Organizational Ethics Consortia

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Topic:

Some observers have argued that present day America is not just a society making use of a market economy, but in fact  a “market society” where all individuals and institutions are forced into cutthroat competition for profits and survival. This situation, if real, will inevitably shape healthcare organizations, and within them, interpersonal interactions like those between patients and their caregivers. These interactions might be forced into transactional, impersonal modes that lead to widespread experiences of moral injury, burnout, loneliness and distrust. And indeed, these experiences seem to be on the rise amongst medical practitioners. Some have talked about the moral crisis of American doctors. This panel will examine the crisis through theoretical, clinical and ethical lenses, asking how it is manifesting, what is causing it, and what we might do about it.

Presenters:

Ian Corbin, PhD, MA, Instructor in Neurology and Co-Director of the Human Network Initiative, Brigham and Women's Hospital and Harvard Medical School

Lydia Dugdale, MD, MAR, Director, Columbia Center for Clinical Medical Ethics; Associate Director of Clinical Ethics, New York-Presbyterian Hospital; Professor of Medicine, Columbia University Vagelos College of Physicians and Surgeons

Jonathan Cahill, PhD, MA, Postdoctoral Fellow in Medical Ethics, Columbia University Irving Medical Center

Omar B. Lateef, DO, President and CEO of RUSH University System for Health and RUSH University, Medical Center; Professor, Department of Internal Medicine, RUSH Medical College

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Topic:

Addressing health inequity generally requires attention to the most marginalized patients, whose health is often undermined by social, legal and financial challenges. In response, many health care delivery organizations have begun to collect data about health-related social needs and build organizational capacity to address these needs, either “in-house” or through partnerships with community-based organizations. This gives rise to challenging ethical questions:

• How do we weigh the potential benefits and harms of screening for social needs? And what responsibilities do health care delivery organizations have once they have health-related social need information?
• How should health care delivery organizations allocate their resources between addressing specific patient needs versus thinking more broadly about community-level social determinants? 

The panel will weigh in on each of these normative questions based on their experiences as physicians, researchers and change agents. Audience participation will be encouraged throughout the 90 minutes.

Presenters:

Monica E. Peek, MD, MPH, MSc, Ellen H. Block Professor of Health Justice, Section of General Internal Medicine; Associate Vice-Chair for Research Faculty Development, Dept of Medicine; Associate Director, Chicago Center for Diabetes Translation Research; Dir. of Research (Assoc. Director), MacLean Center for Clinical Medical Ethics; Executive Medical Director, Community Health Innovation

Marshall Chin, MD, MPH, Richard Parrillo Family Distinguished Service Professor of Healthcare Ethics in the Department of Medicine, University of Chicago; Associate Director, MacLean Center for Clinical Medical Ethics; Co-Director, Robert Wood Johnson Foundation Advancing Health Equity: Leading Care, Payment, and Systems Transformation National Program Office; Co-Chair, CMS Health Care Payment Learning and Action Network Health Equity Advisory Team

Laura Gottlieb, MD, MPH, Co-director, Social Interventions Research and Evaluation Network (SIREN); Professor, Department of Family and Community Medicine, University of California, San Francisco

Moderator:

Lauren A Taylor, PhD, MDiv, Assistant Professor, NYU Grossman School of Medicine

Consortium Co-Chair:

Charlotte H. Harrison, PhD, JD, MPH, HEC-C, Co-Chair, Organizational Ethics Consortium, Harvard Medical School Center for Bioethics; Immediate Past Hospital Ethicist and Director, Office of Ethics, Boston Children’s Hospital

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Topic:

Many patient-facing digital health tools – such as telehealth visits, patient portals, or remote patient monitoring – are associated with improved patient experience, reduced healthcare costs, and – for certain tools in certain conditions – improved health outcomes. However, not all patient populations experience these benefits and evidence suggests that increasing use of digital tools, when not thoughtfully introduced, may worsen health inequities.

Join our expert panel to explore how organizations are grappling with the desire to offer innovative digital health solutions while also ensuring that these solutions are accessible, designed in a nondiscriminatory way, protective of privacy, and otherwise beneficial to those who have the greatest need for increased access to healthcare, whether because of race, ethnicity, education, geography, economic status, linguistic preference, immigration status or other factors.

