The Berman Institute will be well represented at the 24th annual meeting of the American Society for Bioethics and Humanities (ASBH), with a group of faculty, fellows, and students scheduled to present online.
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You can also follow us on Twitter: #ASBH22, featuring our @bermaninstitute, @aregenberg, @kahnethx, @tnrethx, and more. |
The American Association of Critical-Care Nurses (AACN) has honored Cynda Hylton Rushton, PhD, RN, FAAN, with its 2022 Marguerite Rodgers Kinney Award for a Distinguished Career.
Rushton will receive the award for her exceptional contributions that enhance the care of critically ill patients and their families and the nurses who care for them during the 2022 National Teaching Institute & Critical Care Exposition in Houston, May 16-18.
An international leader in bioethics and nursing, Rushton is the Anne and George L. Bunting Professor of Clinical Ethics at the Johns Hopkins University Berman Institute of Bioethics and the School of Nursing. She co-chairs Johns Hopkins Hospital’s Ethics Committee and Consultation Service. A founding member of the Berman Institute, she co-led the first National Nursing Ethics Summit that produced a Blueprint for 21st Century Nursing Ethics.
In 2016, she co-led a national collaborative, State of the Science Initiative: Transforming Moral Distress into Moral Resilience in Nursing and co-chaired the American Nurses Association’s professional issues panel that created “A Call to Action: Exploring Moral Resilience Toward a Culture of Ethical Practice.” She was a member of the National Academies of Medicine, Science and Engineering Committee that produced the report “Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being.”
“Dr. Rushton is an internationally recognized leader in nursing ethics, moral resilience and workforce issues and a longtime contributor to groundbreaking work on these topics,” said AACN President Beth Wathen. “Her work has influenced nursing practice, health policy and patient care.”
A member of AACN since 1979, Rushton is a frequent presenter at NTI and regularly contributes to AACN’s clinical journals.
She is a member of the American Nurses Association’s Center for Ethics and Human Rights Ethics Advisory Board and the American Nurses Foundation’s Well-Being Initiative Advisory Board.
Rushton is the chief synergy strategist for Maryland’s R3 Resilient Nurses Initiative, a statewide initiative to build resilience and ethical practice in nursing students and novice nurses.
She is a Hastings Center fellow, chair of the Hastings Center Fellows Council and a fellow of the American Academy of Nursing.
She is the editor and author of Moral Resilience: Transforming Moral Suffering in Healthcare, the first book to explore the emerging concept of moral resilience from a variety of perspectives including nursing, bioethics, philosophy, psychology, neuroscience and contemplative practice.
She earned her bachelor’s degree in nursing at the University of Kentucky, followed by a master’s degree in nursing at the Medical University of South Carolina and a PhD from Catholic University of America in Washington, D.C.
The Berman Institute will be well represented at the 23rd annual meeting of the American Society for Bioethics and Humanities (ASBH), with a group of faculty, fellows, and students scheduled to present online.
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You can also follow us on Twitter: #ASBH21, featuring our @bermaninstitute, @aregenberg, @kahnethx, @tnrethx, and more. |
Assessing ethical implications of uncertainty for clinical practice during a pandemic: the case of Since the outbreak of the Covid-19 pandemic, an impressive amount of information has been produced and disseminated about potential interventions to prevent or mitigate the effects of disease. Grounded mainly on clinical and epidemiological studies, a series of recommendations regarding Covid-19 prevention and treatment strategies were issued by national and international health organizations. Despite that, innumerable important questions remain unanswered. Uncertainty is the order of the day.
Insofar as uncertainty is intrinsic to healthcare, the competence to make decisions without solid evidence is of paramount importance to practitioners. Even though we now have quite consistent evidence for some interventions, many physicians continue treating patients with substances that, according to the best scientific information available, lack evidence of efficacy. Those physicians are using their professional prerogative to prescribe off-label.
Especially in the course of a public health emergency of international concern, when it comes to professional practice, which factors impact the decision-making process? What counts as evidence for these practicing physicians? What should be the limits of off-label prescribing, and what are the ethical implications of this practice?
