Allocating Blood Products: A New Approach to Scarcity

One of the most difficult problems facing hospitals and health systems today is scarcity of key medical resources. Unfortunately, blood product shortages are not uncommon, and they present significant challenges for patient care. Our guests in this episode developed a specific set of recommendations and a protocol for their hospitals to deal with these situations. They’ve also worked to establish a standard approach across their geographic region, which a lot of locations have not really been able to accomplish. We hope their insights and work can inform other ethicists, hospitals and cities looking to develop similar protocols.

Our guests in this episode include

  • Dr. Paul Hutchison, Pulmonary Critical Care Physician and Clinical Ethicist at Loyola University Medical Center, Maywood, Illinois.
  • Dr. Kathy Neely, Physician and Ethicist at Northwestern Memorial Hospital, Northwestern Medicine, Chicago.
  • Leah Eisenberg, Director of Clinical Ethics Consultation Services at UI Health, University of Illinois Chicago system. Also, an Attorney and Visiting Clinical Associate Professor in the Department of Medical Education.

Additional resources relating to or referenced in this episode:

Rural Healthcare: Unique Ethical Perspectives

According to the United States Centers for Disease Control and Prevention, more than 46 million, or 15% of all Americans live in rural areas. And, as more attention is given to meeting the health needs of this population, a significant gap in health between rural and urban Americans has emerged.  

Rural Americans are more likely to die from heart disease, cancer, unintentional injury, chronic respiratory disease, and stroke than their urban counterparts. Unintentional injury deaths are approximately 50 percent higher in rural areas, partly due to greater risk of death from motor vehicle crashes and opioid overdoses. 

These challenges underscore the important role that critical access hospitals play in helping to address these disparities. But what are the ethical considerations that should be looked at when caring for rural communities? In this episode, our guests offer their perspective and expertise on this important topic. 

Our guests in this episode include:

  • Mary Homan, Southwest Division Vice President of Theology and Ethics for CommonSpirit Health.
  • Leslie Kuhnel, Midwest Division Vice President of Theology and Ethics for CommonSpirit Health.
  • Jason Lesandrini, Assistant Vice President, Ethics, Advance Care Planning and Spiritual Health, WellStar Health System.

Additional resources relating to or referenced in this episode:

Beyond Limitations: Disability and Quality of Life

When you hear the phrase quality of life, what comes to mind? Having dinner with family, learning a language, watching a movie with friends? Or, does the image of a patient struggling to perform basic tasks such as bathing or getting dressed, or someone who is reliant on a ventilator to breathe come to mind? Despite its inherently subjective and multifaceted nature, quality of life is a term that is widely used in healthcare, particularly for making critical decisions that have life-altering consequences. It is a complex construct that encompasses a wide range of factors that affect a person’s overall sense of well-being, including their physical health, emotional state, social connections, and financial stability.

In this all new in-depth episode of EthicsLab, with our guests we explore how the concept of quality of life is used in medical decision making and shed light on the challenges this brings, especially to those in the disability community. We offer several solutions to how these challenges can be overcome.

Our guests in this episode include: 

  • Dr. Devan Stahl, bioethicist and Assistant Professor of Religion at Baylor University specializing in clinical ethics and disability ethics.  
  • Melissa Crisp-Cooper (with support from husband Owen Cooper as her revoicer), Health Advocate at UCSF focused on educating clinicians on the needs of people with disabilities and how to interact with them as patients
  • Dr. Clarissa Kripke, Clinical Professor of Family and Community Medicine at UCSF and Director of Office of Developmental Primary Care, a program dedicated to improving outcomes for people with developmental disabilities across the lifespan with an emphasis on adolescents and adults.

Additional resources relating to or referenced in this episode:

  1. Misuses of “Quality of Life” Judgments in End-of-Life Care, Stahl Devan
  2. Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine, Albert Jonsen, Mark Siegler, William Winslade
  3. Principles of Biomedical Ethics, Tom Beauchamp and James Childress 
  4. Who Defines My Quality of Life?: Perspectives from Disability-Advocates and Caregivers (White Paper) 
  5. Office of Developmental Primary Care 
  6. A survey on self-assessed well-being in a cohort of chronic locked-in syndrome patients: happy majority, miserable minority, Bruno, Marie-Aurélie, et al.
  7. Using quality of life measures in the clinical setting, Higginson, Irene J., and Alison J. Carr
  8. Measuring quality of life: who should measure quality of life, Hall, A. J., and L. Kalra

Ethics Committees: Part II Data & ROI

In our two part series, we have been unpacking how health care ethics committees, ethics programs, and health care ethics consultants provide guidance to patients, their families and clinicians in hospitals and health care delivery sites. In this second episode, we focus on data that demonstrates the impact of ethics consultation. Our guests look to deepen the effectiveness of this service to all involved in health decision making.

