Those who work on responding to the ethical issues and decisions that arise in healthcare realize that we are invited into the most complex stories that patients, families , healthcare professionals and our communities have to offer. They not only involve value-laden clinical decisions about patient treatments, but community decisions about public health that sometimes place the autonomy of individuals against the common good of the community. When reflecting on the work of healthcare ethics, we thought we would ask a couple of colleagues with 25+ years of experience in this area what their thoughts are on this evolving work or calling.

Our guests in this episode include:

• Dan O’Brien, who just retired as Senior Vice President of Ethics at Ascension Health
• Carol Bayley, who just retied as Vice President of Ethics and Justice Education at Dignity Health

Both are highly regarded by their colleagues and have worked in diverse healthcare settings, from community hospitals to teaching hospitals and working to address pubic health issues in very diverse communities. They have lived the evolution of healthcare ethics over the past 25 years and the everyday challenges that arise. In this episode, we sit down and reflect on their experiences.

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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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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.

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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:

• The Medical Incapacity Hold: A Policy on the Involuntary Medical Hospitalization of Patients Who Lack Decisional Capacity

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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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