Chaplaincy and spiritual care are essential components of healthcare, addressing the physical, spiritual, mental, and social aspects of a person’s life. Providing spiritual support to patients, families, and staff during times of illness, crisis, or loss acknowledges the human element and the challenges faced in healthcare. Chaplains play a crucial role in offering emotional and spiritual guidance while respecting diverse religious beliefs and values. They also navigate unique ethical dilemmas inherent to their profession.

Our guests in this episode include:

• LaVera Crawley, System Vice President for Spiritual Care at CommonSpirit Health.
• Reverend Donna Allen, Manager of Chaplain Services at a hospital with three campuses in the Bay Area. 
• Trace Haythorn, Chaplain and former Executive Director and CEO of the Association for Clinical Pastoral Education

Additional resources relating to or referenced in this episode:

• Ethical Conflicts in Healthcare Chaplaincy: Results of an Exploratory Survey Among Protestant Chaplains in Switzerland, Germany, and Austria
• The Art of Spiritual Companionship, Oneing
• The Role of the Healthcare Chaplain: A Literature Review 

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:

1. Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine, Albert Jonsen, Mark Siegler, William Winslade
2. Principles of Biomedical Ethics, Tom Beauchamp and James Childress 
3. Who Defines My Quality of Life?: Perspectives from Disability-Advocates and Caregivers (White Paper) 
4. Office of Developmental Primary Care 
5. 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.
6. Using quality of life measures in the clinical setting, Higginson, Irene J., and Alison J. Carr
7. 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

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 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:

• Drug Shortages: The View Across an Ocean
• Drug Shortages – U.S. Food & Drug Administration
• Drug Shortages – American Hospital Association
• The Drug Shortage Crisis in the United States

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

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 infectious disease through the sharing of infected needles. These harm reduction programs are having an impact, but some have questioned whether such programs inappropriately cooperate with drug abuse. Our two guests today will offer us insight into that question and the impactful experience of two such harm reduction programs at Providence Health Care in Vancouver, British Columbia, Canada.

Our guests in this episode include:

• Scott Harrison, Director for Urban Health, Indigenous Health, Substance Use, Maternity and Neonatal Intensive Care at Providence Health Care
• Christopher DeBono, Vice President of Mission, People and Ethics also at Providence Health Care

This episode was recorded on January 23, 2020

Additional resources relating to or referenced in this episode:

• Assessing the Ethical Issues in “Safe Injection” Sites by Carol Bayley, and Fr. Charles Bouchard
• Catholic Ethicists on HIV/AIDS Prevention, by James Keenan
• Catholic Participation in Needle- and Syringe-Exchange Programs for Injection-Drug Users: An Ethical Analysis, by Daniel Sulmasy
• Safe Injection Sites: A Moral Reflection, by Steven Bozza and Jeffrey Berger

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 environment, what would virtual ethics discussions or consultations look like? What would be important to pay attention to? Our guests today have offered such virtual ethics discussions on tough choice decisions with patients.

Our guests in this episode include:

• Cristie Cole-Horsburgh, lawyer and staff ethicist with the Cleveland Clinic, Center for Bioethics
• Dr. Mahwish Ahmad, physician and transplant ethicist with the Cleveland Clinic, Center for Bioethics

This episode was recorded on March 4, 2020

Resources referenced in this episode:

• Cleveland Clinic Center for Bioethics Virtual Ethics Consultation

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 territory wanting to offer their best. Some might even call this the crafting of virtue. Our guests in this episode include:

• Dr. Bethany Kapp, dual boarded in Emergency Medicine and Palliative Medicine, CHI Franciscan, Tacoma, WA
• Dr. Mojdeh Talebian, pulmonologist and ICU physician, System Medical Director Critical Care, Director ICU & Pulmonary Services, Sequoia Hospital Redwood City, CA
• Dr. Anita Chandrasena, pulmonologist, Chief Medical Officer, Northern California Division-Bay Area, CommonSpirit Health, Redwood City, CA

Three physicians, responding to COVID19… and diving deep.

This episode was recorded on April 1st, 2020