The 32nd Annual Florida Bioethics Conference: Debates, Decisions, Solutions

Session 1   |   Session 2  |   Session 3

About the FBN

Founded 32 years ago, the Florida Bioethics Network is one of the oldest and largest bioethics networks in the country. It is committed to education and to identifying practical solutions to daily challenges faced by Florida hospitals, hospices, and nursing homes. For more information visit https://fbn.miami.edu/index.html or email fbn@med.miami.edu.

Session 1, Dr. Phyllis L. Hendry: The Importance of Pediatric Emergency Care Readiness and Preparation- Every Child, Every Day, Every County 

Slides

Providing emergency medical services for children is a social obligation – and one too-infrequently recognized. This presentation will give an overview of the work of the federally funded Florida Emergency Medical Services for Children State Partnership Program; describe National and Florida EMSC initiatives and the Pediatric Pandemic Network; address how they relate to health care coalitions, disaster planning, and pediatric readiness; review pediatric considerations and resources; and discuss partnerships and collaboration.

Session 2, Drs. Laurel Clark and Cathy Purvis Lively: Reanimation after Circulatory Death: New Opportunities. Ethical and Legal Challenges for Organ Procurement

Slides

Normothermic Regional Perfusion (NRP), an innovative technique for organ procurement, has the potential to maximize transplantation opportunities but also triggers important ethical and legal considerations. NRP involves in situ perfusion and interruption of cerebral blood flow after withdrawal of life support. The patient is declared dead based on circulatory criteria. Post-mortem extracorporeal support restore warm blood circulation and perfuse organs for transplantation. Occlusion or ligation prevents cerebral reperfusion. Functional recovery is assessed by weaning the donor from ECMO before organ retrieval. While NRP-cDCD maximizes organ availability, questions arise about reversing circulatory cessation, interpretation of death, and adherence to the “dead donor rule” (DDR).

Questions about the compatibility of NRP with the DDR and ethical frameworks are compelling. Navigating the ethical and legal issues requires careful consideration of the complex interplay between medical innovation, ethical principles, and legal standards in organ donation practices. The presenters will discuss challenging questions such as whether (i) authorizations include disclosure of differences from other procurement approaches, (ii) whether the in situ reanimation and the occlusion of blood flow to the brain are acceptable if the intent is to have a good effect on organ preservation and the potential hastening death is merely foreseen as a possibility, and (iii) whether NRP-cCDC treats the potential donor as an instrument to obtain organs and as a means to an end. They will also consider recommendations such as limiting NRP-cDCD to research protocol approved by an Institution Review Board, special informed disclosing brain reperfusion and ligation, and the need for public conversation and education.

Session 3, Drs. Ray Moseley and Kenneth Goodman: Ethics Service Tune-up: Consultations, Policies, Education (Reprise)

Slides

Ethics committees are unlike most hospital committees. Failure to recognize this often leads to an under-appreciation of the effort by ethics committee members and of the institutional support needed by a functioning ethics committee. In fact, a fully functioning ethics committee and its related activities is appropriately termed a “Clinical Ethics Service.” Ethics committee members require training/education; this is especially true for members who participate in clinical ethics consultations. Ethics committees should engage in staff and community education, review relevant policies, and support a 24/7 clinical ethics consult function. This session – a continuation of our presentation at last year’s conference, will address membership issues (who should be on the committee, privacy issues, conflicts of interest, etc.), how to structure a staff educational program and a clinical ethics consult service, and how best to run an ethics meeting. The practical value of an effective ethics service – and how best to articulate that value – to institutions, colleagues, and patients will also be addressed.

The most common ethical issues addressed by ethics services concern the end of life, including withdrawal of life-sustaining treatment, use of Advance Directives, and requests to provide futile treatments. Addressing these issues requires a combination of knowledge and skills, including an understanding of the legal framework in Florida and how to help physicians and family understand patient rights. This session will address some of the common misunderstandings about Advance Directives and clinical futility, focusing on policy issues and common ethics consultation situations. Strategies for consultations will be discussed, including how the “facilitation” and “expert” formats work and when to use them. Helpful tips for appropriate consult documentation in the electronic health record will also be explored.

