most complex stories that patients, families , healthcare professionals and our communities have to offer. They not only involve value-laden clinical decisions about patient treatments, but community decisions about public health that sometimes place the autonomy of individuals against the common good of the community. When reflecting on the work of healthcare ethics, we thought we would ask a couple of colleagues with 25+ years of experience in this area what their thoughts are on this evolving work or calling.

Our guests in this episode include:

Dan O'Brien, who just retired as Senior Vice President of Ethics at Ascension Health

Carol Bayley, who just retied as Vice President of Ethics and Justice Education at Dignity Health

Both are highly regarded by their colleagues and have worked in diverse healthcare settings, from community hospitals to teaching hospitals and working to address pubic health issues in very diverse communities. They have lived the evolution of healthcare ethics over the past 25 years and the everyday challenges that arise. In this episode, we sit down and reflect on their experiences.