Thursday, December 10, 2015

Operation Streamline

by Ruth Gomberg-Munoz

L Gipe
In October of 2015, I traveled with a group of Loyola health science students and faculty to southern Arizona for a 4-day immersion trip on the U.S.-Mexico border. On Monday, we took a short bus ride to the Federal Courthouse in downtown Tucson to witness a procedure called Operation Streamline. Operation Streamline prosecutes migrants caught at the U.S. border with Mexico on criminal charges of illegal entry—a charge that was considered a civil violation until 2005, but is now prosecuted as a federal crime that mandates at least 30 days in prison prior to deportation.

LGipe
I was astounded by the degree of repetition. Sixty-seven men and two women, sitting in seven rows composed of some ten seats each, all facing the judge seated at the far wall of the court. Sixty-nine times that the judge repeated a variant of this question: “Is it true that you are not a citizen of the United States and that you entered Southern Arizona from Mexico without coming through a port of entry?” Followed by this question: “How do you plead?” Sixty-nine times that a person—a father, a mother, a daughter, a son—responded, “culpable.” Guilty. Sixty-nine criminal convictions carrying federal prison sentences that ranged in length from 30 to 180 days. Sixty-nine times that a man wearing a suit and blue latex gloves cleaned sixty-nine translation headsets with Clorox wipes as he took them from the defendants filing past. Sixty-nine people who shuffled, shackled at the ankles, wrists, and waist, through a door on the far right wall of the courtroom, headed to serve out their sentences in federal prison and await their subsequent deportations.

I was astounded by the break in repetition. The fourteenth time that the judge asked her questions, a tall man dressed in camouflage hesitated briefly before replying. “It doesn’t matter if I waive my rights,” he said clearly into his microphone. “No one will listen to me anyway. I will just return to my country and eat beans.” His words echoed around the courtroom as defendants and spectators alike looked up in surprise. The judge, clearly stunned, repeated the question slowly in parts, as though the man had not understood her correctly. He answered her questions clearly and then added, “But it doesn’t matter what I say. No one will listen to me anyway.” A current of amusement and curiosity now rippled around the courtroom. The fifty or so remaining defendants began speaking with each other for the first time since the procedure began. They turned to one another, briefly touching shoulders and whispering behind barely-concealed grins. The shackles that bound their wrists and ankles tinkled like wind chimes as they shifted in their seats. The spectators murmured to each other, many smiling in surprised encouragement.

L Gipe
A U.S. Marshall approached the rows and sternly ordered the migrants to stop talking. The murmurs quieted, but the modest rebellion had not yet run its course. Over the course of the following two hours, several more people spoke up to request more time with their attorney, to interrupt the steamrollered proceedings, to delay their incarceration. The facilitator who led our group later commented that this was the first time she had seen the proceedings disrupted; the continual interruptions extended the hearing for nearly an hour.

It would be a mistake to interpret the tall man’s reference to eating beans to his culinary taste. It is more likely that he was referencing the poverty in his home country of Mexico, where many poor people subsist on staples such as beans. He was also likely nodding to his positioning in the U.S. racial order, where for more than one hundred years Mexican migrants like him have been variously denigrated as “beaners,” “wetbacks,” and “illegals.” Programs like Operation Streamline reinforce the racial subjugation of Latino immigrants, and as a result, nearly half of all Federal prison inmates in the United States are Latino, most of them imprisoned on immigration violations.

“Tough crowd today,” remarked the U.S. Marshall to the man with the blue gloves as they passed near my row toward the end of the proceeding. Moments later, the tall man in camouflage glanced around the courtroom, and I caught his eye and smiled. He smiled back and nodded quickly: a moment of humanity in a sea of injustice. “What would have happened,” a member of our group wondered later, “if we had stood up and cheered” when the tall man spoke? What, indeed? The day is over now and the opportunity passed, save for the lingering possibility that one day we will all have the tall man’s courage to speak up.

Ruth Gomberg-Munoz, PhD is an Assistant Professor in the Department of Anthropology, Loyola University Chicago and Associate Editor for North American Dialogue.

Images created by Lawrence Gipe.

Resources:
Fact Sheet: Operation Streamline. No More Deaths. March 2012

Santos F. Detainees Sentenced in Seconds in "Streamline" Justice on Patrol. NY Times, Feb 02, 2012.

Wednesday, October 28, 2015

Social Media: Confessions of a Digital Immigrant

By Patrick D. Herron, D.Bioethics

Among my fellow faculty, who view my fondness for tweeting, posting and sharing content with a mix of apprehension and appreciation, I have been described as “savvy” when it comes to social media. I take that, as an extraordinary compliment, since my usage was very limited several years ago. My deliberate choice to professionally engage through social media started with its use in the teaching of medical students, searching for and sharing content of interest for faculty development sessions, networking with other colleagues, patient advocacy, and utilizing it as a tool to further my own knowledge base in multiple content areas (i.e. medical education, bioethics, public health, etc.). While my academic peers viewed this being a natural inclination, it was not. In fact, it took a lot of work!

Still though, some consider me to be a Digital Native (more on that later), but like many of my faculty peers, initially I didn’t know a “tweet” from a “feed” and the symbol “#” was the pound sign on my phone and not a “hashtag.” I’ve been asked often, “Where did you learn all this stuff?” and “How did you find the time to get into this?” As to where I learned it? Where else, but online! The most important thing to know about social media is that it is meant to be experiential and not something that can be learned without engagement. As to time, there’s no denying that using social media does require you to put in some effort. Your ROI (Return On Investment) is dependent on what goals you have for starting out and your own commitment to the learning process that will follow.

Digital Natives, as coined by Marc Penskyi, refer to those persons who grew up with the Internet and whose familiarity with technology and its application makes them native speakers of the digital language. They stand apart from those who have had to learn to adopt and integrate these new technologies into our lives as Digital Immigrants. I’m frequently reminded that my own status is that of immigrant as there are some aspects of social media usage that remain unfamiliar to me and I hear myself saying, “I just don’t get it.” Pensky would view this as a manifestation of my own digital immigrant accent. Like any accent, some people have ones that are more pronounced than others. The good news is that social media is very much like a proverbial melting pot of users! Yes there are many native speakers, but the majority of users are immigrants with the fastest growing age demographic being persons age 65 and olderii. The desire to connect with others transcends one’s age; it just has taken some of us longer to learn the new language.

Social media is all about communication and the relationships that exist among usersiii. In time social media and online technology will surpass traditional or legacy mediums of learning and communication (i.e. print material). I feel it is not only in my own best interests to continue developing my skills but an obligation to my students, colleagues, patients, and community members I work with to effectively partner with them in their evolving learning processes. That is why I’m proud to be a digital immigrant. Recognizing that my own emerging status offers an opportunity to be a resource for other immigrants as well as share insights formed before and during the dawn of the digital era with native speaking social media users.


Patrick D. Herron, D.Bioethics, is a 2014 graduate of the Loyola University Chicago Doctorate in Bioethics program. He is an Assistant Professor in the Department of Family & Social Medicine at the Albert Einstein College of Medicine in Bronx, New York.

i Prensky, M. Digital Natives, Digital Immigrants: Part 1. On the Horizon, 2001. 9(5), 1-6.

ii Duggan, M., Ellison, N.B., Lampe, C., Lenhart, A,. and Madden, M. “Social Media Update 2014,” Pew Research Center, January 2015.

iii Herron, PD. Opportunities and Ethical Challenges for the Practice of Medicine in the Digital Era. Curr Rev Musculoskelet Med. 2015 Jun;8(2):113-7.

Monday, September 21, 2015

Rethinking Formation for Diversity & Inclusion

by Patrick, McCruden, D.Bioethics, MTS
Senior Vice President, Mission Integration
CHI St. Vincent

Serving as a Mission executive in catholic health care I’ve long been fascinated with a tension that exists between our desire to have diversity in our workforce and our commitment to the formation of our leaders and co-workers into a particular charism or vision of catholic health care. Many health systems have formal programs to increase diversity in hiring and respond to the diverse cultures of our patients and co-workers. Hiring a diverse workforce entails diversity not only of gender, color, culture, etc. but a diversity of ideas, values and beliefs that flow from these characteristics. However, many formation programs stress adherence to a set list of values, beliefs etc. often rooted in the tradition of the founding order(s). I think a recognition of the historical roots of this tension and a concerted effort to revamp formation programs will enhance the ability of our diverse community in catholic health care to work together for the care of our patients.

In 1982, my first job in Catholic health care was in a hospice run by the Hawthorne Dominican sisters. I didn’t realize it at the time but I was given a glimpse of Catholic healthcare that was all but extinct.  The hospice’s administrator, director of nursing and almost all the nurses were Dominican sisters. From the early times of the church down through the middle of the twentieth century, religious orders cared for the sick and operated hospitals principally with the labor and leadership of the members of the order. These communities of women shared a common tradition and commitment to a vision of healthcare interpreted through the particular charism of their founders and handed down through the formation of new members of the order.

By the time I had my first full time job in Catholic healthcare five years later the hospital where I worked only had one member of the founding order who served as the VP of Mission Effectiveness. This was the new norm. It was accepted wisdom that employees and especially leaders would be “formed” into the vision of the hospital’s founders. In a sense the formation of leaders and staff replaced the formation of novices and sisters. Through these programs the founding orders sought to ensure that the identity of the institution would be maintained and that decisions would be made consistent with the charism of the order.

Today very few catholic hospitals are sponsored by one religious order. Most are part of large health systems and loyalty to a particular order’s charism is now being replaced by loyalty to the values and mission of the new entity. Often these values are articulated in a manner that are translatable to a workforce that is growing increasingly diverse. This seems to me to be a positive development and a movement away from formation analogous to religious formation towards a more dialogical approach seems necessary.

The Canadian communitarian Charles Taylor has argued that human diversity is part of how we are made in the image of the triune God .  Truly acknowledging this diversity and recognizing it as a part of God’s plan is therefore fully “Catholic” and transforms the Gospel mandate to “go and make disciples of all nations” (Mathew 28:18) from a  “unity-through-identity” understanding to a “unity-across-difference” understanding .  Thus, we do not have to make physicians, co-workers and leaders into replicas of the amazing women who started these hospitals or close approximations to the same through formation programs in order to be faithful to our Catholic identity. We do have to ensure that our actions as Catholic healthcare are always faithful to a Gospel rooted in agape love.

In our developing relationships with our diverse workforce we must engage in dialogue around the languages and practices that can unite us across our ideological differences. Without doubt there will be practices that the Catholic health system will demand of anyone who wishes to become a part of the ministry including the respect for innocent life, compassion and a willingness to serve the poor. Apart from these essentials there will be a need for dialogue. I feel certain that there will be common themes of reverence, gratitude, forgiveness that cross all cultures and traditions. In faith we believe that in serving the sick and the poor we encounter Christ and this encounter cannot help but be transformative and we need to invite our diverse workforce to encounter this transformation with faith in the Holy Spirit.

Friday, September 11, 2015

Just care for patients in different neonatal intensive care units: a tenable goal?

By Dalia Feltman, MD, MA

One look at a healthcare billboard will reveal that hospitals want to appear unique—one touts superior surgical care; another state-of-the-art cancer treatments.  Quality of medical staff and the array of services offered are not what I mean here by “equal opportunities.” What I’ll examine in detail using two neonatology studies is the variation of initiating and withdrawing life-sustaining treatments for critically-ill newborns between medical centers. I’ll argue that from a principlist standpoint, because extremely premature or critically-ill newborns are completely incapable of autonomous decision-making, and beneficence and non-maleficence are extremely difficult to judge, the remaining principle, justice, is an especially important goal for these patients.

Because newborns lack autonomy, we rely on parents and physicians to make medical decisions in their best interests.  This means weighing benefits and burdens of treatments to maximize beneficence and non-maleficence. However, for newborns whose survival or neurodevelopmental outcomes are ambiguous, life-sustaining treatments such as breathing support, chest compressions, and cardiac medications may seem burdensome. The difficulty in finding beneficent, non-maleficent options is of interest in many neonatology bioethics inquiries. However, evidence that some neonatal intensive care units (NICU’s) are more aggressive in providing life-sustaining treatments than others leads to a different arena of questions, concerning whether justice is a tenable goal for these patients.

Treatments after birth
Based on high chances for death and neurologic impairment, being born at 22 to 24 weeks’ gestation is considered “periviable.”  Professional guidelines from groups such as the American Academy of Pediatrics (AAP) advise: 1.) For babies born into circumstances incompatible with survival, comfort care rather than delivery room resuscitation should be provided; 2.) For a baby with high chances of poor outcome, best estimates of survival and morbidity should be conveyed to parents to inform their decision on resuscitation; and 3.) When good outcomes are likely, resuscitation is indicated with continued reassessment of treatment benefits in collaboration with parents.1

Revasy, et al. examine outcomes for extreme preterm infants born at 24 hospitals.2  While not representative of all NICUs, this is a robust sample of nearly 5000 preterm infants born between 22 and 26 weeks with an impressively high percentage of patients followed until 18-22 months. These authors report survival and neurodevelopmental outcomes for the entire sample of 22-week preterm infants as worse than for the subgroup of patients receiving life-sustaining treatments. Similar trends were noted for each gestational week until 25 and 26 weeks, because babies born 25 weeks and older all received active treatment. None of this is surprising, since we know these babies’ immature lungs require support to survive past a few hours or days. Furthermore, the more mature the baby, the more the benefits of treatment outweigh risks, so life-sustaining treatments are provided. What has been impressive, however, to the authors and the neonatology community, is the fact that, controlling for other patient factors, the hospital itself was what most predicted provision of life-sustaining treatments vs. comfort care, and therefore mortality and morbidity (for without survival there can be no morbidity). The earlier the gestational age of the baby, the more profound the inter-hospital variability, until 25 weeks.

