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.

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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

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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

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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

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Health care ethics committees help patients and clinicians with tough choice decisions. Within this work of clinical ethics consultation, what are practical tools being used to improve their competence and impact? In this episode, our guests present such practical tools that help health care ethics committee members become more competent, become more aware of gaps and trends, and have more impact on improving the care and health experience of patients.

Our guests in this episode include:

• Becket Gremmels, PhD, System Director of Ethics, Mission Integration Department. CHRISTUS Health
• Katherine Wasson, PhD, MPH, Associate Professor, Neiswanger Institute for Bioethics, Stritch School of Medicine, Loyola University Chicago
• Mark Repenshek, PhD, Executive Director, Ethics & Mission, HSHS Eastern/Western Wisconsin Division, Door County Medical Center
• Laura J. Bishop, Ph.D, Associate Teaching Professor and Academic Program Manager, Kennedy Institute of Ethics, Georgetown University

Additional Resources in this Episode: 

10 Week Free Online Introduction to Bioethics (presented by Laura Bishop)

Ethics Tracker Screenshots (presented by Becket Gremmels)

REDCap Software  (presented by Becket Gremmels)

The ACES Project: Online Clinical Ethics Consultation Skills Assessment (presented by Katherine Wasson)

HCEUSA Dashboard Article 2012 (presented by Mark Repenshek)

Dashboard 2011 Data (presented by Mark Repenshek)

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