Informed Consent: Supporting Patient Autonomy

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

Discharge Dilemmas: Patients with Disabilities

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.

Paying Attention: Looking Back, Looking Forward (2019)

As we look back on 2018 and forward to 2019, our guests are editors of key healthcare ethics journals with an international readership:

  • Gregory  E. Kaebnick, Editor, The Hastings Center Report – The Hastings Center
  • Leslie LeBlanc, Managing Editor, Journal of Clinical Ethics
  • Fr. Charles BouchardEditor, Health Care Ethics USA – 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 key articles published in their journals published in the last year might they recommend to you, our listeners? These questions and others, our guests discuss in this episode of the EthicsLab Podcast.

Resources Referenced in this Episode:

Psychiatric Disability and Life Threatening Non-Adherence

Imagine a patient who suffers from an underlying psychiatric disability and comes to a hospital with a critical illness after prolonged non-adherence to a medical treatment plan. Because of their inability to follow a treatment plan, the patient now faces an end-of-life situation, even though the condition would otherwise not be considered terminal. I am sure you can understand that such stories are both tragic and ethically complex. These stories not only   cause moral distress for the healthcare team caring for the patient, but also alarm and confuse patients and their families. Ethics committees in hospitals are asked to consult on the ethics complexities in cases like these. Our guests will reflect on such patient stories and offer their ethical reflections on the challenges, naming the components of complexity, and what is important for ethics committee members to pay attention to in patient stories like these.

Our guests in this episode are:

  • Carol Taylor, a professor of Medicine and Nursing at Georgetown University, past Director of the Pellegrino Center for Clinical Bioethics. Carol is now a Senior Scholar at the Kennedy Institute of Ethics.
  • Michael Pottash, Attending Physician in Palliative Medicine at MedStar Washington Hospital Center, He is also an Assistant Professor of Clinical Medicine at Georgetown University School of Medicine.
  • Laura Guidry-Grimes, is an Assistant Professor of Medical Humanities in Bioethics, at the University of Arkansas for Medical Science. She is also a clinical ethicist at the Children’s Hospital in Little Rock, Arkansas.
  • Sarah Kleinfeld, is a Geriatric Psychiatrist at the VA Medical Center in Washington DC. She works with elderly patients with a range of psychiatric illnesses like Bipolar disorder and Schizophrenia.

Resources Referenced in this Episode:

Mental Health and Discrimination: Mass Shooting Stereotypes

In the wake of past and more recent mass shootings, mental illness has been pointed to in some public statements as the root cause of mass shootings: Statements such as…1) “We don’t need a gun database, we need a mental health database in the United States”, or…2) “People don’t kill people, the mentally ill do”. With such statements, mental illness can become conflated with criminality, mass violence and other tragic events. Discrimination, false stereotypes and increased stigma for mental health patients has become a concern. As an example, when New York passed the Secure Ammunition and Firearms Enforcement (SAFE) Act in 2013, a core component of the law required mental health practitioners to report any patient who was “likely” to be violent to the health department, for potential inclusion in a database. Other states have since enacted similar legal requirements. Mental Health practitioners were concerned that the requirement to report, and anxiety about legal liability, would lead to over-reporting. Would mental health patients lose trust in the confidentiality of their health care? Would mental health patients receive an over vigilant surveillance. One year after enacting this law in New York, the New York Times, reported that the number of names within the SAFE Act database quickly rose to 34,500 names.

What are the harms that occur when mental health is named as the key reason for mass shootings? Is there a deeper complexity to be understood?  To shed light and research data on that greater complexity, we are joined by Dr Jonathan Metzl, physician, psychiatrist, Professor of Sociology and Psychiatry, and the Director of the Center for Medicine, Health, and Society, at Vanderbilt University in Nashville, Tennessee.

Resources Referenced in this Episode:

Organ Donation: Foundational Ethical Approaches

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

Do Not Resuscitate Orders: Key Ethical Issues

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 guest 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.

Moral Distress and Moral Resiliency

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:

 

Today’s Gene Editing Choices: Inclusion and Diversity

The pace of developments in genetic editing over the past two years seems fast and accelerating. What are those developments, the tough choice decisions and accompanying infrastructure that are needed to support researchers, clinicians, and ethics committee members? It may seem trite but is the key to success here better listening, inclusion of voices, and honoring the need for diversity in the human genome itself? Our guests today discussing these issues are three international experts: Damon Hostin, Fr. Kevin FitzGerald, and Michael Burgess.

Resources referenced in this episode:

Whole Person Care: An Ethic of Care

On EthicsLab we often look at specific clinical ethical issues, tough choice dilemmas that patient and clinicians are involved in. In this episode we take a step back and look at the bigger picture…an ethic of care. How should someone be treated? Why are we asking this question today? What are some of the stories that makes this apparent? What are some of the tools and practices that are leading the way to honor patients and their human dignity? Our guests in this episode are two national experts in palliative care that will speak to us about “Whole Person Care”. Dr. Ira Byock, Founder and Chief Medical Officer at the Institute for Human Caring at Providence St Joseph Health and Dr. Mimi Pattison, Medical Director of Palliative Care at CHI Franciscan.

Helpful Links: 

Dr. Pattison – House Model

The Institute for Human Caring

Dr. Ira Byock’s Website

The 3rd International Congress on Whole Person Care

2018 International Congress on Palliative Care