EthicsLab

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.

In healthcare, we are able to capture ever increasing levels and types of data. The potential is there for more accurate diagnosis and more relevant which would better inform healthcare decisions and potentially avoid medical error or unnecessary treatments. Artificial intelligence technologies are increasingly accurate in text, in sound or in image recognition with the capability to process and analyze large volumes of data. They have the potential to lighten the load on healthcare professionals and therefore allowing them to spend more time with patients, potentially improving healthcare decision making and delivering higher quality healthcare. What are ethical questions that arise with this data, and with artificial intelligence technologies?

Our guest in this episode, Anita Ho, is a healthcare ethicist with a background in philosophy and public health and has worked university and hospital settings in Canada, The United States and Singapore. She is currently associate professor at the University of British Columbia Center for Applied Ethics, and Associate Professor at the Bioethics Program at the University of California, San Francisco. A focus of her work has been the ethical impact of innovative technologies such as artificial intelligence in healthcare. We are very pleased to be in conversation with Anita in this episode!

Resources Referenced in this Episode:

Hastings Center Report Article: Deep Ethical Learning: Taking the Interplay of Human and Artificial Intelligence Seriously, by Anita Ho

In healthcare, we are able to capture ever increasing levels and types of data. The potential is there for more accurate diagnosis and more relevant which would better inform healthcare decisions and potentially avoid medical error or unnecessary treatments. Artificial intelligence technologies are increasingly accurate in text, in sound or in image recognition with […]

Goals of care is a term so common to health care professionals and yet, our guests describe significant clinical experiences in which the lack of discussion around goals of care led to problematic cases. A goals of care conversation is an important element at the foundation of high quality discussions around code status. In this episode lead contributor Mark Repenshek, Executive Director of Ethics and Mission at Hospital Sisters Health System in Wisconsin, is in conversation with national experts and clinicians who discuss this important topic.

Our guests in this episode are:

Dr. Kenneth A. Berkowitz, MD FCCP Chief, Ethics Consultation at VHA National Center for Ethics in Health Care, Associate Professor of Medicine and Population Health at NYU School of Medicine

Dr. Tim Jessick, DO, Chair/Co-Founder Palliative Care Network of Wisconsin

Palliative Medicine Physician, AdvocateAuroraHealth

Dr. Jill S. Lowery, Psy.D., Chief, Ethics Policy, National Center for Ethics in Health Care at Veterans Health Administration

Dr. James A. Tulsky, MD, Chair, Department of Psychosocial Oncology and Palliative Care at Dana-Farber Cancer Institute, Chief, Division of Palliative Medicine at Brigham and Women’s Hospital, Professor of Medicine at Harvard Medical School

Helpful Goals of Care Resources:

VHA National Center for Ethics in Health Care - The Life-Sustaining Treatment Decisions Initiative

Goals of care is a term so common to health care professionals and yet, our guests describe significant clinical experiences in which the lack of discussion around goals of care led to problematic cases. A goals of care conversation is an important element at the foundation of high quality discussions around code status. In this episode lead contributor Mark Repenshek, Executive Director of Ethics and Mission at Hospital Sisters Health System in Wisconsin, is in conversation with national experts and clinicians who discuss this important topic.

Our guests in this episode are:

Dr. Kenneth A. Berkowitz, MD FCCP Chief, Ethics Consultation at VHA National Center for Ethics in Health Care, Associate Professor of Medicine and Population Health at NYU School of Medicine

Dr. Tim Jessick, DO, Chair/Co-Founder Palliative Care Network of Wisconsin

Palliative Medicine Physician, AdvocateAuroraHealth

Dr. Jill S. Lowery, Psy.D., Chief, Ethics Policy, National Center for Ethics in Health Care at Veterans Health Administration

Dr. James A. Tulsky, MD, Chair, Department of Psychosocial Oncology and Palliative Care at Dana-Farber Cancer Institute, Chief, Division of Palliative Medicine at Brigham and Women’s Hospital, Professor of Medicine at Harvard Medical School

Helpful Goals of Care Resources:

VHA National Center for Ethics in Health Care - The Life-Sustaining Treatment Decisions Initiative

Informed consent is one of the foundational ethical principles in health care that supports patient autonomy, or stated differently, the patients right to self-determination. More and more the standard for what clinicians should inform patients about the risks benefits and alternatives of treatment are no longer determined by what a responsible body of physicians deems important, but rather by what a reasonable patient deems important. What is needed to meet that goal is a collaborative communication process between clinicians and patients that integrates the best evidence available with the patients values and preferences to promote high quality health care decisions. In the United States at least half of the states have adopted the reasonable patient standard regarding informed consent.