Our guests in this episode include:

  • Dr. Ellen Fox Ellen Fox, President of Fox Ethics Consulting and a bioethics consultant, educator, researcher, and policymaker
  • Mary Homan, Southwest Division Vice President of Theology and Ethics for CommonSpirit Health
  • Mark Repenshek, Vice President of Ethics and Church Relations for Ascension

This episode was recorded on multiple dates in mid 2021.

Additional resources relating to or referenced in this episode:

Ethics Committees: Assessing Impact

It is not unusual for tough choice decisions to be made in health care. In those situations, what help can patients, their families or the clinical team receive? Health care ethics committees and health care ethics consultants provide guidance to patients, their families and clinicians in hospitals and health care delivery sites across the United States and throughout the world. According to the American Society of Bioethics and Humanities, “The goal of ethics consultation is to “improve health care outcomes through the identification, analysis and resolution of ethical issues in health care institutions,” How might better access to these resources be made more available. How might their impact be assessed?

In this first episode, of a two part series, our guests explore the impact that ethics consultation has in the continuum of care, and dive deeper into just how big of an impact this service can have in clinical care.

Our guests in this episode include:

  • Dr. Ellen Fox Ellen Fox, President of Fox Ethics Consulting and a bioethics consultant, educator, researcher, and policymaker
  • Mary Homan, Southwest Division Vice President of Theology and Ethics for CommonSpirit Health
  • Mark Repenshek, Vice President of Ethics and Church Relations for Ascension

This episode was recorded on multiple dates in mid 2021.

Additional resources relating to or referenced in this episode:

Nudging: Influence Without Manipulation

What type of influence should physicians, nurses and patients have on tough choice healthcare decisions? Clinicians want to offer their experience and their competence, so should they be neutral and simply support patient decisions? What type of influence would be helpful and what type would be inappropriate, coercive, or biased? In this episode, our guests explore these questions and a behavioral economics tool called “nudging”. Nudges are subtle changes to the design, framing of information, and decision options that can influence behaviors. These subtle changes, stemming from decision psychology, enable clinicians to inform patients of their options, while at the same time, being very intentional about avoiding manipulation of patient decisions.

Our guests in this episode include:

  • Joanna Hart, assistant professor of medicine and medical ethics and Health Policy at the University of Pennsylvania and core faculty of the palliative and advanced illness Research Center at Penn
  • Jennifer Blumenthal-Barby, professor of medical ethics at Baylor College of Medicine
  • Dr. Aliza Olive, pediatric intensivist currently working in Kansas City, Missouri

This episode was recorded in December 2021.

Additional resources relating to or referenced in this episode:

Drug Shortages: Impacting Care

Drug shortages in health care occur for many reasons and have negative impacts. According to the US Food and Drug Administration, “a high percentage of drug shortages have been, and continue to be, sterile injectables, including chemotherapy, anesthesia and other acute drugs”. And, even though drug shortages have declined in recent years, a significant number of shortages are still active and continue to negatively impact patient care. In this episode, we interview national experts who have focused their professional attention on this issue.

Our guests in this episode include:

  • Dr. Yoram Unguru, pediatric hematologist oncologist, clinical bioethicist, and chair of the ethics committee at Sinai Hospital in Baltimore. Dr. Unguru is also on faculty at the Berman Institute of Bioethics and leads a multidisciplinary, transnational working group examining the ethical and policy implications of chemotherapy shortages in childhood cancer.
  • Dr. Andrew Shuman, associate professor at the University of Michigan medical school and a practicing head and neck cancer surgeon. Dr. Shuman is also a clinical ethicist who helps to run the clinical ethics service at The University of Michigan and has focused on issues related to access to medications that are scarce either due to cost or supply

This episode was recorded in February 2021.

