Snapshot of Clinical Ethics Work

I received training in clinical ethics by participating in several seminars and practica:

• Summer Seminar in Health Care Ethics, Univ. of Washington School of Medicine (2015)
• Bioethics Consultation Skills Course, Montefiore-Einstein Center for Bioethics (2015)
• Clinical Ethics Immersion, MedStar Washington Hospital Center (2015)
• Clinical Practicum, Center for Clinical Bioethics at Georgetown University (2012)

Since 2015, I have contributed to clinical ethics consultation, hospital committees and subcommittees (including substantial policy work), clinical education, and QI/QA projects and data collection at several hospitals. From 2015-2017, I was a clinical ethicist at MedStar Washington Hospital Center in Washington, DC, and I participated on the ethics committee of Children's National Medical Center. From 2017-2022, I served the University of Arkansas for Medical Sciences Health System and Arkansas Children's Hospital. In the summer of 2022, I moved to Cleveland, OH to join the Center for Bioethics at Cleveland Clinic. Our service receives over 900 consults per year throughout northeast Ohio. I am often asked about what I do as a clinical ethicist, so the below sections give a snapshot of what this work is like. 

Case Consultation

In my role as a clinical ethics consultant, my aim is to address ethical uncertainty and concerns that arise in patient care. My experiences include:

•  Serving as the lead on-call ethicist on an individual consultant model, responding to pages from healthcare professionals, family, and patients.  ​​
• ​Rounding on different services and attending multidisciplinary meetings, such as those for psychiatry, medical ICU, neonatal ICU, complex case management, palliative care, pediatric hematology/oncology, cardiovascular ICU, high risk OB, and intermediary care

Organizational Ethics

I work collaboratively with clinicians and healthcare leadership on diverse issues aimed at promoting ethical care and climate in the institution. I have served in various capacities, such as contributing to:

• Ethics committees and policy, consultation, and education subcommittees
• Medical Center Policy Review Committee
• Healthcare Equality Index Committee 
• Schwartz Rounds Advisory Committee
• Transplant committees
  
• Psychiatry & Bioethics Case Conference 
• Mortality Review Committee
• Patient- and Family-Centered Care ICU Committee

Data and Quality

Data from the clinical ethics consultation service can be valuable for several purposes, including peer review, QI/QA, and keeping track of trends. This can help the service understand repeated ethical issues and where they arise, as well as the extent of the service's outreach. My role has included:

• Creating data collection system at multiple hospitals
• Tabulating and highlighting data from intake and the electronic health records to show a meaningful picture of contributions from ethics services
• Creating a feedback survey for key players in a clinical ethics consult process to gauge usefulness and barriers to consult
• Reporting key data trends to the ethics committees and consultation subcommittees
• Conducting an ethics needs assessment in neonatal ICUs

Education

I provide formal and informal ethics education to residents, fellows, attending physicians, nurses, social workers, case managers, and others. For example, I have contributed to the following:

• Grand Rounds presentations
• Psychiatry residency program didactics
• Nurse residency program didactics
• Nurse orientation
• Case management and social work initiatives
• Learn on Demand online modules available to all faculty and staff 
• Clinical faculty section meetings​
• Moral distress debriefs for morning and evening staff
• Resident case conferences
• Training on LGBTQ+ patient care for nurses
• ​Implicit bias training
• ​Mentoring interns in ethics