Who is My Neighbor in Catholic Health Care?

Caring for Undocumented Immigrants in our Community

When the Family has Other Ideas: A Case Discussion of Shared Decision-Making

While the Opioid Epidemic Rages:

A Case Discussion in the Clinical Setting

Presenter:

Mark G. Kuczewski, Ph.D.

October 2-3, 2018 Providence St. Vincent Medical Center Providence Portland Medical Center

Donor contributions to Providence St. Vincent Medical Foundation make this lectureship possible.

2018 Curtis R. Holzgang, M.D., MACP Visiting Scholar

This lectureship honors retired director of Critical Care Medicine, Dr. Curtis Holzgang, who was an inspiration in ethics education, especially for internal medicine residents working in critical care.

Sponsored by Providence Center for Health Care Ethics

The Curtis R. Holzgang, M.D., MACP Visiting Scholar Sponsored by

Providence Center for Health Care Ethics

Established in 2002, the Curtis R. Holzgang, M.D., MACP Visiting Scholar lectureship honors an exemplary role model in medical ethics. The Visiting Scholar lectureship is a program of Providence Center for Health Care Ethics named for Dr. Holzgang, emeritus faculty, Internal Medicine Residency at Providence St. Vincent Medical Center. During his tenure as director of critical care medicine, Dr. Holzgang was an inspiration in ethics education, especially for internal medicine residents and nurses working in critical care. He is a master teacher who instructs by example and instills enthusiasm for

bedside rounds and a deep appreciation for the caregiver-patient relationship. The Oregon Chapter of the ACP recognized Dr. Holzgang with the 2010 Laureate Award for his devotion to, and modeling of, the highest ideals of doctoring. Dr. Holzgang was instrumental in establishing Providence Center for Health Care Ethics in 2000. The center is a recognized leader in advancing the role and value of ethics in health care. It contributes to excellence by providing ethics education to all health disciplines, consultation across the continuum of care, and research and scholarship on key ethical issues.

www.providence.org/ethics

This lectureship is made possible by gifts from generous donors to the Providence St. Vincent Medical Foundation Visiting Scholar Fund.

Curtis R. Holzgang, M.D., MACP

Mark G. Kuczewski, Ph.D.

Mark G. Kuczewski, Ph.D., is the Fr. Michael I. English, S.J. Professor of

Medical Ethics. He is also the director of the Neiswanger Institute for

Bioethics and Health Policy and a past president of the American Society for

Bioethics and Humanities (ASBH). Dr. Kuczewski is a dedicated bioethics

educator. He is known for having created two of the major online graduate

programs in bioethics. In the mid-1990s, his experience in providing

resources to support ethics committees in community hospitals led him to explore online

education. His mission has been to form a supportive learning community that enables

experienced professionals to share their insights and support each other to meet their emerging

clinical and administrative challenges. The graduate bioethics programs of the Neiswanger

Institute are the outcome of this guiding ideal.

Dr. Kuczewski’s current interests include attention to the role of culture and spirituality in decision

making. This has led him to a particular interest in the bioethical issues related to the recent wave

of immigration to the United States. He has been an articulate spokesperson for the just and

equitable treatment of immigrant patients. His writings argue for a prohibition on forced medical

repatriation and the severing of any relationship between health insurance and immigration

status. Dr. Kuczewski served as the project manager of the Loyola University Chicago Stritch School

of Medicine effort to include Dreamers in medical education. This resulted in Stritch becoming the

first medical school in the nation to welcome applications from Dreamers of DACA status. He is

also co-chair (with Bruce Boyer, JD) of the university-wide Dreamer Committee at Loyola University

Chicago that seeks to foster inclusion of Dreamers in all aspects of the life of the university

including its research, education, and service missions.

For this work, Dr. Kuczewski has received numerous awards including the Moral Courage Award

(with Linda Brubaker, MD) from Faith in Public Life, the Transformative Education Award from

Loyola University Chicago’s Department of Student Diversity and Multicultural Affairs, Special

Recognition (with Linda Brubaker, MD) from the Illinois Legislative Latino Caucus Foundation, the

Carmen Velasquez Warrior Award (with Linda Brubaker, MD) from Alivio Medical Center, and the

Policy Award (with Linda Brubaker, MD) from the Health & Medicine Policy Research Group, the

Strangers No Longer Award from the Archdiocese of Chicago, and the Cultural Unity Award (with

Diana Andino, Rosa Aramburo, Everardo Arias, Manuel Bernal, Johana Mejias-Beck and Aaima

Sayed) from TEACH (Tutoring English to Advance Change).