This project is part of the Berman Institute’s Global Infectious Disease Ethics Collaborative (GLIDE) in conjunction with the Wellcome Trust and the University of Oxford. Its primary aim is to understand how physicians make decisions when evidence is inconclusive. Secondarily, the team intends to analyze how physicians interpret scientific evidence, how they respond to it and why they might not adhere to it. Finally, they will also discuss the ethical and practical implications of prescribing treatments off-label during a pandemic.
In observance of YomHaShoah – Holocaust Remembrance Day – the Berman Institute cohosted a webinar on April 8, 2021, “Bias, Structural Racism, and Health Professionals: Lessons for Today from Nazi Medicine,” presented by Sheldon Rubenfeld, clinical professor of medicine, Baylor College of Medicine executive director of The Center for Medicine after the Holocaust.
With the implementation of the 21st Century Cures Act on April 5, healthcare providers are now required to give their patients free access to all the health information in their electronic medical records. Black patients are much more likely than white patients to discover language in those records that indicates they are not believed by their physicians, according to a new study by Johns Hopkins faculty published in the Journal of General Internal Medicine.
“We set out to see if we could identify linguistic mechanisms through which physicians communicate disbelief of patients in medical records and, if so, to explore racial and gender differences in the use of such language,” said Mary Catherine Beach, a faculty member in JHU’s schools of medicine and public health, and its bioethics institute. “Our analysis of medical record language suggests Black patients are less likely to be believed by physicians. The bias reflected in those medical records may in turn affect care from future clinicians.”
Beach and her Hopkins Medicine colleague Somnath Saha first noticed in the medical records of patients with sickle cell disease that doctors and nurses were signaling disbelief in their patients’ reports of pain. They began examining additional records to see if this phenomenon extended to patients receiving treatment for other conditions. Working with a linguist and a computer scientist they identified three aspects of language in clinic notes by which physicians communicate disbelief of patients:
“We evaluated the prevalence of these features in over 9000 notes in one clinic, then tested differences by race and gender. We found all 3 of these forms of language more often in the records of Black patients than white patients. Women’s records were somewhat more likely than men’s to have quotes, but not judgment words or evidentials,” said Saha. “Some of this language reflects how clinicians are taught to document things, and there are reasons to use quotes and evidentials that don’t necessarily cast doubt on what patients are saying. But if it’s just benign word use, why would we see a difference in their application by patients’ race and gender? That’s what makes such language so insidious.”
Beach and Saha note that the prevalence of electronic medical records means that one clinician’s notes will follow a patient wherever they go in the healthcare system and could adversely impact the patient’s care moving forward. According to Beach, Hopkins Medicine has been extremely receptive to addressing the impact of biased language on patient care, asking her to speak at Grand Rounds, to residents, and to all current medical students about her and Saha’s research.
“Clinicians know that patients are sometimes mistaken or even deceptive,” said Beach. “But if we also know there is racial bias in the way patients’ credibility gets assessed, we must revisit the certainty we have in our own impressions. We have to question ourselves before we question the statements of others.”
The Berman Institute will be well represented at the 22nd annual meeting of the American Society for Bioethics and Humanities (ASBH), with a group of faculty, fellows, and students scheduled to present online.
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You can also follow us on Twitter: #ASBH19, featuring our @bermaninstitute, @aregenberg, @kahnethx, @tnrethx, @DiStefano_MJ, and more. |
Join Jeff Kahn, Ruth Faden, Jeri Lacks (granddaughter of Henrietta Lacks), and Patricia King for a panel discussion examining social justice and bioethics through the lens of issues and challenges raised by the story of Henrietta Lacks and the HeLa cell line derived from her cells.
A groundbreaking project that fuses dramatic readings by acclaimed actors of Sophocles’ Antigone with live choral music culminating in a powerful, healing discussion that will foreground the perspectives of people in Baltimore whose lives have been impacted by racialized police violence and health inequity
Frontline medical workers continue to confront unprecedented professional and personal challenges of the COVID-19 pandemic. From their own inadequate access to personal protective equipment to facing impossible decisions about allocating limited lifesaving resources among their patients, clinicians have experienced feelings of betrayal, anger, and fear.
