Center for Health Care Ethics Publications
2020-2021
Extremely Premature Infants, Scarcity, and the COVID-19 Pandemic (A Different View)
2021 November, Acta Paediatrica
Joseph W. Kaempf, Kevin M. Dirksen, and Nicholas J. Kockler
Scarcity is Nature's creative provenance, the wellspring of human conflict and subsequent adaptation. Deficiencies of food, shelter and basic safety are primary, but secondary privations real or imagined (material comforts, money, power and sex), are often perceived in-sufficient by humankind and drive history's discord.1 The COVID-19 ... Read full article
Is the Life-Cycle Principle Justified as a Tie-Breaker in Triage Decision-Making Within Catholic Health Care? Part II
2020 Fall, Health Care Ethics USA
Nicholas J. Kockler
A few questions may help clarify the analysis. These questions derive from the following components undergirding a distinctively Catholic approach to triage decision-making and the question of a life-cycle principle as a tie-breaker. These questions span the following areas: sources of morality, categorical exclusions, age as sole consideration, distinctive roles of age, aging as a universal human experience, ... Read full article
Is the Life-Cycle Principle Justified as a Tie-Breaker in Triage Decision-Making Within Catholic Health Care? Part I
2020 Summer, Health Care Ethics USA
Nicholas J. Kockler
In the early weeks of the coronavirus pandemic, stories coming from the hard-hit areas of northern Italy generated tremendous moral concern about the role age may be playing in the rationing of scarce critical care resources to meet the needs of patients suffering from COVID-19.1 Indeed, it seemed that professional guidance affirmed the need for and use of age-based cut-offs in the allocation of critical care.2 Public health surveillance data on age-stratified ... Read full article
Periviability in a Pandemic: Good Ethics Still Considered Essential
2020 July, American Journal of Bioethics
Kevin M. Dirksen, Joseph W. Kaempf, and Nicholas J. Kockler
Haward et al. (2020) review how lifespan considerations and health outcomes might be considered in the allocation of scarce resources during the COVID-19 pandemic with particular attention toward extremely premature infants. Our experience developing medical staff guidelines for the care of extremely premature infants at our medical center (JWK) and coordinating region-wide responses to scarce resource allocation ... Read full article
Can’t Hit Pause? On the Constitutive Elements of Responsible Ventilator Management & the Apnea Test
2020 June, American Journal of Bioethics
Kevin M. Dirksen and Lilith Judd
Berkowitz and Garrett (2020) provide the opportunity to consider the state of the apnea test in critical care medicine for mechanically ventilated patients suspected of death via neurological criteria, arguing for a shift toward obtaining explicit informed consent before proceeding. Especially in the setting of challenging clinical disagreements between families of patients and treating teams about the obligations of treating ... Read full article
Bylaws for Clinical Ethics Consultation at the Providence Center for Health Care Ethics
2020 Winter-Spring, Health Care Ethics, USA
Nicholas J. Kockler
At Providence in Oregon, our ethicists accompany caregivers, patients and their families as they wrestle with complex and value-laden issues that often impact life and death decisions. Rooted in the notion of clinical ethics as professional practice, our ethics consultation service is staffed by professionally trained ethicists. While best practices, standards ... Read full article
The Inaugural Catholic Healthcare, Ethics Innovation Forum
2020 Winter-Spring, Health Care Ethics USA
Nicholas J. Kockler, Becket Gremmels, Kevin Murphy, and Mark Repenshek
Great ideas are shared. After discussing the possibility of sharing ideas and best practices at a recent Theology and Ethics Colloquium presented by the Catholic Health Association in St. Louis, we realized we do not have a venue as ethicists in Catholic health care to submit innovative ideas, present them to our colleagues, and enhance them together. Our hope was to ... Read full article
2018 - 2019
Extremely Premature Birth, Informed Written Consent, and the Greek Ideal of Sophrosyne
2018 December, Journal of Perinatology
Joseph W. Kaempf, MD, Kevin M. Dirksen, MDiv, MSc
Most extremely premature infants die in the intensive care unit or suffer significant neurologic impairment. Many therapies result in unhealthy consequences, and the emotional and financial turmoil for families warrant reappraisal of our motives. Shared decision-making and informed consent in preference-sensitive conditions imply the family: (a) understands the medical problem... Read full article
Integrating Ethics Services in a Catholic Health System in Oregon
2018 Spring, National Catholic Bioethics Quarterly
Nicholas J. Kockler and Kevin M. Dirksen
Ethical issues are embedded in every patient encounter. In the majority of patient-care situations in Catholic health care, caregivers practice in ways that reflect the mission, values and ethical commitments of their professions. Therefore, ethical issues rarely become problematic or interfere with or delay appropriate care. Yet questions for ethicists arise when these issues create barriers to the ethically sound delivery of ... Read full article
Health Zones in Oregon: Exploring an Ethical Deliberation Process in County Public Health
2018 January-March, Ethics, Medicine, and Public Health
K.M. Dirksen, S.D. Present, P. Mason, and D. Emerick
Clackamas County, an administrative division in the State of Oregon on the west coast of the United States, has provided training in ethics and a decision-making framework to members of its public health advisory committee in an attempt to develop an ethical deliberation mechanism in public health. The goal of this mechanism is to ensure that ... Read full article
Complex Considerations: 'Right to Try' Laws Raise Ethical Concerns
2018 March-April, Health Progress
Nicholas J. Kockler, PhD, MS
In 2015, the Oregon legislature passed a "Right to Try" law, allowing a qualified patient to use an investigational product – meaning one that has not been approved by the U.S. Food and Drug Administration, when the product is offered by a lawfully authorized health care practitioner for the purposes of treating a terminal illness.1 To date, 38 states have passed Right to Try laws, and in 2017 the U.S. Senate ... Read the full article
Caring for Patients with a History of Illicit Intravenous Drug Use: Ethical Obligations from Bedside to Boardroom
Winter 2017, Health Care Ethics USA
Nicholas J. Kockler
A few years ago, Infection Control in one of our ministries asked for an ethicist’s perspective of whether it was ethically permissible to unilaterally remove a peripherally-inserted central catheter (PICC) from a person who tampered with it and who had a history of illicit intravenous drug use. The tampering concern was precipitated by regulations on ... Read full article