BIOS

Phyllis L. Hendry, MD, FAAP, FACEP

Phyllis L. Hendry, MD, FAAP, FACEP, is Professor of Emergency Medicine and Pediatrics and Associate Chair for Research in the Department of Emergency Medicine at the University of Florida College of Medicine, Jacksonville Florida. She serves as Medical and Program Director of the Florida Emergency Medical Services for Children (EMSC) State Partnership Program.

Laurel Clark, RN, PhD

Laurel Clark, RN, PhD, has been Bioethicist for Cleveland Clinic Florida since 2016. Prior to that she worked for Baptist Health South Florida’s Department of Bioethics. She attained a doctoral degree in the Science of Nursing from Barry University in 2020. In May of this year, she will complete a doctoral degree in Bioethics from Loyola University Chicago’s Neiswanger Institute of Bioethics in the Stritch School of Medicine. She has experience in clinical ethics consultation, ethics committee work, policy development, ethics education, advance directives, and bioethics program development. She has special interests in healthcare surrogate decision-making, shared medical decision-making, Advance Care Planning, and Transplant Ethics.

Cathy Purvis Lively, JD, DB

Cathy Purvis Lively, JD, DB, is an attorney, mediator and a Visting Scholar at the University of Miami Miller School of Medicine Institute for Bioethics & Health Policy. Her professional and educational background is a combination of healthcare, law, and ethics. In healthcare, she has experience as a critical care nurse in adult and neonatal intensive care and case management, and as a program director. As an attorney, her practice has been in family law and mediation. She received her JD from Nova Southeastern University, her MS in Bioethics from Columbia University, and her Doctor of Bioethics from Loyola University.

Ray Moseley, PhD

Dr. Moseley received his Master's Degree in Philosophy and Medical Ethics at the University of Tennessee and completed his Doctorate in Bioethics at the Kennedy Institute of Ethics at Georgetown University in Washington, D.C.

Dr. Moseley is the Director of the UF Health Clinical Ethics Service and holds the Grace H. Osborn Professorship in Bioethics and is a member of the Bioethics, Law and Medical Professionalism Program, Department of Community Health and Family Medicine, in the University of Florida College of Medicine.

He is the Founder and Senior Board Member of the Florida Bioethics Network (FBN) and played a key role in the development of the FBN as a significant statewide resource.  Dr. Moseley is an expert on hospital ethics services/committees and research ethics, and he is the author of the widely used CITI Training modules for members of clinical ethics committees/services and serves as vice chair of the UF IRB. 

His research focuses on technological approaches to effectively addressing clinical ethics issues. His recent projects include the development of an innovative Ipad App to develop Video Advance Directives, and a major NIH project to create and evaluate an interactive electronic informed consent process. His latest research is using AI and natural language processing to extract information from an electronic medical record to determine whether threshold criteria are met to implement a patient’s Advance Directive His publications include articles on “Withdrawal of Life-Sustaining Medical Treatment”, “Advance Medical Directives”, “Genetic Testing”, and “Ethics Committees”.

Kenneth W. Goodman, PhD

FBN Director Kenneth W. Goodman, PhD, FACMI, FACE, is founder and director of the University of Miami Miller School of Medicine’s Institute for Bioethics and Health Policy and director of the university’s Ethics Programs. The Institute has been designated a World Health Organization Collaborating Center in Ethics and Global Health Policy, one of 14 in the world and the only one in the United States.

Dr. Goodman is a Professor of Medicine at the University of Miami with appointments in the Department of Philosophy, School of Nursing and Health Studies and Department of Public Health Sciences.

He is immediate past chair of the Ethics Committee of AMIA (American Medical Informatics Association), for which organization he co-founded the Ethical, Legal and Social Issues Working Group. He has been elected as a Fellow of the American College of Medical Informatics (FACMI). He is also a Fellow of the American College of Epidemiology (FACE) and The Hastings Center.

He directs ethics services for the UHealth and Jackson Memorial Hospital systems.