Two faculty members in the Department of Philosophy are making important contributions to the field of medical ethics.
Dr. Kimberly Garchar is currently consulting as a clinical ethics consultant for Akron Children’s Hospital. This is a departure from her work with other general hospitals that focus primarily on adult patients, and the pediatric element of the new position brings with it unique challenges. Dr. Garchar relishes the opportunity to serve her profession and community in this way.
Clinical ethicists specialize in values conflicts within the practice of medicine. These consults may occur between a treatment team and patient or family members, among the treatment team, within the family, or in any other area of patient care. Dr. Garchar works to clarify the conflict, illuminate relevant ethical theories and cases, and communicate the various positions to the involved parties.
In general hospitals, the majority of ethical consults are cases related to end-of-life issues. Specifically, many cases arise when a patient’s family disagrees with the treatment team. The disagreements and conflicts arise for cultural, familial, and religious reasons, not to mention a difference in understanding of technology. The end-of life cases—heartbreakingly—occur in pediatric settings as well, along with the same variables. But there are many other situations that regularly arise. First, the patients in pediatric hospitals do not possess autonomy under the law. Autonomy is roughly self-determination: the ability to direct the course of one’s life with authority. Ethically, children are not autonomous, and legally, children are nonautonomous until the age of 18 in the United States. Second, it goes without saying that any case involving a child is highly emotional for everyone involved, including the treatment team. Third, there are many conditions, disorders, and diseases that are typically lethal in childhood, which redirects attention to quality of life. While quality of life is at the forefront in all clinical consults, in pediatric patients it is important to separate the patient’s quality of life from the parents’ understandable grief and desires. Lastly, family dynamics are amplified, especially when the relationship between parents is contentious.
In addition to consulting in cases of values conflicts, Dr. Garchar and the Ethics Committee also contribute to educational opportunities for hospital staff regarding issues in clinical ethics, especially in the form of Grand Rounds presentations. Lastly, she and other ethics consultants regularly review and create policy regarding ethical questions.
These projects allow Dr. Garchar to share her academic expertise with communities outside of the university and, importantly, her clinical experiences inform her teaching with KSU students and her publications.
Dr. Deborah Barnbaum continues to bring philosophical expertise to the world of clinical research ethics. Since 2009 she's been a reviewer for the Congressionally Directed Medical Research Program, a federally funded program that sponsors research in areas as diverse as tick-borne illnesses, breast cancer, infectious disease, and autism, among many other programs. Her specialization in research ethics has made her a sought-after reviewer of grant applications. She works alongside scientist reviewers, technology transfer experts, statisticians, and patient advocates to make determinations about which grant submissions merit being funded. She's been invited to serve on over 60 review panels.
The grant review panels assess the ethics of clinical research before it commences. In addition to that work, Dr. Barnbaum is immersed in evaluating research that is ongoing. Her work on Data Safety Monitoring Boards (sometimes called Data Safety Monitoring Committees) involves looking at the findings in ongoing clinical trials and making recommendations whether the studies are safe to continue, should be modified, or in some cases suspended altogether. She's served on a dozen such committees over nearly two decades. These committees oversee clinical research studies from their inception until they are completed — most clinical trials take years to complete. She specializes in studies sponsored by the National Eye Institute, and the National Heart Lung and Blood Institute, although she's also done this type of work for the Department of Defense and pharmaceutical companies. She's worked with clinicians and biostatisticians to oversee studies on diabetic retinopathy, macular degeneration, emphysema, pulmonary fibrosis, and heart disease. She's most proud of the studies that demonstrated that new injectable drugs are superior to steroids for treating diabetic retinopathy, and a study that used patients’ own stem cells from their one healthy eye to help repair contralateral eyes that had been damaged from chemical burns and fireworks.
The above two activities take a lot of time, but Dr. Barnbaum finds them invaluable in her work as a bioethicist here at Á½ÐÔÉ«ÎçÒ¹. For one, she is able to share her experiences with her classes, ensuring that every student enrolled in Health Care Ethics or Medicine and Morality is exposed to up-to-the-minute discussion of ethics in the clinical research. Second, she is sharing ethical expertise researched at Á½ÐÔÉ«ÎçÒ¹ with the world.
