Tag: organizational ethics

Bioethics Blogs

Where’s the Social Justice?

by Craig Klugman, Ph.D.

Picking up a newspaper or clicking to your favorite news site could lead one to believe that the U.S. is entering a civil war along racial divides. For 6 days in a row in Chicago, protestors have marched against police brutality—specifically police shooting young, black men. Then a former soldier tried to kill white cops in Dallas. And a shooting inside of a gay club in Orlando takes many LGBT and allies lives. The news media has drawn this debate as a racial one—cops targeting minorities; minorities targeting minorities; and the disaffected targeting law and order. At the heart of all this violence is social injustice—poverty, stigmatization, and a growing acceptability of civil undiscourse.

So where are the voices in bioethics arguing for social justice? Where are the OpEds and special journal issues looking at gun control, improving schools, destigmatizing social conditions? Where is the support for urging Congress to remove the federal ban on gun research or declaring violence a public health issue? Instead we write letters urging the IOC to cancel the Olympics based on concern about Zika (a move that financially and politically is unlikely to happen. Although this makes great press, it does not really change lives. And to be transparent, I did sign that letter). I do not read all of the literature, but as a scholarly group that has a strong public presence, we have been remarkably silent on these issues. This lack of interest in larger social issues has even led some individuals to resign from ASBH.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Pediatric Clinical Ethics Summer Internship (Minneapolis)

Proudly serving as Minnesota’s children’s hospital since 1924, Children’s Hospitals and Clinics of Minnesota, is the eighth-largest pediatric health care organization in the U.S. 

Each year, Children’s provides care through nearly 13,000 inpatient visits and more than 200,000 emergency room and other outpatient visits. An independent, not-for-profit health care provider, Children’s has 319 staffed hospital beds and services available in all major pediatric specialties: emergency care; newborn and pediatric intensive care; outpatient and inpatient surgery; diagnostic services, including radiology and laboratory; and special programs in the areas of respiratory, cardiology, cancer, premature birth, adolescent development, child abuse, and epilepsy. 

This internship (June – August) will provide an introduction to clinical, research and/or organizational ethics for qualified individuals with a particular interest in pediatric clinical ethics. In addition, to provide opportunities for qualified candidates to work on department based projects, develop potential publication opportunities, and work on personal interest research.

Clinical Ethics Internship Requirements:

  • Attend Ethics Case Consultations and Care Conferences
  • Round with the Clinical Ethicists in the Intensive Care Units and with other clinical services.
  • Attend educational sessions sponsored by the Office of Ethics.
  • Attend all meetings of the Bioethics Committee and Subcommittees.
  • Develop a personal research project for presentation at final Bioethics Committee meeting.
  • Attend the IRB meetings with Clinical Ethicists to understand research ethics
  • Participate in directed reading program developed with senior leadership in the Office of Ethics
  • Light office administrative work as needed

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Ethics at the Chocolate Factory

Two women are being trained for work on a factory assembly line. As products arrive on a conveyor belt, their task is to wrap each product and place it back on the belt. Their supervisor warns them that failing to wrap even one product is a firing offense, but once they get started, the work seems easy. Then the belt speeds up.

Recognize the scene? Lucy and Ethel at the chocolate factory is a classic episode  from the 1950s television program I Love Lucy.It is also a good illustration of how people make rapid judgments in response to changing conditions at work, devising workarounds – shortcuts, fixes, patches – to bridge the gap between the rules of work and what’s actually happening. When I give talks, usually to physicians, nurses, and other health workers, about the ethics of workarounds, I often use this clip, in part because it’s fun to have four minutes of nonstop laughter during an ethics lecture, but mostly because shows how workarounds happen.

Thanks to research from cognitive neuroscience and behavioral psychology, synthesized by Daniel Kahneman and others, we now understand that “fast,” instinctive thinking and “slow,” reasoned thinking are both part of how we think, and that fast thinking occurs so quickly that we may not recognize what’s going on, or that we’re ruling out options as we make choices under pressure. When Lucy and Ethel notice that the conveyor belt has sped up and that unwrapped chocolates are sliding past them, putting them at risk of being fired, they devise a workaround: grabbing the chocolates off the belt, and eating them, or hiding them under their hats or in their bras.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Assisted-Dying Provisions: California Legislature Says Yes, the U.K. Says No

A new chapter in efforts to secure legal provisions for physician-assisted dying began last week when the California State Legislature voted to approve the End of Life Option Act. If Governor Jerry Brown signs the bill, California will become the fifth state to permit physician-assisted dying through statute (as in Oregon, Washington, and Vermont) or case law, as in Montana; a lower court decision permitting the practice in New Mexico was overturned last month. For advocates, it is a huge victory to have an assisted dying provision available in the nation’s most populous state.

Factors influencing the debate in California have included the recent Brittany Maynard case; in 2014, Maynard moved from California to Oregon to make use of that state’s longstanding assisted dying provision. Before her death last November, she recorded a series of videos urging California lawmakers to adopt a similar provision; the most recent video was released by her family four months after her death and was viewed by a committee of California’s State Senate during their deliberations on the bill. The rebranding of the Oregon-style provision reflected in California’s legislation as “end of life choice” rather than “death with dignity” may also turn out to be relevant to securing political and public support for the measure.

California’s population of 38.8 million is 10 times that of Oregon, and implementing this provision will be more complicated than in the much smaller states that have similar laws, protocols, and reporting requirements for voluntary self-administration of a lethal medication proscribed by a physician for that purpose.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Strengthening Hospital Ethics Committees

The first hospital ethics committees in the nation were established in the 1970s, and the primary catalyst for their growth was the 1976 Karen Quinlan case. As the case was argued, the judge, who had read an article about ethics committees in the Baylor Law Review, remarked that cases like this belong before ethics committees rather than courts.

