This monthly conference series at Johns Hopkins Hospital attracts 60-70 attendees to each session from the entire hospital community – physicians, nurses, medical students, social workers, chaplains, etc. – to participate in discussion about an important clinical ethics issue.
2018-19 Panels (Upcoming)
Tuesday, June 18
Looking Back and Looking Forward 2019
In addition to her work in genetics, Dr. Geller’s other substantive areas of scholarship include the use of complementary and alternative medicine (CAM), the role of palliative care in chronic diseases, and the medical socialization process. She received one of the highly coveted NIH “challenge” grants to explore the integration of palliative care in the management of children, young adults and families affected by chronic, life-threatening disorders (muscular dystrophy and sickle cell disease). She received a prestigious Kornfeld Fellowship to explore the intersection of bioethics and CAM. She has served as co-director of the educational component of the Johns Hopkins CAM Center, ethics representative on the Data Safety & Monitoring Board of the National Center for Complementary & Alternative Medicine (NCCAM), and adjunct faculty at the Tai Sophia Institute in their Master’s Program in Transformative Leadership and Social Change. For 15 years, she co-directed the required Integrative Medicine course for Hopkins medical students, and the Healer’s Art elective. Several of the grants onwhich she has served as PI, Co-PI or Co-I have focused oncultivating respect, trust, empathy, wonder, and tolerance forambiguity among current and future health professionals. The unifying themes that animate her work are communication and decision-making under conditions of uncertainty, and the intrapersonal, interpersonal and social/cultural forces that influence moral development, attitudes and behavior.
Dr. Geller also has longstanding interests in ethics education. She served as Co-Deputy Director of the Greenwall Fellowship Program in Bioethics & Health Policy until 2012, and now, as the Berman Institute’s Director of Education Initiatives, she oversees the Hecht-Levi Fellowship Program in Bioethicsand the Masters in Bioethics . Dr. Geller has occupied several educational leadership positions in the SOM. She was involved in the revision to the undergraduate medical curriculum that took place in 2009. Currently, she co-directs the “culture of medicine” core theme which includes horizontal strands of particular relevance to ethics, professionalism and social justice. In addition, she directs the Scholarly Concentrationcalled the HEART (Humanism, Ethics, and the ‘Art’ ofMedicine), teaches in the “Medical Humanities & Social Medicine” elective, serves on the Advisory Board for the Center for Medical Humanities & Social Medicine, and directs the Program in Arts, Humanities & Health. She is a member of the School of Medicine’s Admissions Committee.
Dr. Geller has served on the Board of Directors of the American Society for Bioethics & Humanities, the scientific review panel for the ELSI Program (Ethical, Legal and Social Issues) at NIH’s National Human Genome Research Institute, the Advisory Board of the Center for Genetics Research Ethics and Law (CGREAL) at Case Western Reserve University, and the IOM Committee on the Review of Omics-Based Tests for Predicting Patient Outcomes in Clinical Trials. She was a Consultant to the Ethics Working Group of the National Children’s Study, the Informed Consent Working Group of the Secretary’s Advisory Committee on Genetic Testing (SACGT), the CDC’s Program in Public Health Genetics, and the Presidential Advisory Committee on Human Radiation Experiments. She is a Fellow of the Hastings Center.
Joseph Carrese, MD, MPH, FACP is Professor of Medicine at the Johns Hopkins University School of Medicine, a member of the Division of General Internal Medicine at the Johns Hopkins Bayview Medical Center, and a core faculty member of the Johns Hopkins Berman Institute of Bioethics.
Dr. Carrese’s scholarship focuses on clinical ethics and professionalism, with a particular interest in medical education, examining ethical issues in the context of cultural diversity and clinical ethics consultation. Dr. Carrese’s peer-reviewed articles have been published in leading medical and bioethics journals, such as JAMA, BMJ, CHEST, Academic Medicine, the Hastings Center Report, the Journal of General Internal Medicine, the Journal of Clinical Ethics, the American Journal of Bioethics and Medical Education. Dr. Carrese has been a visiting professor at several academic medical institutions and he has been invited to speak at many national and international meetings.
