EFL-042220jc ethics in medicical dept.pptx

Medical

1. Ethics for Lunch 4/22/20 JHBMC Covid-19 ethics issues, version 2.0 Joseph Carrese , MD, MPH, FACP Professor of Medicine Chair, JHBMC Ethics Committee Core Faculty, Johns Hopkins Berman Institute of Bioethics   1

2. Agenda Review logistics - 3 min Overview, presentation of framework - 7 min Part 1: Ethical issues for practitioners - 20 min Part 2: Ethical issues for practice - 20 min Wrap up - 5 min 2

3. Acknowledgements Contributions to slide content: Zack Berger, MD, PhD Megan Collins, MD, MPH Ruth Faden , PhD, MPH Marielle Gross, MD, MBE and other Berman Institute Faculty 3

4. Ethical issues For Practitioners Resource allocation Rights and responsibilities Moral distress & moral panic Stigma and racial bias Individual care vs. public health priorities Education vs. public health priorities For Practice Essential vs. nonessential care Telemedicine benefits/limits Health disparities, stigma/bias Resource allocation during scarcity Counseling during uncertainty 4

5. Ethical issues For Practitioners Resource allocation Availability of PPE Rights and responsibilities Duty of care Redeployment/scope of practice Essential staff/activities Allocating risks/burdens Fair division of labor Personal circumstances Moral distress & moral panic Role of social media Stigma and racial bias Individual care vs. public health Education vs. public health For Practice Essential vs. nonessential care Telemedicine benefits/limits Health disparities, stigma/bias Resource allocation during scarcity Counseling during uncertainty 5

6. Ethical issues For Practitioners Resource allocation Rights and responsibilities Duty of care Redeployment/ Scope of practice Essential staff/activities Allocating risks/burdens/scope of practice Fair division of labor Personal circumstances Moral distress & moral panic Role of social media Stigma and racial bias Individual care vs. public health priorities Education vs. public health For Practice Essential vs. nonessential care Urgent visits vs routine follow up Who decides? Vision vs life-threatening? Telemedicine benefits/limits Technology/resources Vision impairment Health disparities, stigma/bias Vulnerable populations Resource allocation during scarcity Counseling during uncertainty 6

7. Case Scenarios For Practitioners 7

8. CASE 1 An intern was scheduled to do a cardiology elective to help confirm both her interest in the field and her plan to pursue a cardiology fellowship. She was also hoping to get a strong letter of recommendation to help secure a competitive fellowship position. However, she has been pulled to work on a Covid inpatient unit for the next 4 weeks and had to cancel her elective. 8

9. CASE 2 You are working in the ED. Currently there are 3 patients in respiratory failure who need to be intubated but you are informed there is only 1 ventilator available in the hospital. What do you do? Who should get the ventilator? How do you decide – based on what parameters and considerations? 9

10. Case Scenarios For Practice 10

11. CASE 3 You are the PCP for a 62 y.o . male with a remote history of kidney stones who contacts you to report the abrupt onset of very intense left flank pain, consistent with his only other episode of kidney stones 10 years ago. What should be done? What do you advise? What are the key considerations/tradeoffs? 11

12. CASE 4 A 18 year old male calls the GIM clinic to report intense RLQ pain for the past 24 hours associated with N/V. The triage nurse is worried about the possibility of appendicitis and negotiates with the patient to come in and be examined in clinic first rather than going directly to the ED. The patient is advised he must wear a mask when coming to the clinic per the Governor’s order. The patient angrily replies, “I am not going to wear a mask! This is all a hoax!” The nurse asks you (= the “ d oc of the day”) to call the patient to address this issue. What should you say? How should you approach this situation? 12

13. Bonus case: What are your thoughts about people who are protesting the “stay at home orders”, who want to “open up” the country and get us back to ‘normal’? Does this matter to you? Why? 13

14. Also: In selecting telehealth vs. clinic evaluation vs. postponement of care, are their unique considerations for different patient populations? What about patients with the following? Severe medical co-morbidities No medical co-morbidities History of non-compliance Non-English speaking Limited technology/phone access 14

15. Ethical issues For Practitioners Resource allocation Rights and responsibilities Duty of care Redeployment/scope of practice Essential staff/activities Allocating risks/burdens Fair division of labor Personal circumstances Moral distress & moral panic Role of social media Stigma and racial bias Individual care vs. public health priorities Practical guidance for minimizing nonessential patient contact Education vs. public health For Practice Essential vs. nonessential care Urgent visits vs routine follow up Who decides? Vision vs life-threatening? Telemedicine benefits/limits Technology/resources Vision impairment Health disparities, stigma/bias Resource allocation during scarcity Counseling during uncertainty 15

16. Questions ? [email protected] 16