Dr. Kuczewski was named co-winner of the Loyola University Chicago 2017 Faculty Member of

the Year.

Medical Grand Rounds Presentation Descriptions and Objectives

Who is My Neighbor in Catholic Health Care? Caring for Undocumented Immigrants in our Community

Learning objectives

Identify ethical challenges raised in caring for undocumented patients.

Analyze the opportunities to bring Catholic values to bear on the challenges confronting health

care providers with this patient population.

Develop strategies to support undocumented patients in seeking health care and addressing

their life challenges.

Brief description of presentation

A variety of challenges have confronted providers over the last 25 years in caring for patients who are

undocumented immigrants. We will consider a variety of issues from difficulty in providing chronic or

long-term care for this population to more recent fears affecting these patients. We’ll consider how the

mission of health care providers, especially those in Catholic health care, can address the needs of our

neighbors who are often the victims of widespread unjust treatment.

The Power Point presentations can be accessed within a week of the lectureship by:

Visiting our website: www.providence.org/ethics

Clicking on the 2018 Curtis R. Holzgang, M.D., MACP Visiting Scholar link

(PowerPoint slides will be listed on that page)

Open Forums Presentation Descriptions and Objectives

When the Family has Other Ideas: A Case Discussion of Shared Decision-Making Providence St. Vincent Medical Center

October 2

Learning objectives

Identify common case scenarios in which families try to micromanage medical care.

Analyze ethically sound approaches to decision-making with “micromanaging families.”

Develop strategies for partnering with families in these kind of difficult cases.

Brief description of presentation

Clinical ethics consultations are increasingly requested because of families who seem to be micromanaging the

patient’s medical care at the bedside. Clinicians complain that families are mixing and matching treatments in

ways that make little sense and change their minds quickly regarding particular interventions thereby making it

very difficult to carry out a coherent plan of care. We will discuss some typical cases with an eye to developing

strategies to cope with such difficult provider-patient relationships.

While the Opioid Epidemic Rages: A Case Discussion in the Clinical Setting Providence Portland Medical Center

October 3 Learning objectives

Identify current trends in the opioid epidemic in the United States.

Analyze common clinical challenges involved in treating patients who have substance use disorders

involving opioids.

Apply principles of ethics and good clinical care to these common ethical challenges.

Brief description of presentation

The opioid crisis currently presents numerous challenges for virtually every clinician. We’ll discuss common case

scenarios and develop strategies to address ethical quandaries that this epidemic routinely presents.

The Power Point presentations can be accessed within a week of the lectureship by:

Visiting our website: www.providence.org/ethics

Clicking on the 2018 Curtis R. Holzgang, M.D., MACP Visiting Scholar link

(PowerPoint slides will be listed on that page)

2018 Curtis R. Holzgang, M.D., MACP Visiting Scholar Continuing Education

Mark G. Kuczewski, Ph.D.

EVALUATION SURVEY for In-Person Attendance

Providence Center for Health Care Ethics offers continuing education credit of 1.2-1.8 nursing contact hours and 1.0 AMA PRA Category 1 CME credit™ for these presentations. If you wish to receive CEC, completion of the online evaluation survey as well as signing in at the registration table are required. The deadline for completing this survey is Friday, October 12. Certificates will be delivered the week of

October 22 to the email address you include on this survey.

TO COMPLETE SURVEY: (Opportunity to receive continuing education credit ends after October 12)

*Medical Grand Rounds: “Who is My Neighbor in Catholic Health Care” https://appsor.providence.org/selectsurvey/TakeSurvey.aspx?SurveyID=961Lln40 Open Forum (Oct 2): “When the Family has Other Ideas” https://appsor.providence.org/selectsurvey/TakeSurvey.aspx?SurveyID=961Llo40 Open Forum (Oct 3): “While the Opioid Epidemic Rages” https://appsor.providence.org/selectsurvey/TakeSurvey.aspx?SurveyID=961Llp40 *CME FOR MEDICAL GRAND ROUNDS To receive CME, sign in with and speak to:

Ruth Parker, Medical Education, at Providence St. Vincent Medical Center

Stephanie Munoz, Medical Education, at Providence Portland Medical Center SOCIAL WORKERS

The Oregon Board of Licensed Social Workers will accept the CME hours approved for physicians by the American Medical Association and the Oregon Medical Association. You will want to sign in with Ruth Parker at PSVMC or Stephanie Munoz at PPMC if you want a certificate for this presentation. Let them know at sign in if you wish to pick up a certificate after the presentation. Questions about this survey or CEC for nursing contact hours may be directed to Patty Goss at patricia.goss@providence.org or 503.216.1906.