Dr. Carrese was on the Board of Directors for the American Society for Bioethics and Humanities from 2012-15. In 2012 Dr. Carrese was a founding Board member and Chair-elect of the Academy for Professionalism in Healthcare (APHC). From 2013-2015 he was Chair of the Board of Directors of APHC and he was the immediate past-Chair 2016-18.
Dr. Carrese received a National Award for Scholarship in Medical Education at the Society of General Internal Medicine annual meeting in April 2008 for his body of work in the area of clinical ethics education. From 2009-2014 Dr. Carrese was a member of the ASBH standing committee on Clinical Ethics Consultation Affairs (CECA) and in October 2011 he received the ASBH Presidential Citation Award for his work on this committee. Dr. Carrese is a Fellow of the Hastings Center.
Dr. Carrese is Chair of the Ethics Committee at the Johns Hopkins Bayview Medical Center, Chair of an Institutional Review Board at the Johns Hopkins School of Medicine, and primary care doctor to a panel of patients seen at the Bayview Medical Offices internal medicine clinic on the Johns Hopkins Bayview Medical Center campus.
Dr. Carrese graduated from Williams College and the University at Buffalo School of Medicine. He completed a fellowship in the Robert Wood Johnson Clinical Scholars Program at the University of Washington in Seattle, where he studied medical ethics and anthropology. Dr. Carrese joined the faculty at Johns Hopkins in 1994.
Calling access to essential medicines a basic human right, Berman Institute professor Yoram Unguru made a compelling argument for the United States Food & Drug Administration to establish an Essential Medicines List, as a first step in ensuring that the population has access at all times, and in sufficient amounts, to medicines that satisfy their priority health care needs.
Speaking at a Nov. 27 Washington, DC, meeting “Identifying the Root Causes of Drug Shortages and Finding Enduring Solutions,” convened in cooperation with the U.S. FDA, Dr. Unguru explained that shortages of vital drugs have harmed countless patients, been implicated in patient deaths between 2010-2012, and had a lasting detrimental impact on clinical research, threatening researchers’ ability to achieve meaningful progress in improving the lives of children with cancer.
“Typically, we only get one chance to cure children with cancer. If that opportunity is missed, it’s rare that we are able to cure them of their disease,” said Dr. Unguru.
“At the height of the shortages, a survey of medical oncologists found that a staggering 83% of oncologists weren’t able to prescribe their preferred chemotherapy agent. More than 75% had to make a major change in treatment such as choosing a different treatment regimen or substitute different drugs during the treatment. And over 40% had to delay the start of treatment. Two surveys of childhood cancer specialists, one in 2015 and again just last year, found the two out of three pediatric oncologists reported that their patients’ clinical care was compromised by the shortages.”
The purpose of the Nov. 27 meeting was to give stakeholders including health care providers, patients, manufacturers, wholesalers, pharmacists, pharmacy benefit managers, veterinarians, public and private insurers, academic researchers, and the public, the opportunity to provide input on the underlying systemic causes of drug shortages and to make recommendations for actions to prevent or mitigate drug shortages.
Dr. Unguru called on the FDA to join many other countries throughout the world in adopting the World Health Organization’s essential medicines list (EML). As defined by the WHO, essential medicines: “Satisfy the priority health care needs of the population. Medicines included in the EML are both clinically effective and cost effective and are to be available at all times in adequate amounts, in the appropriate dosage forms, with assured quality and adequate information, and at a price the individual and the community can afford.”
The current WHO Essential Medicines List for Children includes 18 chemotherapy agents and 4 supportive care medicines.
“This may shock you to hear, but over the past 2.5 years, nearly two-thirds of these essential medicines for children with cancer have been or are currently in short supply in the U.S. In fact, at this time, 5 of the 18 essential medicines, nearly 30%, are in short supply in the U.S.,” said Dr. Unguru.
Dr. Unguru is a pediatric hematologist/oncologist with joint faculty appointments at The Herman and Walter Samuelson Children’s Hospital at Sinai and The Johns Hopkins Berman Institute of Bioethics, where he is a Core Faculty member. He is also an Assistant Professor in the Johns Hopkins School of Medicine. Dr. Unguru is a member of the Children’s Oncology Group, and leads a multidisciplinary, transnational working group examining the ethical and policy implications of chemotherapy shortages in childhood cancer.