Moderator:

Elaine Khoong, MD, MS, Assistant Professor of Medicine, University of California San Francisco

Presenters:

• Courtney R. Lyles, PhD, Director, UC Davis Center for Healthcare Policy and Research; Professor, Department of Public Health Sciences, UC Davis School of Medicine
• Deepti Pandita, MD, FACP, FAMIA, Associate Professor of Medicine and Chief Medical Information Officer, University of California, Irvine
• Safiya I. Richardson, MD, MPH, Assistant Professor, Department of Population Health; Director, Program for Digital Health Equity, Institute for Excellence in Health Equity, NYU Grossman School of Medicine

Discussant:

Francis X. Shen, JD, PhD, Member, Harvard Medical School Center for Bioethics; Professor of Law & Graduate Program in Neuroscience Faculty Member, University of Minnesota

Consortium Co-Chair:

Charlotte H. Harrison, PhD, JD, MPH, HEC-C, Co-Chair, Organizational Ethics Consortium, Harvard Medical School Center for Bioethics; Immediate Past Hospital Ethicist and Director, Office of Ethics, Boston Children’s Hospital

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Topic:

How can hospitals and health systems prepare for ethical and practical challenges presented by widespread shortages of certain critical care resources? When life-threatening shortages may arise with little notice, how can organizations quickly build multi-stakeholder support for a fair and workable approach to triage and resource-sharing? Is there a role for inter-institutional collaboration in short- or longer-term planning?

Many institutions recently faced an impending shortage of ECMO circuits due to a scarcity of available oxygenators. With a few weeks’ notice and with the sponsorship of hospital leaders, Seattle Children’s Hospital used a broad existing triage algorithm developed through regional disaster response refined during COVID-19 as a basis for creating a similar algorithm and triage process specifically for ECMO allocation. ECMO physicians from the neonatal, pediatric and cardiac ICUs, surgeons, organizational ethics, the center for health equity and diversity, hospital leadership and risk management met frequently to develop and finalize a standard operating procedure. Panelists will discuss challenges and lessons learned in that process, in light of anticipated needs for similar efforts as other shortages occur.

Panelists:

• Emily R. Berkman, MD, MA, Assistant Professor, Department of Pediatrics, Divisions of Pediatric Critical Care Medicine and Bioethics & Palliative Care, Seattle Children’s Hospital; University of Washington Treuman Katz Center for Pediatric Bioethics
• Douglas S. Diekema MD, MPH, Professor of Pediatrics, University of Washington School of Medicine; Director of Education, Treuman Katz Center for Pediatric Bioethics & Palliative Care, Seattle Children’s Research Institute
• Mithya Lewis-Newby, MD, MPH, Associate Professor of Pediatrics and Bioethics & Palliative Care, University of Washington School of Medicine; Divisions of Pediatric Cardiac Critical Care Medicine and Bioethics & Palliative Care, Department of Pediatrics, University of Washington School of Medicine; Attending Physician, Pediatric Cardiac ICU, Seattle Children’s Hospital; Chair, Hospital Ethics Committee; Seattle Children’s Hospital

Discussant:

Matthew Wynia, MD, MPH, FACP, Director of the Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus

Moderator:

Charlotte H. Harrison, PhD, JD, MPH, HEC-C, Co-Chair, Organizational Ethics Consortium, Harvard Medical School Center for Bioethics; Immediate Past Hospital Ethicist and Director, Office of Ethics, Boston Children’s Hospital

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Topic:

There have been many calls for health care systems to engage and listen to community voices, particularly when making consequential policy decisions about patient care. Such decisions may range from policies for rationing scarce COVID-19 interventions to requiring masking in hospitals in the post-pandemic era, and beyond, to reproductive and transgender care policies in a post-Dobbs public landscape. But what does it really mean to engage the public in deliberation on hospital policies? What are the benefits and hazards of such engagement? What would hospital leaders and community members need to put such a decision-making model into place? And how can ethics leaders facilitate this work?

Join us for a special joint Clinical and Organizational Ethics Consortium exploring the ethics, challenges of, and opportunities for public engagement regarding patient-facing policy. We will hear first about what public engagement is, both in theory and in practice, and then perspectives from a local hospital leader and patient advocate on the promise and challenges of publicly-engaged deliberation to help inform organizational decision-making. Through facilitated discussion amongst speakers and attendees, we will explore a practical approach for this model’s potential application in health care systems.

Presenters:

• Erika Blacksher, PhD, John B. Francis Chair in Bioethics, Center for Practical Bioethics; Research Professor, University of Kansas Medical Center
• Julius Yang, MD, PhD, Vice Chair for Clinical Affairs, Department of Medicine; Senior Medical Director for Clinical Operations and Analytics, Silverman Institute for Health Care Quality and Safety, Beth Israel Deaconess Medical Center
• Basel Tarab, MD, MBE, MHA, Director of Patient Experience, Volunteers, and Transport; Co-Chair of Ethics Committee, Winchester Hospital

Moderators:

