Maintaining Integrity and Voice As Clinical Ethicists: CHALLENGES and Successes from Some Old Folks in the Field I WANT to share how this panel came together. The three of us began by asking - how we can all work in one organization with a common mission, yet – have such different projects, different approaches, different auxiliary skill sets, and different hospital administrative preferences – and yet, somehow still succeed. We pondered further, what makes us successful – is it what we learned in our bioethics training, or was it a mixture of what learned in our feeder career fields that was leading to success in the work we do? We also asked, what component of who we are as an individual molds the ethics program at our individual hospitals - and how do the personalities and structure of our individual hospital priorities mold what programs we create under the umbrella of “bioethics” . The answer seemed to be – “yes” – to all of the above. Our paths represent three different journeys – highlighting three unique individuals, from three different feeder careers, now practicing integrated bioethics in the same organization So we asked, can we learn something from this amalgam about what it means to be a clinical bioethicist?

What does a Successful Clinical Ethicist Look Like? In 1999 Edmund Pellegrino predicted change would occur where Bioethics moved from a field which brought new issues to light in healthcare to one in which challenges in the profession were ones of identity, and where the terrain would become ones of inter- relationships and connections between the theoretical and the practical What does a Successful Clinical Ethicist Look Like? In 1999 Edmund Pellegrino predicted - Bioethics was changing - from a field which brought new issues to light in healthcare – to one with challenges in professional identity, as well as how to manage inter-relationships and connections between the theoretical and the practical So in this vein, we all asked What does a Successful Clinical Ethicist Look Like?  

Introducing the “Old Folks” Panelist First Career Years in Healthcare Paula Goodman-Crews San Diego Kaiser Permanente Social Work 33 years (MSW in 1981) Craig Nelson South Bay Kaiser Permanente Clinical Laboratory/ Research 40 years (CLS in 1974) Deborah Kasman Baldwin Park Kaiser Permanente Family Physician 29 years (MD in 1985) I have the pleasure of introducing the three “old folks” to you. Each of us work in Southern Cal region of Kaiser Permanente, where some of our work is on a mutual Regional Bioethics Agenda We are also the Bioethics Director at our own individual hospital and outlying medical office building centers, which each are run by a unique set of administrators, with some different top priorities. We don’t like to think we are OLD, but at this point we have earnestly earned our grey hairs (Even for those of us who color our hair!) Between Us we have over 100 years working in health care Our first speaker will be Paula Goodman Crews, who is also the Co-Director of our Regional Bioethics Committee and whose diligent work, and forward vision – brought the Southern Cal Kaiser Permanente Integrated Bioethics program into being , She began as a energetic social worker. Our second speaker is Craig Nelson, who is a Bioethics Director at Kaiser P South Bay, and had his ernest beginnings in Clinical Laboratory research, And I am Deborah Kasman, and I will speak third. I now am the Bioethics Director at Kaiser P Baldwin Park and had began my humble career as a family physician. Paula…

Maintaining Integrity and Voice as Clinical Ethicists: Reflections on Challenges and Successes from Some Old Folks in the Field Craig M. Nelson, PhD, CLS Medical Bioethics Director Kaiser Permanente South Bay

A long time ago in a hospital far, far away….. Professional Journey Clinical Scientist Principal Investigator Lecturer Religion and Science Christian Thought World Religions Clinical Ethicist

Integrated Studies “Use of a Rapid Intraoperative PTH Assay in the Surgical Management of Hyperparathyroidism” (KPSC IRB Approval #4629), Study Coordinator 2006-2007 “A Clinical Evaluation of LS-3M/LS-04R for the Detection of Sentinel Lymph Node Metastasis from Breast Cancer” (KPSC IRB Approval #4708), Study Coordinator 2006-2007  “Improving D-dimer Positive Predictive Ability for Outpatients with Suspected Deep Vein Thrombosis” (KPSC IRB Approval #5076) , Principal Investigator 2008-2009 “Life Care Planning Consults and the Probability of Hospital Readmission” (KPSC IRB Approval #5626), Principal Investigator 2010-2012  “Why Patients Find Life Care Planning Consultation Helpful: A Qualitative Study” (KPSC IRB Approval #5644), Principal Investigator 2010-2012 “POLST (Physician Orders for Life Sustaining Treatment) Appropriateness: Closing an Ethics Quality Gap and Opening Another” (KPSC IRB Approval # 5861), Principal Investigator 2011-2012 “Retrospectively Evaluating a Nephrology Test of Change: Second Opinion Consultation for Chronic Kidney Disease Patients” (KPSC IRB Approval # 5977), Principal Investigator 2011-2013 “Non-Beneficial Treatment and Conflict Resolution: A Qualitative Study” (KPSC IRB # 6311), Principal Investigator 2012-2013 “Characterizing Moral Distress in Clinical Ethics Consultations” (KPSC IRB # 10252), Principal Investigator 2014-2015

The Path Finding your voice Developing your skill set Maintaining Integrity Integrative ethics projects Growth as an evolving mosaic