He has appeared, among other places, in the New York Times and on NPR to discuss allocation of scarce children’s cancer-treating drugs.
“Given the continued shortages of drugs, especially generic injectable drugs that are essential to the treatment of children with cancer, the United States should create an EML for pediatric oncology drugs,” Dr. Unguru said.
“Ultimately, what is needed is greater involvement by government. Congress must grant federal authorities the ability to ensure that patients in need have access to medications. Children with cancer should not have to continue to suffer because of inaction and a lack of will; they deserve better.”
Leading bioethics scholars from around the world lecture on vital issues in the field at our biweekly Seminar Series. Lectures, held at lunchtime, are free and open to the public.
2018-2019 Berman Institute Seminar Series
Seminars are video recorded and posted on our YouTube channel.
March 25, 2019 Marion Danis, MD
“Engaging the Public in Setting Health Care Priorities”
April 8, 2019 Brian Carter, MD
Hutzler-Rives Memorial Lecture: “Insights from patienthood: A pediatrician and bioethicist’s reflections on pediatric palliative care”
April 22, 2019 Effy Vayena, PhD
“Digital Health Ethics: The Systemic Oversight Approach”
Cynda Rushton, PhD, RN, FAAN, has been chosen to serve on a newly formed National Academies of Science, Engineering, and Medicine committee to develop recommendations for systemic solutions to combating clinician burnout. Rushton was one of only two nurses selected for the committee and will bring knowledge and insight as an experienced clinician, educator, and researcher in moral distress and suffering of clinicians, moral resilience, and cultures of ethical health care practice.
Burnout remains a critical problem for health care providers across the country and has potential for significant consequences on the profession’s workforce development, retention, and on the quality and safety of patient care. The committee—Systems Approaches to Improve Patient Care by Supporting Clinician Well-Being—will examine the current scientific evidence on burnout and implications for both clinician and patient, and develop interventions to promote well-being and resilience.
“Increased severity of illness, patient volumes, pressures to reduce costs, and moral distress are just a few of the factors putting additional stress on health care providers today,” says Rushton. “To turn the tide of burnout, we must commit to fundamental systemic changes in health care along with expanding tools to support the resilience and integrity of frontline clinicians.”
Beginning at its first meeting in October, the committee will also investigate key factors that influence clinical workflow and workload, functioning of interdisciplinary care teams, use of technology, and regulations and policies that impact clinicians and their ability to work well within their role and the health care system.
As JHSON Anne and George L. Bunting Professor of Clinical Ethics and a founding member of the Johns Hopkins Berman Institute of Bioethics, Rushton has been internationally recognized for her contributions to bioethics, ethics education, and clinical ethics consultation. In 2014, she co-led the first National Nursing Ethics Summit, held at JHSON, where nursing leaders developed the Blueprint for 21st Century Nursing Ethics. In 2016, she co-led a symposium focusing on transforming moral distress into moral resiliency and was co-chair of a subsequent American Nurses Association’s professional issues panel.
Her most recent work has been designing, implementing, and evaluating the Mindful Ethical Practice and Resilience Academy (MEPRA) to build moral resilience in frontline nurses who face ethical challenges related to patient suffering, adequacy of informed consent, resource allocation, and ineffective communication and care coordination. She has edited and authored the bookMoral Resilience: Transforming Moral Suffering in Healthcare to be published by the Oxford University Press.
Recognized as one of Maryland’s Top 100 Women, Rushton has received three post-doctoral fellowships: a Robert Wood Johnson Nurse Executive Fellowship, a Kornfeld Fellowship in end-of-life, ethics, and palliative care, and a Mind and Life Institute Fellowship in Contemplative Science. She is a Fellow of the American Academy of Nursing and recognized as an “Edge Runner” and a Hasting’s Center Fellow.
“Now is the time to restore the integrity of clinicians by dismantling the systemic barriers that undermine their ability to provide safe, quality care to the patients and families they are called to serve,” says Rushton.
– originally published by Johns Hopkins School of Nursing