Bioethics group receives donation from Gundersen Medical Foundation

Gundersen Health System and the Gundersen Medical Foundation are donating $5,000 towards a biothetics group formed in response to the COVID-19 pandemic and its ethical challenges.

Bioethics Network of the Upper Midwest (BENUM) supports healthcare entities, medical providers, members of the public and bioethicists in advancing health equity, with current members including health systems in Wisconsin, medical schools in the region and state government.

“The pandemic has been an unprecedented time in human history, as such, our mission – to foster, promote and share best practices in health care ethics through education, research and public engagement – became vital work in support of our health care providers and local communities.”

Dr. Stephen Shapiro of Gundersen Medical Foundation says the pandemic has highlighted the importance of groups like BENUM, calling the concept “easy to support.”

“Addressing shared challenges in the ethical delivery and practice of health care is increasingly necessary as medicine and technology evolve. We discovered how critical bioethics is during Covid-19 and as health care evolves, there is ongoing work to be done,” Shapiro says. “Education, policies and methodologies to enhance health care practices will only become more critical support work, so the Gundersen Medical Foundation is proud to back this innovative endeavor.”

BENUM, says Harter, was formed when members of the medical community who knew each other well connected to address some of the ethical questions surrounding the pandemic, the main one at the time being ventilator allocation.

“That was the big worry — what happens if and when we run out of ventilators and we need to start making decisions about who’s going to get one and who is not?” Harter explains. “There’s no standard in the state of Wisconsin for making those decisions. And so the question on the table was, ‘how do we want to do this and what are other places doing and how are they doing it? It began very much as an exercise in curiosity and an exercise in ethics of wanting us to make sure we were making the best quality decisions we could as advisers and how we advise our physician colleagues around these decisions.”

While currently comprised mainly of those in the medical field, BENUM is open to any individual with interest, as Harter notes fostering relationships with the general public and collaborating with them helps improve health care decisions. At present, the approximately 30 members have a monthly meeting and exchange emails in between.

In addition to ventilator allocation, BENUM has looked into vaccine distribution, mask mandates, where to prioritize staff during shortages, vaccine requirements for healthcare workers, and determining who should be eligible for the limited supply of new oral COVID treatments.

“When it comes to ethical decision making, especially with health care decisions, it’s wanting to make sure that we treat people equally and fairly and accounting for potential social inequities so that we don’t unfairly discriminate against somebody because of their race, because of their current health status, et cetera, that we’re making the most informed decisions,” says Harter. “And it’s a difficult discussion to have.”

Looking at the prioritization of oral therapeutics, which must be given in the early stages of infection, has been tricky from an ethical standpoint, Harter says. The drugs are designed for those at high risk of severe symptoms and hospitalization, both of which are more common for those who have not been vaccinated, and at present there are not enough courses available for all those who may qualify.

“When we look at who’s been vaccinated and the value of vaccination, you would say people who are vaccinated actually shouldn’t get this because the vaccination has already been sort of shield for them and this is really for people who are completely vulnerable to it,” Harter says. “And so some people say, ‘Well, how is that fair that the people who have chosen not to be vaccinated are entitled to this therapy over people who are vaccinated?’

“And that’s been a question that’s come up in larger bioethics circles across the country and certainly in Wisconsin as well. And part of the work that we do with BENUM and bioethics is to say, ‘Well, what’s our goal? What’s the end goal of making decisions like this?’ With the therapeutics, we would say, ‘Your goal is to eradicate this disease as much as possible and minimize the harmful effect.”

When the pandemic no longer requires the intense focus of BENUM, the group will be able to look at both new health practices and reviewing and revising current standards of practice that may no longer be relevant or adequate. Addressing structural racism is one such issue.

“We learned that the structures upon which we deliver health care are not as solid as we thought, that they’re a bit fragile when it comes to social equity and social justice,” Harter says. “And so there’s value, I think, in going back and saying, ‘How are we actually doing with some of these other contentious areas of health care that we’ve sort of taken for granted?

“So even after COVID, questions around things such as resource distribution and fair treatment of individuals are going to be pervasive and continue.”

IN PHOTOS: UW-La Crosse donates gift baskets to healthcare workers