A profile of Gundersen’s Bioethics Department

A profile of Gundersen's Bioethics Department

Such is the influence of the Department of Bioethics and Humanities led by Thomas Harter, PhD, and supported by Gundersen Medical Foundation.
The impact of Gundersen's ethics program can be felt at all levels of the organization:

Caring for patients and providers
Ethics consultations are patient-directed and may be initiated by a patient or a member of the patient's care team when there is a values conflict.

Example 1: A physician in the emergency room at an affiliate hospital recently had a patient who was found in distress at home, transported to the hospital by EMS, received CPR and was resuscitated. The patient did not have an advance directive or healthcare power of attorney document, so the default plan was to transfer the patient to La Crosse to receive "higher-level" care. However, the patient's family members and friends shared their certainty that the patient would not want to be transferred to an ICU or have breathing supported by a ventilator. The physician was concerned that transferring the patient would violate the patient's treatment preferences, so an ethics consult was requested.

Example 2: A middle-aged patient with a newly diagnosed eating disorder was being treated in the hospital for severe malnutrition (and resulting medical complications). Although the eating disorder was newly diagnosed, previous hospitalizations indicated the disorder was ongoing. The patient was offered a feeding tube and readily accepted, but there were concerns about the patient's decision-making capacity. There was also worry about the patient's discharge plan. Because there was no support network at home, the medical team and psychiatrist believed the patient needed to discharge to a specialized facility or to a care center where eating could be monitored. Our ethics consult service was asked to offer assessment and guidance on the decision to place a feeding tube, as well as on the discharge plan.

"As a collective, we practice more than just medicine at Gundersen. The inclusion of an ethics program ties back to the roots of who we are, emphasizing how we as people, as neighbors in this beautiful city along the Mississippi River, can support and value each other." -Thomas Harter, PhD, Bioethics

Shaping organizational practices
As a bioethicist, Dr. Harter uses his expertise to help shape institutional policies and practices, including the following:
• Provided guidance for end-of-life care practices
• Assisted with the development of Gundersen's COVID vaccination protocols
• Helped develop a policy for managing situations in which parents or guardians refuse treatment recommendations for minor patients (that may be required by law)

Delivering educational programming
While Dr. Harter presents lectures and workshops (at the local, national and international level), his work also directly impacts medical education students. Examples of this include:
• Presents lectures to surgical, family medicine and internal medicine residents
• Attends the surgical residents' Morbidity and Mortality conferences
• Joins the care and teaching teams of the Intensive Care unit, Palliative Care and Internal Medicine units during rounds
• Publishes a variety of empirical and conceptual research
• Co-edited a textbook on medical professionalism (that will soon be published by Oxford University Press)

The history of Bioethics at Gundersen: In the right place at the right time with the right skillset
In the mid-1980s, Bud Hammes, PhD, served Gundersen as a volunteer member of the Ethics Committee. Soon thereafter, he began providing ethics education to residents in the Medical Education and Surgical Residency programs. Over time, the requests by clinicians for ethics consultations grew, so the hospital contacted the Foundation about providing funding for a full-time position. The presentation to the Foundation board was so convincing, one member of the board, John Mooney, immediately made a donation to fund the position for the first two years.

Dr. Hammes was Gundersen's clinical ethicist for 30 years, and under his leadership, Gundersen's Advanced Care Planning Program was developed. By 2011, Bud was dividing his time between providing ethics consultations, supporting the Medical Education programs and advanced care work. In 2012, Thomas Harter, PhD, joined the team, and the program continued to grow until Bud retired in 2016.

Since Bud's retirement, Dr. Harter has led the Department of Bioethics and Humanities, which is housed within the Foundation.