EthicsLab

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: Ethics consultation in U.S. hospitals: A national follow-up study Ethics consultation in U.S. hospitals: New findings about consultation practices  Examining Quality and Value in Ethics Consultation Services (subscription required) Health care ethics programs in U.S. hospitals: Results from a national survey  Hiring Clinical Ethicists: Building on Gremmels' Staffing Model Approach

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 […] The post Nudging: Influence Without Manipulation appeared first on Mission Network.

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 […] The post Drug Shortages: Impacting Care appeared first on Mission Network.

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 […] The post Racial Disparities: SOFA and Allocation appeared first on Mission Network.

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 […] The post Transgender Health: Accompaniment appeared first on Mission Network.

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, […] The post Addiction and Trust: Part II from Melbourne appeared first on Mission Network.

Harm reduction programs like needle exchange programs or medically supervised injection sites 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 […] The post Harm Reduction: Safe Injection Sites appeared first on Mission Network.

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 […] The post Virtual Ethics Consultation: A Digital Approach appeared first on Mission Network.

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 […] The post Portland Street Medicine: A Local Picture appeared first on Mission Network.

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 Pittsburg, 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 […] The post Street Medicine: Serving an Excluded Community appeared first on Mission Network.

  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 […] The post COVID-19: Physicians Diving Deep appeared first on Mission Network.

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 […] The post COVID-19: The Ethical Landscape appeared first on Mission Network.

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 […] The post Undocumented Patients: Two Journeys appeared first on Mission Network.

  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 […] The post Paying Attention: Looking Back, Looking Forward (2020) appeared first on Mission Network.

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 […] The post End of Life Disparities: The African American Community appeared first on Mission Network.

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). […] The post HIV Disclosure: New Ethical Approaches appeared first on Mission Network.

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 […] The post Urban Bioethics: Building Trust appeared first on Mission Network.

Imagine you are a patient that is seriously ill and the standard clinical treatment is not working for you. You may want to try experimental drug products, still being investigated and not yet approved by the US Food and Drug Administration (the FDA)…what are your options? There are currently a couple of pathways: First, you […] The post Patient Access: Right to Try appeared first on Mission Network.

Brain death is a fundamental ethical topic that is complex and often fraught with emotion. As ethics committees are faced with considerations involving brain death, these cases are often those that stick with professionals the most. Our lead contributor in this episode Becket Gremmels, System Director of Ethics at CHRISTUS Health in Irving TX is […] The post Brain Death: A Foundational Yet Emotional Ethical Concept appeared first on Mission Network.

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, […] The post Feeding Tubes: Are Things What They Seem? appeared first on Mission Network.

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 […] The post The Work: Reflections of Two Healthcare Ethicists appeared first on Mission Network.

  In healthcare, we are able to capture ever increasing levels and types of data. The potential is there for more accurate diagnosis and more relevant which would better inform healthcare decisions and potentially avoid medical error or unnecessary treatments. Artificial intelligence technologies are increasingly accurate in text, in sound or in image recognition with […] The post Artificial Intelligence: Issues Arising appeared first on Mission Network.

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 […] The post Goals of Care appeared first on Mission Network.

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 […] The post Informed Consent: Supporting Patient Autonomy appeared first on Mission Network.

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 […] The post Discharge Dilemmas: Patients with Disabilities appeared first on Mission Network.

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 Bouchard, Editor, Health Care Ethics USA – Catholic Health Association of the United States What are […] The post Paying Attention: Looking Back, Looking Forward (2019) appeared first on Mission Network.

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 […] The post Psychiatric Disability and Life Threatening Non-Adherence appeared first on Mission Network.

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”. […] The post Mental Health and Discrimination: Mass Shooting Stereotypes appeared first on Mission Network.

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 […] The post Organ Donation: Foundational Ethical Approaches appeared first on Mission Network.

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 […] The post Do Not Resuscitate Orders: Key Ethical Issues appeared first on Mission Network.

