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

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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

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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

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One of the challenging areas in clinical practice today is wanting to honor patient wishes but not being clear on the competency or capacity level a patient with dementia or behavioral health issues. In this episode we explore different challenging situations that ask: a) What is the best assessment of capacity? b) What level of risk should be supported? c) How might health care professionals approach these situations at a deeper human level? Our guests, who are national experts in this area and will offer insight and practical consideration and approaches to the questions list above and others.

Our guests in this episode include:

• Sherri Boggs, Quality, Patient Safety & Education Manager, Our Lady of Peace Hospital
• Dr. Stephen Post, international speaker, best selling author and the Director for the Center for Medical Humanities, Compassionate Care, and Bioethics at Stony Brook University
• Dr. Paul S. Appelbaum, New York State Psychiatric Institute and Columbia University Department of Psychiatry
• Dr. Ali Abbas Asghar-Ali, Michael E. DeBakey VA Medical Center

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Are there better ways to build and support a culture of clinical ethics in healthcare? What might that look like? What has worked and how could the ideas and tools offered be implemented? In the late 1990’s the idea was proposed, why not marry the work being done in health care ethics with quality improvement methodology. Would this type of “Thinking Differently” help us get traction and improve the systems and initiatives that clinical ethics tries to accomplish? These are some of the questions and issues that our guests will wrestle with as well as offering concrete examples and even practical solutions being tested today.

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