• Charlotte H. Harrison, PhD, JD, MPH, HEC-C, Immediate Past Hospital Ethicist and Director, Office of Ethics, Boston Children’s Hospital
• Jonathan Marron, MD, MPH, HEC-C, Director of Clinical Ethics, Harvard Medical School Center for Bioethics; Instructor in Pediatrics, Harvard Medical School
• Leanne Homan, RN, BSN, MBE, HEC-C, Associate Director of Clinical Ethics, Harvard Medical School Center for Bioethics; Clinical Ethicist, Beth Israel Deaconess Medical Center

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Topic:

A national mental health crisis, exacerbated by the isolation, interruptions, and uncertainties of the pandemic, is overwhelming stressed health care delivery systems and leaving many without needed care. Psychiatry is the branch of medicine specifically trained to respond to such crises, and yet psychiatry too faces challenges of limited workforce, financing disparity, and continually evolving science. How, then, can psychiatry situate itself within treatment systems to meet its responsibilities to the population? And what is the role of the American Psychiatric Association (APA), the world’s largest psychiatric organization, in setting the norms and targets of the profession to meet today’s and future mental health crises?  Join the Harvard Medical School Organizational Ethics Consortium for a conversation with leaders from the APA about the future of psychiatry and the work the APA has done over the past year to revisit norms and priorities for the profession against a backdrop of crisis and change. Together, we will consider how a professional association plays a powerful organizing role in the health care system and its ability to ethically serve the public.

Panelists:

Rebecca Weintraub Brendel, MD, JD, Immediate Past President, American Psychiatric Association; Director of the Center for Bioethics and Associate Professor of Psychiatry at Harvard Medical School

Charles Dike, FRCPsych, MBChB, MPH, Ethics Committee Chair, American Psychiatric Association; Professor of Psychiatry, Yale School of Medicine; Medical Director, Commissioner’s Office of the Connecticut Department of Mental Health and Addiction Services

Robert L. Trestman, PhD, MD, Chair of Presidential Work Group on Roadmap for the Future of Psychiatry, American Psychiatric Association; Chair, Psychiatry and Behavioral Medicine, Carilion Clinic and Virginia Tech Carilion School of Medicine

Moderator:

Kelsey N. Berry, PhD, Lecturer, Department of Global Health and Social Medicine, Harvard Medical School; Associate Faculty Director, Master of Bioethics Degree Program, Harvard Medical School; Faculty Director, Graduate Fellowship in Ethics, Edmond & Lily Safra Center for Ethics

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Topic:

Physician moral stress and burnout have emerged as major challenges for US health care, particularly as physicians struggle to prevent patients from falling through the cracks of the complicated, and often opaque, health and hospital systems within which they work. Can hospitals help physicians recapture the moral core of their practice through a broader institutional commitment to equity? And what does it take to establish equity as a core element of hospital systems and practice? Join critical care physician and health and human rights specialist Katherine Peeler, MD, MA as she hosts a conversation with expert panelists on the challenges physicians face in 21st century hospital systems as well as organization-level interventions to align hospital and physician efforts toward health equity.

Panelists:

Katherine Peeler, MD, MA, Assistant Professor of Pediatrics, Global Health and Social Medicine, Harvard Medical School; Attending Physician, Division of Medical Critical Care, Boston Children's Hospital; Justice, Health and Democracy Impact Initiative Fellow, Edmond & Lily Safra Center for Ethics, Harvard University

Omar B. Lateef, DO, President and CEO of RUSH University System for Health and RUSH University Medical Center; Professor, Department of Internal Medicine, RUSH Medical College

Vikas Saini, MD, President and CEO of the Lown Institute

Thea James, MD, MBA, Vice President of Mission and Associate Chief Medical Officer, Boston Medical Center; Professor of Emergency Medicine, Boston University Chobanian & Avedisian School of Medicine 

Moderators:

Kelsey N. Berry, PhD, Lecturer, Department of Global Health and Social Medicine, Harvard Medical School; Associate Faculty Director, Master of Bioethics Degree Program, Harvard Medical School; Faculty Director, Graduate Fellowship in Ethics, Edmond & Lily Safra Center for Ethics

Charlotte H. Harrison, PhD, JD, MPH, HEC-C, Immediate Past Hospital Ethicist and Director, Office of Ethics, Boston Children’s Hospital

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Economist Kenneth Arrow once famously said, "The very word 'profit' is a signal that denies the trust relationship." By this reasoning, non-profit hospitals positively contribute to the health care industry at least in part by inviting the trust of their users. But does trust actually track with non-profit status? Can patients even pinpoint which hospitals are non-profits?

Management scholar and ethicist Lauren Taylor shared findings from a new national survey measuring public attitudes toward hospital ownership status. Discussion with management and public health scholar Nancy Kane and bioethics scholar Jonathan Marks focused on revisiting the social value of non-profit hospitals to make evidence- and ethics-aligned recommendations for hospital practice and public policy.