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 […] The post Moral Distress and Moral Resiliency appeared first on Mission Network.

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 […] The post Today’s Gene Editing Choices: Inclusion and Diversity appeared first on Mission Network.

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 […] The post Whole Person Care: An Ethic of Care appeared first on Mission Network.

Since the Human Genome Project was declared complete in April of 2003, there has been great anticipation of medical treatments tailored to the individual genetic makeup of patients. For you, for patients, for family members…where have most of the advances been made since that time and what ethical questions are arising as this work continues […] The post Precision Medicine – Its Potential and Questions appeared first on Mission Network.

Health care ethics committees help patients and clinicians with tough choice decisions. Within this work of clinical ethics consultation, what are practical tools being used to improve their competence and impact? In this episode, our guests present such practical tools that help health care ethics committee members become more competent, become more aware of gaps […] The post Practical Tools Helping Ethics Committees appeared first on Mission Network.

One of the challenging areas in clinical practice today is wanting to honor patient wishes but not being clear on the competency or capacity level a patient with dementia or behavioral health issues. In this episode we explore different challenging situations that ask: a) What is the best assessment of capacity? b) What level of […] The post Beyond Capacity: Assessing Challenging Cases appeared first on Mission Network.

Our guests are editors of key healthcare ethics journals with an international readership: Fr. Charles Bouchard, Editor, Health Care Ethics USA – Catholic Health Association of the United States Gregory  E. Kaebnick, Editor, The Hastings Center Report – The Hastings Center Leslie LeBlanc, Managing Editor, Journal of Clinical Ethics What are the issues in health care ethics that are impacting ethics […] The post Paying Attention: Looking Back, Looking Forward appeared first on Mission Network.

Health care professionals, patients and family members could all agree that patient wishes about their care are important and need to be respected. Why then, nationally, do only 30 percent of adults have an advance directive that documents those wishes? Given that statistic, how could the town of La Crosse, Wisconsin, achieve the surprising goal […] The post Traction: Innovative Practices Honoring Patient Wishes appeared first on Mission Network.

Health care professionals, patients and family members could all agree that patient wishes about their care are important and need to be respected. Why then, nationally, do only 30 percent of adults have an advance directive that documents those wishes? Given that statistic, how could the town of La Crosse, Wisconsin, achieve the surprising goal […] The post Traction: Innovative Practices Honoring Patient Wishes appeared first on Mission Network.

Are there better ways to build and support a culture of clinical ethics in healthcare? What might that look like? What has worked and how could the ideas and tools offered be implemented? In the late 1990’s the idea was proposed, why not marry the work being done in health care ethics with quality improvement […] The post Thinking Differently: Building Blocks for a Quality Ethics Program appeared first on Mission Network.

Our guests in this episode include: Dr. Bethany Kapp, Board certified physician in Emergency Medicine and Palliative Care, Franciscan Health System, Tacoma, Washington. David Vukadinovich, Deputy General Counsel, CommonSpirit Health, CA Lori Dangberg, Alliance of Catholic Health Care, Sacramento, CA Thaddeus Mason Pope, Health Law Professor, Mitchell Hamline School of Law, Saint Paul, Minnesota. Jackie […] The post The Unrepresented Patient appeared first on Mission Network.

Human Trafficking is an egregious form of exploitation of vulnerable individuals by for the personal gain of the captor. We are very pleased to have five very experienced guests who bring a great diversity of expertise on this issue. We will be speaking to these guests with a particular point of view…we want to understand […] The post Human Trafficking appeared first on Mission Network.

Tune in to this latest episode of the EthicsLab podcast. In this episode we talk with international leaders in ethics about the future of healthcare ethics. In this episode we talk with international ethics leaders about the future of health care ethics. We traded stories of events that convinced us that we need to change, […] The post The Future of Healthcare Ethics appeared first on Mission Network.