EthicsLab EthicsLab

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:

How do I allocate blood products at the end of life?
How Should Decision Science Inform Scarce Blood Product Allocation?
Insights from Blood Products Management for Pre-Crisis Ethical Resource Allocation

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:

A New Portrait of Rural America 
Health in Rural America
Handbook for Rural Health Care Ethics: A Practical Guide for Professionals
Where the Rubber Hits the Road: Implications for Organizational and Clinical Ethics in Rural Healthcare Settings
Recognizing and Resolving Ethical Dilemmas in Rural Medicine

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:

Misuses of “Quality of Life” Judgments in End-of-Life Care, Stahl Devan
Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine, Albert Jonsen, Mark Siegler, William Winslade
Principles of Biomedical Ethics, Tom Beauchamp and James Childress 
Who Defines My Quality of Life?: Perspectives from Disability-Advocates and Caregivers (White Paper) 
Office of Developmental Primary Care 
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.
Using quality of life measures in the clinical setting, Higginson, Irene J., and Alison J. Carr
Measuring quality of life: who should measure quality of life, Hall, A. J., and L. Kalra

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:

How Much Volume Should Healthcare Ethics Consult Services Have?
Assessing ROI for Clinical Ethics Consultation Services
Factors Associated with the Timing and Patient Outcomes of Clinical Ethics Consultation in a Catholic Health Care System
Ethics Consultation in U.S. Hospitals: A National Follow-Up Study

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 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:

Penn Medicine Nudge Unit
Nudging for Ethics, Applying Small Changes To Promote Ethical Outcomes, University of Notre Dame
The ethics of nudging: An overview, by Andreas T. Schmidt
Good Ethics and Bad Choices: The Relevance of Behavioral Economics for Medical Ethics, by Jennifer Blumenthal-Barby
The Ethics of Nudging, by Cass R. Sunstein
Nudge Units to Improve the Delivery of Health Care, by Mitesh S. Patel, Kevin G. Volpp, and David A. Asch
Designing Nudges for Success in Health Care, by Joseph D. Harrison