Presenter:

• Lauren Taylor, PhD, MPH, MDiv
  Assistant Professor, Department of Population Health, NYU Grossman School of Medicine

Commentators:

• Nancy Kane, DBA
  Professor of Management, Harvard T.H. Chan School of Public Health
• Jonathan H. Marks, BCL, MA
  Director, Bioethics Program; Professor of Bioethics, Humanities, Law, and Philosophy; Affiliate Faculty, Public Policy & International Affairs, Penn State University

Moderators:

• Charlotte H. Harrison, PhD, JD, MPH, HEC-C
  Co-Chair, Organizational Ethics Consortium
  Center for Bioethics, Harvard Medical School
  Immediate Past Hospital Ethicist and Director, Office of Ethics
  Boston Children’s Hospital
• Kelsey N. Berry, PhD
  Associate Faculty Director, Master of Science in Bioethics Degree Program
  Lecturer, Department of Global Health and Social Medicine
  Harvard Medical School

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When patients' health suffers from social factors such as food and housing insecurity, limited health benefits, or an uncertain immigration status, what are hospitals and health care providers to do? One proven solution is for the hospital to connect impacted patients to effective legal assistance, to help patients secure remedies for social determinants of health available through civil law. This innovative model, known as a medical-legal partnership (MLP), is beginning to take root across the USA – but what does it take for it to become the norm? Why do hospitals decide to adopt MLPs and what role can ethics play?

Join Beth Israel Deaconess Medical Center and its partner Health Law Advocates as organizational leaders describe how and why they are partnering together on their MLP and take us through the ethical and strategic choices they are making along the way. We will also hear from representatives of other MLP providers in Boston. Together we will consider learnings for extending MLPs to vulnerable patients everywhere.

Presenters:

• Sarah Boonin, JD
  Associate Dean for Experiential Learning, Director of Clinical Programs,
  Director of Health Law Clinic, Suffolk University Law School
• Andrew P. Cohen, JD, MA
  Director and Lead Attorney, Access to Care and Coverage Team,
  Health Law Advocates
• Nancy I. Kasen, MSc
  Vice President, Community Benefits & Community Relations,
  Beth Israel Lahey Health
• Yoni Levy, JD
  Partner, Ropes & Gray LLP
• David N. Sontag, JD, MBE, HEC-C
  Senior Associate General Counsel and Director of Ethics, Beth Israel Lahey Health;
  Co-Chair, Ethics Advisory Committee, Beth Israel Deaconess Medical Center;
  Lecturer on Medicine, Part-Time, Harvard Medical School

Commentator:

• Ellen Lawton, JD
  Senior Fellow, Health Begins

Moderators:

• Charlotte H. Harrison, PhD, JD, MPH, HEC-C
  Co-Chair, Organizational Ethics Consortium
  Center for Bioethics, Harvard Medical School
  Immediate Past Hospital Ethicist and Director, Office of Ethics
  Boston Children’s Hospital
• Kelsey N. Berry, PhD
  Associate Faculty Director, Master of Science in Bioethics Degree Program
  Lecturer, Department of Global Health and Social Medicine
  Harvard Medical School

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Hospital systems are increasingly using data science, including artificial intelligence, to address complex problems in health care delivery and operations. Projects can range from performing quality improvement or research activities to assessing external AI and other potentially useful tools. Yet the attendant ethical issues -- including concerns about algorithmic bias, transparency, privacy and equity -- have challenged traditional models of research oversight and ethics engagement in the patient care setting. 

What is distinctive about data ethics in the hospital context, and what are some practical steps that hospital systems can take to integrate ethics into their data science enterprise? At this consortium, we will be joined by a team from Seattle Children’s Hospital and its related 4-state network of specialty clinics that has confronted these issues and developed a model for data ethics. Speakers will share the evolution of the model, which arose from interest within the hospital’s data science community. Questions include:

• What are some current ethical challenges arising in the use of data science at the hospital or health-system level? 
• What values should be of foremost concern in designing and evaluating data science projects and products in a hospital environment?
• To what extent can ethical oversight of data science make use of traditional models in health care, such as Institutional Review Boards? 
• How can an organization build a culture of ethical awareness and accountability among data scientists and the clinicians and others who seek their services?

Presenters:

• Dwight Barry, PhD
  Principal Data Scientist
  Seattle Children’s Hospital
• Douglas Diekema, MD, MPH
  Professor of Pediatrics, University of Washington
  Director of Education, Treuman Katz Center for Pediatric Bioethics, Seattle Childrens Research Institute
• David Danks, PhD
  Professor of Data Science & Philosophy, UC San Diego
• T. Eugene Day, DSc
  Data Science Manager, Seattle Children’s Hospital
• Elizabeth Montague, MS
  Manager, Surgical Services Analytics, Seattle Children’s Hospital

Moderator:

• Charlotte H. Harrison, PhD, JD, MPH, HEC-C
  Co-Chair, Organizational Ethics Consortium
  Center for Bioethics, Harvard Medical School
  Immediate Past Hospital Ethicist and Director, Office of Ethics
  Boston Children’s Hospital

Commentator:

• Alex John London, PhD
  Clara L. West Professor of Ethics and Philosophy
  Director, Center for Ethics and Policy
  Carnegie Mellon University

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A growing body of research suggests that the design and architecture of a health care facility substantially influences the health outcomes of the patients in it. Yet despite the mission-critical insights that this line of research unlocks for hospitals and other health care facilities, evidence-based design remains relatively underutilized in the health care industry. This gap leaves ample opportunity for bioethics and health care leaders to shape the ethical use and potential impacts of evidence-based design for healthcare organizations and systems. This consortium will explore both the bioethical dilemmas presented by the new science of design as well as practical opportunities to advance evidence-based design in health care. Key questions will include:

• What implications does the new science of design have for developing an organizational and systems approach to improving patient outcomes?
• To what extent should the healthcare building itself be conceived of as a health intervention?
• What are the responsibilities of healthcare systems to design, build, and renovate their physical structure for optimal health and health equity outcomes?
• What values ought to guide the intentional design of healthcare spaces, and how should health systems respond when prior, sticky design choices are found to contravene those values?
• How can ethics and health care leaders’ partner with architects to facilitate care transformation focused on the built environment?

Presenters:

• Diana C. Anderson, MD, MArch, ACHA
  Geriatric Neurology Research Fellow, VA Boston Healthcare System
• Stowe L. Teti, MA, HEC-C
  Clinical Ethicist, Inova Health System
• William J. Hercules, MArch, FAIA, FACHA, FACHE
  CEO, WJH Health
• David A. Deemer, MD, MA
  Bioethicist and Internal Medicine Resident, University of Wisconsin, Madison

Moderator:

• Kelsey N. Berry, PhD
  Associate Faculty Director, Master of Science in Bioethics Degree Program
  Lecturer, Department of Global Health and Social Medicine
  Harvard Medical School

Commentator:

• Pierre M. Barker, MD, MBChB
  Chief Scientific Officer, Institute for Healthcare Improvement (IHI)

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Hospitals and other health care organizations face myriad opportunities to advance their ethical commitments to health equity, including through activities that fall outside the bounds of their traditional role of caring for the sick. In recent years, for example, many hospitals have begun to fund housing programs, tackle food insecurity in their local communities, and undertake other initiatives to combat the social determinants of health inequity.

As hospitals increasingly intervene on social determinants of health, how can they ensure that their entry into this space advances, rather than sets back, goals of social and health justice? Join us for a conversation about how hospitals and health organizations can reason through their commitments and responsibilities as ethical actors in the social realm.

Presenters:

• Kelsey N. Berry, PhD
  Associate Faculty Director, Master of Bioethics Degree Program
  Lecturer, Department of Global Health and Social Medicine
  Harvard Medical School
• Lauren Taylor, MPH, MDiv, PhD
  Assistant Professor, NYU Grossman School of Medicine in the Department of Population Health

Discussant:

• Rishi Manchanda, MD, MPH
  Chief Executive Officer, HealthBegins

Innovations in health tech and biotech have the potential to create significant health benefits for diverse populations. However, the erosion of trust in science and skepticism of industry motives may hinder patient and consumer participation in beneficial health innovations. Vaccine hesitancy during the COVID-19 pandemic is one recent example, but others abound.

How might organizations developing new technologies such as therapeutics, wearable devices, and artificial intelligence for health navigate the dynamics of trust to deliver the benefits of scientific innovation to society? How can industry engage and communicate with the public to become not only worthy of trust, but also trusted?

This "works in progress" consortium session shared emerging ideas from practitioners and scholars who have worked with industry, as we together explored how ethically-minded industry actors can nurture trust and contribute to the public good from within the market-based system of which they are a part.

Speakers:

• Sravya Chary, MS, MBE
  Solution Design Manager
  Novartis
• Dorothée Caminiti, JD, LLM, MBE
  Research Fellow in Global Health and Social Medicine
  Harvard Medical School
• Karin Blumer, PhD
  Director, Global Patient Engagement
  Novartis Oncology

The development of safe, effective COVID vaccines has been a game-changer in the pandemic, but despite widespread availability, progress in getting the U.S. population fully vaccinated has been slow.Vaccine mandates increasingly appear to be one of the most effective ways to increase vaccination rates and protect people. Yet efforts to mandate vaccines have been met with pushback and legal challenges, leaving organizational leaders to navigate murky waters when establishing vaccination policies for their employees.

Houston Methodist led by example when in June 2021 it became the first health care system in the U.S. to mandate the initial series of COVID-19 vaccinations for its 30,000+ employees and physician affiliates. In 2022, Houston Methodist again led the charge in mandating booster vaccinations in the wake of the Omicron variant.

Susan M. Miller, MD, MPH, a key architect of Houston Methodist's pioneering vaccination policies, took us through the ethics process underlying these mandates, their implementation, and lessons learned. Houston Methodist's experience shared lessons for other health care systems and organizational leaders that extend well beyond the current moment.

Speaker:

• Susan M. Miller, MD, MPH
  Chair, Department of Family Medicine, Houston Methodist Hospital
  John S. Dunn Senior Research Chair in General Internal Medicine, Houston Methodist Hospital Department of Medicine
  Professor of Clinical Medicine, Houston Methodist Research Institute
  Associate Professor, Weill Cornell Medical College

Discussants:

• Rebecca Weintraub Brendel, MD, JD
  Director, Master of Bioethics Degree Program
  Associate Director, Center for Bioethics, Harvard Medical School
  President-Elect, American Psychiatric Association
• Elliot Crigger, PhD
  Director of Ethics Policy, American Medical Association

Extreme capacity challenges have been pervasive throughout the COVID-19 pandemic, with hospitals often facing severe shortages of critical resources, including staffing, space and medications. While some states have established effective mechanisms for cross-system resource sharing and patient transfers during the pandemic, many lack such mechanisms or failed to implement them when they were urgently needed. Stories of patients dying while awaiting needed transfers have become too common.

The current crisis will eventually abate, but it would be imprudent to assume it will be the last. What has been the experience of public health and hospital leaders in states that have activated regional or statewide inter-hospital transfer systems during recent months?  What ethical issues have arisen?  What can be learned for approaching future capacity issues, with or without direct state involvement? 

In an interactive format, panelists from three states with active transfer systems will identify ethical and practical challenges that have arisen for them in recent months and will explore ongoing questions and lessons learned.

Moderator:

• Matthew Wynia, MD, MPH, FACP
  Director, Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus

Panelists:

• Darlene Tad-y, MD, MBA
  Vice President, Clinical Affairs, Colorado Hospital Association
• John L. Hick, MD
  Emergency Medicine, Hennepin County Medical Center
• Erin Talati Paquette, MD, JD, MBe, HEC-C, FAAP
  Assistant Professor of Pediatrics, Northwestern University Feinberg School of Medicine
  Assistant Professor of Law, Northwestern University Pritzker School of Law, by courtesy
  Chair, Ethics Advisory Board and Associate Director of Clinical and Organizational Ethics
  Attending Physician, Pediatric Critical Care, Ann & Robert H. Lurie Children's Hospital of Chicago
• Elke Shaw-Tulloch, MHS
  Administrator, Division of Public Health, Idaho Department of Health and Welfare

The practice of psychiatry raises unique ethical challenges, with new ethical demands frequently emerging in moments of social and political crisis. Consider, for example, the recent resurgence of dialogue around racial determinants of health and the Goldwater Rule prohibiting diagnostic statements about public figures.

The American Psychiatric Association (APA), the largest and most influential professional psychiatric organization globally, holds an important role setting and monitoring ethical and professional norms to guide its nearly 38,000 psychiatrist members.  

How does the APA fulfill this crucial role, and what can other organizations and communities facing controversies of professionalism, violence, racism, and political upheaval learn from its approach? In this session of the Organizational Ethics Consortium, members of the APA’s Ethics Committee discuss the APA’s approach to ethics oversight, focusing on its use of data to keep the organization responsive to evolving ethics themes. Presenters will share recent empirical work examining APA’s ethics process, discuss the role of empirical bioethics in organizational ethics, and consider how similar approaches can shed light on broader challenges like inequity and social polarization. 

Presenters:

• Philip Candilis, MD, DFAPA
  Director of Medical Affairs, Saint Elizabeths Hospital
  Professor of Psychiatry, George Washington University School of Medicine 
• Michelle Hume, MD, PhD
  Forensic Psychiatrist, Mendota Mental Health Institute 

Discussant: 

• Donna T. Chen, MD, MPH
  Associate Professor, Center for Health Humanities and Ethics, Department of Public Health Sciences,
  Department of Psychiatry and Neurobehavioral Sciences, University of Virginia
• Jeremy Lazarus, MD
  Clinical Professor of Psychiatry, University of Colorado Denver School of Medicine
  Past-President, American Medical Association
  Member, Council on Ethical & Judicial Affairs, American Medical Association

While bioethics has flourished in academic and health care settings, it has gained relatively little ground in industry. Change is happening, as a wider range of companies consider the strategic and moral importance of drawing on bioethics frameworks when developing their technologies for use in public, clinical, and personal health. How does one build a robust bioethics program in an industry setting? What can newly emerging bioethics programs learn from more mature programs in other settings, such as healthcare delivery, payer, and policy organizations? What are the norms that ought to guide bioethics program development, and the challenges of program-building? How do bioethics and trust intersect, and what does it take to build trust with diverse stakeholders and communities?

Lisa S. Lehmann, MD, PhD, director of the new Bioethics and Health Trust Program at Google, will discuss the process of building bioethics and trust at Google from the ground-up. She will be joined by a panel of bioethics and health equity leaders to reflect on approaches to developing bioethics and trustworthiness in a company setting.

Speakers:

• Lachlan Forrow, MD
  Associate Professor of Medicine, Harvard Medical School
• Lisa Lehmann, PhD, MD
  Director, Bioethics and Health Trust Program, Google
• Kwame McKenzie, MD
  Chief Executive Officer Wellesley Institute
• James Sabin, MD
  Professor of Population Medicine, Harvard Medical School
• Peter Singer, MD, MPH
  Special Advisor to the Director General, World Health Organization

Technological advances have made it possible for drug discovery and development to be tailored to single patients with rare genetic diseases, with this work conducted at academic medical centers. Such a process allows clinician-investigators to provide treatment through an individual FDA expanded access request. While FDA previously allowed a waiver of full IRB review, it has recently issued limited draft guidance for IRB involvement. In this unusual and evolving scientific and regulatory environment, what issues of ethics and governance are posed for the institution? What institutional measures can effectively address the challenges?

David Williams, MD, Chief Scientific Officer at Boston Children's Hospital (BCH), will describe the creation and operation of the hospital's Oversight Committee for Personalized Experimental Therapeutics (OCPET), which is charged with reviewing proposed studies of such therapies, in the context of the Boston Children's Hospital research community of 3000 researchers and scientific staff. Dr. Williams will identify and comment on scientific and ethical issues arising in such studies. Additional perspectives will be offered by leaders in the research administration and ethics committee at BCH. Commentary will be provided by surgeon Martin McKneally, MD PhD, who has worked extensively with oversight of innovative treatment.

Presenters:

• David A. Williams, MD
  Senior Vice President for Research, Chief Science Officer, Boston Children's Hospital
  Leland Fikes Professor of Pediatrics, Harvard Medical School
• Tina Poussaint, MD
  Attending Neuroradiologist, Boston Children's Hospital
  Professor of Radiology, Harvard Medical School
• Susan Kornetsky, MPH
  Director of Clinical Research Compliance
  Boston Children's Hospital
• David Urion, MD, FAAN
  Charles F. Barlow Chair, Neurobiology
  Associate Director, Child Neurology and Neurodevelopment Disabilities Residency, Boston Children's Hospital
  Associate Professor of Neurology, Harvard Medical School

Discussant:

• Martin McKneally, MD, PhD
  Visiting Lecturer, Department of Surgery, Beth Israel Deaconess Medical Center
  Co-Chair, Surgical Ethics Working Group, Center for Bioethics, Harvard Medical School
  Professor Emeritus of Surgery, University of Toronto

Workers in essential industries have been exceptionally vulnerable in the COVID-19 pandemic. How might a body of public health ethics experts advise on industry's specific obligations to protect the health and safety of essential workers and their communities in this pandemic? What challenges can be entailed in ethics advising under such circumstances? The Global Center for Health Security at the University of Nebraska Medical Center established its Ethics Advisory Committee in the early stages of the COVID-19 outbreak. With a multidisciplinary panel of experts in disaster and public health emergency ethics, the Committee offers ethics consultation services to public health, civic, health care, and professional organizations.  Committee members shared their approaches and experience in consultations involving the meat-packing industry and other entities grappling with their ethical obligations in the pandemic.