In 1992, the Joint Commission – then the Joint Commission for the Accreditation of Healthcare Organizations – mandated that hospitals establish a clinical ethics “mechanism.” For more than two decades, this guidance has allowed hospitals to craft widely varied responses. A facility may or may not have a standing ethics committee. The committee may or may not meet regularly. Its members may or may not have training in thinking through issues ethically.

The three primary functions of ethics committees, as identified by the American Hospital Association in 1986, are to:
• Educate themselves to “do ethics”
• Develop and review hospital policies
• Consult on complex cases arising in the hospital

Center for Practical Bioethics’ Efforts

In 1986, in response to numerous ethics committee members seeking opportunities to learn from each other, the Center for Practical Bioethics, which counseled both sides of the Cruzan case, convened the Kansas City Regional Hospital Ethics Committee Consortium, This is the oldest continuously operating Consortium of its kind in the nation.


In a project entitled “Organizational Ethics: Beyond Compliance,” Center staff traveled to cities across the country to present new standards for patients’ rights and organizational ethics, after collaborating with the Joint Commission in 1993 to promulgate them.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Beyond the “Silver Tsunami”: Toward an Ethic for Aging Societies

I spent last week in Singapore, where an excellent breakfast of noodles and teah o ais limau (Malaysian-style iced tea with lemon) costs about $2 and is served at an open-air hawker center in under 10 seconds. Observing this Singaporean balance of efficiency, quality, and cost, made possible by the unstinting hard work of the hawkers and also by a system that plans and regulates these complexes of food stalls throughout the city, was good daily preparation for a week of discussions about the social values of this aging society as they are translated into policies and practices benefiting aging, chronically ill, and dying people and their families.

Singapore is the fastest-aging society in the world. Being ranked number one is usually a matter of local pride, but in this case, it means that this highly developed city-state of 5.5 million is ahead of other nations in grappling with the reality that if your society is aging, it includes a lot of people facing dementia. Our team, led by Singaporean bioethics scholar Jacqueline Chin, has begun these discussions with local physicians, nurses, social workers, program administrators, and policy-makers as background for the second edition of the Singapore Casebook, which will focus on the ethics of care transitions in aging societies.

Some of the definitions and questions we began to tackle are familiar across aging societies. For example, the common metaphor of population-level aging as the “silver tsunami” is problematic. By suggesting that the oldest old, as their health deteriorates, become a natural disaster, the metaphor presents older people as a threat to society rather than members of society.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Responding to Ebola: Organizational Ethics, Frontline Perspectives

Beyond crucial questions of fair access to scarce supplies of the experimental drug ZMapp and to other potentially effective drugs to treat Ebola, commentators from bioethics, public health, journalism, and other sectors are increasingly focused on “staff, stuff, and systems.” The consequences of chronically inadequate local and national public health infrastructures in developing countries are tragically revealed as systems in affected West African nations are overwhelmed by epidemic. In a recent interview Hastings Center Fellow George Annas described the Ebola epidemic as a “public health disaster that requires a heavy-duty public response,” including capital investments in clinics in addition to emergency measures needed to control the spread of the highly contagious virus, and to care for the sick. Annas also cautioned against reducing ethical questions to procedures for drug testing and allocation, important as these issues are.

Funding cutbacks and the loss of expert staff through attrition at global entities such as the World Health Organization (W.H.O.) are also problems with ethical dimensions, as uncertainty over who should be responsible for coordinating an effective response to the epidemic persists.  Margaret Chan, director general of the W.H.O., told NPR that her financially strapped organization should play a primarily supportive role, a position characterized as unconvincing in a September 6 New York Times editorial.  Commentators widely acknowledge severe, seemingly insoluble shortages of health care workers, plus supply-chain breakdowns, as air and sea deliveries of supplies and the movement of supplies on the ground are interrupted due to fear of transmission during unloading, and to roadblocks. The Times editorial concludes by suggesting that the United States may need to step in to coordinate the international response if the U.N.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

The VA Crisis is Fundamentally an Ethics Crisis

The crisis and failure of caregiving that have engulfed the Veterans Health Administration cannot be solved with increased resources or even by hiring more doctors and nurses. Additional resources are critical and necessary—but they are not a sufficient long-term and comprehensive solution to a problem that has been recognized by many as cultural and fundamentally ethical.

Two newspaper articles summarize the problem, citing the findings of a White House review of the Veterans Health Administration  by Rob Nabors, President Obama’s deputy chief of staff, which characterizes the institutional culture as “corrosive” and concludes, “The VHA leadership structure is marked by a lack of responsiveness and an inability to effectively manage or communicate to employees or veterans.”  According to The New York Times  this culture “has led to poor management, a history of retaliation toward employees, cumbersome and outdated technology, and a shortage of doctors and nurses and physical space to treat patients.” The Wall Street Journal points to “a ‘corrosive culture’ that degraded the timely delivery of care and requires a restructuring to improve transparency and accountability.”

Doing the right thing—in other words, taking ethics seriously—has proved to be difficult for the VA (as it has for many large organizations) or worse, irrelevant to quality care. I know this from first-hand experience as the former hospital ethicist of the Philadelphia Veterans Affairs Medical Center (PVAMC) and as founder and first chair of PVAMC Institutional Ethics Committee.  Simply put, “ethics quality” could not be measured with validated measurement tools, and therefore could not be valued as an essential part of health care quality.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.