Additional resources relating to or referenced in this episode:

Image Credit: Pavel_Chag, via Getty Images, found via promarket.org.

Racial Disparities: SOFA and Allocation

In March 2020, the coronavirus pandemic created a devastating impact within and outside the United States. COVID-19 made us painfully aware of systemic racism in healthcare with the allocation of scarce resources for vulnerable populations. In May 2020, the murder of George Floyd by a police officer brought the continued injustice of systemic racism into sharp focus for many Americans. The nation’s focus on confronting systemic racism highlighted foundational questions of bias against people of color in public health ethics and bioethics regarding providing fair and equitable responses to the coronavirus pandemic. Specifically, one example was the SOFA score tool, a proposed unbiased method to fairly allocate scarce resources like ventilators, was shown to be less likely to allocate resources to people of color compared to white Americans. In this podcast, we learn from experts why our resource allocation methods fail to be fair and equitable and how we can work towards an equitable approach to scarce resource allocation in particular and bioethics in general.

Our guests in this episode include:

  • Gina Campelia, Assistant Professor, Department of Bioethics and Humanities, University of Washington – School of Medicine
  • Edwin Lindo, Assistant Dean for Social & Health Justice at University of Washington – School of Medicine
  • Nneka Sederstrom, Chief Health Equity Officer, Hennepin Healthcare

Jaime Konerman-Sease, our graduate intern at EthicsLab in 2020 and 2021, will be interviewing our guests. Jaime is completing her PhD in Healthcare Ethics and Theology at Saint Louis University.

This episode was recorded on February 5, 2021.

Additional resources relating to or referenced in this episode:

Image Credit: Equality vs. Equity – by the Interaction Institute for Social Change | Artist: Angus Maguire.” Image Found: interactioninstitute.org and peacecorps.gov

Transgender Health: Accompaniment

If primary health care professionals are to serve and accompany the transgender community well, what would that look like? What would need our attention? What approaches have proved helpful and supportive? What would accompaniment require from health care professionals? Our guests today are either health professionals who are transgender or who have devoted their professional lives to serving the transgender community.

Our guests in this episode include:

  • Shane Snowdon, past/founding director of the National Center for LGBTQ Health and Equity at UC San Francisco, past/founding director of the National LGBTQ Health and Aging Program at the Human Rights Campaign and Principal at EdgeWork Consulting
  • Jamison Green, policy consultant for business, educational, and governmental institutions, and past president of the World Professional Association for Transgender Health (WPATH)
  • Lin Frasier, psychotherapist with a specialty of working with trans people, past president of the World Professional Association for Transgender Health (WPATH), former co-chair of the Global Education Initiative and co-chair of the ethics committee for WPATH
  • Dr. Colt St. Amand, Clinical Psychologist, Author, Family Medicine Resident Physician and Chief Educational Officer of the Gender Education Network
  • Sr. Luisa Derouen, a Dominican Sister of Peace who has been offering Spiritual Direction and accompaniment with transgender individuals across the country for over 22 years

This episode was recorded on multiple dates in 2019 and 2020.

Additional resources relating to or referenced in this episode:

Addiction and Trust: Part II from Melbourne

Offering a composite picture of someone with a drug addiction is not easy. It is not specific to gender, age, income, education, ethnicity, or geography. In this second episode on addiction and medically supervised injection rooms, we go to Melbourne Australia and speak to health care leaders there, on their experience with these programs. Again, these programs aim to a) respond to the addiction health issues of those who are dependent on injection drugs, and b) respond to the broader public health impact of addiction on a community, such as a high amount of drug overdose or the transmission of infectious disease through the sharing of infected needles.

Our guests in this episode include:

  • Dr Yvonne Benomo, Director of the Department of Addiction Medicine at St Vincent Hospital in Melbourne, Australia and Associate Professor at the Department of Medicine University of Melbourne
  • Dan Fleming, Group Manager of Ethics and Formation at St Vincent’s Health Australia, Fellow in the Law, Health and Justice Research Center in the University of Technology Sydney, Adjunct Lecturer and the Institute for Ethics and Society at the University of Notre Dame, Australia

This episode was recorded on November 18, 2019

Additional resources relating to or referenced in this episode: