Answering Hard Questions: Clinical Ethicist Dr. Elizabeth Lanphier

When a patient’s family, caregivers, or medical providers raise ethical questions about how to best balance a patient’s needs, who helps them navigate those conversations and decisions? At the Cincinnati Children’s Hospital Medical Center, a team comprising of doctors and philosophers that all have special training in ethics is prepared to help guide those conversations, hear concerns of families and health care providers, and prepare nurses and other bedside care providers for caring for diverse patient populations ranging from young kids to legal adults.

Dr. Elizabeth Lanphier is part of this team.

As a clinical ethicist, Lanphier is on call to provide counsel about patient care decisions when ethical concerns arise from patients, family, and physicians. Dr. Lanphier addresses questions from families about why an alternate care choice may not be offered, helps doctors and families weigh risks and benefits of medical options, and may work to rectify miscommunications. Much of the time, there is no single clear answer. Lanphier recognizes that families are their own ”experts on their family“ making decisions alongside medical expertise, and provide different perspectives on the risks and benefits of various choices.

Research

Lanphier also researches and writes about bioethics and social and political philosophy, often as it relates to medical care. In addition to being a clinical assistant professor in the Division of General and Community Pediatrics in the UC College of Medicine, Lanphier is a research assistant professor in the UC philosophy department, and affiliate faculty in the UC women, gender and sexuality studies department. In graduate school at Vanderbilt University, from which she earned her PhD in philosophy, she was interested in the intersection of medicine and philosophy, and sought out experiences related to this intersection with the Vanderbilt University Medical Center and its Center for Biomedical Ethics and Society.

Now, she uses moral philosophy to put bioethics into practice, especially as it relates to healthcare access, justice, and inclusion. Her desire to understand and serve vulnerable populations, especially those who have historically been mistreated or neglected, drives her research.  Currently , Dr. Lanphier is working on the connection between  trauma-informed care and ethics consultation and recently published a paper advocating for a trauma informed approach to ethics consultation with neonatologist Uchenna Anani.

Additionally, her community work during graduate school with people incarcerated on Tennessee’s death row has instilled in her research and advocacy a commitment towards the incarcerated population. Last year Lanphier along with colleauges Takunda Matose and Abu Ali Abdur’raham (who is currently incarcerated on Tennessee’s death row) published a paper in the Public Philosophy Journal. In December she advocated for incarcerated persons to be prioritized higher in Ohio’s COVID-19 vaccine allocation. The resulting opinion piece received positive feedback, including from a senator who acknowledged how much work needs to be done. While some public reactions were critical, she was thrilled that it had such a wide impact, as she always aims to reach as broad an audience as possible. She and a colleague are investigating if and how the incarcerated population can take part in studies such as the COVID-19 vaccine trials without risking the coercion or exploitation this population has historically experienced in the medical research leading to tighter research regulations on incarcerated persons and other vulnerable populations.

Trust in Science

COVID-19 has brought important questions about bioethics, healthcare access, and public confidence in medical research to the forefront.  Lanphier sees medical professionals growing frustrated as the public’s trust in science deteriorates. To her, this means that clear communication and approaching medical research in a way that regains that trust is paramount. Part of this includes increasing representation of persons of color (POC) in biomedical research as researchers and participants to help increase confidence in clinical trial outcomes. As her opinion piece in the Columbus Dispatch shows, she has been considering the problem of who should have access to the COVID-19 vaccine, as it is still a limited resource. For example, healthcare workers should be offered it, because we need them to keep us healthy and they are at risk of virus exposure. Beyond that, it gets more complex. How do you designate other frontline workers? Many groups, including store workers and teachers, are needed, but by the time we include so much of the population, we are well beyond the number of available doses, though this number of available doses continues to increase. With this scarcity and the vaccine currently approved for emergency use, we are also a long way from being able to mandate receiving the vaccine for those who work with the vulnerable. She also posed the question of how to approach undocumented populations, who still play a critical role in their communities but may have limited access to healthcare, and also stressed that vaccine roll out needs to also address hesitancy.

Lanphier’s career path leading to her position on a clinical ethics team combined philosophy with practical experience and post-doctoral training working in healthcare environments.  Her role mixes a theoretical, philosophical approach to broader questions with day-to-day interaction with families and care teams related to ethical concerns that come from a diversity of beliefs and backgrounds. She encourages anyone wanting to follow a similar path to seek out a wide variety of experiences and talk to others who are already established in their field.