Now, by combining one of the pandemic’s newest forms of communication – the Zoom webinar – with the ancient art of Greek tragedy, an innovative project is reaching frontline medical workers who may be struggling in isolation, providing them the opportunity to name and communalize their experiences, connect with colleagues, and access available resources.
Theater of War for Frontline Medical Providers – developed by Theater of War Productions, the Johns Hopkins Berman Institute of Bioethics, and the Johns Hopkins Program in Arts, Humanities & Health – presents dramatic readings by acclaimed actors of scenes from ancient Greek plays for audiences of frontline medical providers to open up powerful dialogue about difficult subjects. In a paper published by The Lancet on July 23, the project’s organizers write “we have found that presenting scenes from ancient tragedies about complex ethical situations for frontline medical providers generates an open, non-threatening space in which health personnel can begin to process, interrogate, share, and bear witness to experiences of loss, betrayal, grief, and other forms of moral suffering during the COVID-19 pandemic.”
Theater of War for Frontline Medical Providers events begin with a live reading of scenes carefully curated to address themes and issues that medical providers may be facing during the pandemic, such as personal risk, abandonment, deferred grief, deviation from standards of care, helplessness, and complicity in creating suffering. After the performance, the actors are replaced by four panelists—a diverse group of front-line medical providers—who respond to what they heard in the plays that resonated with their own experiences of caring for patients during the pandemic. After the panelists’ remarks, a skilled facilitator prompts the audience to join the discussion with a series of questions encouraging reflection and dialogue about themes raised by the plays. The discussion provides an opportunity for the medical workers in the audience to take center stage, sharing the impact of COVID-19 on their lives and finding solace in the community of their peers.
The project premiered on May 24, with 417 clinicians from the Baltimore area logging onto Zoom for a performance featuring Frances McDormand, Jesse Eisenberg, David Strathairn, and Frankie Faison. In a post-performance evaluation, 93% of respondents reported that the program offered new insights about their experience during COVID; 92% said the program made it easier to talk about difficult subjects related to COVID. Following that success, the Arts in Health Initiative of the Laurie M Tisch Illumination Fund provided a grant to fund 10 performances of the project in New York City.
The first of these performances, focusing on the EMS/first responder community in NYC will take place Thursday, July 30, at 7 p.m. While focusing on EMS professionals, this first performance will be open to the general public. To register, please visit: www.towems.eventbrite.com. Cast members will include: Anthony Almojera, Vice President of New York City’s Uniformed EMS Officers Union; Amy Ryan, whose credits include “The Office,” “Birdman,” and “Gone Baby Gone;” and Chad Coleman from “The Wire” and “The Walking Dead,” among other credits.
Other actors confirmed to participate in upcoming performances include McDormand, Strathairn, Faison, Eisenberg, and David Zayas. The next two performances will be:
August 19, noon-2 p.m.
Lincoln Medical Center, Bronx
Featuring Frances McDormand, Jesse Eisenberg, David Zayas, Frankie Faison
September 16, noon-2 p.m.
Lenox Hill Hospital
Manhattan Eye, Ear, and Throat
Lenox Health Greenwich Village
Cast TBA
“Ancient tragedies provide a new entry point for clinicians to process moral suffering generated by the pandemic,” wrote Theater of War Artistic Director Bryan Doerries and Berman Institute faculty Cynda Rushton, Jeremy Greene and Gail Geller in The Lancet. “While individual cognitive reframing can be helpful in the treatment of traumatic disorders, there is also a role for collective social interventions in responding to collective trauma. Ancient Greek plays about chronic and terminal illness, moral distress, the challenges of witnessing suffering, and end-of-life care can be used to forge a common vocabulary for openly engaging doctors, nurses, students, and other health-care professionals in creating constructive dialogue, fostering understanding, compassion, and a renewed sense of community.”