EthicsLab

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

Imagine a patient who suffers from an underlying psychiatric disability and comes to a hospital with a critical illness after prolonged non-adherence to a medical treatment plan. Because of their inability to follow a treatment plan, the patient now faces an end-of-life situation, even though the condition would otherwise not be considered terminal. I am sure you can understand that such stories are both tragic and ethically complex. These stories not only   cause moral distress for the healthcare team caring for the patient, but also alarm and confuse patients and their families. Ethics committees in hospitals are asked to consult on the ethics complexities in cases like these. Our guests will reflect on such patient stories and offer their ethical reflections on the challenges, naming the components of complexity, and what is important for ethics committee members to pay attention to in patient stories like these.

Our guests in this episode are:

Carol Taylor, a professor of Medicine and Nursing at Georgetown University, past Director of the Pellegrino Center for Clinical Bioethics. Carol is now a Senior Scholar at the Kennedy Institute of Ethics.

Michael Pottash, Attending Physician in Palliative Medicine at MedStar Washington Hospital Center, He is also an Assistant Professor of Clinical Medicine at Georgetown University School of Medicine.

Laura Guidry-Grimes, is an Assistant Professor of Medical Humanities in Bioethics, at the University of Arkansas for Medical Science. She is also a clinical ethicist at the Children’s Hospital in Little Rock, Arkansas.

Sarah Kleinfeld, is a Geriatric Psychiatrist at the VA Medical Center in Washington DC. She works with elderly patients with a range of psychiatric illnesses like Bipolar disorder and Schizophrenia.

Resources Referenced in this Episode:

The Medical Incapacity Hold: A Policy on the Involuntary Medical Hospitalization of Patients Who Lack Decisional Capacity

Imagine a patient who suffers from an underlying psychiatric disability and comes to a hospital with a critical illness after prolonged non-adherence to a medical treatment plan. Because of their inability to follow a treatment plan, the patient now faces an end-of-life situation, even though the condition would otherwise not be considered terminal. I am sure you can understand that such stories are both tragic and ethically complex. These stories not only   cause moral distress for the healthcare team caring for the patient, but also alarm and confuse patients and their families. Ethics committees in hospitals are asked to consult on the ethics complexities in cases like these. Our guests will reflect on such patient stories and offer their ethical reflections on the challenges, naming the components of complexity, and what is important for ethics committee members to pay attention to in patient stories like these.

Our guests in this episode are:

Carol Taylor, a professor of Medicine and Nursing at Georgetown University, past Director of the Pellegrino Center for Clinical Bioethics. Carol is now a Senior Scholar at the Kennedy Institute of Ethics.

Michael Pottash, Attending Physician in Palliative Medicine at MedStar Washington Hospital Center, He is also an Assistant Professor of Clinical Medicine at Georgetown University School of Medicine.

Laura Guidry-Grimes, is an Assistant Professor of Medical Humanities in Bioethics, at the University of Arkansas for Medical Science. She is also a clinical ethicist at the Children’s Hospital in Little Rock, Arkansas.

Sarah Kleinfeld, is a Geriatric Psychiatrist at the VA Medical Center in Washington DC. She works with elderly patients with a range of psychiatric illnesses like Bipolar disorder and Schizophrenia.

Resources Referenced in this Episode:

The Medical Incapacity Hold: A Policy on the Involuntary Medical Hospitalization of Patients Who Lack Decisional Capacity

In the wake of past and more recent mass shootings, mental illness has been pointed to in some public statements as the root cause of mass shootings: Statements such as…1) “We don’t need a gun database, we need a mental health database in the United States”, or…2) “People don’t kill people, the mentally ill do”. With such statements, mental illness can become conflated with criminality, mass violence and other tragic events. Discrimination, false stereotypes and increased stigma for mental health patients has become a concern. As an example, when New York passed the Secure Ammunition and Firearms Enforcement (SAFE) Act in 2013, a core component of the law required mental health practitioners to report any patient who was "likely" to be violent to the health department, for potential inclusion in a database. Other states have since enacted similar legal requirements. Mental Health practitioners were concerned that the requirement to report, and anxiety about legal liability, would lead to over-reporting. Would mental health patients lose trust in the confidentiality of their health care? Would mental health patients receive an over vigilant surveillance. One year after enacting this law in New York, the New York Times, reported that the number of names within the SAFE Act database quickly rose to 34,500 names.

What are the harms that occur when mental health is named as the key reason for mass shootings? Is there a deeper complexity to be understood?  To shed light and research data on that greater complexity, we are joined by Dr Jonathan Metzl, physician, psychiatrist, Professor of Sociology and Psychiatry, and the Director of the Center for Medicine, Health, and Society, at Vanderbilt University in Nashville, Tennessee.

Resources Referenced in this Episode:

Dr. Jonathan Metzl's Website

American Medical Association Declares Gun Violence a Public Health Crisis 

American Nurses Association Declaration for Gun Control Measures

Physician Groups Representing 426,000 Doctors: Gun Violence Must Stop (American Psychiatric Association, June 2016)

American Psychiatric Association: Position Statement on Firearm Access, Acts of Violence and the Relationship to Mental Illness and Mental Health Services (American Psychiatric Association, June 2015)

Firearm-Related Injury and Death in the United States: A Call to Action From 8 Health Professional Organizations and the American Bar Association (Annals of Internal Medicine, April 2015)

Funding and Publication of Research on Gun Violence and Other Leading Causes of Death (Journal of the American Medical Association, January 2017)

In the wake of past and more recent mass shootings, mental illness has been pointed to in some public statements as the root cause of mass shootings: Statements such as…1) “We don’t need a gun database, we need a mental health database in the United States”, or…2) “People don’t kill people, the mentally ill do”. […]

The big picture is that 115,000 men, women and children await organ transplants in the United States. Even the largest football stadium in the US could not fit the number of patients on the national transplant waiting list. In 2016, 33,600 transplants brought new life to patients and their families. Since 1988, 683,000 transplants have taken place in this country.

In this episode, our lead contributor Becket Gremmels, speaks to a transplant surgeon, an ICU doctor and a health care ethicist about some of the foundational ethical approaches that honor organ donors, the patients who receive those organs, and the health care professionals who care for both.

Our guests in this episode include:

Dr. Carol Bayley, past Vice President for Ethics and Justice Education at Dignity Health, San Francisco

Dr. Anji Wall, Abdominal Transplant Surgeon at Baylor Medical Center, Dallas

Dr. Wes Ely, Intensivist at Vanderbilt University Medical Center and Nashville VA Hospital, Nashville

The big picture is that 115,000 men, women and children await organ transplants in the United States. Even the largest football stadium in the US could not fit the number of patients on the national transplant waiting list. In 2016, 33,600 transplants brought new life to patients and their families. Since 1988, 683,000 transplants have taken place in this country.

In this episode, our lead contributor Becket Gremmels, speaks to a transplant surgeon, an ICU doctor and a health care ethicist about some of the foundational ethical approaches that honor organ donors, the patients who receive those organs, and the health care professionals who care for both.

Our guests in this episode include:

Dr. Carol Bayley, past Vice President for Ethics and Justice Education at Dignity Health, San Francisco

Dr. Anji Wall, Abdominal Transplant Surgeon at Baylor Medical Center, Dallas

Dr. Wes Ely, Intensivist at Vanderbilt University Medical Center and Nashville VA Hospital, Nashville

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 […]

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