This week I had the wonderful opportunity to interview Professor Ashley Hurst for Grounds. Professor Hurst, a former partner at an Atlanta law firm, teaches undergraduate and graduate courses on clinical and legal ethics in healthcare. She also is currently part of the UVA Hospital Ethics Consult Service. Her research focuses on moral distress and preventative ethics.
Just wanted to thank you again for taking the time to do this interview. Do you mind giving some background about yourself and sharing your professional journey?
My professional background is as an attorney. I practiced for 13 years, mostly in employment discrimination law. After deciding to pursue a new path, I went back to graduate school and that’s where I got my first introduction to bioethics.
In grad school, I had the opportunity to be a teaching assistant for an undergraduate bioethics class and decided that it was a wonderful blend of ethical theory and practical decision making with real-life consequences. I then began pursuing how to continue teaching and learning about bioethics. This is what ultimately led me to UVA, where I am currently on the hospital’s ethics consultation service as well as an ethics professor in the School of Nursing.
Wow! That seems like a really interesting and unique path.
That’s right, there is no standard path for a clinical ethicist, which I think is a good thing.
Something I’ve noticed is that a lot of people don’t really have a good idea about what exactly the ethics consult service is meant for/does. Do you mind explaining the fundamentals?
Of course. The ethics consult service at UVA is a 24/7/365 consult service with two people on call at all times. We switch coverage daily and consist of a group of both clinicians and non-clinicians. We currently include physicians, nurses, social workers and faculty members. We have also had chaplains in the past.
We respond to ethics pages, which can come from anybody at the hospital (e.g., patients, family members, doctors, nurses, respiratory therapists, social workers, etc.). Anyone can call the ethics pager at any time. We field anything from basic questions about who a surrogate decision maker would be for a patient unable to make their own healthcare decisions, to more complicated end-of-life decision making situations.
On a daily basis, what do you typically get contacted about the most as a part of the ethics consult service?
We get all kinds of different cases in any given week, but we joke on the service that we have a tendency for certain types of calls to consistently come up within a given week. For example, we might have a run of complex surrogate decision maker cases (e.g., we cannot find the legal surrogate decision maker) in a row. In another week, we might field multiple questions about the new “Do Not Attempt Resuscitation” (DNAR) policy.
One of the clusters we are currently seeing involves being able to balance the psychiatric needs of a patient on the medical floor. This is a recurring issue because the medical floors aren’t necessarily geared towards treatment of complex mental health issues. As a result, there is added complexity when you have a physical health issue with an individual who concurrently has a mental health issue.
What are some pressing issues that you personally believe need to be addressed in the field of bioethics in the healthcare setting?
At their core, I believe that many ethical issues consist of/are due to a lack of communication between team members, patients, and family members. On one hand, it might seem like a simple solution to have individuals talk to each other more. A more subtle analysis would show that we have a healthcare system that doesn’t allow adequate time for patients, families, and team members to think about critical and potentially life altering medical decisions. That, in and of itself, leads to ethical dilemmas.
The pace and intricacy of modern healthcare allows us to do many wonderful things for patients and their families, but it also raises a new level of complexity that we have not dealt with in human history. This does in fact require us to spend more time thinking about things, but when we don’t have that necessary time/space/training, people feel that they are making bad decisions or decisions that could have come out differently. That then leads to ethical dilemmas, and/or as we often talk about on the consult service, moral distress.
I think that one of the big challenges moving forward is creating necessary space for ethical dialogue amongst team members, patients, and families, so that we can properly work through these complicated situations.
I really agree with you about the whole communication issue. I don’t think that it is only an issue between patients and healthcare providers, but also between different healthcare providers on the same case. I feel like the current trend towards efficiency actually hurts the connection formed between different individuals/parties.
That’s right. It is a paradox that we are in a system of fast-paced efficiency in order to care for as many people as possible, yet to actually care for a patient as a person we need to slow down. All of these competing and important needs and demands often come into conflict and we don’t spend enough time trying to resolve these tensions, which just ends up perpetuating the problem.
What advice do you have for those aspiring to enter the healthcare field, especially in regards to being prepared to deal with various ethical dilemmas?
I highly suggest taking classes that involve ethical theory and application. The more you have a chance to think about things in a classroom setting, the more equipped you will be when you need to think through problems in a real-life setting.
I also think taking classes and being in dialogue with people from very different educational backgrounds, programs, and diversity of thought and view, is one of the best ways to better understand how different people think about the same issues. We need to realize that it is not crucial to have everyone agree on the right thing to do, but to recognize that there might be multiple right things to do.
This interview has been lightly edited for length and clarity.