Presenters:

• Kelly K. Dineen, RN, JD, PhD
  Director, Associate Professor, Health Law Program, Creighton University School of Law
• Abbey Lowe, MA
  Director , Ethics and Public Health Preparedness, Center for Preparedness Education, University of Nebraska Medical Center, College of Public Health
• Matthew K. Wynia, MD, MPH
  Director, Center for Bioethics and Humanities, University of Colorado
  Professor, University of Colorado School of Medicine, Colorado School of Public Health

Discussant:

• Ruqaiijah Yearby, JD, MPH
  Executive Director and Co-Founder Institute for Healing Justice and Equity, Saint Louis University
  Professor, Saint Louis University School of Law

Surges in health need and demand for potential COVID-19 therapeutics have contributed to emergent drug shortages during the pandemic. Whereas health care provider organizations can draw on numerous ethical frameworks to navigate the allocation dilemmas these drug shortages raise, a similar source of guidance is still lacking for the biopharmaceutical industry. This gap creates challenges for ethically-minded manufacturers of emerging COVID-19 drugs, who are exploring how to manage and distribute their products in the setting of overwhelming local and global demand. This session explored the experience of one private biopharmaceutical company as it navigates the ethical complexities associated with managing an FDA-approved drug that is being explored for secondary use in the COVID-19 pandemic, and the ethics process the company has convened to support its decision making. Members of the company's executive team were in attendance to discuss the case.

Key Questions:

• How should a private biopharmaceutical company plan for an unanticipated surge in demand for its product in the context of COVID-19? 
• How should it consider preserving access to drug inventory for patient populations it already serves? How should it consider targeting supply for new, COVID-19 populations?
• What role, if any, should a biopharmaceutical company play in drug allocation? What values should guide it?
• What opportunities/ challenges are presented by ethics consultations in the biopharma setting?

Ethics Consultants:

• Kelsey Berry, PhD
  Postdoctoral Fellow, Center for Bioethics, Harvard Medical School
• Nikola Biller-Andorno, MD, PhD
  Professor of Biomedical Ethics, Director, Institute of Biomedical Ethics and History of Medicine/Center for Medical Humanities, University of Zurich, Switzerland
• Jonathan Marron, MD, MPH
  Pediatric Oncologist and Ethicist, Boston Children's Hospital and Dana-Farber Cancer Institute
  Teaching Faculty, Center for Bioethics, Harvard Medical School
• Christine Mitchell, RN, MS, MTS
  Executive Director, Center for Bioethics, Harvard Medical School

Discussant:

• Jennifer E. Miller, PhD
  Assistant Professor, Yale Medical School

Reducing racial disparities in health outcomes is an urgent priority for many health care organizations, leading to a continual search for novel organization-level interventions that can yield substantive health gains for Black patients in particular. One emerging line of research demonstrates that Black patients treated by Black physicians achieve better health outcomes in several domains compared with Black patients seen by non-Black physicians. Recent studies demonstrate a 50% reduction in Black-White infant mortality gaps and a 19% decline in male cardiovascular mortality with racially concordant care.

Key Questions:

• What implications does this line of research have for developing an organizational approach to reducing racial disparities?
• Do these studies merely underscore the need to improve the diversity of the physician workforce?
• Should administrators looking to create an anti-racist health care organization take proactive steps to match Black patients with available Black physicians?
• How might such programs be understood in the context of the historical effort to desegregate medicine?

Presenters:
Ethicist and management scholar Lauren Taylor (NYU Langone), in conversation with historian Adam Biggs (University of South Carolina) and 4th year medical student and MBA Osaze Udeagbala (NYU Medicine), discussed how health care organizations can identify appropriate responses to the morally urgent project of closing racial disparities.

Improving health equity is an important goal for many health care institutions, but turning values into sustainable action can be challenging in today's complex social, political, and economic conditions.
What has been the experience of hospitals, health systems and other healthcare institutions that have invested in health equity efforts in recent years, using tools and understandings from improvement science?
The Pursuing Equity initiative of the Institute for Healthcare Improvement (IHI) has brought together a group of institutions to tailor improvement strategies for their respective patient populations and circumstances, and to share experience and learnings in a collaborative action network. 

Presenters:

• Kedar Mate, MD
  President and CEO
  Institute for Healthcare Improvement
• David Ansell, MD, MPH
  Senior Vice President for Community Health Equity
  Rush University Medical Center
  Associate Provost for Community Affairs
  Rush University
• Nancy Berlinger, PhD
  Research Scholar 
  The Hastings Center

The U.S. health system separates community health, treatment of illness, and financial stewardship into separate silos and separate organizations.
In this event, ethics leaders from three typically separate silos will discuss the challenge of interorganizational or transorganizational ethics. The discussion will address the question of how joint organizational ethics might contribute to moving from a reactive stance within organizations to one proactively promoting community health and well-being across organizations.

Presenters:

• Anita Wagner, PharmD, MPH, DrPH
  Director, Ethics Program
  Harvard Pilgrim Health Care
• Jonathan Harland, MD
  Director, Ethics Program
  Atrius Health
• Lachlan Farrow, MD 
  HMS Associate Professor of Medicine
  Beth Israel Deaconess Medical Center

Moderator:

• Sharon Levine, MD
  Physician, Southern California Permanente Medical Group
  Former Director and Senior Advisor, The Permanente Medical Group