Treatments before death

Another article compared circumstances around deaths of NICU patients in four centers—two Midwestern, one Canadian, and one in the Netherlands.3  In all but one center, most “unstable” neonates died with life-sustaining treatments withdrawn. That same outlier center had higher rates of babies dying after chest compressions than the other three. No baby died in the delivery room at that center, while the other three reported similar rates of deaths in the delivery room.

Directions for future study

Equal opportunities will only be possible when we understand why hospitals have such different rates of providing life-sustaining treatments. What options are offered to parents?  Do parents’ cultural differences account for hospital variability? How do obstetricians influence these decisions?

One might argue that if there’s no clear-cut answer on what’s in a certain type of preterm infant’s best interests, why strive for uniformity? To ensure NICU patients receive a just experience, options of comfort care and offering life-sustaining treatments need to be consistently explored with parents in truly shared decision making. A new clinical report from the AAP encourages institutions to create approaches to threatened deliveries at 22 to 24 weeks.4  One possibility for institutional variability is that centers have created strategies to promote just opportunities for their patients. If so, these studies are a call to foster another level of agreement—across hospitals. Otherwise, it may only be where the ambulance brings a prematurely-laboring woman that might determine her baby’s outcome.

Dalia Feltman, MD, MA, is a 2015 graduate of the Loyola MA program in Bioethics and Health Policy.  She is a neonatologist at Evanston Hospital in Evanston, IL and a Clinician Educator at the University of Chicago Pritzker School of Medicine, Chicago, IL


  1. Batton DG.  Antenatal counseling regarding resuscitation at an extremely low gestational age.  Pediatrics 2009;124:422–427.
  2. Rysavy MA, Lei L, Bell EF, Das A, Hintz SR, Stoll BJ, et al.  Between-Hospital Variation in Treatment and Outcomes in Extremely Preterm Infants.  N Engl J Med 2015;372(19):1801-11.
  3. Verhagen AA, Janvier A, Leuthner SR, Andrews B, Lagatta J, Bos AF, Meadow W.  Categorizing Neonatal Deaths: A Cross-Cultural Study in the United States, Canada, and The Netherlands.  J Pediatr 2010 Jan;156(1):33-7.
  4. Cummings J, AAP Committee on Fetus and Newborn.  Antenatal Counseling Regarding Resuscit

Friday, August 28, 2015

Labor Day Reflection: Being Hospitable toward Labor

Originally published 8/27/2013

Labor Day traditionally marks the end of summer in the United States. Most of us observe the holiday without much reflection on labor and its meaning in our lives and our society. Many trends have contributed to this lack of identification with the concept of labor including the conversion from a manufacturing to a knowledge-based or service-oriented economy and the erosion of collective bargaining and unions. However, labor is a fundamental feature of human life and is central to our dignity and flourishing.  For this reason, the United States Conference of Catholic Bishops issues an annual letter to mark Labor Day. I would like to share a some key features of the place of labor in a Catholic philosophical anthropology (a theory of being human) in order to show why the bishops have identified the need for immigration reform as central to their labor day message.

Our labor, i.e., our work, is how we provide sustenance for ourselves and our families.  But work is also a way that we express our creative natures – it is a means of self-expression. Clearly, when we speak of our work as our vocation, it even assumes a spiritual dimension as an expression of our relationship to God. In our creativity, we image the activity of God and in discerning the work proper to us, we respond to God’s call. In our culture, we often recognize these higher dimensions of work in the professions such as medicine and in highly-compensated paths that we term careers.

Unfortunately, our attitudes are often quite different toward work performed at the low end of the wage scale. We somehow have come to dichotomize the labor ladder into the “makers” at the more fortunate end and the “takers” on the lower rungs. Such a view is implicitly suspicious of those on the lower end and can blind us to our duty to foster opportunity for all.

The Bishops in their letter have kept in sight the fundamental principles of the Catholic social justice tradition. This tradition sees the state as established to foster the common good, i.e., the conditions for all community members to participate to their full capabilities. This tradition prioritizes giving a “hand up” over a “hand out.” It recognizes that people do not seek dependency but an opportunity to contribute to their community. When one views our society through the lens of these principles, the immigration question comes clearly into focus. The struggles of immigrant workers to find work, to provide for their families, and to have a say in the shaping of their lives are the defining features of their day-to-day existences. Once we are liberated from prejudices that assume people intrinsically are “takers,” we see our essential similarities and our differences recede.

The Bishops tell us, “Whenever possible we should support businesses and enterprises that protect human life and dignity, pay just wages, and protect workers’ rights. We should support immigration policies that bring immigrant workers out of the shadows to a legal status and offer them a just and fair path to citizenship, so that their human rights are protected and the wages for all workers rise.

We honor the immigrant worker by remembering that the building of America has been carried out by so many who fled persecution, violence, and poverty elsewhere, coming to America to offer their talents and gifts to support themselves and their families. We welcome the stranger, the refugee, the migrant, and the marginalized, because they are children of God and it is our duty to do so. But at the same time it is important to end the political, social, and economic conditions that drive people from their homelands and families. Solidarity calls us to honor workers in our own communities and around the world.”

On this Labor Day, I wish you a full appreciation of the value of your work. And I pray that we might all be bound in the hospitality that flows from mutual respect and solidarity.

Sincerely,
Mark

Mark G. Kuczewski, PhD
The Fr. Michael I. English, SJ, Professor of Medical Ethics
Chair, Department of Medical Education
Director, Neiswanger Institute for Bioethics & Health Policy
Loyola University Chicago Stritch School of Medicine


For the full USCCB Labor Day Statement, go to:
http://www.usccb.org/issues-and-action/human-life-and-dignity/labor-employment/labor-day-statement-2013.cfm



Friday, August 21, 2015

"They are Not Worse Than You and I!": Human Dignity and Incarceration

By Greg Dober, MA 2007

I have been asked numerous times why I advocate for adequate human rights and conditions, especially adequate healthcare, for incarcerated individuals.  I tend to jokingly refer to my graduate education at a Jesuit institution, Loyola University Chicago.  However, there is a kernel of truth to the comment.

Nearly a decade ago, my capstone paper in the MA program for Bioethics and Health Policy critiqued and criticized the Institute of Medicine’s (IOM) recommendations to reopen prisons to general medical research.  Many bioethicists and medical researchers from large research-oriented institutions were quick to seize the opportunity to support and testify on behalf of the IOM’s recommendations.i  I was quite surprised and perplexed that many voices in the bioethics community, especially at these large research–oriented institutions, fell in line with the IOM or fell silent on this issue.  It seemed that bioethics seemed to all but abandon incarcerated individuals to commodification as research subjects.

In 2013, a Jesuit priest, Cardinal Jorge Mario Bergoglio, became Pope Francis of the Roman Catholic Church.  Since becoming pontiff, Pope Francis has spent time visiting prisoners and prisoner’s families and even washing the feet of inmates.  In 2014, the Pontiff said to thousands of people gathered at St. Peter’s Square for an audience, “Listen up. Each one of us is capable of doing the same thing done by that man or woman in jail. All of us are capable of sinning and making the same mistake in life. They are not worse than you and I!”ii  “Eureka!” I thought after this comment, another Jesuit has vindicated me!

Many people seem to get their perception of prison or jails from reality television shows, sensationalist news stories or even politicians. The media often conveys that all those incarcerated are evil, conniving, ruthless or violent. Simultaneously, they are often seen as having a better lot in life than some taxpayers who contribute to their support in prison. While many Americans cannot afford adequate health care, inmates and prisoners are protected under the 8th amendment of the Constitution and thereby receive medical care (subject to the interpretation of local authorities). In October 2014, Pope Francis reminded delegates at the International Association of Penal Law meeting that they should be wary of media and political portrayal and influence of incarcerated individuals and to do their job justly.

 The statistics are staggering in the United States when it comes to locking up individuals. The United States leads the developed world when it comes to incarcerating its citizens at a rate of approximately 700 per 100k of population.iii  This is compared to Germany at 78, or England at 148 per 100k.  Approximately, 1 in 35 adults in the United States was under some form of correctional supervision-- either incarcerated, paroled or on probation, at year-end of 2013.iv  1 in 110 adults are actively incarcerated in state and federal prisons or local jails.v

 In healthcare issues, an estimated 40% of state and federal prisoners and local jail inmates were reported having a current chronic medical condition.vi Twenty-one percent of prisoners were reported to have tuberculosis, hepatitis B or C, or other STDs (excluding HIV or AIDS).vii  Due to failed corrections policies, these individuals are sometimes released to the general population of society without treatments and a risk to public health.  Also, it is estimated that approximately 60% of those incarcerated in local jails and 55% in state prison facilities suffer from a mental illness requiring 12 month of continuous treatment.viii  For those with mental illnesses and addictions, the system offers very little hope.  In federal prisons, whole families lack adequate healthcare and nutrition from the mass warehousing of “undocumented immigrants.”

The reasons our society has found itself in an incarceration epidemic are many and varied.  As a society, we seem to have an appetite to build more jails and prisons at the expense of community mental health centers and homeless shelters.  Tough on crime polices gets votes for politicians from a paranoid public. Prison and jails create jobs, which makes it an easier political “sell.”  With the current influx of privatized prisons and prison services, such as health care, our governments seek the lowest bidder at the expense of human dignity.

The policies and practices of our current incarceration system are flawed in many areas.  Absurd policies exist that include allowing corrections department to not treat prisoners with hepatitis-C unless the inmate waives their parole.  In essence, give up your freedom and receive treatments.  Also, corrections departments with policies that refuse eye care for inmates going blind if the inmate has at least “one good eye.”  In rural prisons, stroke victims often times do not have access to proper rehabilitation and are released with cognitive and physical disabilities. The system's current practices focus more on fiscal initiatives rather than human dignity.  The system's punitive practices affect the mentally ill and the addicted when they are swept into the net via the judicial system.

There is no argument that there are people incarcerated that did bad things and deserve just punishment.  However, a society’s greatness can be measured by the humanity and compassion it shows for its most vulnerable citizens, including victims of crime and those that may perpetrate them.  Pope Francis often speaks of the compassion that we are to have for the incarcerated and reminds of us of our responsibility to insure human dignity for all humans, victims and perpetrators alike.

 Under Pennsylvania state law, I and a few other nongovernment individuals are designated as  “Official Visitor.”  The designation grants us the same access to prison and jails; as state officials, to review, resolve or mitigate inmate’s complaints.   During my visits, I see first hand the problems in the jails and prisons.  Often it is a lack of basic or adequate health care, mental health care and inadequate addiction treatment and support programs.  When mitigating or trying to resolve an issue between the inmate and state or county governments, I reflect on Pope Francis’s comments mentioned earlier.  The person on the other end of the conversation could have been me with one wrong choice, one addiction I could not beat or even the wrong birthright as a citizen.

Greg Dober is a 2007 graduate of the MA in Bioethics and Health Policy.  He is contributing writer for Prison Legal News and coauthor of Against Their Will; The Secret History of Medical Experimentation on Children in Cold War America. (Palgrave 2013)

i Institute of Medicine, (2007) Ethical Considerations for Research Involving Prisoners, National Academies Press, Washington D.C.
ii Cindy Wooden, (2015) There but for the grace of God: What Pope Francis thinks of prisoners. The Catholic Sun, May 28, 2015.
iii BJS, (2013) Correctional populations in the United States, December 2013, NCJ 243936.
iv Ibid.
v Ibid.
vi BJS (2006) Special report, mental health problems of inmates in prisons and jails. September 2006, NJC213600
vii BJS (2015) Medical problems of state and federal jail inmates, 2011-2012.  February 2015
viii BJS (2006) Special report, mental health problems of inmates in prisons and jails. September 2006, NJC213600

Friday, June 19, 2015

An Integrated Bioethics: A Reflection on Laudato Si

Michael P. McCarthy, PhD
Pope Francis's social encyclical, “Laudato Si”, issues an urgent call for responsible action rooted in solidarity, with both human and non-human others, to recognize the interconnectedness of a shared reality suffering from neglect. As a theologian, several items of significance stood out:

1) the use of gender inclusive language, the first for a social encyclical;
2) the footnotes incorporate non-Catholic, theological, and scientific resources in addition to references to other papal documents; 
3) the attempt to engage and join with non-believers in concern over the state of the environment.

These items are being well-covered elsewhere, and you would do well to read further. However, as a theologian and bioethicist, Pope Francis also strikes an important chord with his critique of a what he describes as a “dominant technological paradigm,” a paradigm prevalent in both the medical practice and medical research. 

Chapters Three and Four—of this well-researched and crafted encyclical—prove most pertinent to questions of bioethics because of its call to resist control over care as the dominant framework for discerning a course of action (106). While scientific research often claims an air of neutrality, Pope Francis describes reality as interconnected, and “that technological products are not neutral, for they create a framework which ends up conditioning lifestyles and shaping social possibilities along the lines dictated by the interests of certain powerful groups” (107). He expresses some skepticism towards established research priorities, such as Genetic Modification, that utilize resources (financial, environmental, intellectual) that take away from other potential gains with no promise of benefit for the common good (133). While he notes that the techniques employed may pose little risk, “improper or excessive application” contributes to the unjust burdens born by the “poorest of our brothers and sisters” (158). Focusing on technology and increased control, both of which present opportunities for financial gain, draws our attention away from the present sufferings of the majority of human beings and its correlation to the inattention given to environmental degradation.  

Francis wants us to connect the global inattention to the premature and unnecessary deaths of the majority of the planet’s population, reflective of a global health crisis, with the disposable utilization of environmental resources. In order to rectify these injustices, both human and environmental, we need “to hear both the cry of the earth and the cry of the poor” (49, emphasis original). In so doing, he calls for an “integral ecology” that expresses a concern for the environment understood as “a relationship between nature and the society which lives in it” (139). His integral approach raises questions about priorities and practices for medical research and the development of new technologies to impact clinical care.

A more socially conscious approach will consider the technological resources at the hospital: do they promote control or flourishing, enhancement or sustainability? Hospital executives should more deeply probe the environmental impact for developing, using, and disposing of particularly technologies, while also considering the clinical efficacy and patient populations that stand to benefit from the technologies used. For medical research, Francis explicitly cautions against research with animals that does not offer a reasonable possibility of contributing to “caring for or saving human lives” (130). Caring for and saving human lives remains the fundamental goal of medical research, and serves as a guard against research that prioritizes economic gain and scientific development at the expense of more immediate health benefits.

Medical research and health care delivery on a global scale has historically prioritized the health needs of a few over those of the majority. Francis’s encyclical challenges us in the bioethics community to consider not only an integral ecology, but an integral bioethics that argues for a balance between the natural costs of advancement with its potential for sustainability and broad applicability for and with the society in which we live. So while a bioethics blog might be an unlikely place to read about a papal encyclical, Pope Francis’s insights challenge us to more comprehensively consider the global context of bioethics.

Wednesday, April 22, 2015

The Dreamer Committee* of Loyola University Chicago: Promoting Dignity through Education

Loyola University Chicago has been a leader in working for educational opportunity for Undocumented students, i.e., persons who were brought to the United States as children and were raised and educated in this country, but remain without a path to normalization of their immigration status.  They are often said to be “Americans in every way but on paper.”

The Dreamer Committee is a university-wide standing committee that succeeds a major task force that reviewed Loyola’s progress in meeting the needs of these students. The task force found that Loyola University Chicago had become an emerging national leader in promoting equity for these students.  Achievements included the Stritch School of Medicine becoming the first U.S. medical school to openly welcome DACA-eligible students (www.stritch.luc.edu/daca) and the incredible undergraduate effort that create the Magis Scholarship Fund for Undocumented students from a self-imposed student activity fee.  Such “firsts” have brought the university renown and highlighted the value all levels of the university place on social justice.  However, progress was uneven across the schools of the university and sustained attention needed to be given to these issues.  The collaboration of dedicated faculty, administrators, and students is needed to further opportunity for Undocumented students at Loyola and to seek systemic change in our nation’s immigration system through scholarship and advocacy.

Mission
The mission of the Dreamer Committee is to develop equitable policies and practices to promote educational opportunities and improve the lives of undocumented students at Loyola University Chicago. This will be achieved by through multidisciplinary collaboration, and the promotion of research, education, advocacy and service that is informed by the lives and experiences of undocumented students seeking higher education.

Mark Kuczewski
The mission of the Dreamer Committee is grounded in the Catholic and Jesuit mission to promote social justice and in the bedrock principle that acceptance of undocumented students is part of Loyola University Chicago’s broader culture of acceptance, inclusion, safety and support. As a Catholic university that is sponsored by the Society of Jesus (the Jesuits), we firmly believe in the dignity of each person and in the promotion of social justice. The dignity of persons calls us to steward the talents of qualified applicants rather than reject their contributions for arbitrary and arcane reasons, including immigration status. Social justice requires that we foster the conditions for full participation in the community by all members of our community. Undocumented, DACA, and DACA eligible applicants are typically woven into the fabric of our communities and have a basic right to contribute to the fullest extent of their abilities. This approach echoes a long tradition articulated by the U.S. Conference of Catholic Bishops (USCCB) of advocacy for immigrant members of our communities. [Excerpt from the UCUS report]
What the Dreamer Committee will do: Policy, Scholarship, Education

As indicated in our mission statement, the admission and financial aid policies and practices of each school will be studied.  Progress and successes will be noted and best practices shared across schools. Strategies for fundraising and funding students will be priorities for action.  As noted, there is an urgency to the issue of funding for these students as they lack eligibility for federal student aid, a key element in the financial aid packages of many students.

The main work of a university is scholarly and educational. Thus the Committee will develop a network of support for the many faculty currently creating relevant scholarship.  The Committee will foster collaboration among these scholars and promote their work.  And, creative educational approaches and programming will be shared and new educational efforts will follow from this cross fertilization.  This kind of inquiry and teaching that is in the service of the University’s Jesuit ideals of social justice and human dignity is central to the university’s self-understanding and strategic vision.

Loyola University Chicago believes in education that is transformative of the person.  Those who participate in a Jesuit education are intellectually and personally formed such that they are aware of persons who are unjustly marginalized and this understanding results in action.  The Dreamer Committee seeks to model this Ignatian dynamic within our university community and to promote justice for our immigrant neighbors within and beyond the walls of our campus.

Co-Chairs:
Bruce Boyer, JD
Loyola University Chicago School of Law

Mark Kuczewski, PhD
The Fr. Michael I. English Professor of Medical Ethics
Loyola University Chicago Stritch School of Medicine

*The name of this working group, Dreamer Committee, is to convey the commitment to Undocumented students at Loyola who inspire, strive for more, and achieve excellence.

The members of the Dreamer Committee welcome serving as allies and sources of information regarding university policies and opportunities for undocumented students.  Students and applicants to Loyola University Chicago should feel free to contact any one of them via e-mail.

Committee Co-Chairs:
Bruce Boyer, School of Law, bboyer@luc.edu
Mark Kuczewski, Stritch School of Medicine, mkuczew@luc.edu

Committee Members:
Paula Camaya, SDMA, pcamaya@luc.edu
Michael Canaris, Institute of Pastoral Studies, mcanaris@luc.edu
Aurora Chang, School of Education, achang2@luc.edu
Alex Escobedo, MAGIS Scholarship, aescobedo@luc.edu
Kelsey Gerber, Financial Aid, kgerber1@luc.edu
Yolanda Golden, Academic Advising, ygolden@luc.edu
Ruth Gomberg-Munoz, Department of Anthropology, rgombergmunoz@luc.edu
Philip Hale, Government Affairs, phale@luc.edu
Ezgi Ilhan, Student Government, eilhan@luc.edu
Kathryn Jackson, Career Development Center, kjackson9@luc.edu
Judith Jennrich, Acute Care Programs, jjennri@luc.edu
Katherine Kaufka-Walts, Center for Human Rights for Children, kkaufkawalts@luc.edu
Timothy Love, Student Life, tlove@luc.edu
Ronald Martin, Graduate & Professional Enrollment, rmarti17@luc.edu
Virginia McCarthy, SSOM Ministry, vmccarthy@luc.edu
Cristina Nunez, MAGIS Scholarship, cnunez@luc.edu
Sullibert Ramirez, MAGIS Scholarship, sramirez4@luc.edu
Thomas Regan, College of Arts & Sciences, tregan1@luc.edu
Julian Ruiz, Latin American Student Organization, jruiz12@luc.edu
Matthew Sanchez, Assoc Professor, msanches11@luc.edu
Peter Sanchez, Political Science, psanche@luc.edu
Joseph Saucedo, Student Diversity & Multicultural Affairs, jsaucedo4@luc.edu
Maria Vidal De Haymes, Social Work, mvidal@luc.edu



    Monday, April 6, 2015

    Loyola Stritch DREAMers Advocate for Students of DACA Status at LMSA Policy Summit

    
    Loyola Stritch DREAMers
    On March 27, 2015, the House of Delegates of the Latino Medical Student Association (LMSA) held its second annual policy summit.  This meeting considers resolutions that set policy for the organization, especially in regard to its policy advocacy and education efforts.  This year, the delegates considered a resolution related to the eligibility of Dreamers of DACA status to apply to medical schools.  This resolution was of great interest to the Loyola University Chicago Stritch School of Medicine (SSOM) because of its position of national leadership in promoting social justice for this student population.  See www.stritch.luc.edu/daca.  Four of Stritch’s first-year medical students who have DACA status attended the summit.  Below is the text of the resolution that carried and the testimony of the two Loyola Dreamers who spoke in support of the resolution, Manuel Bernal and Diana Andino.  For more on this event, click here.

