Sound Ethics in Health Care - National Center for Ethics in Health Care
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National Center for Ethics in Health Care

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Sound Ethics in Health Care

Sound Ethics in Health Care is a series of podcasts developed by the National Center for Ethics in Health Care on a range of relevant health care ethics issues in VA. They can be downloaded to your computer or MP3 player, or played in a meeting as part of an ethics education program.

These podcasts directly support the mission of NCEHC through the distribution of accessible ethics educational materials for practitioners, staff, patients, and families.

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Ethical Considerations in Prescribing Home Oxygen for Patients Who Smoke (7:00)

20 to 40 percent of patients on long-term home oxygen continue to smoke. In this podcast, pulmonologist Dr. Sharon Douglas of the GV "Sonny" Montgomery VA Medical Center in Jackson, Mississippi, discusses common concerns among clinicians who care for these patients, and ways to address those concerns.

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Identifying the Patient’s Authorized Surrogate: Close Friends as Surrogate Decision-Makers (6:12)

The surrogate decision-maker is the person authorized to make health care decisions on behalf of a patient who no longer has decision-making capacity. This podcast reviews the hierarchy of surrogates in VA, discusses the documentation requirements that must be followed in order to establish a close friend as the surrogate, and examines the implications for same-sex married and unmarried couples.

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Informed Consent for Long-Term Opioid Therapy for Pain (7:27)

VHA Directive 1005, Informed Consent for Long-Term Opioid Therapy for Pain, defines long-term opioid therapy as “the medically indicated use of opioids on a daily or intermittent basis for 90 or more calendar days to treat non-cancer pain.” This podcast examines the personal and public health risks associated with long-term opioid therapy and discusses VHA policy on patient education and consent for long-term opioid therapy.

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Urine Drug Testing in the Context of Long-Term Opioid Therapy for Pain (5:42)

VHA Handbook 1004.01 requires that providers obtain and document oral informed consent for tests that are “particularly sensitive and may have consequences that the patient might reasonably want to avoid,” including tests used to identify illicit drug use. This podcast discusses the informed consent requirements for urine drug testing (UDT) in the context of long-term opioid therapy for pain.

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Life-Sustaining Treatment Orders and Advance Directives - How are they different? (8:37)

VA will implement new processes to ensure that goals of care conversations occur proactively with high risk patients, and that those patients’ life-sustaining treatment decisions are understood, documented, and honored. Lucy Potter, a social worker and Ethics Policy Specialist with the National Center for Ethics in Health Care, explains which patients are considered high risk, why it is important to initiate a goals of care conversation with those patients, and how the conversation is documented.

Sound Ethics in Depth

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Speak Up! Listen Up! (51:07)

VA employees are encouraged to speak up, and management to listen up, whenever Veterans, their families, or employees have compliance or ethics concerns. In this podcast, Dr. Ginny Creasman of VA Ann Arbor (MI) Health Care System and Michelle Sorie of Aleda E. Lutz VA Medical Center (Saginaw, MI) discuss what happened, and how it helped Veterans, when they put Speak Up! Listen Up! into action.

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Giving Voice to Values (56:30)

On May 1, 2017, Dr. Mary Gentile of the University of Virginia Darden School of Business spoke on an IntegratedEthics Improvement Forum call on the topic of "Giving Voice to Values." This innovative approach to values-driven leadership development encourages employees, Veterans, and families to speak up when they have ethical concerns and act on their values. Dr. Gentile was introduced by Dr. Lisa Lehmann, Executive Director of NCEHC. Joining the call was Matt Tuchow, Executive Director of VA Office of Compliance and Business Integrity.

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Ethical Leadership and Culture: An Interview with Jeffrey Gering, Director, VA San Diego Healthcare System (42:03)

On December 8, 2014, NCEHC Acting Deputy Director Dr. Melissa Bottrell interviewed Jeffrey Gering, Director and Chief Executive Officer of the VA San Diego Healthcare System, during an IntegratedEthics® Improvement Forum national call. The topic was “Ethical Leadership and Culture.” Mr. Gering and Dr. Bottrell discussed strategies that VA leaders can use to build a culture of integrity in order to deliver the best possible care to Veterans in MyVA. 

 

 

Managing Conflicts between Clinicians and Surrogates

This presentation addresses preventing, mitigating, and managing conflicts between clinicians and surrogate decision-makers. Topics include conflicts with surrogates related to life-sustaining treatment decisions; conflicts related to surrogate requests or demands; and conflicts related to surrogate behaviors.

Part 1: Conflicts Related to Life-Sustaining Treatment Decisions 9:51

Part 2: Conflicts Related to Surrogate Requests or Demands 6:49

Part 3: Conflicts Related to Surrogate Behaviors 7:02

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