Let's Get Ethical ™

We like to pretend autonomy is neat and clean — a signature on a consent form, an advance directive in a drawer. But what happens when saying "no" costs the system something? And what happens when the decision isn't even left in your hands?

In this episode, Mike and Rob take on the pillar they keep circling back to: patient autonomy — your right to say yes, and your right to say no. They lay out what autonomy actually requires (informed consent, capacity, competence), why a treatment can be medically beneficial yet morally unacceptable to the patient, and how autonomy gets quietly stripped away in ways that never make headlines.

Then they connect the threads from recent cases: the Georgia law that overrode Adriana Smith's surrogate decision-maker, the WISeR model where a third party thousands of miles away can deny approved care, and Pete Jacobs — the competent patient who mouthed "suction me," pointed to his airway, and was ignored while staff hid behind scope. Different stories, same erosion.

The uncomfortable question at the center: are we treating the patient's goals, or our own institutional protocol?

Congratulations also to co-host Rob — New Hampshire's Respiratory Care Practitioner of the Year 2026.

Join the conversation. Let's get ethical.

A nurse agrees to be a gestational surrogate. The contract includes a clause: if doctors find a serious fetal anomaly, the intended parents can request termination — and she signs it, with a psychologist involved, fully informed. Then, 20 weeks in, a serious diagnosis comes. The parents invoke the clause. And she says no.

Is that a broken promise, or is it exactly what bodily autonomy is supposed to look like?

Mike and Rob dig into one of the thorniest cases they've covered — a real, ongoing surrogacy dispute now spanning three states and lawsuits over custody, parentage, and breach of contract. They work through the difference between promising to do something and consenting to have something done to you, why almost no legal system will force a medical procedure on someone no matter what they signed, and the eerie echoes of the 1988 Baby M case that drew this same line decades ago.

Then the sharpest question of all: nothing about the ethics changed when she crossed a state line — so why does geography end up deciding a child's entire legal identity? Law and ethics point in different directions here, again and again, and this episode sits right in that gap.

No verdict. No easy answers. Just the questions worth sitting with.

Join the conversation. Let's get ethical.

Who gets to decide whether you receive the care your doctorordered — and what happens when the person deciding is rewarded for saying no?

Mike and Rob dig into WISER, a new Medicare model (theWasteful and Inappropriate Service Reduction model) that pairs AI and machine learning with human reviewers to evaluate whether certain services get approved. Prior authorization isn't new, and reducing genuine waste is a good thing — but this episode is about what happens when financial incentives, algorithms, and blurred accountability get built into that decision.

They work through the ethics underneath: the appeal processmost patients never use, the human cost of a wrongful denial, the conflict of interest in paying reviewers based on what they save, and the accountability gap when "the algorithm decided." Along the way — the GAO's review, the congressional fight over the model, and two personal stories (including Mike's father's months-long battle over a Medicare eye referral) that put a face on the whole thing.

No easy villains, no partisan axe to grind — just the fourpillars of medical ethics applied to a system where, as Rob puts it, complicated structures can quietly hide who's responsible.Join the conversation. Let's get ethical.

A suction machine sat at the bedside, switched off. Over an eight-hour shift, aides asked more than ten times for the patient to be suctioned. He mouthed that he couldn't breathe. And by morning, an 87-year-old Korean War veteran named Pete was dead — from something as simple, and as preventable, as a machine that was never turned on.

In this episode, Mike and Rob work through one of the hardest cases they've covered: a real preventable death in an Iowa long-term care facility. It's not just a story about one clinician. It's about the ethics underneath — the duty to rescue, scope of practice used as a shield, moral injury, the bystander problem, and the institutional rot that let "that's not my job" end a man's life.

They dig into the legal aftermath (what an Alford plea actually means, why a license was suspended rather than revoked), the aide who says she was fired for speaking up, and the uncomfortable question at the center of it all: when the system fails and one person takes the blame, does anyone actually get justice?

A sobering look at what we owe the patient in front of us — and everyone who could have picked up the phone.

Join the conversation. Let's Get Ethical.

Where does ethics actually come from? Mike and Rob trace the entire arc of medical ethics — from the Code of Hammurabi in 1754 BCE and the Greek philosophers, through Hippocrates and "do no harm," all the way to the four pillars that govern clinical practice today.

Here's the part that surprises everyone: the framework modern healthcare runs on — autonomy, beneficence, non-maleficence, and justice — is barely 40 years old, formalized by Beauchamp and Childress in 1979. Rob walks through the hard history that forced it into being: the Nuremberg Code born from the Nazi doctor trials, the 1964 Declaration of Helsinki, and the Tuskegee Syphilis Study that ran for 40 years until journalist Jean Heller exposed it in 1972.

