On March 11, the World Health Organization (WHO) declared COVID-19 a pandemic, pointing to the over 118,000 cases of the coronavirus illness in over 110 countries and territories around the world and the sustained risk of further global spread. To discuss some of the ethical issues regarding COVID-19 we are joined by Dr. Ken Iserson and Becket Gremmels. This episode was recorded on Friday March 20, 2020.

Our guests in this episode include:

• Dr. Ken Iserson, Professor Emeritus of Emergency Medicine at The University of Arizona, Medical Director (Emeritus) of the Southern Arizona Rescue Association (search & rescue), a Supervisory Physician with Arizona’s Disaster Medical Assistance Team (AZ-1), and a member of the American Red Cross disaster response team.
• Becket Gremmels, System Director of Ethics for CHRISTUS Health based in Irving, Texas. CHRISTUS Health can be found in 60 US cities and is comprised of 60 hospitals and long-term care facilities, as well as 175 clinics and outpatient centers.

Additional resources relating to or referenced in this episode:

• Improvised Medicine: Providing Care in Extreme Environments, Ken Iserson
• Joint Statement on Multiple Patients Per Ventilator
• Must I Respond If My Health Is at Risk, Ken Iserson
• Triage in Medicine, Part II-Underlying Values and Principles, John Moskop and Ken Iserson

Sessions are monitored on a monthly basis by CME office and content confirmed to be evidence based and without bias. Secondly, the CME Program Director and CME Coordinator reviewed and approved all material prior to the educational activity being approved to confirm that the educational activity was evidenced based. Peer reviewed journals and other literature are used, as applicable during discussions.

References for Further Study:

• Dignity Health COVID-19 Library Portal features current CME opportunities related to COVID-19

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Health disparities and health outcomes for African Americans, is egregious… Regarding pain medication, a 2019 published article offered that the pain of African Americans is systematically under-diagnosed and under-treated

Our guests today will offer stories and discuss insights on end of life care in the African American community. Our guests in this episode include:

• Patrick Smith, professor at the Duke Divinity School and associate faculty with the Trent Center for Bioethics, Humanities, and History of Medicine at Duke University School of Medicine.
• Dr Farr Curlin, Josiah C. Trent Professor of Medical Humanities in the Trent Center for Bioethics, Humanities and History of Medicine, and Co-Director of the Theology Medicine, and Culture Initiative at Duke Divinity School.
• Claretta Dupree, Chair of the Academy of Fellows at the Center for Bioethics and Human Dignity at Trinity International University, Deerfield, Illinois.

Additional resources relating to or referenced in this episode:

• Center for Practical Bioethics, Richard Payne, MD
• Palliative Care in the African American Community
• Perceptual Contributions to Racial Bias in Pain Recognition
• Racial Bias in Pain Assessment and Treatment Recommendations, and False Beliefs About Biological Differences Between Blacks and Whites

Sessions are monitored on a monthly basis by CME office and content confirmed to be evidence based and without bias. Secondly, the CME Program Director and CME Coordinator reviewed and approved all material prior to the educational activity being approved to confirm that the educational activity was evidenced based. Peer reviewed journals and other literature are used, as applicable during discussions.

References for Further Study:

• Boucher, N. A., Raghavan, M., Smith, A., Arnold, R., & Johnson, K. S. (2016). Palliative care in the African American community# 204. Journal of palliative medicine, 19(2), 228-230.
• Elk, R., Johnson, K., Reaves, A., White-Hammond, G., Williams, S., & Vaughan, L. (2019). “God Is Able”: Miracles and Hope in Our African-American Patients: Challenges, Historical Perspective and the Way Forward (FR459). Journal of Pain and Symptom Management, 57(2), 427-428.
• Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences, 113(16), 4296-4301.
• Johnson, J., Hayden, T., True, J., Simkin, D., Colbert, L., Thompson, B., … & Martin, L. (2016). The impact of faith beliefs on perceptions of end-of-life care and decision making among African American church members. Journal of palliative medicine, 19(2), 143-148.
• Rhodes, R. L., Ukoha, N. C., Williams, K. A., Elwood, B., Knox-Rice, T., Lee, S. C., … & Halm, E. A. (2019). Understanding underuse of advance care planning among a cohort of African American patients with advanced cancer: formative research that examines gaps in intent to discuss options for care. American Journal of Hospice and Palliative Medicine®, 36(12), 1057-1062.

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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.

Sessions are monitored on a monthly basis by CME office and content confirmed to be evidence based and without bias. Secondly, the CME Program Director and CME Coordinator reviewed and approved all material prior to the educational activity being approved to confirm that the educational activity was evidenced based. Peer reviewed journals and other literature are used, as applicable during discussions.

References for Further Study:

• Beware of Discharge: A Case Exploring the Ethics of Societal Expectations Placed on Families at Hospital Discharge
  Castro, A. R., & Tsimicalis, A. (2020). Beware of Discharge: A Case Exploring the Ethics of Societal Expectations Placed on Families at Hospital Discharge. Home Healthcare Now, 38(2), 98-104.
• Evaluation of an integrated model of discharge planning: achieving quality discharges in an efficient and ethical way
  Wells, D. L., LeClerc, C. M., Craig, D., Martin, D. K., & Marshall, V. W. (2016). Evaluation of an integrated model of discharge planning: achieving quality discharges in an efficient and ethical way. Canadian Journal of Nursing Research Archive, 34(3).
• Rehabilitation as “destination triage”: a critical examination of discharge planning
  Durocher, E., Gibson, B. E., & Rappolt, S. (2017). Rehabilitation as “destination triage”: a critical examination of discharge planning. Disability and rehabilitation, 39(13), 1271-1278.
• Thinking about the patient’s wishes: practical wisdom of discharge planning nurses in assisting surrogate decision‐making
  Kageyama, Y., & Asano, M. (2017). Thinking about the patient’s wishes: practical wisdom of discharge planning nurses in assisting surrogate decision‐making. Scandinavian journal of caring sciences, 31(4), 796-804.
• Schlairet, Maura C. “Complex hospital discharges: Justice considered.” HEC forum. Vol. 26. No. 1., 2014.

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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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