Fig Tree - Medical Ethics Director, Providence

Medical ethics director broadens dialogue opportunities

Andi Chatburn stands before tapestry from Zambia.

Aware that there's more mystery in life and death than medicine may acknowledge, Andi Chatburn, medical director of ethics for Providence Health Care, is organizing monthly discussions on ethics with community leaders and health care providers.

"I seek to bring diverse insights into ethics," she said, "because we need to be constantly curious about the many ways people think about health, disease and family."

For example, Andi learned from reading The Spirit Catches You When You Fall Down that in the Hmong culture, a seizure may be a spiritual gift. The book describes the dilemma of parents of a girl with seizures. They don't want her to turn blue or die, but taking anti-seizure medicine would take away the seizures, which for them was not a good outcome.

"We need to understand what is a good outcome for each person or culture, avoiding preventable death while honoring diverse beliefs," she said.

"Ethics discussions have blossomed and expanded, opening us to robust conversations with people beyond those in health care," she said. "Health care can be a sub-culture in ways of being and thinking. We need to learn more about how the community experiences us and illuminate biases of the culture of medicine.

"If we are more aware of our biases, they lose their power so we can focus on what matters in the lives of people who seek healing," Andi said. "Best practices may not fit everyone. Most come to the ER scared, needing people to listen and find what response fits."

Growing up in Michigan, Andi wanted to be a doctor, so she studied biology, pre-medicine, Christian leadership and philosophy at Graceland University in Ramona, Iowa, a Community of Christ university.

"At Graceland, we explored what it is to bring meaning in the midst of suffering," she said.

After graduating in 2006, she went to medical school at the University of Kansas City, focusing on ethics and palliative care.

As a child, Andi spent summers with her grandparents on their farm. Her grandmother was the quintessential volunteer, campaigning for the governor, bathing patients in the hospital and building Habitat houses, so Andi went with her.

She also helped care for her great grandparents, so talk of death was a normal part of life.

In addition, three weeks volunteering in 2002 in Nicaragua with Participatory Human Development and a summer in 2003 doing HIV education and community development through her church in Livingston, Zambia, helped frame Andi's ministry in ethics.

In Nicaragua, volunteers hiked to villages and asked what help the people wanted, rather than offering to meet a pre-determined need—"toxic charity" from a colonial approach.

In Zambia, the hospital requested volunteers. She did wound care in the ER and gave free anti-retrovirals to breastfeeding mothers with HIV, so they would not pass HIV through cracks in their nipples.

Insights from those experiences opened doors for her to explore the mysteries of human beings and health care outcomes.

Andi and her husband came to Spokane in 2010, when he became Community of Christ bishop for Washington, Oregon and Montana. He now works with Community Frameworks.

Her residency in family medicine in Spokane was followed by a year fellowship with hospice and palliative medicine at the University of Kansas in Kansas City.

When she returned to Spokane, Providence ethicist Jim Shaw retired. In 2014, she began working half time each in palliative care and ethics, building the ethics curriculum.

Andi urges the palliative care team—social workers, chaplains, nurses, doctors and nurse practitioners—to consult as they walk alongside people hospitalized with serious illnesses, communicating so they not only manage symptoms but also respond to patients' personhood and existential questions.

Sacred Heart has 20 employed chaplains who rotate with the team, plus six chaplain residents in the one-to-two-year clinical pastoral education (CPE) program.

"Chaplains and chaplain residents are of many faiths. Because it's a Catholic health care facility, many expect that chaplains are Catholic, but chaplains are members of many faiths," she said. "The chaplains engage in interfaith dialogue to build bridges."

"Chaplains accompany patients through spiritual dimensions of their health care," she said.

Along with classes, Andi travels to Mt. Carmel and St. Joseph hospitals in Stevens County, St. Mary's Hospital in Walla Walla, Kadlec Medical Center in Richland, and to Missoula to support ethics programs and learn about experiences of people with serious illnesses living in rural communities and isolated as family members move.

"What are ethics issues for people in rural communities, for people living in poverty, for people at the end of life? Who can access heart medicine? How do those living alone arrange to have an IV infusion or travel to chemotherapy in urban areas?

For people who do not have immediate family members, the Washington State Medical Association is promoting HB 1175 to set up a surrogate decision-making hierarchy for people without a durable power of attorney and with no spouse, adult children or adult siblings. The bill would recognize the voice of grandparents, nieces, nephews, aunts and uncles without going to court to gain consent for surgery or placement in adult family homes.

"Some have been stuck in hospitals 500 days with no one legally authorized to make decisions for them," she said. "The County Superior Court does not have enough certified professional guardians."

Andi also asks about care for the few patients with rare diseases requiring expensive treatment. For example, for children with a rare genetic spinal muscular atrophy, there is a medication which includes five shots the first year, costing $1 million. The shots mean the child who starts to walk does not regress and die, she said.

"It's a life-saving miracle drug, but how does that cost relate to care for whole communities?" she asked. "What is justice in health care? Insurance coverage is case by case. Do medical centers and families bear the burden for uncovered costs? The question is why should any medicine cost $1 million, not if it should be prescribed."

Andi said the cost of rare medical care is a medical ethics dilemma as new discoveries are made.

As an ordained lay minister in the Community of Christ, she affirms that "the enduring principle is the worth of all people and the pursuit of justice and peace—shalom.

"In a Catholic health care center we ask: Who is the most vulnerable? How do we honor the dignity of all? How do we fall short? How do we create space for reconciliation?" she said.

As Andi sees God expressed in different ways in different faiths and cultures, she sees that the healing ministry mission is to restore people to community, which includes having housing when they are released from a hospital.

For information, call 474-3097 or email andrea.chatburn@providence.org.

Providence plans lectures, dialogue on ethics

The Providence Health Care Theology and Ethics Department is hosting Ethics Grand Rounds Lectures on "Implicit Bias and Clinical Ethics" from noon to 1 p.m., second Tuesdays, live and through Telehealth and Lync/Skype at Sacred Heart Mother Joseph Room, Holy Family Hospital St. Joseph Room, St. Mary Medical Center, Mount Carmel Hospital, St. Joseph Hospital in Chewelah and St. Luke's Rehab Institute.

On Tuesday, March 12, a panel will discuss "Binary Code Status and DNR in the OR: Assumptions We Bring."

The April 9 program is "Population Health and Implicit Bias" with Fr. Michael Rozier, SJ, who teaches health management and policy at Saint Louis University.

"Transplant Ethics" is the theme for the May 14 discussion with Adie Goldberg, social worker in Providence Sacred Heart Medical Center's heart transplant unit.

Shari Clarke, vice president of diversity and inclusion at Eastern Washington University, will discuss "Race and Healthcare" on June 11.

The goal is professional development of caregivers and community leaders, and ethics competency for professionals. Classes qualify for CME credits. Classes combines lecture, small groups and practical care ideas.

Other 2019 educational offerings include "Who Makes Decisions in Tough Cases," March 27, and "Ethical Dilemmas Related to Difficult Discharges" on April and 15, May 8, and June 19.

Classes will stimulate conversations among health care providers, community members and caregivers on what care makes for a good life," said ethics director Andi Chatburn. "How can we be diverse caregivers with diverse patients? How can we be curious and have integrity in responding to those differences?"

Other 2019 sessions will address ethical dilemmas in caring for elderly and pediatric patients, and principles of the Providence model for ethical decision making.

For information, call 474-3097.