Virtual Ethics Consultation: A Digital Approach

Today, tough choice healthcare ethics dilemmas are discussed by patients, their loved ones and health care professionals. These discussions are about the care and treatment plan of the patient based on their values. Most often these discussions and decisions have been held in person. As healthcare moves to virtual care, especially in our current COVID19 environment, what would virtual ethics discussions or consultations look like? What would be important to pay attention to? Our guests today have offered such virtual ethics discussions on tough choice decisions with patients.

Our guests in this episode include:

  • Cristie Cole-Horsburgh, lawyer and staff ethicist with the Cleveland Clinic, Center for Bioethics
  • Dr. Mahwish Ahmad, physician and transplant ethicist with the Cleveland Clinic, Center for Bioethics

This episode was recorded on March 4, 2020

Resources referenced in this episode:

Portland Street Medicine: A Local Picture

Street Medicine is local and international. In this second episode on Street Medicine we hear about health care leaders in Portland, Oregon responding to the needs in their community. The challenge? Nationally, Oregon has the fourth highest rate of homelessness and the second highest rate of families without shelter. In recent years Portland’s chronic homelessness has increased at twice the national rate. The homeless population is growing older, more disabled, and is on the streets for longer periods of time. The homeless in any community face stigma, social isolation, and loss of relationships. They suffer a disproportionate burden of illness and premature death. The life expectancy of a homeless person is 47 years.  The healthcare leaders collaborating in the Portland Street Medicine program are working to shape a different future.

Our guests in this episode include:

  • Dr. Dan Bissell, emergency physician and co-founder and executive director of Portland Street Medicine
  • Drew Grabham, social worker and board member of Portland Street Medicine

This episode was recorded on April 10, 2020

Resources referenced in this episode:

Street Medicine: Serving an Excluded Community

A 2019 White House Report tells us that half a million people are homeless each night in the UnitedStates.In 1992, Dr. Jim Withers began doing street rounds in Pittsburgh, Pennsylvania, bringing medical care to the homeless. Since that time the Street Medicine Institute he founded has grown to become international organization. In 2015, CNN named Dr Withers as one of their “Top Ten Heroes.” How might healthcare best include and serve people living without any shelter?

This episode was recorded on March 16, 2020

Resources referenced in this episode:

COVID-19: Physicians Diving Deep

 

COVID19 has caused all of us to prepare and it has also demanded something from us. We hear many stories of the technical and resource preparation. In this episode we speak with three physicians from California and Washington state about their preparation and what it has demanded from them. We hear people in frontier territory wanting to offer their best. Some might even call this the crafting of virtue.
Our guests in this episode include:

  • Dr. Bethany Kapp, dual boarded in Emergency Medicine and Palliative Medicine, CHI Franciscan, Tacoma, WA
  • Dr. Mojdeh Talebian, pulmonologist and ICU physician, System Medical Director Critical Care, Director ICU & Pulmonary Services, Sequoia Hospital Redwood City, CA
  • Dr. Anita Chandrasena, pulmonologist, Chief Medical Officer, Northern California Division-Bay Area, CommonSpirit Health, Redwood City, CA

Three physicians, responding to COVID19… and diving deep.

This episode was recorded on April 1st, 2020

COVID-19: The Ethical Landscape

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:

Undocumented Patients: Two Journeys

We hear many stories these days about immigration. Certainly, healthcare workers see undocumented individuals in Emergency Rooms or clinics. What is that experience like of being undocumented and needing healthcare? What would be helpful for clinicians to know? Does healthcare ethics have something to say on this topic? Today we hear from two healthcare leaders on these issues. One, who was an undocumented person and who later became a physician in the United States, and the other is the healthcare leader who supported her journey.

Our guests in this episode include:

  • Mark G. Kuczewski, PhD, is the Fr. Michael I. English, S.J., Professor of Medical Ethics and also Director of the Neiswanger Institute for Bioethics and Health Policy at Loyola University, Chicago
  • Dr Johana Mejias-Beck, internal medicine pediatrics specialist, currently at the University of Missouri, Kansas…and one of the first undocumented students to attend the first medical school in the country to accept applicants with DACA status.

Additional resources relating to or referenced in this episode:

Paying Attention: Looking Back, Looking Forward (2020)

 

As we look back on 2019 and forward to 2020, our guests are editors of key healthcare ethics journals with an international readership:

  • Gregory E. Kaebnick, Editor, The Hastings Center Report
  • Leslie LeBlanc, Managing Editor, Journal of Clinical Ethics
  • Nate Hibner, Primary Editor, Health Care Ethics USA and Director of Ethics at the 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 are they hearing from authors and readers? What key articles published in their journals published in the last year might they recommend to you, our listeners? We explore these questions and more in this episode of EthicsLab.

Additional resources relating to or referenced in this episode:

End of Life Disparities: The African American Community

Health disparities and health outcomes for African Americans, is egregious… A 2019 report identified that African American Adults, compared to non-Hispanic white adults, are:

  • 44% More likely to die from stroke
  • 20% more likely to have asthma
  • 40% more likely to die from breast cancer
  • 25% more likely to die from heart disease
  • 52% more likely to die from cervical cancer
  • 23% more likely to be obese
  • 72% more likely to be diabetic

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:

HIV Disclosure: New Ethical Approaches

New research findings regarding HIV status will impact how we understand and practice disclosure of HIV status of patients… specifically whether or not to disclose a sick patients’ HIV serostatus to their family or partner. The new research demonstrates that when an HIV-positive person sticks to their treatment, their HIV is undetectable and untransmittable (U=U). Our three guests are working together on bioethical projects to spread the awareness of U=U.

Our guests in this episode include:

  • Jamie Crist, JD, MA a Clinical Ethics Fellow at the Baylor College of Medicine, Houston Texas and doing clinical ethics consultation at Houston Methodist Hospital. Jamie has a JD and Masters in Bioethics at Case Western University.
  • Nicole Meredyth, MD, is a clinical ethics fellow at Weil Cornell Medicine in New York Presbyterian Hospital. She is also completing her surgical residency at Weil Cornell University.
  • Nekee Pandya, MD; is a clinical ethics fellow at Weil Cornell Hospital and also a hospitalist at that hospital.

Additional resources relating to or referenced in this episode:

Urban Bioethics: Building Trust

Buildings in TriBeCa, New York City.

Urban Bioethics may be a new term for you. It is a field and focus in bioethics that points a critical lens on the extreme inequalities of health and access to medical, legal, and other resources that leave many urban dwellers and communities distinctly disadvantaged, disenfranchised, and vulnerable. What is this focus, its scope, its lens, its challenges…

Our guests today are from the Center for Urban Bioethics at Temple University in the Lewis Katz School of Medicine in Philadelphia.

  • Nora Jones, anthropologist, Associate Professor in Bioethics, and Associate Director of the Center.
  • Nicolle Strand, Assistant Director for Research at the Center, as well as Assistant Professor. Nicolle is a lawyer and bioethicist.
  • Providenza (or Enza) Rocco, also a lawyer and a social worker, Assistant Professor at the Center.

Additional resources relating to or referenced in this episode: