Decisions under duress

The Fourth Annual Krug Lecture in Biomedical Ethics tackled a subject consistent with OUWB values and critical to the success of all future physicians — maintaining sound ethical decision-making under duress.

The event was held Oct. 14 at OUWB’s O’Dowd Hall with audience members in-person and online.

A total of about 50 people listened to a lecture from Tyler S. Gibb, J.D., Ph.D., co-chair of the Department of Medical Ethics, Humanities, and Law at Western Michigan University Homer Stryker M.D. School of Medicine.

The annual event is commensurate with the significance medical humanities and clinical bioethics has within the OUWB community — an importance that cannot be overstated, said Jason Wasserman, Ph.D., associate professor, Department of Foundational Medical Studies, and coordinator of the lecture.

Wasserman

“Ethics in medical humanities is really at the foundation of OUWB as an institution,” he said. “It’s the niche we put out there for ourselves in terms of curriculum and cultural orientation.”

Ernest F. Krug III, M.Div., M.D., played a fundamental role in establishing the curriculum and values, said Wasserman.

Krug served as Beaumont’s director of the Center for Human Development and established Beaumont's first clinical ethics consultation service. After joining the inaugural faculty at OUWB, he developed the Medical Humanities and Clinical Bioethics (MHCB) longitudinal curriculum. 

Krug attended the lecture with his wife, Sarah, and said the program holds “a very special place in my heart.” He has sponsored the last four OUWB biomedical ethics lectures and said that he views support of such events as “very worthy.”

“It’s always a good thing to think about ethics in a variety of contexts,” he said.

Before Gibb spoke, the audience watched a 10-minute video with a 12 students, staff, and faculty connected to OUWB and Beaumont Health paying tribute to Krug.

OUWB Stephan Sharf Dean Duane Mezwa, M.D., helped frame Krug’s impact on both institutions.

“You…spent years helping patients, families, physicians, nurses, and other members of the health care team navigate morally challenging and often distressing situations,” said Mezwa.

He also talked about Krug’s role in establishing OUWB’s MHCB curriculum and noted it “continues to impact generations of students today (and) remains one of the distinctive features of OUWB.”

Mezwa also acknowledged Krug’s “significant donations to support ethics initiatives” at OUWB.

“For all this and more, the staff and students of OUWB are forever grateful,” he said. 

Krug noted that the topic of this year’s lecture was “very appropriate” given the general stress associated with the COVID-19 pandemic.

“It’s one thing to make ethical decisions when you have plenty of time and no pressure,” he said. “When you have to make ethical decisions because there’s limited time and a lot of stress from the exigencies of life…that’s another battle.”

Reducing moral distress

During his lecture, Gibb touched on several philosophies often at play in the decision-making process: divine command theory; social contract theory; deontology/duty ethics; teleology/virtue ethics; consequentialism/utilitarianism; and more.

He also talked about how variables can affect how those philosophies are applied. Further, Gibb emphasized that practice is the key to getting better at making decisions in times of stress.

“There are dozens of different frameworks, different ways in which we can make decisions, and if we get better at doing that in times of nonstress, we will get better at doing that in times of stress,” he said. 

Gibb noted that it all starts in the classroom.

“The case studies you do, the responses that you have to have to these case studies…the justifications, the challenging of each other, of your views and their views…those are all critically important,” he said.

Gibb also stressed the importance of making the proper ethical decisions by talking about the toll that wrong decisions can take on health care providers. Too much buildup of stress leads to issues like burnout and compassion fatigue, he said.

“If we don’t proactively work on reducing (residual distress), the level of distress that we’re carrying over time is going to build up,” he said.

That’s where the importance of training in the realm of medical humanities and clinical ethics comes into play, said Gibb.

“Clinical ethics (and) medical humanities are…trying to provide tools and safe spaces and mechanisms by which we can reduce that moral distress,” said Gibb.

After his lecture, Gibb said he hoped people understood the significance of thinking about how they make their decisions.

“If we are able to have that thought cross our mind — not just what decisions should be made but how decisions are being made — I think people will make better decisions,” he said.