The Role Of A Health Care Ethicist [Interview][Transcript]

Dawn_Ann_Farnin_Healthcare_Ethicist

Guest: Dawn Ann Farnin
Presenter: Neal Howard
Guest Bio: Dawn Ann Farnin is a Health Care Ethicist located in Orange County, CA. She earned a
Master of Science degree in Health Care Ethics from Creighton University School of Medicine with a discipline in end of life care. She currently works in her community in an effort to introduce and implement Ethical standards of care related to transitional treatment of terminally ill patients.

Segment overview: Dawn Ann Farnin discusses her role as a Healthcare Ethicist and how ethics and morality are often interchangeable terms.

Neal Howard: Hello and welcome to Health Professional Radio. I’m your host Neal Howard, so glad that you could join us today. When we talk of ethics, our minds usually go straight to ethics in law or ethics in business or maybe most recently in law enforcement. But when it comes to ethics in healthcare maybe many of us assume that as a healthcare professional or healthcare worker you are ethical, you got into the field so that you could help people and fix people’s problems. Our guest in studio today is Dawn Ann Farnin. She is a healthcare ethicist located in Orange County California and she earned her masters of science degree in Health Care Ethics from Creighton University School of Medicine with a discipline in end of life care. She currently works in her community in an effort to introduce and implement ethical standards of care related to transitional treatment of terminally ill patients. How are you doing today Dawn Ann?

Dawn Ann Farnin: Good. How are you Neal?

N: I’m doing quite well. Thank you so much for lending some of your time.

D: Well thank you for inviting me.

N: Personally, I have never heard of a health care ethicist. What exactly is the role of a health care ethicist?

D: Well, many people who ask me what I do when I tell them what I do, I get a blank stare. So you’re not the only one that has no idea or has never heard of what a health care ethicist does. A health care ethicist is also known as a Bioethicist, so the terms are interchangeable.

N: Okay.

D: I think health care ethicist is more acceptable nowadays, versus years ago when it was first introduced. And basically it’s a, you made a great point about ethics because as soon as people hear the world, they think of either “right or wrong.” And it’s really not that “black and white.” It’s actually everything in between those areas, it’s in the gray zone. So it relates to ethical conduct or in anything in medicine or medical ethics when people ask me what I specifically do, I don’t start out by talking about the four principles of bioethics because that is something that’s a little bit more clinical even and even a clinician who hasn’t taken a course or understands bioethics knows what that means but I’ll get back to that a little bit later. So what I tell people I do is that I’m a moral negotiator and facilitator about ethical and moral challenges related to end of life care.

N: You’re not a blanket ethical consultant. You are specifically focused on end of life ethics.

D: Correct. Because with ethics the moral and ethical challenges that are related to medicine and healthcare also include wellness, health and mental wellbeing and the overall health of a person so I try not to narrow down too much to the scope of just medical ethics because the world of health care ethics needs to be larger and people need to understand that there’s more involved than just a health care ethicist coming into a hospital, sitting down and getting a consultation at an ethics committee board which some people do. And there’s other ethicists that are clinical consultants that are hired hourly by hospitals or healthcare facilities to come in on a particular case, give a review, which I’ve done before, and then you give a report, where you give an opinion based on both sides of the moral dilemma or the moral issue or the moral challenge. And then there’s also a whole field of research ethics that can be related to pharmaceutical companies or research ethics related to any type of medical research. So there’s a lot of different disciplines, but mine just happens to be end of life care.

N: Having gone to Creighton University School of Medicine, did you go there with the intent to become a Health Care Ethicist or were you planning on pursuing a traditional medical degree?

D: No. I actually made the decision after both my parents died unexpectedly in a short amount of time between each other. And my company shut down because of several FDA issues. My life of sort did a 180 flip and I wasn’t sure if I wanted to go back to doing what I was previously doing which was medical device sales and working in hospital side by side with healthcare professionals, mainly physicians and nurses. After the death of my parents, so I’m Christmassy if I sat down and I just started researching through the internet and different books and because I had so many questions related to recent deaths that have surrounded me. I didn’t even really know it was ethics that surrounded everything that I had questions about. So when I found through my research that Creighton University School of Medicine was starting a pilot program where they were taking 10 candidates across the nation for a Master of Science, but it was an accelerated program so you have to complete it with 18 months. So you had to give about 80 hours a week to complete it within two years. I thought to myself when I read the course outline and what the courses that were being offered, I thought I could probably provide me with a lot of answers to the questions I had related to the people that have died around me, that I couldn’t get from healthcare professionals or at the healthcare institutions because of the types of deaths between both my parents that they were very different. And so I bought the Principles of Biomedical Ethics which is the primary book and I didn’t even know it at the time of bioethics and I read it one day and I just knew that it was my calling.

N: When we’re talking about terminally ill patients such as your parents, such as many of us deal with from time to time. The end of life – there are so many preparations, there are so many documents, there are so many you know drugs and equipment, things of that nature that are provided or sometimes not provided for different reasons. Obviously you have focused in on end of life care on a personal level. It sounds to me like you’re a little close to maybe being a legal negotiator or a legal consultant. I heard you mentioned earlier moral negotiation and facilitation. Could you explain a little bit about what you mean when it comes to moral negotiation and facilitation? Is there a difference between morality and ethics in this case or are they interchangeable?

