As they navigate the complex ethical dilemmas that can emerge while caring for their patients, physicians and the treatment teams they lead at Kalamazoo’s two teaching hospital systems are being assisted and guided by a team of professors from the medical school’s Program in Medical Ethics, Humanities and Law.
That team – Michael Redinger, MD, MA; Parker Crutchfield, PhD, and Tyler Gibb, JD, PhD – are providing clinical ethics consultations at Ascension Borgess Hospital and Bronson Methodist Hospital, as well as at area outpatient clinics and other Ascension Borgess and Bronson locations in Southwest Michigan. They support physicians when they are faced with convoluted ethical questions that their medical training may not have equipped them to answer alone.
“For many of the physicians and care team members who utilize us, our counsel helps provide them with reassurance in really complex medical situations that they’re doing the right things,” said Dr. Redinger who, along with Dr. Gibb, serves as co-chief of the Program in Medical Ethics, Humanities and Law.
The work by the team from WMed began in 2015 in response to what officials at both hospital systems and Dr. Hal B. Jenson, WMed’s founding dean, recognized was a need to develop and deliver clinical ethics support to physicians, nurses and other medical staff who provide patient care, Dr. Redinger said. The initiative also fulfills a requirement by The Joint Commission that a mechanism be in place to resolve ethical dilemmas that can crop up during health care delivery.
The work by the team from WMed has led to steady growth, year over year, in the number of clinical ethics consultations at both Ascension Borgess and Bronson. Dr. Gibb said the arrival of Dr. Crutchfield to WMed in 2017 was important for the Department of Medical Ethics, Humanities and Law in that it increased capacity for conducting the consultations, as well as enhancing the ethics curriculum in each of the medical school’s residency programs.
“Our service helps a lot with the moral distress and burnout that physicians can often feel,” Dr. Gibb said. “They’re faced with these issues that they haven’t received training on and having us come in and provide some reassurance and guidance helps decrease that amount of moral distress they are feeling.
“Their questions are questions that strike at the heart of who a provider is,” Dr. Gibb added. “’Is this good medicine?’ ‘Is this what medicine is for?’ We’re able to shoulder some of that moral burden that physicians take on.”
The cases that Drs. Crutchfield, Gibb, and Redinger have been asked to assist on have run the gamut, from resolving ethical conflicts within treatment teams or patients and patients’ families to conflicts solely within the treatment team itself. They’ve also provided guidance in cases where it was difficulty to identify a designated decision maker for care for a patient with diminished capacity.
Dr. Gibb said they’ve also been presented with difficult cases where “there are no good options” and the team has been left to help physicians identify and focus on their professional obligations as doctors and carrying out those obligations to the fullest.
“Part of our role becomes helping physicians and their team identify what their professional obligations are and that they’ve discharged those obligations,” Dr. Gibb said.
Prior to the team at WMed’s involvement in clinical ethics consultations, the task was handled by committees or groups from each hospital that were made up of members who did not have formal training in clinical ethics. As they fulfill that important role now, Drs. Crutchfield, Gibb, and Redinger have taken on leadership roles within the ethics committees at both Ascension Borgess and Bronson.
“Partnering with the ethics team at the WMU Homer Stryker M.D. School of Medicine has been a real enhancement to the care we deliver at Ascension Borgess Hospital and Ascension Medical Group-West Michigan,” said Gary Druskovich, MD, MBA, chief physician officer at Ascension Borgess. “As part of the nation’s largest Catholic health system we partner with Mike, Tyler, and Parker to help our patients, families, and staff create clarity about the ‘why’ in our decision making. They demonstrate special sensitivity to our Catholic teaching and our Ethical and Religious Directives.”
Outside of their direct work with care teams in the hospitals, the team at WMed is also expanding education around clinical ethics for community physicians, as well as resident physicians and medical students at WMed.
That work is being accomplished through the integration of ethics training during employee orientations at both local hospitals. They are also helping set policies for the hospitals around ethics and hosting lunch and learn events for doctors and nurses or even educational sessions for specific units within the hospitals.
“It has been especially rewarding to see this program, which began as an idea just four years ago, grow and quickly become established as an integral resource for providing outstanding clinical care at the medical school and our two hospitals," Dr. Jenson said. "The program has also strengthened the ethics curriculum for medical students, as well as contributing to the training of our residents.”
At WMed, Dr. Gibb said he and Drs. Crutchfield and Redinger have developed “a robust curriculum” around clinical ethics for residents and medical students. That curriculum, among other things, includes a session where students roleplay as members of an organ transplantation selection committee and must choose who receives an organ after reviewing patient profiles. During their second year at WMed, students take part in a panel discussion about abortion, elected termination and other women’s health issues during their Endocrine and Reproductive Systems course, among other things.
“I think our students are as prepared as any students from any program in the country,” Dr. Gibb said. “Students have given us feedback that the instruction we provide puts them head and shoulders above their peers.”