Expanding Clinical Ethics Education

On any given day, healthcare providers face a handful of complex ethical questions.

When does life-sustaining treatment do more harm than good? How do you discharge a teenage patient with nowhere to go? Who makes decisions for an unidentified, unconscious patient that needs urgent treatment?

Questions like these challenge providers to decide on the “right” action while considering any mix of other factors, such as patient values or constrained resources. And as medical technology continues to advance, ethical questions are becoming even more difficult, says Mark T. Hughes, MD, MA, assistant professor of medicine at the School of Medicine and a core faculty member at the Berman Institute of Bioethics.

“Clinicians might have one perspective, but patients and families have their own reasons for wanting or not wanting care,” he says. “So, we are always trying to mesh what we think is appropriate with what the patient and family want for themselves.”

While clinical ethics education has become standard in medical schools, continuing education in ethics can vary. To help address this, Hughes and members of the Johns Hopkins Hospital Ethics Committee and Consultation Service, which he co-chairs, began the Ethics for Lunch conference series at Johns Hopkins Hospital in 2015. This educational forum started at the Johns Hopkins Bayview Medical Center in the 1990s and was later replicated at Johns Hopkins Hospital with support from the Freeman Family Fund.

Once a month during lunchtime, as many as 40 members of the hospital community–including physicians, nurses, social workers, chaplains, administrators, ethics faculty, nursing students, and medical students–are provided a light meal as they gather to hear from a multidisciplinary panel on a clinical ethics topic. Recent topics have covered cancer exceptionalism, end-of-life care, informed consent, resource allocation, organ donation, and conflicts of interest.

“Some clinicians will work nonstop,” Hughes says. “If we provide food and beverage during lunch hours, it becomes a time where they can take a break and hear about something that helps them in their own work.”

The topics usually derive from patient cases or policies on which the hospital’s ethics committee has recently consulted. The committee’s members will use those details as a starting point for creating a hypothetical case and invite panelists from relevant disciplines to share their thoughts.

“Clinicians value the sessions because it’s real for them,” Hughes says. “We talk about issues they have seen and maybe they themselves have had moral distress about.”

“It’s helping them think through those ethical issues so that the next time they encounter them, they’ll be better prepared,” he says.

Clinical ethics is foundational to a healthcare provider’s duty to diagnose and treat patients with compassion while honoring their autonomy. But supporting providers through complex clinical scenarios doesn’t just affect patient care, it also shapes the confidence and wellbeing of the clinicians themselves, says Cynda Rushton, PhD, MSN, RN, FAAN, the Anne and George L. Bunting Professor of Clinical Ethics at the Berman Institute and co-chair of the Johns Hopkins Hospital Ethics Committee.

“Patient cases can stick with clinicians in a way that often depletes them, leads to burnout, and causes them to leave their profession,” Rushton says.

“That moral impact of our work is not always accounted for. We’re trying to give people the resources to meet ethical challenges and restore their sense of agency.”

All Ethics for Lunch sessions are recorded and available online, with the hope that the program can grow as a local and global resource for healthcare professionals. But this is only one part of a greater mission.

The Berman Institute has sought to meet the need for more ethics education through offerings like Ethics for Lunch, degree programs, comprehensive trainings, online courses, seminars, symposia, lectures, and research opportunities.

Topics often step beyond clinical care into bioethics, the broader study of—and response to—ethical issues across diverse fields, including medicine, biotechnology, life sciences, public health, policy, law, and philosophy. Questions become: how does artificial intelligence impact medical care? What is an appropriate use of gene editing? What responsibilities do healthcare systems have to address health inequities?

“Throughout its 30-year history, the Berman Institute has worked to help address ethical and policy issues in the clinical context, and in the process protect patients’ rights and support healthcare professionals, working hand-in-hand with Johns Hopkins Medicine,” says Jeffrey Kahn, PhD, MPH, the Andreas C. Dracopoulos Director of the Berman Institute.

“But we’ve only scratched the surface of what is possible. Drawing more fully on the world-class status of both Hopkins Medicine and the Berman Institute will help us create the leading clinical ethics program in the world.”

In 2015, the Freeman Family Fund made its first of regular annual gifts to Ethics for Lunch. John Freeman, Med ’58 (MD), and his wife, Elaine Freeman, had supported clinical ethics education through the Berman Institute for a decade before Elaine Freeman made this gift in her late husband’s honor.

John Freeman was one of the founding chairs of the Johns Hopkins Hospital Ethics Committee, one of the first faculty members of the Berman Institute, and the emeritus Lederer Professor of Pediatric Epilepsy.

“John Freeman was a known advocate for expanding clinical ethics education,” Hughes says. “Ethics for Lunch is one clear example of doing that.”