D: They can be interchangeable. And it really depends on the situation because within the world of ethics, there are moral issues and moral issues relate to value systems and it also relates to when we talk about the four principles of bioethics, which I’ll talk about now. The first one is “Respect for Autonomy” so that’s really respecting a patient right to make self-directed decisions. And then the second is “Beneficence” which is really the healthcare professionals acting in the best behavior for the patients. So they have weigh the risks versus what’s best for the patient which is basically similar to the hypocritical of “do no harm.” And then there is “Non-maleficence” which is doing no harm. And then there is “Social Justice” which is fair treatment for all regardless of who that person is. And it’s a little bit different than what I applied justice was before. I finished my masters, I learned a lot more about morality related to justice. So morality touches every aspect of the four Principles of Bioethics so it falls into the world of ethics, so they are interchangeable.

N: Let’s talk a little bit about morality. We’re talking end of life and it seems to me that the simple fact that your field exist at all, kind of tells me that if you’re a medical provider and you’ve been working with a patient for 10-15 years or whatever, and they’re in at the end of their life you maybe kind of finish with them and you want to get on the next person who is viable and full of life, and you tend to maybe slack off on the care of the person who is terminal. Am I correct in that assumption or is there something that healthcare professionals have inherently or maybe under pressure to kind of keep suppressed as far as the morality and the helping and the peer counseling that goes along with someone who’s at the end of their life?

D: One thing, it’s a lot of what you said. I think a lot of people are afraid of once they become terminal, whether it’s through cancer or it’s through some type of trauma or some type of debilitating disease that last quite a long time but there’s no cure for it. When they’re dealing with their healthcare professionals, the moral issues start to become complex because it starts to be okay now the treatment team changes because let’s say somebody is curable, they have a certain group of doctors and physicians that treat them for that particular disease or condition that they have. If it becomes more serious then they go to a specialist.

N: Okay.

D: And so then they have different group of people that are treating them. And then if it becomes terminal, then they have to make the decision “Okay, do they end up in the hospital, in the ICU? Are they given palliative care?” which is the ability to still give them curative care but keep them comfortable and not give them a 100% measures that they would have if they weren’t terminal or do they go to “hospice” which is “compassionate care” for the terminally ill? And people are very confused about this right now because transition care which should be a very smooth transition from what you’re talking about from the start of being sick to be coming terminally ill and dying and to be able to talk about the process of dying, is a very difficult subject for people in the United States compared to other countries. And my role or one of my goals is to have healthcare professionals have those conversations with those patients and it’s difficult for them to do because they’re trained to treat and cure and heal. And so when it comes to death and dying, they don’t have that type of language and I’m not saying they don’t have the compassion for the patient but they don’t have the language or the ability to sit down and talk to people about dying. Now what’s interesting that I found out from the very beginning even when I did – I did my thesis with trauma survivors. I went to strangers’ homes who had survived extreme traumas. People who were in boating accidents by propellers, in just horrific traumas but survived them talk to me about everything moral issues such as that. And every single person I spoke with through my thesis talked about that they made their own moral decision whether they wanted to live or die when it came a point where life became unbearable and they either decided to stay or leave this earth. And each one of them told me that without me even asking them and so I found that very interesting. So it prompted me to wonder if most people actually made a moral decision when they left this earth. And the more people that I speak with that are dying say that. So I do believe that and but they’re not having those conversations with their healthcare providers, to the people around them and they’re not having them with their caregivers or their family because they feel as though that’s too much of a burden for people around them to hear. Because the people around them want that to keep them around as long as they can, but often the patient wants to leave this earth but they just can’t tell people. And that’s a lot for somebody to carry and I talked to several people that are dying, and that have died because I actually was a weekly hospice volunteer for two years. And they were completely comfortable talking about death and dying and we talked about it all the time but they felt that they were a burden to everybody else and that’s what I want, I guess, healthcare clinicians to understand is that people that are dying from my experience – every person that I’ve spoken with – I’ve never had a single person not be willing to talk about it. Or the moral issues involved with it meaning okay what do you think is right and wrong for you as far as the type of treatment? Where do you want to end up? Where you want to go? and that’s where advance directives come into play.

N: We’ve been talking mostly about what you do. Let’s talk a little bit about how you do it through DAF Health Care Proxy Facilitations, that’s you’re company. How can healthcare professionals benefit from what your company has to offer as far as starting this conversations, these very important conversation with their patients who may have become terminally ill?

D: Well it’s very difficult and I know that I guess is this radio broadcast is for clinicians and healthcare professionals. And so my goal today is not to disparage anybody who works in the healthcare field. My goal is to get people to be closer to their patients by being able to communicate with them on a level that isn’t that complicated. It’s just the ability to be able to be truthful, to be honest and direct, but to be compassionate and have a conversation where you’re not dancing around the truth of death. People understand when they’re dying, they understand that they’re headed towards dead and that they have a terminal illness. But they want somebody to speak with and they want to speak with their healthcare professionals. And they want to be able to have that type of relationship and it can take two minutes to have a conversation with somebody because nowadays you’re lucky if you get two minutes with your doctor. But just to be able to say, “We both understand what’s happening here. Do you have any questions? Let’s talk about it.” Or they just want to be, people just want to be heard.

N: Absolutely, thank you so much. You’ve been listening to Health Professional Radio, I’m your host Neal Howard. We’ve been talking in studio today with Dawn Ann Farnin – Health Care Ethicist out of Orange County California, who’s earned a Master Science Degree in Health Care Ethics at Creighton University. And she’s been working in her community in an effort to introduce and implement ethical standards of care related to those that are terminally ill. We’ve been here talking about some of the barriers and some of the misconceptions surrounding “end of life” as those issues relate to the healthcare provider and the patient. It’s been great talking with you today Dawn Ann.

D: You too, Neal.

N: Transcripts and audio of this program are available at hpr.fm and also at healthprofessionalradio.om.au and you can subscribe to our podcast on iTunes.