Medical Grand Rounds Select Bibliography

Who is My Neighbor in Catholic Health Care? Caring for Undocumented Immigrants in Our Community

With Mark G. Kuczewski, Ph.D. October 2-3, 2018

Henson, Darren. “Deportation: A Moral Morass.” Health Progress. Jul-Aug 2017. 35-40.

Heyer, Kristin. “A Catholic Ethics for Immigration.” Health Progress. Jul-Aug 2017. 31-34.

Hochman, Rod. “Promoting the Health of Immigrants and Refugees.” Health Progress. Jul-Aug 2017. 47-50.

Kuczewski, Mark, Cassidy T. “Health Care for Our Immigrant Neighbors: The Need for Justice and Hospitality.” Health Care Ethics USA. 2013. 21 (3):8-16.

Kuczewski, Mark. “Here's what we are supposed to believe about immigration as Catholics.” America. September 29, 2017.

Kuczewski, Mark. “The Really New Jim Crow: Why Bioethicists Must Ally With Undocumented Immigrants.” American Journal of Bioethics. 2016. 16 (4): 21-23.

Kuczewski, Mark. “Can Medical Repatriation Be Ethical? Establishing Best Practices.” American Journal of Bioethics. 2012. 12 (9): 1-5.

Kuczewski, Mark. “Who is My Neighbor? A Communitarian Analysis of Access to Health Care for Immigrants.” Theoretical Medicine and Bioethics. 2011. 32 (4): 327-36.

Parsi, Kayhan, and Nina Hossa. “Complex Discharges and Undocumented Patients: Growing Ethical Concerns.” Journal of Clinical Ethics. Winter 2012. 23 (4): 299-307.

Prepared by N. Kockler

Center for Health Care Ethics

Open Forum Select Bibliography When the family has other ideas: a case discussion of shared decision making

With Mark G. Kuczewski, Ph.D. October 4, 2018

Berger, Jeffrey T., Evan G. DeRenzo, and Jack Schwartz. "Surrogate decision making: reconciling ethical

theory and clinical practice." Annals of internal medicine 149.1 (2008): 48-53.

Covinsky, Kenneth E., et al. "Communication and decision‐making in seriously ill patients: Findings of the

SUPPORT project." Journal of the American Geriatrics Society 48.S1 (2000): S187-S193.

Jimenez, Xavier F., Jaime O. Hernandez, and Ellen M. Robinson. "When mediation fails: identifying &

working w/ inappropriate surrogate decision makers." Progress in PC 23.3 (2015): 142-147.

Kopelman, Loretta. “The best interests standard for incompetent or incapacitated persons of all ages.”

Journal of Law, Medicine, and Ethics 35.1 (2007). 187-96.

Kuczewski, Mark G., Rosa Lynn B. Pinkus, and Katherine Wasson. An Ethics Casebook for Hospitals:

Practical Approaches to Everyday Ethics Consultations. 2nd edition. (Washington, DC:

Georgetown University Press, 2018). 83-111.

Kuczewski, Mark G. "Reconceiving the family: The process of consent in medical decisionmaking."

Hastings Center Report 26.2 (1996): 30-37.

Levine, Carol, and Connie Zuckerman. "The trouble with families: toward an ethic of accommodation."

Annals of Internal Medicine 130.2 (1999): 148-152.

Oshima Lee, Emily, and Ezekiel J. Emanuel. "Shared decision making to improve care and reduce costs."

New England Journal of Medicine 368.1 (2013): 6-8.

Torke, Alexia M., et al. "The physician-surrogate relationship." Archives of internal medicine 167.11

(2007): 1117-1121.

White, Douglas B., et al. "A Randomized Trial of a Family-Support Intervention in Intensive Care Units."

New England Journal of Medicine (2018).

Open Forum Select Bibliography

While the Opioid Epidemic Rages: A Case Discussion in the Clinical Setting With Mark G. Kuczewski, Ph.D.

October 3, 2018

Cheng, Michael K.S. “New Approaches for Creating the Therapeutic Alliance: Solution-Focused Interviewing, Motivational Interviewing, and the Medication Interest Model.” Psychiatric Clinics of North America. 2007. 30:157-166.

Conrad, Peter, and Joseph W. Schneider, Deviance and Medicalization: From Badness to Sickness. (Philadelphia, PA: Temple University Press, 1992).

DiMaio, J. Michael, et al. “Ethical Obligation of Surgeons to Noncompliant Patients: Can a Surgeon Refuse to Operate on an Intravenous Drug-Abusing Patient With Recurrent Aortic Valve Prosthesis Infection?” Annals of Thoracic Surgery. 2009. 88:1-8.

Halpern, Jodi. “Empathy and Patient-Physician Conflicts.” Journal of General Internal Medicine. 2007. 22:696-700.

Ho, Jennifer, et al. “Safe and Successful Treatment of Intravenous Drug Users with a Peripherally Inserted Central Catheter in an Outpatient Parenteral Antibiotic Treatment Service.” Journal of Antimicrobial Chemotherapy. 2010. 65:2641-2644.

Jacobson, Jay A. “The Effect of Patients’ Noncompliance on Their Surgeons’ Obligations.” Surgical Clinics North America. 2007. 87:937-948.

Kockler, Nicholas J. “Caring for Patients with a History of Illicit Intravenous Drug Use: Ethical Obligations from Bedside to Boardroom.” Health Care Ethics USA. Winter 2017. 7-19.

Kuczewski, Mark G., Rosa Lynn B. Pinkus, and Katherine Wasson. An Ethics Casebook for Hospitals: Practical Approaches to Everyday Ethics Consultations. 2nd edition. (Washington, DC: Georgetown University Press, 2018). 32-36.

Merrill, Joseph O., et al. “Mutual Mistrust in the Medical Care of Drug Users: The Keys to the ‘Narc’ Cabinet.” Journal of General Internal Medicine. 2002. 17:327-333.

Prepared by N. Kockler

Center for Health Care Ethics

2018-2019 Lectureship SeriesSave-the-Date

Curtis R. Holzgang, M.D., MACP Visiting Scholar:Mark Kuczewski, Ph.D

Mark Kuczewski, Ph.D

Professor of Medical Ethics;Chair, Department of MedicalEducation; and Director,Neiswanger Institute forBioethics at Loyola UniversityChicago Stritch School ofMedicine.

Tuesday, Oct. 2: Providence St. VincentW ednesday, Oct. 3: Providence Portland

Who is My Neighbor in Catholic Health Care?Who is My Neighbor in Catholic Health Care?Caring for Undocumented Immigrants inCaring for Undocumented Immigrants inOur CommunityOur CommunityMedical Grand Rounds: Oct. 2 & 38 - 9 am • 9 - 9:30 Q&A

When the Family has Other Ideas: A CaseWhen the Family has Other Ideas: A CaseDiscussion of Shared Decision-MakingDiscussion of Shared Decision-MakingOpen Forum: Oct. 212 - 1 pm

While the Opioid Epidemic Rages: A CaseWhile the Opioid Epidemic Rages: A CaseDiscussion in the Clinical SettingDiscussion in the Clinical SettingOpen Forum: Oct. 312 - 1 pm

Allen M. Boyden, M.D. Memorial Lectureship:Alexa Miller, MA

Alexa Miller, MA

Tuesday, Feb. 12: Providence St. VincentW ednesday, Feb. 13: Providence Portland

Medical Grand Rounds8 - 9 am • 9 - 9:30 Q&A

Open Forum12 - 1:30 pm

Founder and Consultant in Arts and ClinicalLearning, Arts Practica. Arts Practica is a medicaleducation consultancy dedicated to the humanpractices that improve healthcare quality.

Alexa will explore the topic of Safe Dilemmas:Visual Art and the Cultivation of the Medical Mind.

Goldman-Berland Lectureship in PalliativeMedicine:

Daniel Fu-Chang Tsai, M.D., Ph.D

Daniel Fu-Chang Tsai,M.D, Ph.D

Tuesday, April 30: Providence St. VincentW ednesday, May 1: Providence Portland

Medical Grand Rounds8 - 9 am • 9 - 9:30 Q&A

Open Forum12 - 1:30 pm

Professor at the Department & Graduate Institute ofMedical Education and Bioethics, National TaiwanUniversity College of Medicine, AttendingPhysician at the Department of Medical Research,National Taiwan University Hospital, and Directorfor the Center for Biomedical Ethics, NationalTaiwan University.

Dr. Tsai will share his work on the relationshipbetween Confucian, Buddhist, and Taoist thinkingon end-of-life decision-making and painmanagement.

These ev ents are free thanks to our generous donors throughthe Prov idence St. Vincent Medical Foundation Visiting Scholar Fund.

Post ev ent online v iewing and accreditation av ailable

Questions may be directed to Patty Goss: patricia.goss@providence.org l 503.216.1906

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Notes