    RESOLUTION #2
    RESOLVED, that our LMSA provide a safe environment for the edification and advancement of Latino students applying to medical school, irrespective of their immigration status; and be it further
    RESOLVED, that the LMSA strongly encourage medical schools, residency and fellowship programs to clarify their DACA admission and match policies; and be it further
    RESOLVED, that our LMSA supports regulatory relief to DACA eligibility in the absence of comprehensive reform as seen by the Executive Action declared in 2014, and be it further
    RESOLVED that the LMSA strongly encourage medical schools, residency and fellowship programs to support the admission, retention and promotion of DACA eligible students; and be it further
    RESOLVED, that our LMSA write an open letter to the AAMC asking for regulatory relief for DACA eligible students who are accepted into medical school but are unable to matriculate; and be it further
    RESOLVED that the LMSA work with medical advocacy organizations to develop policy language that promotes the admission, retention and promotion of DACA eligible students.

    Congressional Action: ADOPTED as amended.

    Testimony of Manuel Bernal, MS-1, Loyola University Chicago Stritch School of Medicine

    
    Manuel Bernal, SSOM
    Thank you Mr. Speaker for letting me share why I think this resolution that we will be voting on is crucial for improving healthcare delivery to Hispanic populations, especially the immigrant community.  My name is Manuel Bernal a first year medical student and a DACA beneficiary. I also speak on behalf of the community of future physicians from Loyola University Chicago Stritch School of Medicine and our LMSA chapter.  I am a firm believer that that a reduction in health disparities will only be possible when the community of health professionals better reflects the population of patients that we will serve in the future. By encouraging more medical schools to open their doors to DACA recipients we will produce a pool medical providers that are more culturally competent and that will be able to relate to the struggles that immigrant patients face during their journey to the American Dream. So let's continue this fight together, for current and future DACA medical students, but most importantly for our future patients. Thank you.

    Testimomy of Diana Andino, MS-1, Loyola University Chicago Stritch School of Medicine

    Thank you, Mr. Policy Chair. My name is Diana Andino, a current medical student, speaking on behalf of myself, students of the Stritch School of Medicine and other DACA students present here, as supporters of this resolution.

    With the passage of DACA, support of mentors, and institutions, myself along with few other students are one step closer in becoming healthcare providers. We have been able to overcome many obstacles. For example I was not able to apply to graduate school, internships, nor work during my undergrad due to the lack of a nine digit number. My dream of becoming a physician was deferred until DACA allowed me to apply to medical school.

    The passage of this resolution is of interest not only to the medical profession, but to our community. We call for more actions like the ones being done today, to be implemented in other schools and continue to open more opportunities for DREAMers like ourselves. Thank you.

    Thursday, March 26, 2015

    Medical School Dreams & DREAMers: What the New Contributors to Medicine Have Taught Us

    Mark Kuczewski & Linda Brubaker
    Mark Kuczewski, PhD & Linda Brubaker, MD, MA
    (Remarks delivered at the 19th Annual Meeting of the National Hispanic Medical Association, March 28, 2015)

    What We’ve Learned from these Medical Student DREAMers
    In the early fall of 2011, we received an email from Professor Herbert Medina, chair of the mathematics department at Loyola Marymount University in Los Angeles. In the e-mail he described a student whom he had characterized as one the best students he’d ever had. She had a very high grade point average, was a double major in biology and Spanish, had significant service involvements, and a variety of other qualifications. We have told this story in several places. (1, 2, 3) But it bears repeating that this student, who also happened to be a DREAMer, captured our interest for several reasons intrinsic to the mission of a medical school.
    1. Best and brightest – Isn’t that who we all seek to recruit?
    2. Unique Skills – Such students are bi-lingual, bi-cultural and understand our large, recent immigrant patient populations. 
    3. Service to patients – DREAMers usually are persons of color from underserved communities and thereby fit the profile of potential physicians who are more likely to desire to serve underserved populations
    4. Fairness for this DREAMer – This student has all the talents and qualifications to become an outstanding physician in addition to being incredibly motivated in the face of seemingly insurmountable barriers. On what grounds could we justify her exclusion from the profession?
    However, in 2011, a DREAMer could procure no authorization to work in the United States and therefore would be denied a license to practice medicine by every state medical board. As a result, we did not think it would be wise to admit and utilize copious school-based aid to graduate a physician who could not practice. Fortunately, on June 15, 2012, President Barack Obama granted a kind of temporary reprieve to “DREAMers” when he created the Deferred Actions for Childhood Arrivals Program which has become commonly known as DACA. As is well-known, DREAMers are young people who were brought to the United States without authorization as children and have lived and been raised here for more than five years. They have often received a substantial part, if not all, of their education in the United States and become integrated into the fabric of their communities. The DACA program is an exercise of prosecutorial discretion that removes any concern of deportation for eligible DREAMers during the covered period (originally two years but it is now conferred for three).  In addition, DACA status includes conferral of an Employment Authorization Document (EAD) and the recipient may apply for a social security number.

    Because DACA alleviated the barrier to practicing medicine, the Loyola Stritch School of Medicine became the first medical school in the country to openly accept applications from DREAMers of DACA Status shortly after the creation of DACA. While some schools quietly accepted an occasional DREAMer, we felt it was important to be open and clear about our intent. We characterized this effort as “bringing them in the front door” or a “front-door approach.” Seven such DACA-documented DREAMers are currently thriving as they complete their first year at Loyola Stritch School of Medicine.

    We think that on a societal level, the Loyola Stritch DREAMers are very important because they help us to move beyond the “makers” versus “takers” debate in which our political dialogue is mired. The Loyola Stritch DREAMers highlight that the image of undocumented immigrants as “takers” is mistaken. They are not here to take something to which they are not entitled. They are talented contributors. Their story shows that to a large extent, whether one becomes a maker or a taker is society’s self-fulfilling prophecy, and this is not exclusively (or at all) related to immigration status. Society can be inclusive and provide the conditions that enable these young people to use their God-given talents and motivations to serve sick patients and improve health within communities and populations. Or it can continue to reinforce barriers such as not allowing access to the same funding mechanisms that enable nearly all medical students to secure their educations, e.g., federal student loans. We sometimes half-jokingly say that the Loyola Stritch DREAMers are superheroes. They have hurdled so many barriers and obstacles on their way to a college education and a level of achievement that simply makes it unthinkable for us to turn them away from our medical school. “Leaping tall buildings in a single bound” seems like child’s play next to their accomplishments. But, even they needed the protections and opportunities that DACA affords them and a medical school - state partnership that provides a realistic funding vehicle. (4) They remind us of the many undocumented young people who are not superheroes like the Loyola Stritch DREAMers, but ordinary people like us. For ordinary people, removal of such artificial barriers is even more important to reaping the benefits of their contributions to society.

    Society must own up to its responsibility in deciding whether it will enable our undocumented neighbors to be makers or will shackle them and demand that they be takers. This dynamic is also in effect in other sectors of health care.  For instance, we can bar the door to the opportunity to buy health insurance through the provisions of the Affordable Care Act and complain about the burden they pose on our emergency room charity care systems or we can provide the conditions for these neighbors to take responsibility for their health. (5) The choice is ours, not theirs.

    The Importance of the Loyola University Chicago “Front Door Approach”
    With the realization that the medical profession and the medical education community is engaged with individuals being marginalized unfairly by society, a “front door approach” to their plight is morally required of us.

    First, the front door approach means that we welcome these students for who they are.  Our admissions policy states that applicants of DACA status are welcome to apply and we recognize them as their own category of applicants. (6) We are not trying to force them into an international student category but recognize that they bring their own particular qualities to the table and that they are best considered in terms of being evaluated by the same criteria we apply to citizens and permanent residents, not students applying from other countries.  This is a pragmatic consideration. But, we must not make too sharp a distinction between pure pragmatism and idealism.  Injustice has very pragmatic consequences as health and health care disparities demonstrate. In terms of ideals, our medical schools must not simply be a tolerant community; we must be a hospitable and welcoming community. Imagine if we were living in the era before desegregation. It would not be enough to occasionally entertain an application from an African-American, have them check boxes on their applications indicating that they are from racial or ethnic groups to which they do not actually belong, and pretend that they are white after matriculation. No, they must be welcome for who they are. This will entail a commitment to educating the entire medical education community (and our alumni community) lest the environment simply mirror much of the prejudice and implicit hostility of the larger society. (7) For instance, at Loyola, we have made a conscious effort not to use the common method of describing DREAMers as young people who were brought to the United States “through no fault of their own” as if migrating to feed one’s family is a fault and their parents are guilty of it. We will not speak that way in our institution. Thus, the issues that DREAMers confront and the larger context of immigration in the United States will become a thematic focus of education at all levels on the campus of our health science centers. Of course, this will yield the additional benefit that all health-care providers on the campus will likely become more culturally aware and competent in caring for immigrant patient populations.

    Second, a front-door approach is important in gathering support.  Medical students of DACA status, like all medical students, are raw assets to our society. But we must invest in them in order to develop them into physicians who can serve the community.  DACA status students are denied access to basic resources such as federal student loans. We need support from the community such as medical school alumni, friends, and related health-care institutions. It’s hard to know how one gathers support without articulating commitment. Clearly our ability to partner with the Illinois Finance Authority to provide loans to these students was dependent on our public commitment.

    Finally, the presence of such DREAMers ultimately is transformative for our campus, for medical education, and for medicine. One cannot look at the contributions of these students, come to understand the realities of immigration in the United States and globally, and simply remain indifferent. We must advocate for change and for justice.  As we’ve seen, these injustices have implications for the health of our communities and for the development of physicians and health-care professionals to treat our communities. And beyond those pragmatic aspects, we find ourselves looking at a situation that is just plain wrong. To look at the Loyola Stritch DREAMers is to immediately recognize how wrong it is that they live with the insecurity of a temporary immigration status subject to the will of the nation’s chief executive. And while they are rapidly becoming community leaders, they lack the basic right to self-determination through voting or participating in systems in which we are all commonly invested, such as social security. While we live in the practical and pragmatic world of advocacy and in that world, we often confine our speech to the art of the politically possible, we must never stop simply saying the truth. As academics and health care professionals we must never stop saying that our present immigration policies from the militarization of our southwest borders, through the lack of qualified and effective representation of immigrants in our courtrooms, to the confining of migrants for long periods in our detention centers and prisons, to the failure to provide a path to citizenship for long-time members of our communities, are unhealthy and just plain wrong. These injustices must be changed.

    1. Mark G. Kuczewski, Linda Brubaker. (2015) Equity for ‘DREAMers’ in Medical School Admissions. AMA Journal of Ethics 17(2): 152-156. Article  |  Podcast

    2. Mark G. Kuczewski, Linda Brubaker. (2014) Medical Education for “Dreamers”: Barriers and Opportunities for Undocumented Immigrants. Academic Medicine 89(12): 1593-1598.

    3. Mark G. Kuczewski, Linda Brubaker. (2013) Medical Education as Mission: Why One Medical School Chose to Accept Dreamers, Hastings Center Report 2013;43(6): 21-24.

    4. Kristen Schorsch, “A Year Later, Loyola Still Alone in Enrolling Undocumented Students.” Crain’s Chicago August 9, 2014 http://www.chicagobusiness.com/article/20140809/issue01/308099984/a-year-later-loyola-still-alone-in-enrolling-undocumented-students#

    5. Mark G. Kuczewski. (2011) Who is My Neighbor? A Communitarian Analysis of Access to Health Care for Immigrants. Theoretical Medicine and Bioethics 32(4): 327-336.

    6. DREAMers of DACA Status Welcome.  Loyola University Chicago Stritch School of Medicine Website. www.stritch.luc.edu/daca

    7. “Loyola University Chicago Medical Students Show Support for DREAMer Peers”, Ignatian Solidarity Network, August 14, 2014. http://ignatiansolidarity.net/blog/2014/08/14/loyola-university-chicago-medical-students-show-support-dreamer-peers/


    Mark G. Kuczewski, PhD is Fr. Michael I. English Professor of Medical Ethics, Director of the Neiswanger Institute for Bioethics & Health Policy, and Chair of the Department of Medical Education at the Loyola University Chicago Stritch School of Medicine. Follow him on Twitter: @BioethxMark

    Linda Brubaker, MD, MA, is the Dean and Chief Diversity Officer of the Loyola University Chicago Stritch School of Medicine and she also currently serves as the Interim Provost for the Health Sciences Division of Loyola University Chicago. Follow her on Twitter: @StritchMedDean

    Monday, January 26, 2015

    Social Media for Health-Care Professionals: A Starter Kit

    Mark G. Kuczewski, PhD

    Facebook, Twitter, LinkedIn and a host of other social media platforms seem to be everywhere. It can seem as if everything we read and watch is accompanied by a call to “Follow us on Twitter” or “Like us on Facebook.” You may already use one or more of these platforms for personal purposes.  For instance, having a Facebook account on which one posts items such as pictures about oneself and family for friends and others. Quite commonly, we might find ourselves facing certain questions such as whether to accept friend requests from patients or others and what kinds of disclosures about one’s work life are appropriate. Health systems are always concerned that the confidentiality to which patients are entitled may be violated by a member of the staff and result in the fabled “HIPAA violation.” And, they might simply prefer to control all communications that can be interpreted as emanating from the institution so that their facility “speaks with one voice.” Fear of getting into some kind of trouble at work can lead us to conclude that we’d be better off simply not engaging in social media.

    Social media poses many opportunities to improve one’s professional life and to further one’s vocation of serving others. And, it can be fun. As a result, many institutions are now taking a far more positive approach. For instance, the Mayo Clinic has put together a video that encourages their employees to engage on social media and offers a few caveats.  The Loyola University Health System has a very minimalist policy. For the most part, it articulates the principle that is the prime directive of health care professionals in the modern age: Do not make any disclosure of the Personal Health Information (PHI) of any patient in your care or the care of the institution. And, the policy affirms that you may use LUHS work stations to access such platforms for educational and business purposes. In other words, it recognizes that your work can be enhanced through these media.

    It’s About Who You Are

    Busy professionals do not have time for one more thing they “should” do. There’s no point in trying to convince them that like going to the gym and getting more vitamin D, they should participate in social media. I’ll make the simplest case for it: You are very likely to enjoy it on many levels.  You probably went into health care for a variety of reasons. You have an intellectual curiosity that led you into a field that combines science, art, and people skills. And, you enjoy sharing your wisdom and insights for the benefit of others. If you could, you’d like an easy way to put forward your professional persona, keep current on all sorts of relevant issues, and share helpful information and insights.  And, of course, it would be wonderful if this led to satisfying interactions, perhaps more patients, and even injected some humor into your day. It sounds like making use of social media in your professional life is right up your alley. So, how do you get the fun started?

    What to do
    1. Establish Facebook, Twitter, and LinkedIn accounts for your professional use. -  While there are many interesting social media platforms, these have become more or less standard equipment. If you use a platform such as Facebook for personal use, you might consider a second account that is for your professional use so that you can share information and links with colleagues and relative strangers without also sharing private materials such as your family photos.
    2. “Like” (on Facebook) and “Follow” on Twitter people and institutions that will bring you the kind of news you enjoy. -  Think about what kind of information you try to obtain in your daily life. Most of your favorite news outlets, reporters and columnists post their stories to Twitter. Similarly, professional societies and journals often have accounts or Facebook pages.  Search for conferences or meetings you like to attend or even people you admire.  Chances are that you’ll be able to get information directly from them through social media.  Once you have connected to the kinds of information sources that you enjoy, you’ll go into your account frequently in order to get information.  You will slowly but surely become a master of these tools.
    3. Share the information you find interesting and relevant. Comment on some of it. - You might find some of your favorite writers or folks you admire in your field engaging in “conversation” with you.  How cool is that?
    4. Establish a LinkedIn account and build your profile page. – I’ll write more in this space in the future about LinkedIn. It’s tame, static, and boring. But it is the one platform that is quickly becoming mandatory for all professionals. It is your public CV and you need to have a decent profile page on LinkedIn. It’s what people will get when they Google you. Without it, you risk being seen as unengaged in your profession.

    What Not to Do
    1. Do not share any information about particular patients on social media. - You can talk about illnesses and common issues, but no identifiable patient information should ever be included. And be careful with pictures at your facility.  Capturing even a glimpse of an unaware person in a background discloses that they were at the facility.  That shouldn’t happen.
    2. Don’t diagnose people on social media. -  If people ask particular questions about their health, you can suggest they see a health-care provider and/or tell them about reputable information sources. But you definitely should not be treating patients on a social media outlet.
    3. Sleep on it. – People will say the darnedest things. Some will put forward caustic, bombastic and even hateful viewpoints.  Generally, such persons will not want to be persuaded by you.  If you do respond at all, it should be mainly to provide factual or well-reasoned counter information so that it can be seen by others who follow your posts. If you find yourself about to respond in anger, take a time out, maybe even overnight.  Rest assured it’s a pretty good strategy even if your lesser angels want to get back at this person for their rudeness; such interlocutors will find your delay uncomfortable and it gives you time to decide whether any response is worthwhile.  And don’t feel you need the last word.  Once you have made any relevant factual points, do not persist in posting simply because the other person is.
    4. Don’t engage others criticizing your hospital or health-care institution – You may “represent” your institution because people’s impression of a facility is partly drawn from their experiences of particular professionals they know work there.  But you are not the spokesperson charged with responding to any particular allegations and unless you are a senior administrator appropriately so charged, you do not speak for the institution. And, you may find your words twisted and used against you and your institution if you engage.

    In general, be yourself- the bright, engaging professional that you are.  And have fun!

    Here are a few of my favorite Twitter and Facebook sites related to bioethics or health-care professionalism to get you started. On Twitter, you search for the site by the “handle” e.g., @BlahBlah, whereas on Facebook, you search for a page by its name.

    Follow on Twitter

    Bioethics:
    @LoyolaBioethics
    @BioethxChat
    @LifeMMedia
    @ArthurCaplan
    @HastingsCenter
    @JournalofEthics
    @Bioethics_net
    @NoHiddenMagenta

    Health Care/Policy:
    @Health_Affairs
    @NEJM
    @JAMA_current
    @NHMAmd
    @NationalMedASSN
    @ANANursingWorld
    @NNEC2015
    @AcadMedJournal
    @LMSA_National
    @TheCHAUSA
    @HSHPS96

    News:
    @CitizenCohn
    @ThinkProgress
    @NYTimesHealth
    @NYTimes
    @WSJhealthblog
    @HuffingtonPost
    @FiveThirtyEight
    @BoldFaithType
    @IGsolidarityNET
    @TheOnion - humor

    Like On Facebook

    Bioethics:
    LoyolaBioethics
    BioethxChat
    Life Matters Media
    ASBH
    Bioethics – AJOB Discussion Group
    Bioethics InternationalDiscussion Group


    Health Care/Policy:
    National Hispanic Medical Association
    New England Journal of Medicine
    American Journal of Nursing
    Hispanic Serving Health Professions Schools
    Latino Medical Student Association
    Student National Medical Association
    Catholic Health Association

    News:
    Jonathan Cohn
    Think Progress
    The New York Times
    The New York Times – Well – Health
    FiveThirtyEight
    Faith In Public Life
    Ignatian Solidarity Network
    The Onion - humor


    Mark Kuczewski, PhD, is the Chair of the Department of Medical Education and the Director of the Neiswanger Institute for Bioethics and Health Policy at Loyola University Chicago Stritch School of Medicine.  Dr. Kuczewski teaches Clinical Bioethics and Organizational Ethics in the Bioethics & Health Policy Graduate Program at Loyola University Chicago.  You can follow him on Twitter @BioethxMark or friend him on Facebook (Mark G. Kuczewski).