This episode of EthicsLab Essentials is led by lead contributor Rachelle Barina, VP - Mission Integration at SSM Health based in Wisconsin and is in conversation with two nationally known guests:

Dr. Jenny Heyl, Director of Ethics at Mercy Hospital in St. Louis

Dr. Kayhan Parsi, Professor of Bioethics at the Neiswanger Institute for Bioethics: Loyola University Chicago

Informed consent is one of the foundational ethical principles in health care that supports patient autonomy, or stated differently, the patients right to self-determination. More and more the standard for what clinicians should inform patients about the risks benefits and alternatives of treatment are no longer determined by what a responsible body of physicians deems important, but rather by what a reasonable patient deems important. What is needed to meet that goal is a collaborative communication process between clinicians and patients that integrates the best evidence available with the patients values and preferences to promote high quality health care decisions. In the United States at least half of the states have adopted the reasonable patient standard regarding informed consent.

This episode of EthicsLab Essentials is led by lead contributor Rachelle Barina, VP - Mission Integration at SSM Health based in Wisconsin and is in conversation with two nationally known guests:

Dr. Jenny Heyl, Director of Ethics at Mercy Hospital in St. Louis

Dr. Kayhan Parsi, Professor of Bioethics at the Neiswanger Institute for Bioethics: Loyola University Chicago

Consider someone leaving a hospital, after their care is completed at that location, to return to their home and local community. As discharge plans are made to continue their care, their healing, their rehabilitation, are there ethical challenges that arise? Can there be biases that shape that plan because of their ability, disability, lack of family support systems or resources available in the community? What are the frameworks, tools, approaches that an assist all involved? Our guests will offer their experience in these discharge plan dilemmas and offer the practical approaches they have utilized every day.

Joining us in conversation in this episode are:

Debjani Mukherjee, trained as clinical psychologist and clinical ethicist, is Director of the Donnelley Ethics Program at the Shirley Ryan Ability Lab, Associate Professor of Physical Medicine and Rehabilitation and Medical Education at Northwestern University, Feinberg School of Medicine.

Preya Tarsney, trained as a lawyer Bioethicist - Donnelley Ethics Program at the Shirley Ryan Ability Lab and a Lecturer of Physical Medicine & Rehabilitation at Northwestern University Feinberg School of Medicine and faculty lecturer at the University of Chicago, MacLean Center for Clinical Medical Ethics.

Kristi L. Kirschner MD is a physician in physical medicine and rehabilitation and has practiced in this area for 30 years. She also has a background in clinical ethics and physical disability ethics and a faculty member of the university of Illinois College of Medicine where she directs the sub-theme of Humanities in Ethics for the College of Medicine.

Consider someone leaving a hospital, after their care is completed at that location, to return to their home and local community. As discharge plans are made to continue their care, their healing, their rehabilitation, are there ethical challenges that arise? Can there be biases that shape that plan because of their ability, disability, lack of family support systems or resources available in the community? What are the frameworks, tools, approaches that an assist all involved? Our guests will offer their experience in these discharge plan dilemmas and offer the practical approaches they have utilized every day.

Joining us in conversation in this episode are:

Debjani Mukherjee, trained as clinical psychologist and clinical ethicist, is Director of the Donnelley Ethics Program at the Shirley Ryan Ability Lab, Associate Professor of Physical Medicine and Rehabilitation and Medical Education at Northwestern University, Feinberg School of Medicine.

Preya Tarsney, trained as a lawyer Bioethicist - Donnelley Ethics Program at the Shirley Ryan Ability Lab and a Lecturer of Physical Medicine & Rehabilitation at Northwestern University Feinberg School of Medicine and faculty lecturer at the University of Chicago, MacLean Center for Clinical Medical Ethics.

Kristi L. Kirschner MD is a physician in physical medicine and rehabilitation and has practiced in this area for 30 years. She also has a background in clinical ethics and physical disability ethics and a faculty member of the university of Illinois College of Medicine where she directs the sub-theme of Humanities in Ethics for the College of Medicine.

As we look back on 2018 and forward to 2019, our guests are editors of key healthcare ethics journals with an international readership:

Gregory  E. Kaebnick, Editor, The Hastings Center Report – The Hastings Center

Leslie LeBlanc, Managing Editor, Journal of Clinical Ethics

Fr. Charles Bouchard, Editor, Health Care Ethics USA – 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 key articles published in their journals published in the last year might they recommend to you, our listeners? These questions and others, our guests discuss in this episode of the EthicsLab Podcast.

Resources Referenced in this Episode:

Ethics, Public Policy and Care of Individuals with Intellectual Disability – Health Care Ethics USA

Advance Directives and Discrimination against People with Dementia – The Hastings Center Report

An Open Letter to Norman Cantor Regarding Dementia and Physician‐Assisted Suicide – The Hastings Center Report

On Avoiding Deep Dementia – The Hastings Center Report

When Voluntary Stopping of Eating and Drinking in Advanced Dementia Is No Longer Voluntary – The Hastings Center Report