It's a fast, surprisingly gripping tour through the moral codes, atrocities, and turning points that shaped how we treat patients today — and a look ahead at the next frontier: what AI will do to ethical decision-making in medicine.

Whether you're an RT, a nursing or med student, or just someone who thinks about right and wrong in healthcare, this one reframes how you see the field.

Join the conversation. Let's get ethical.

Is it ever ethical for healthcare workers to walk off the job? When roughly 4,000 nurses at Brigham and Women's Hospital — part of the Mass General Brigham system — staged the largest nursing strike in Massachusetts history, it forced a hard question: where's the line between workers' rights and a clinician's duty to the patients in the beds?

Rob and Mike work through every side of it — the one-day walkout, the multi-day lockout that followed, the contracted "registry" nurses brought in to cover, and the roughly 3.5% raise the Massachusetts Nurses Association was asking for. Then they flip the ledger: a system reporting billions in net income, with a CEO whose total compensation reached $8.4 million — the highest of any hospital executive in the state. Is a modest raise really the unreasonable ask, or does walking out on patients cross a line no paycheck can justify?

Unions, "scabbing," executive compensation, and what actually happens to patients when both sides dig in. No cheerleading, no easy answers — just an honest look at a genuinely hard call.

Join the conversation. Let's get ethical.

Great leaders aren't born knowing how to handle a team that turns on them — they learn it in the trenches. This week, Rob and Mike sit down with Meliza Walsh, Director of Respiratory Care at Children's Memorial Hermann Hospital in the Texas Medical Center, co-host of Sis, Let's Talk Leadership, and a rising voice in respiratory therapy leadership.Meliza opens up about the core values that anchor her (integrity, faith, and family), the year of leadership so brutal she cried the whole drive home, and the "leadership buddy" advice that changed everything. The conversation goes deep on accountability without cruelty, why she refuses to correct staff who mistake her for a new grad, and how "just culture" really works when you're troubleshooting a failing device at 3 AM.Then things get real: Mike shares actual social-media posts from RTs bragging about skipping treatments, faking respiratory rates, and charting therapy they never did — and Meliza explains how a leader should respond when the person misrepresenting the profession is on your own team.Honest, funny, and full of hard-won wisdom on what ethical leadership actually looks like in respiratory care.Join the conversation. Let's get ethical.

Mayo Clinic is replacing overnight respiratory therapists with telehealth in its critical access hospitals — so Rob and Mike revisit the decision with someone who's lived it.

Jill Wolber, an RT with nearly 30 years in critical care and a year as the lone night RT at a rural critical access hospital, takes the conversation into the trenches: running from ER codes to deliveries, managing near-sentinel events, and feeling like her license was on the line every shift.

Having done telehealth herself, she explains why Mayo's "quality of care" framing crosses a line — and the critical difference between telehealth as a backup versus a replacement. A candid look at staffing, ethics, and what rural communities stand to lose.

Plus: a birthday shout-out to the U.S. Navy Hospital Corps.

New here? Start with our first conversation on the Mayo decision: https://open.spotify.com/episode/3IfjcHYfTodvjtPXV9Eqrv?si=PQImJiX7SeCTLByrxPE6_g

Join the conversation. Let's get ethical.

Recorded live at the California Society for Respiratory Care conference, We are joined by crew from RT Sidebar for a special crossover edition with the Let's Get Ethical crew. And if that wasn't enough, a familiar face makes his long-awaited return — the one and only JB is back in the house.

The crew gets candid about how podcasting has transformed respiratory therapy education, reaching listeners across 14+ countries and platforms like Spotify, YouTube, iHeart, and Amazon Music. They share their funniest, most cringe-worthy podcast memories — from garage recordings about meat marinades to one unforgettable bedside moment involving a bassinet and a very awkward congratulations. Plus, hear how this unlikely group of friends found each other through webinars, word of mouth, and a little bit of fate.

It's laughs, love, and a whole lot of respiratory therapy energy — straight from sunny California.

Is the next pandemic already here, or is it just social media noise? In this episode of Let's Get Ethical, Rob and Mike welcome back Mindy Conklin to discuss the ethical implications of healthcare professionals venting on social media while in uniform. We break down the reality of the Hantavirus "scare," address the toxic culture of negativity facing students and new grads, and discuss what it truly means to uphold the oath in a post-COVID world. If you are feeling burned out, or if you're tired of the bedside "venting" culture, this conversation is for you.