October 31, 2023 • 40 mins
Expand your understanding of healthcare ethics and AI's future role with our guest, Joe Ivie, Regional Mission Director for Bay Care Health System in Florida, USA. A life journey that began with a medic's role in the Army, spiraled onto the path of a hospital Chaplain, and culminated in being a Mission Director, Joe's story is a compelling testament of passion and purpose.
This episode sheds light on the intriguing workings of the Ethics Committee, discussing the profound importance of advanced directives and patient autonomy. Drawing from his rich experience, Joe explains the critical role of a surrogate in making decisions on behalf of patients, and how this interplays with the four main ethical principles. He highlights the intricate dilemmas faced in healthcare ethics and how the committee navigates these challenges.
As we strive to understand the future of healthcare, we delve into the impact of AI on the industry. Weighing the pros and cons of technology, we explore everything from precision in conducting x-rays and scans to the potential of AI replacing human jobs. We further delve into the pivotal role of privacy and the game-changing potential of AI in writing and education. Joe shares his expert perspective on these topics, revealing a fascinating glimpse into the future of healthcare. Listen in and expand your horizons about the ethical and technological dilemmas faced in healthcare.
Connect with Mr. Joe Ivie: mrjoeivie@icloud.com or Alfred Joe Ivie on LinkedIn.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Hi there, welcome to Conversations where we seek to
advance your leader in teamexcellence by discussing
relevant topics that impacttoday's organizations.
Welcome to the show.
Hey there, and welcome toConversations, where today we
have Mr Joe Ivy.
Joe currently serves as aregional mission director for
Bay Care Health System.
(00:21):
In his role, he providesoversight in the areas of
spiritual care, palliative careand healthcare ethics.
Ivy has completed an MDiv atRegent University and an MBA at
St Leo University.
Welcome to the show, joe.
Where are you coming to us from?
Speaker 2 (00:40):
So you know, I'm a Floridian through and through,
born and raised here.
Speaker 1 (00:45):
Right, that's unusual .
Speaker 2 (00:47):
I left for grad school, left when I was younger
for the Army, but always cameback to Florida.
You know, as I say, you cantake the boy out of Florida, but
you can't forward out of theboy.
Speaker 1 (01:01):
That's right, so it does yeah, well, I'm happy to
have you on today.
We're going to talk a littlebit about a lot of different
things, about what you do andhow you touch and how you serve
people.
Now it says here that Bay CareHealth System.
So where is Bay Care HealthSystem?
Where are the people that theyserve?
(01:21):
Is it just one area?
Is it regional?
Speaker 2 (01:24):
No, it's actually multiple counties throughout
West Central Florida and alongthat West Coast of Florida, so
think Clearwater, tampa Bay, allthe way into Polk County, which
would be Lakeland, winterhavenspecifically, and then Bartho.
(01:46):
They also recently built one oftheir newest hospitals in
Westlady Chapel.
They are an expanding healthsystem, absolutely.
Speaker 1 (01:58):
That's terrific.
Well, I know that healthcarehas been your passion for the
last 15 years, but, as youmentioned, you were in the Army
as a medic.
So how do you go from being amedic to a hospital chaplain, to
a mission?
Speaker 2 (02:15):
Well, I mean, obviously, all that kind of
starts, the call on your life,and I literally thought that
becoming a pastor is that's whatI was going to do.
And you've probably heard tonsof people say this tell God your
(02:36):
plans.
And he just laughs and says,okay, buddy, you're going to do
what I say you're going to do.
We did some church planting andserved on plenty of churches as
associate pastors and variousthings, and then my father had a
(02:58):
stroke when we were at a churchnear Gainesville, florida, and
so we wanted to get back closerto help my mother, and so I
actually took a detour andstarted working in correctional
chaplaincy, which I had neverdone institutional chaplaincy
(03:22):
work, and so that's a wholedifferent ball of wax working in
the correctional system.
So I wasn't 100% sure that'swhere God would have me planted.
But I was looking for a federalposition because at that point
(03:43):
I had already earned the mastersin divinity, and so that allows
you to expand where you canactually do ministry, and one of
those is in the federal prisonsystem.
And in looking on the federalwebsites I found something
(04:06):
called clinical pastoraleducation at James Haley VA
hospital, and I'd never reallyeven thought about healthcare
chaplaincy.
I'd never kind of connected thetwo together.
My background as a medic mymother was the nurse for 52
years, just raised in thatenvironment, and so I went ahead
(04:29):
and applied for that as well,and it wasn't supposed to start
until January, I think I appliedfor it in like June or July,
and I was approved to do theyear long residency with the VA
hospital.
And then I got a call from theCP supervisor at the time saying
(04:50):
hey, we had someone drop out ofthe program, we need you to
come in August, and so I reallyhad to pray.
So I'm in long story short.
We ended up doing that about ayear, and three months there,
took a position as a PRNchaplain with Moffitt Cancer
(05:10):
Center in Tampa towards the endof that CPE experience and then,
after working for Moffitt for alittle while, I took a job at
Winter Haven Hospital, which atthe time was not part of Baycare
, it was an independentcommunity hospital and I was a
staff chaplain at that hospital,and not long, I think only
(05:36):
about a year and a half.
They had made the announcementthat we were going to go ahead
and sell the hospital to theBaycare health system to become
part of that system and themanager of the chaplaincy
program had retired and so theoperations director at the time
(05:58):
approached me and said, hey,would you like to manage the
chaplaincy program?
And so kind of ended up in thatposition through a bunch of
different circumstances.
And when Baycare came in theyhad a lot of community outreach.
They had a lot of internalprogramming, the mission piece
(06:19):
which is helping those folks inour community who are less
fortunate through food banks andconnections with those things.
An ethics program, what werefer to as faith community
nursing.
A lot of hospitals don't havethat, but those are nurses who
use their faith to serve theirfaith communities.
(06:44):
So you think of a faithcommunity nurse would be someone
who volunteers their time totake their expertise in health
care to their local church andbe that connection between the
church and those individuals tomake sure that they're better
taken care of when they leavethe hospital.
So that's a whole differentthing.
(07:06):
But in any case, baycare washaving all these new programs
and at the local level theydidn't know where to put them
and so eventually they juststarted putting them under me,
so they would put faithcommunity nursing under me and
palliative care under me and inethics and all these different
(07:26):
things, and so they weren'tthings I didn't have experience
in.
You know, when I was at the VAhospital, I got experience in
palliative care and experiencein ethics, but eventually we had
a new VP come in and say youknow what you're doing is you're
doing the work of a missiondirector, and so that position
(07:47):
was created for the Polk areaand that's what I've been doing
for quite a while now.
Speaker 1 (07:54):
Oh my gosh, what a journey.
You know, God is funny likethat, how he'll just, you know,
kind of turn things around.
And it's interesting how youstarted in healthcare and you're
in healthcare now you know,yeah, so that's terrific.
What a great story.
Yeah, thank you.
Yeah, so you talked abouthospital ethics committee, right
(08:20):
?
And that's part of what you do.
So how about we talk a littlebit about what the purpose of
that is?
Speaker 2 (08:28):
Sure, sure.
So.
So I can tell you that, youknow, in bake here we have both
a system ethics process and wealso have a process at the local
level.
So our hospitals have advisorygroups and these are
multidisciplinary groups thatyou know.
(08:49):
They include physicians andnurses, and maybe social workers
, sometimes community members,chaplains, and what it allows
the hospital to do, whether itbe the patients or the
healthcare workers or thefamilies, it gives them a
(09:10):
process for, you know, forseeking guidance and we call
that ethical consultation.
So that's part of what we it'slike.
It's like a stool with threelanes right.
So an ethics committee has threemain purposes.
One is to provide consultationso you know, anytime you have
(09:32):
difficult choices on the line.
It could be end of lifedecisions, it could be various
treatment options that peopleare facing there are.
There's tension between andI'll talk about this a little
bit but there's tension betweenthe ethical principles.
There's four guiding principlesand we'll go over those a
(09:52):
little bit, but consultation isone of the legs.
Another thing that an ethicscommittee does is we're the ones
who are looking at policiesthroughout the hospital and we
either systematically reviewthose, we're involved in the
development of policy, and allof these guidelines are related
(10:15):
directly to patient care.
They're directly to thoseethical matters that are going
to come up and you think aboutthe benefit of a policy, right?
So if you look at a DNR policyor a policy around the end of
life, these are things that areconstantly happening in your
hospital and so, instead ofhaving to constantly reinvent
the wheel, if you have a policythat addresses a specific area,
(10:39):
then you can align it withethical principles and you can
take care of any legalrequirements and you don't have
to constantly deal with thoseissues because it's kind of in
the policy.
And then the third thing we dois education and trainings.
So you have healthcare staffand, whether it's around general
(11:00):
ethical issues or informedconsent or advanced directives
or various topics, you'rehelping them to better
understand the ethical concernsthat are going to come up.
So if you look at those threethings that flow out of the
ethics committee, they're verysymbiotic, right, you're
creating an education spacewhere you're going to identify
(11:23):
people who have a passion forethics, so that feeds into your
actual committee and then thathelps you to train more
consultants and then that helpsyou to review policy.
And you know they all kind ofinterwork together.
So it kind of makes sense ifthat helps.
Speaker 1 (11:40):
Yeah, it does help.
You mentioned about advanceddirectives.
Did you want to talk a littlebit about that here?
Speaker 2 (11:48):
Oh yeah, no, I mean.
So you know in the healthcaresystem what those are.
They're specifically legaldocuments that what they're
doing is they're allowing apatient an opportunity to
express what they would or wouldnot want done in the worst case
(12:10):
scenario.
So you think, right, what wewould love?
And you have to realize thisright, all doctors want their
patients to get better.
There's not a doctor I've evermet who doesn't want their
patients to get better.
But we live in a world wherethat's not always the case.
Right, we have death, we havedisease, and we have to deal
(12:32):
with the realities of that.
And the thing.
One of the things and we werekind of going to talk about the
ethical principles, I'll justmention one right now.
It's autonomy.
Autonomy is your ability tomake your own decisions.
Right, you have the right tocome into a hospital and not
only be informed about what'shappening, but to make your own
(12:53):
decisions, and so an advanceddirective lets you express those
medical preferences ahead oftime.
So sometimes, what happens toindividuals as they get sicker,
they become incapacitated, andthat's a legal term.
It's also a term that we use inhealthcare.
That means that you can't makecomplex medical decisions, and
(13:14):
it could be because of aphysiological reason right,
you're in a phasic patient whocan no longer communicate
because of the trajectory ofyour disease process.
Or it could be because you'reconfused right, that you
actually have to have a consultcome in to evaluate your mental
capacity right, and sometimesthat can be a phycological in
(13:37):
nature.
Sometimes it could be a UTI orsome other unknown infection
could be medical.
So capacity is something whereit's always assumed when someone
comes into a hospital, that ishow we treat them.
But they are a fullyfunctioning, autonomous
individual with capacity.
Until there's a reason toquestion that, right.
(13:58):
So it is something that's veryimportant and the way that we
protect that is, we use a coupleof forms.
I mean, as far as people'sdecision-making, protecting
decision-making we use a formcalled a surrogate form.
A surrogate in Florida isanother legal determination.
We have surrogates and we haveproxies.
(14:20):
They do the same job butthey're assigned differently.
So if somebody comes into ahospital and they were a very
sick individual and they'reunable to make decisions,
somebody has to make decisionsfor them.
What we would prefer is to seethat they had an advanced
directive where they named anindividual that would be their
(14:40):
surrogate.
If they didn't, florida lawallows us to go down and order a
priority to find out who wouldmake the decision.
So typically it's gonna bespouse, then it would be adult
children, a parent, a relative.
It could even be a closepersonal friend.
But the problem with the proxyorder is we have to follow the
(15:02):
order.
So that's why I think it'salways best that someone has a
surrogate.
You wanna name a person whocould make decisions for you,
somebody you trust.
The other form we have iscalled a living will and that's
more prescriptive right.
You get to actually name inthere, line by line, what you
would or would not want, right,like if I had basically it's
(15:24):
stating if I had a terminalillness, if I was in a position
where I was not going to getbetter, like think things like
the advanced stages ofAlzheimer's, the advanced stages
of HIV or AIDS, the advancedstages of cancer, things where
I'm not saying you'll never findme saying that God can't do
(15:48):
certain things.
But medicine has itslimitations, right?
Doctors and medicine, they'rehuman beings, so we're limited
in what we can do.
And so people wanna know thatif I don't want CPR or I don't
wanna be kept alive on machines,they can stay ahead of time, in
(16:08):
those worst case scenarios,their preferences and that's
their right, right?
I mean, I get the frustrationfrom somebody who's not involved
in this all the time becauseyou're thinking, well, why would
you give up or why would you?
But that's not really what'shappening, right?
I mean this is just someone notgiving up but accepting the
(16:29):
reality of their situation.
I've always said to peopleconsider Lazarus right.
When he came out of the tomb hewas already gone.
So God doesn't need aventilator or machines or tubes.
If it's God's will thatsomebody is here, they'll be
here, and if it's God's willthat they're gonna go home,
(16:51):
he'll take them home.
So we don't have as muchcontrol over when that time
comes is sometimes we like tothink we do.
So it's better, I think, forpeople to plan to really
understand the healthcare systemand navigate it, because the
default of every hospital theseare acute care centers.
(17:12):
Their default is to treat.
That's their default is totreat.
So if you don't tell peoplewhat you want, they're gonna
treat you.
There's some other ones thatattorneys do locally, like a
durable power of attorney forhealthcare.
It's really the same thing.
It's just all wound up togethersurrogate and then line by line
(17:34):
like a living will.
And then in Florida we alsohave a do not resuscitate order,
and that one is specificallyabout CPR.
There are certain people whomight have congestive heart
failure or some of a chronicdisease process.
Maybe they do have stage fourcancer and they've been living
(17:56):
with just terrible pain and sothey wanna ensure that when
they're gonna go they wanna go Alot of times.
Elderly patients right when CPRwould result in cracking their
ribs and just a lot of.
(18:18):
If you've never seen CPR, it'sa very violent thing.
I mean it does save lives,don't get me wrong.
But there's a certainpopulation of people where
medicine is.
I've always said this medicineis like a double-edged sword.
Right, when medicine is makingyou better, it is wonderful, it
(18:40):
is God-given.
But when medicine is no longermaking you better, it can hurt
you.
We can continue to prolongsuffering in people beyond what
really we maybe should be doingethnically in healthcare
(19:00):
sometimes.
Speaker 1 (19:03):
And, as you're naming all these things, it goes back
to so, like the leaders that Iwork with, busy, busy people,
and I think as a society, wereally don't think about death
that much or getting sick andhaving an illness and having to
(19:26):
have these things in place, andwhat I'm hearing and thinking on
is that we really, when we arewell, we should be having these
things in place for the timethat perhaps they need to be
used Absolutely that's the wholeidea behind advanced care
planning.
Speaker 2 (19:44):
I mean that's the whole point.
The point is I get it.
I mean people that's not normalto fixate on death all the time
, right, I mean people justdon't do that right.
Speaker 1 (19:56):
It's the reality.
Speaker 2 (19:58):
Yeah, I mean, you know it's out there.
Yeah, you know it's out there.
I mean, some people they're alittle superstitious, they're
like if I talk about it, it'sgonna happen, which that's not
true.
But people get like that.
People are afraid to approachit with their parents because
maybe they think that theirparents are gonna think, oh man,
they're gonna think I want themto die so I can get their money
(20:21):
.
Most of the time that's nottrue.
Now, occasionally you're gonnafind people that are just
uncomfortable talking about it,and so I recommend to them look,
you should at least, right at aminimum, express to your loved
ones what you may want in theseworst case scenario.
(20:44):
I'm not telling you.
You have to write it down.
I think that's the right thingto do.
I think filling out a surrogateform is the right thing to do,
but at a minimum, at least talkto somebody so that you know
really if you think about it.
You know I have five kids, fivegrandkids.
My gift, right, I think, to mychildren, to my adult children,
(21:07):
is not having them feel likethey're making those decisions,
that they know what I feel aboutit, so that really all they're
doing is respecting my wishes,and I think you're gonna help
your own children when they haveto deal with the reality of
your death, which is gonnahappen.
Speaker 1 (21:28):
So it's like what you were talking about policy
before, and it's, you know, ourown personal policy.
This is how we want things togo, and I know my mother-in-law
is currently moving out of herhome and into a facility and we
were asked all these questionsand it's these are the things
(21:50):
that you know in theconversations.
It's in my head.
I'm thinking to myself, yeah,these are really needed.
And so, knowing that you werecoming on and I know Florida's
different right it is, it is sopeople would need to take a look
at their own state.
Speaker 2 (22:08):
So you know they are pretty reciprocal.
You know across the 50 states.
You know most of them,including the territories, are
going to respect your wishescoming in from another state.
But it is important if you'reliving in a different state that
you look and see what'savailable in your state Because
it may not be exactly the sameas what we have here.
Speaker 1 (22:32):
Good stuff, yeah, all right.
What else did we want to talkabout?
Was there anything on ethicsthat you wanted to share that we
didn't get to?
Speaker 2 (22:47):
yet I mean, I'll just say so, yeah, so an ethics
committee.
I'll explain this.
So it's different depending onthe hospital that you work with.
You know we happen to be aconnection you know, bay care, a
connection of communityhospitals and Catholic hospitals
(23:11):
, and so we have a real missionconnected to everything we do,
which means in our ethicscommittee we have appointed
chairs, and so the missiondirectors, which we have four of
them in the various regionsthat serve the hospitals and the
communities.
They chair the ethics committee, and so that ensures that you
(23:34):
know the missions and the goals,the guidelines for the
committee, the direction for theethics committee is the same
right.
So no matter what hospital youfind yourself in within Bay care
, you're going to get the samegood ethical care, and all of
our hospitals have thoseunderlying principles.
(23:55):
So I kind of mentioned that alittle bit.
Let me go ahead and just namethem off real quick.
So I talked about autonomy,right, and that is the respect
for the patient's right to selfdetermination.
They use an individual.
You get the final say as towhether or not you do this or
that in health care People.
(24:17):
So back in the day, doctors werevery paternalistic.
It started that way, where youwere like the child, and they
were the parent.
And there was a woman in NewYork.
There's a famous case where thewoman was visiting, I believe,
from California to New Yorkhospital and she had pain in her
(24:40):
abdomen and she went in to seethe doctor and she consulted
with the surgeon and he saidwell, I believe you have fibroid
tumors.
And she said well, you can, Iwant you to evaluate.
You know they had to do aninternal evaluation, but I don't
want you to remove them.
(25:01):
She wanted to go back toCalifornia.
Whatever she wanted to do, shewas directing the doctor what
she didn't want done.
This was at the turn of thecentury, so it was a long time
ago.
But they put her under ether.
He saw that they're tumors andthey were big and he removed
them.
He did exactly the opposite ofwhat she because he believed
(25:24):
that was what was best for her.
And so when she awoke, ofcourse she was angry and she
went before the judge.
She actually sued the hospitaland won, and so that was kind of
the beginning of the idea thatreally patients have the same
over their own medical treatment.
(25:44):
And so autonomy is a highprinciple in ethics and we want
to respect people's autonomy.
There's two bookends we talkabout.
One of them is beneficence.
Very simply just means toalways do good, right,
everything should be to thebenefit of the patient.
And then the other bookend isnon maleficent.
So that just means to don't doharm.
(26:06):
So do good, don't do harm,don't give people interventions
that they don't need, don't dothings that are violating
someone's autonomy.
And then the last one we lookat is justice, and that's just
to make sure that all people aretreated equally and fairly
within the health care system.
(26:26):
And so, when you take those fourprinciples, a lot of times an
ethical dilemma is when thosethings are butting up against
one another, right?
So maybe the family'sdisagreeing with the physician,
or the patient doesn't think thetreatment is going the way they
think it should, and so that'spart of the role is to make sure
(26:46):
that our consultants are alwaysprepared to offer that advice
to our health care system, toour patients, to our families,
and it's important that peopleknow that ethics committees when
they come to a decision, it'snot law, we're not telling
(27:06):
people, we're only offering ouradvice on the situation.
Ultimately, there's a lot ofdecisions really that the
patients need to make or thedoctors need to make, and
they're seeking some guidance onthat.
So that's what we do.
Speaker 1 (27:21):
So, as a committee, do you have people coming to you
, or is it that the consultantsare the people that?
Speaker 2 (27:30):
perhaps.
So you have a larger committee.
We have about 12 people, 14people on the committee.
Not everyone on the committeeis a consultant, and so the
consultants will work in thehospital.
They're normally individualsthat have the time, because we
have a four quadrant model thatthey walk through and they look
(27:53):
at the case itself, they reviewthe medical chart, they meet
with the patient and the familyand the physician, so it is
involved.
Right, if you're going to offersome advice, you need to know
what you're advising on.
So not everyone who serves on anethics committee serves as a
consultant, but anyone on anethics committee may have a
(28:16):
consultant reach out to them,right, to talk about a
particular case.
Right, because they may havesome expertise.
Like, for instance, we havesomeone who is over our
infection control person, right,so you know she's spent years
doing infection preventionwithin hospitals, so she may be
an expert, you know, in certainareas.
(28:37):
And then, of course, physiciansoffer really good advice, you
know, from a little bit.
Now, we don't necessarily havephysicians serve as consultants,
and that's just because theremight be a little conflict of
interest, right, not that theycouldn't do it, but it turns out
better if you have someone whois disconnected from actually
(29:03):
being able to write an order orjust correct it with a snap of
the finger.
You know.
Speaker 1 (29:09):
No, that makes sense.
Oh well, I'd love to talk alittle bit about AI and ethics.
Speaker 2 (29:16):
Everybody does.
I mean.
Speaker 1 (29:18):
I know it's like it's out there and you know I myself
am trying to you know, justlearn as much as I can from you.
Know various people and aspects.
There's a lot of conversations.
You know both.
You know positive and negativeand some people landing in the
middle, depending on what it isand how it's being used and
(29:40):
who's using it and what not I'dlove to hear your thoughts and
maybe how your committee has orhasn't kind of touched on it.
Speaker 2 (29:51):
So, like I said, you know, so we have a local ethics
committee that covers thehospitals, you know.
But I, as an ethics chair ofthat, you know we're not dealing
with AI, but it is something atthe system ethics level, which
I'm part of that group, right,and we have a system ethicist as
well.
(30:11):
So I can promise you thatBaycare has a seat at the table.
You know, when it comes to theimplementation of AI, they've
put a lot of ethics to have aseat at that table.
So you know what it's gonnalook like.
You know it's so hard to say.
I mean, like you said, there'spositives and negatives.
(30:31):
I mean I just think abouttechnology in general, right, I
mean things that has been, hasbeen like helpful, right, like
it's not always harmful to haveword processors, so I'm glad
that I don't have to lug atypewriter out, you know, out
onto the patient floor.
(30:52):
Word processors, cell phones,right, I mean we have this whole
suite of software calledPatientSafe that connects all
the nurses and ethics andeveryone, and it all just worked
so smoothly.
Just the idea of an electronicmedical record you know, when I
started in healthcare we werestill writing our stuff in paper
(31:13):
charts, I mean, and stuff wasjust being, you know, stored in
a gigantic warehouse.
So you know AI, I think you knowit is gonna be helpful.
I don't think it's always gonnabe a bad thing.
We have an initiative in Bakercalled Zero Harm, where
obviously you know you wanna aimthat everything you do does not
(31:36):
harm the patient.
And so when I think about ZeroHarm, when I think about
preventative health right,preventative medicine I imagine
AI is gonna be a good thing.
Right, it's gonna be precise,like, think about x-rays and
scans and things like that whereyou're trying to identify a
(31:58):
disease.
Right, maybe you need it.
Earlier you can identify it,the better, and you know we're
gonna have better patientoutcomes as it gets integrated,
we're gonna have less inaccuratediagnosis, right.
So it's a tool.
We just went through a pandemic, right?
Would it be used to be able topredict future outbreaks?
(32:20):
You know, if we have a largeenough database, if we have
enough resources in there, canwe look at waves of demand and
healthcare.
So there's lots of like thingson the horizon, but you know, I
don't wanna be the Pied Piper ofAI.
Right, I mean, there arenegatives.
There's things.
We have to look at both sidesof the coin, right.
So we just we talked abouttechnology being good.
(32:44):
I mean, hey, at the same time,we have an entire generation
that does not have a spellbecause we use word processors.
You got too much screen time,you know, for your kids,
everybody's face is stuck in aphone.
We rely on copy and paste toomuch, right.
So we have all thesetechnologies, but things that
are legitimate concerns One ofthe big ones in AI I think that
(33:06):
we've talked about at a higherlevel is gaps in privacy.
Right, we take that veryimportant.
You have private healthinformation and it is your
information, and so, as we givegreater access to these systems,
that's gonna be a challenge.
That I don't know, that we havefigured that out yet, right?
(33:27):
So I don't think we're gonnamarch directly to just creating
these gigantic databases untilwe look at what are the real
concerns of people's privateinformation remaining private.
Another thing I thought aboutis AI is never going.
I don't think AI will ever beable to duplicate the insight
(33:47):
and empathy of a human being,and you know, I think that
people bring that to theirdecision making, and so there
are nuances in healthcare.
So AI as a tool can be helpful,but we don't want to rely on it
.
And then another thing that wetalk about and I think this is a
(34:11):
legitimate concern is jobreplacement.
Right, we have a lot of jobs inhealthcare that are routine and
task, and do we really wannareplace humans, you know, with
technology?
and at what rate, and so thoseare real things we have to
consider.
I think we talked about thisbefore.
(34:34):
I think I kind of said and Iwouldn't first say this but
we're like lying to plane whilewe're building it, because AI
came on the scene so fast.
But I can assure you that, at asystem level, ethics has a seat
at the table before weimplement this type of stuff.
Speaker 1 (34:52):
That's good to hear, because that is one of the areas
where, you know, I'm kind ofitching my head about is like,
okay, you know there's a lot ofgood, but there's a lot of you
know whose hands it's in andwhat it's being used for, and
that makes it kind of, you know,piques my interest into
(35:12):
thinking about it more deeply.
Sure and even-.
Speaker 2 (35:17):
I can't even imagine being a high school English
professor right now.
I'd probably be pulling my hairout.
Speaker 1 (35:22):
Yeah, well, that's you know, I adjunct.
And one of the things is it'slike when all of a sudden
somebody's writing is just sopristine where before it wasn't
you know, I kind of have to say,okay, is it because of my
wonderful feed forward feedbackthat I'm giving you, or-.
Speaker 2 (35:42):
Right, or did a computer writer for you, but
it's still, to this point, rightand maybe this will change.
I still think there's nuance,there's humanity that I don't
know, that they can duplicatethat.
Speaker 1 (36:01):
No, I mean we each uniquely made, you know, and we
are creative beings and ofcourse you know it's helped
create these.
Speaker 2 (36:10):
You know crazy things that were Look everybody has
had a curiosity went on a chatGPT and put a command in there.
I think I put in there one timeto like I have a comedian I
can't remember his name butthere's a couple of comedians I
like I think they're prettyfunny and I said write a joke
about a particular subject inthe style of this comedian.
(36:36):
And it was not funny, it wasawful and it was nothing like
them.
So now we're not quite thereyet.
Speaker 1 (36:44):
Well, speaking of chat, gpt, you know there's so
many others.
That's the one that everybodytalks about.
There's many out there now andthat have been coming and then,
all of a sudden, you know, withopening eye, that's really been
the one that people talk about.
But I was in the car yesterdayand they were saying that they
(37:04):
were actually talking about CPRand they had said how, you know,
don't rely on you know yourvoice, you know asking how to do
CPR, because I think it waslike nine out of 20 didn't say
automatically call 911, you know, I always want to be doing that
, and so there are somedownfalls, and if we as a
(37:27):
society are constantly relyingjust on that, I think we're
going to be a law society.
We need to still have ourthinking caps on, as my mother
100%.
Speaker 2 (37:37):
I couldn't agree more .
Speaker 1 (37:41):
Oh well, joe, this has been a great conversation.
I appreciate you and yourknowledge, your wisdom around
ethics and you know the goodwork that you're doing within
the hospital system and, gosh,just really good.
Was there anything left thatmaybe we didn't touch on that
you just want to share?
Speaker 2 (38:01):
No, I mean, I think I think we got most of it.
You know, I think you know AIis a good thing to end on
because it reminds us that youknow you're always going to have
to have the human touch.
You know, and as long as thiswhole world is spinning around,
my thoughts is you know, whetherit's ethics or whether it's
(38:22):
patient care or whether it's AI,is something simple, always
apply.
So I always think the goldenrule right Do unto others as you
would have them do unto you.
If you can keep that justsimple thing in focus, I think,
any of the challenges we face inlife or in healthcare if you
(38:44):
remember that, that you need toalways treat people with dignity
and respect at the core of whatyou're doing, because you know
we have values that underpineverything we do in this health
system and I think if you cankeep those values, you can
always do things well.
Speaker 1 (39:05):
Absolutely, Absolutely.
That's a great note to end onConnect with you.
Maybe it's like, hey, I want toknow how he does what he does.
This is an interesting you knowfield maybe I'd like to get
into, or something like that.
How can people connect with you?
Speaker 2 (39:22):
So they can always drop me an email.
That's fine.
So it's mrjoeid at iCloudcom.
I don't mind sharing that.
So, mrjoeivei at iCloudcom, orthey can find me on LinkedIn.
It's under Alfred Joe Ivey.
(39:44):
I think that's where we connect.
It's with LinkedIn whereeveryone connects.
But you know, drop me a messageand I'll be happy to respond.
Speaker 1 (39:53):
Yeah, I mean, maybe there's a medic out there who's
like hey.
Speaker 2 (39:57):
I'm going to go.
Hey, you never know.
Speaker 1 (39:59):
I want to be a missions director.
Speaker 2 (40:02):
You never know.
We're always planning for whoreplaces us, hopefully.
Speaker 1 (40:08):
You're feeding into the next generation.
All right.
Well, you keep doing greatthings and we'll see you soon,
all right.
Speaker 2 (40:14):
God bless.
Good talk to you, bye, thankyou.
Hi there, welcome to Conversations where we seek to
advance your leader in teamexcellence by discussing
relevant topics that impacttoday's organizations.
Welcome to the show.
Hey there, and welcome toConversations, where today we
have Mr Joe Ivy.
Joe currently serves as aregional mission director for
Bay Care Health System.
(00:21):
In his role, he providesoversight in the areas of
spiritual care, palliative careand healthcare ethics.
Ivy has completed an MDiv atRegent University and an MBA at
St Leo University.
Welcome to the show, joe.
Where are you coming to us from?
Speaker 2 (00:40):
So you know, I'm a Floridian through and through,
born and raised here.
Speaker 1 (00:45):
Right, that's unusual .
Speaker 2 (00:47):
I left for grad school, left when I was younger
for the Army, but always cameback to Florida.
You know, as I say, you cantake the boy out of Florida, but
you can't forward out of theboy.
Speaker 1 (01:01):
That's right, so it does yeah, well, I'm happy to
have you on today.
We're going to talk a littlebit about a lot of different
things, about what you do andhow you touch and how you serve
people.
Now it says here that Bay CareHealth System.
So where is Bay Care HealthSystem?
Where are the people that theyserve?
(01:21):
Is it just one area?
Is it regional?
Speaker 2 (01:24):
No, it's actually multiple counties throughout
West Central Florida and alongthat West Coast of Florida, so
think Clearwater, tampa Bay, allthe way into Polk County, which
would be Lakeland, winterhavenspecifically, and then Bartho.
(01:46):
They also recently built one oftheir newest hospitals in
Westlady Chapel.
They are an expanding healthsystem, absolutely.
Speaker 1 (01:58):
That's terrific.
Well, I know that healthcarehas been your passion for the
last 15 years, but, as youmentioned, you were in the Army
as a medic.
So how do you go from being amedic to a hospital chaplain, to
a mission?
Speaker 2 (02:15):
Well, I mean, obviously, all that kind of
starts, the call on your life,and I literally thought that
becoming a pastor is that's whatI was going to do.
And you've probably heard tonsof people say this tell God your
(02:36):
plans.
And he just laughs and says,okay, buddy, you're going to do
what I say you're going to do.
We did some church planting andserved on plenty of churches as
associate pastors and variousthings, and then my father had a
(02:58):
stroke when we were at a churchnear Gainesville, florida, and
so we wanted to get back closerto help my mother, and so I
actually took a detour andstarted working in correctional
chaplaincy, which I had neverdone institutional chaplaincy
(03:22):
work, and so that's a wholedifferent ball of wax working in
the correctional system.
So I wasn't 100% sure that'swhere God would have me planted.
But I was looking for a federalposition because at that point
(03:43):
I had already earned the mastersin divinity, and so that allows
you to expand where you canactually do ministry, and one of
those is in the federal prisonsystem.
And in looking on the federalwebsites I found something
(04:06):
called clinical pastoraleducation at James Haley VA
hospital, and I'd never reallyeven thought about healthcare
chaplaincy.
I'd never kind of connected thetwo together.
My background as a medic mymother was the nurse for 52
years, just raised in thatenvironment, and so I went ahead
(04:29):
and applied for that as well,and it wasn't supposed to start
until January, I think I appliedfor it in like June or July,
and I was approved to do theyear long residency with the VA
hospital.
And then I got a call from theCP supervisor at the time saying
(04:50):
hey, we had someone drop out ofthe program, we need you to
come in August, and so I reallyhad to pray.
So I'm in long story short.
We ended up doing that about ayear, and three months there,
took a position as a PRNchaplain with Moffitt Cancer
(05:10):
Center in Tampa towards the endof that CPE experience and then,
after working for Moffitt for alittle while, I took a job at
Winter Haven Hospital, which atthe time was not part of Baycare
, it was an independentcommunity hospital and I was a
staff chaplain at that hospital,and not long, I think only
(05:36):
about a year and a half.
They had made the announcementthat we were going to go ahead
and sell the hospital to theBaycare health system to become
part of that system and themanager of the chaplaincy
program had retired and so theoperations director at the time
(05:58):
approached me and said, hey,would you like to manage the
chaplaincy program?
And so kind of ended up in thatposition through a bunch of
different circumstances.
And when Baycare came in theyhad a lot of community outreach.
They had a lot of internalprogramming, the mission piece
(06:19):
which is helping those folks inour community who are less
fortunate through food banks andconnections with those things.
An ethics program, what werefer to as faith community
nursing.
A lot of hospitals don't havethat, but those are nurses who
use their faith to serve theirfaith communities.
(06:44):
So you think of a faithcommunity nurse would be someone
who volunteers their time totake their expertise in health
care to their local church andbe that connection between the
church and those individuals tomake sure that they're better
taken care of when they leavethe hospital.
So that's a whole differentthing.
(07:06):
But in any case, baycare washaving all these new programs
and at the local level theydidn't know where to put them
and so eventually they juststarted putting them under me,
so they would put faithcommunity nursing under me and
palliative care under me and inethics and all these different
(07:26):
things, and so they weren'tthings I didn't have experience
in.
You know, when I was at the VAhospital, I got experience in
palliative care and experiencein ethics, but eventually we had
a new VP come in and say youknow what you're doing is you're
doing the work of a missiondirector, and so that position
(07:47):
was created for the Polk areaand that's what I've been doing
for quite a while now.
Speaker 1 (07:54):
Oh my gosh, what a journey.
You know, God is funny likethat, how he'll just, you know,
kind of turn things around.
And it's interesting how youstarted in healthcare and you're
in healthcare now you know,yeah, so that's terrific.
What a great story.
Yeah, thank you.
Yeah, so you talked abouthospital ethics committee, right
(08:20):
?
And that's part of what you do.
So how about we talk a littlebit about what the purpose of
that is?
Speaker 2 (08:28):
Sure, sure.
So.
So I can tell you that, youknow, in bake here we have both
a system ethics process and wealso have a process at the local
level.
So our hospitals have advisorygroups and these are
multidisciplinary groups thatyou know.
(08:49):
They include physicians andnurses, and maybe social workers
, sometimes community members,chaplains, and what it allows
the hospital to do, whether itbe the patients or the
healthcare workers or thefamilies, it gives them a
(09:10):
process for, you know, forseeking guidance and we call
that ethical consultation.
So that's part of what we it'slike.
It's like a stool with threelanes right.
So an ethics committee has threemain purposes.
One is to provide consultationso you know, anytime you have
(09:32):
difficult choices on the line.
It could be end of lifedecisions, it could be various
treatment options that peopleare facing there are.
There's tension between andI'll talk about this a little
bit but there's tension betweenthe ethical principles.
There's four guiding principlesand we'll go over those a
(09:52):
little bit, but consultation isone of the legs.
Another thing that an ethicscommittee does is we're the ones
who are looking at policiesthroughout the hospital and we
either systematically reviewthose, we're involved in the
development of policy, and allof these guidelines are related
(10:15):
directly to patient care.
They're directly to thoseethical matters that are going
to come up and you think aboutthe benefit of a policy, right?
So if you look at a DNR policyor a policy around the end of
life, these are things that areconstantly happening in your
hospital and so, instead ofhaving to constantly reinvent
the wheel, if you have a policythat addresses a specific area,
(10:39):
then you can align it withethical principles and you can
take care of any legalrequirements and you don't have
to constantly deal with thoseissues because it's kind of in
the policy.
And then the third thing we dois education and trainings.
So you have healthcare staffand, whether it's around general
(11:00):
ethical issues or informedconsent or advanced directives
or various topics, you'rehelping them to better
understand the ethical concernsthat are going to come up.
So if you look at those threethings that flow out of the
ethics committee, they're verysymbiotic, right, you're
creating an education spacewhere you're going to identify
(11:23):
people who have a passion forethics, so that feeds into your
actual committee and then thathelps you to train more
consultants and then that helpsyou to review policy.
And you know they all kind ofinterwork together.
So it kind of makes sense ifthat helps.
Speaker 1 (11:40):
Yeah, it does help.
You mentioned about advanceddirectives.
Did you want to talk a littlebit about that here?
Speaker 2 (11:48):
Oh yeah, no, I mean.
So you know in the healthcaresystem what those are.
They're specifically legaldocuments that what they're
doing is they're allowing apatient an opportunity to
express what they would or wouldnot want done in the worst case
(12:10):
scenario.
So you think, right, what wewould love?
And you have to realize thisright, all doctors want their
patients to get better.
There's not a doctor I've evermet who doesn't want their
patients to get better.
But we live in a world wherethat's not always the case.
Right, we have death, we havedisease, and we have to deal
(12:32):
with the realities of that.
And the thing.
One of the things and we werekind of going to talk about the
ethical principles, I'll justmention one right now.
It's autonomy.
Autonomy is your ability tomake your own decisions.
Right, you have the right tocome into a hospital and not
only be informed about what'shappening, but to make your own
(12:53):
decisions, and so an advanceddirective lets you express those
medical preferences ahead oftime.
So sometimes, what happens toindividuals as they get sicker,
they become incapacitated, andthat's a legal term.
It's also a term that we use inhealthcare.
That means that you can't makecomplex medical decisions, and
(13:14):
it could be because of aphysiological reason right,
you're in a phasic patient whocan no longer communicate
because of the trajectory ofyour disease process.
Or it could be because you'reconfused right, that you
actually have to have a consultcome in to evaluate your mental
capacity right, and sometimesthat can be a phycological in
(13:37):
nature.
Sometimes it could be a UTI orsome other unknown infection
could be medical.
So capacity is something whereit's always assumed when someone
comes into a hospital, that ishow we treat them.
But they are a fullyfunctioning, autonomous
individual with capacity.
Until there's a reason toquestion that, right.
(13:58):
So it is something that's veryimportant and the way that we
protect that is, we use a coupleof forms.
I mean, as far as people'sdecision-making, protecting
decision-making we use a formcalled a surrogate form.
A surrogate in Florida isanother legal determination.
We have surrogates and we haveproxies.
(14:20):
They do the same job butthey're assigned differently.
So if somebody comes into ahospital and they were a very
sick individual and they'reunable to make decisions,
somebody has to make decisionsfor them.
What we would prefer is to seethat they had an advanced
directive where they named anindividual that would be their
(14:40):
surrogate.
If they didn't, florida lawallows us to go down and order a
priority to find out who wouldmake the decision.
So typically it's gonna bespouse, then it would be adult
children, a parent, a relative.
It could even be a closepersonal friend.
But the problem with the proxyorder is we have to follow the
(15:02):
order.
So that's why I think it'salways best that someone has a
surrogate.
You wanna name a person whocould make decisions for you,
somebody you trust.
The other form we have iscalled a living will and that's
more prescriptive right.
You get to actually name inthere, line by line, what you
would or would not want, right,like if I had basically it's
(15:24):
stating if I had a terminalillness, if I was in a position
where I was not going to getbetter, like think things like
the advanced stages ofAlzheimer's, the advanced stages
of HIV or AIDS, the advancedstages of cancer, things where
I'm not saying you'll never findme saying that God can't do
(15:48):
certain things.
But medicine has itslimitations, right?
Doctors and medicine, they'rehuman beings, so we're limited
in what we can do.
And so people wanna know thatif I don't want CPR or I don't
wanna be kept alive on machines,they can stay ahead of time, in
(16:08):
those worst case scenarios,their preferences and that's
their right, right?
I mean, I get the frustrationfrom somebody who's not involved
in this all the time becauseyou're thinking, well, why would
you give up or why would you?
But that's not really what'shappening, right?
I mean this is just someone notgiving up but accepting the
(16:29):
reality of their situation.
I've always said to peopleconsider Lazarus right.
When he came out of the tomb hewas already gone.
So God doesn't need aventilator or machines or tubes.
If it's God's will thatsomebody is here, they'll be
here, and if it's God's willthat they're gonna go home,
(16:51):
he'll take them home.
So we don't have as muchcontrol over when that time
comes is sometimes we like tothink we do.
So it's better, I think, forpeople to plan to really
understand the healthcare systemand navigate it, because the
default of every hospital theseare acute care centers.
(17:12):
Their default is to treat.
That's their default is totreat.
So if you don't tell peoplewhat you want, they're gonna
treat you.
There's some other ones thatattorneys do locally, like a
durable power of attorney forhealthcare.
It's really the same thing.
It's just all wound up togethersurrogate and then line by line
(17:34):
like a living will.
And then in Florida we alsohave a do not resuscitate order,
and that one is specificallyabout CPR.
There are certain people whomight have congestive heart
failure or some of a chronicdisease process.
Maybe they do have stage fourcancer and they've been living
(17:56):
with just terrible pain and sothey wanna ensure that when
they're gonna go they wanna go Alot of times.
Elderly patients right when CPRwould result in cracking their
ribs and just a lot of.
(18:18):
If you've never seen CPR, it'sa very violent thing.
I mean it does save lives,don't get me wrong.
But there's a certainpopulation of people where
medicine is.
I've always said this medicineis like a double-edged sword.
Right, when medicine is makingyou better, it is wonderful, it
(18:40):
is God-given.
But when medicine is no longermaking you better, it can hurt
you.
We can continue to prolongsuffering in people beyond what
really we maybe should be doingethnically in healthcare
(19:00):
sometimes.
Speaker 1 (19:03):
And, as you're naming all these things, it goes back
to so, like the leaders that Iwork with, busy, busy people,
and I think as a society, wereally don't think about death
that much or getting sick andhaving an illness and having to
(19:26):
have these things in place, andwhat I'm hearing and thinking on
is that we really, when we arewell, we should be having these
things in place for the timethat perhaps they need to be
used Absolutely that's the wholeidea behind advanced care
planning.
Speaker 2 (19:44):
I mean that's the whole point.
The point is I get it.
I mean people that's not normalto fixate on death all the time
, right, I mean people justdon't do that right.
Speaker 1 (19:56):
It's the reality.
Speaker 2 (19:58):
Yeah, I mean, you know it's out there.
Yeah, you know it's out there.
I mean, some people they're alittle superstitious, they're
like if I talk about it, it'sgonna happen, which that's not
true.
But people get like that.
People are afraid to approachit with their parents because
maybe they think that theirparents are gonna think, oh man,
they're gonna think I want themto die so I can get their money
(20:21):
.
Most of the time that's nottrue.
Now, occasionally you're gonnafind people that are just
uncomfortable talking about it,and so I recommend to them look,
you should at least, right at aminimum, express to your loved
ones what you may want in theseworst case scenario.
(20:44):
I'm not telling you.
You have to write it down.
I think that's the right thingto do.
I think filling out a surrogateform is the right thing to do,
but at a minimum, at least talkto somebody so that you know
really if you think about it.
You know I have five kids, fivegrandkids.
My gift, right, I think, to mychildren, to my adult children,
(21:07):
is not having them feel likethey're making those decisions,
that they know what I feel aboutit, so that really all they're
doing is respecting my wishes,and I think you're gonna help
your own children when they haveto deal with the reality of
your death, which is gonnahappen.
Speaker 1 (21:28):
So it's like what you were talking about policy
before, and it's, you know, ourown personal policy.
This is how we want things togo, and I know my mother-in-law
is currently moving out of herhome and into a facility and we
were asked all these questionsand it's these are the things
(21:50):
that you know in theconversations.
It's in my head.
I'm thinking to myself, yeah,these are really needed.
And so, knowing that you werecoming on and I know Florida's
different right it is, it is sopeople would need to take a look
at their own state.
Speaker 2 (22:08):
So you know they are pretty reciprocal.
You know across the 50 states.
You know most of them,including the territories, are
going to respect your wishescoming in from another state.
But it is important if you'reliving in a different state that
you look and see what'savailable in your state Because
it may not be exactly the sameas what we have here.
Speaker 1 (22:32):
Good stuff, yeah, all right.
What else did we want to talkabout?
Was there anything on ethicsthat you wanted to share that we
didn't get to?
Speaker 2 (22:47):
yet I mean, I'll just say so, yeah, so an ethics
committee.
I'll explain this.
So it's different depending onthe hospital that you work with.
You know we happen to be aconnection you know, bay care, a
connection of communityhospitals and Catholic hospitals
(23:11):
, and so we have a real missionconnected to everything we do,
which means in our ethicscommittee we have appointed
chairs, and so the missiondirectors, which we have four of
them in the various regionsthat serve the hospitals and the
communities.
They chair the ethics committee, and so that ensures that you
(23:34):
know the missions and the goals,the guidelines for the
committee, the direction for theethics committee is the same
right.
So no matter what hospital youfind yourself in within Bay care
, you're going to get the samegood ethical care, and all of
our hospitals have thoseunderlying principles.
(23:55):
So I kind of mentioned that alittle bit.
Let me go ahead and just namethem off real quick.
So I talked about autonomy,right, and that is the respect
for the patient's right to selfdetermination.
They use an individual.
You get the final say as towhether or not you do this or
that in health care People.
(24:17):
So back in the day, doctors werevery paternalistic.
It started that way, where youwere like the child, and they
were the parent.
And there was a woman in NewYork.
There's a famous case where thewoman was visiting, I believe,
from California to New Yorkhospital and she had pain in her
(24:40):
abdomen and she went in to seethe doctor and she consulted
with the surgeon and he saidwell, I believe you have fibroid
tumors.
And she said well, you can, Iwant you to evaluate.
You know they had to do aninternal evaluation, but I don't
want you to remove them.
(25:01):
She wanted to go back toCalifornia.
Whatever she wanted to do, shewas directing the doctor what
she didn't want done.
This was at the turn of thecentury, so it was a long time
ago.
But they put her under ether.
He saw that they're tumors andthey were big and he removed
them.
He did exactly the opposite ofwhat she because he believed
(25:24):
that was what was best for her.
And so when she awoke, ofcourse she was angry and she
went before the judge.
She actually sued the hospitaland won, and so that was kind of
the beginning of the idea thatreally patients have the same
over their own medical treatment.
(25:44):
And so autonomy is a highprinciple in ethics and we want
to respect people's autonomy.
There's two bookends we talkabout.
One of them is beneficence.
Very simply just means toalways do good, right,
everything should be to thebenefit of the patient.
And then the other bookend isnon maleficent.
So that just means to don't doharm.
(26:06):
So do good, don't do harm,don't give people interventions
that they don't need, don't dothings that are violating
someone's autonomy.
And then the last one we lookat is justice, and that's just
to make sure that all people aretreated equally and fairly
within the health care system.
(26:26):
And so, when you take those fourprinciples, a lot of times an
ethical dilemma is when thosethings are butting up against
one another, right?
So maybe the family'sdisagreeing with the physician,
or the patient doesn't think thetreatment is going the way they
think it should, and so that'spart of the role is to make sure
(26:46):
that our consultants are alwaysprepared to offer that advice
to our health care system, toour patients, to our families,
and it's important that peopleknow that ethics committees when
they come to a decision, it'snot law, we're not telling
(27:06):
people, we're only offering ouradvice on the situation.
Ultimately, there's a lot ofdecisions really that the
patients need to make or thedoctors need to make, and
they're seeking some guidance onthat.
So that's what we do.
Speaker 1 (27:21):
So, as a committee, do you have people coming to you
, or is it that the consultantsare the people that?
Speaker 2 (27:30):
perhaps.
So you have a larger committee.
We have about 12 people, 14people on the committee.
Not everyone on the committeeis a consultant, and so the
consultants will work in thehospital.
They're normally individualsthat have the time, because we
have a four quadrant model thatthey walk through and they look
(27:53):
at the case itself, they reviewthe medical chart, they meet
with the patient and the familyand the physician, so it is
involved.
Right, if you're going to offersome advice, you need to know
what you're advising on.
So not everyone who serves on anethics committee serves as a
consultant, but anyone on anethics committee may have a
(28:16):
consultant reach out to them,right, to talk about a
particular case.
Right, because they may havesome expertise.
Like, for instance, we havesomeone who is over our
infection control person, right,so you know she's spent years
doing infection preventionwithin hospitals, so she may be
an expert, you know, in certainareas.
(28:37):
And then, of course, physiciansoffer really good advice, you
know, from a little bit.
Now, we don't necessarily havephysicians serve as consultants,
and that's just because theremight be a little conflict of
interest, right, not that theycouldn't do it, but it turns out
better if you have someone whois disconnected from actually
(29:03):
being able to write an order orjust correct it with a snap of
the finger.
You know.
Speaker 1 (29:09):
No, that makes sense.
Oh well, I'd love to talk alittle bit about AI and ethics.
Speaker 2 (29:16):
Everybody does.
I mean.
Speaker 1 (29:18):
I know it's like it's out there and you know I myself
am trying to you know, justlearn as much as I can from you.
Know various people and aspects.
There's a lot of conversations.
You know both.
You know positive and negativeand some people landing in the
middle, depending on what it isand how it's being used and
(29:40):
who's using it and what not I'dlove to hear your thoughts and
maybe how your committee has orhasn't kind of touched on it.
Speaker 2 (29:51):
So, like I said, you know, so we have a local ethics
committee that covers thehospitals, you know.
But I, as an ethics chair ofthat, you know we're not dealing
with AI, but it is something atthe system ethics level, which
I'm part of that group, right,and we have a system ethicist as
well.
(30:11):
So I can promise you thatBaycare has a seat at the table.
You know, when it comes to theimplementation of AI, they've
put a lot of ethics to have aseat at that table.
So you know what it's gonnalook like.
You know it's so hard to say.
I mean, like you said, there'spositives and negatives.
(30:31):
I mean I just think abouttechnology in general, right, I
mean things that has been, hasbeen like helpful, right, like
it's not always harmful to haveword processors, so I'm glad
that I don't have to lug atypewriter out, you know, out
onto the patient floor.
(30:52):
Word processors, cell phones,right, I mean we have this whole
suite of software calledPatientSafe that connects all
the nurses and ethics andeveryone, and it all just worked
so smoothly.
Just the idea of an electronicmedical record you know, when I
started in healthcare we werestill writing our stuff in paper
(31:13):
charts, I mean, and stuff wasjust being, you know, stored in
a gigantic warehouse.
So you know AI, I think you knowit is gonna be helpful.
I don't think it's always gonnabe a bad thing.
We have an initiative in Bakercalled Zero Harm, where
obviously you know you wanna aimthat everything you do does not
(31:36):
harm the patient.
And so when I think about ZeroHarm, when I think about
preventative health right,preventative medicine I imagine
AI is gonna be a good thing.
Right, it's gonna be precise,like, think about x-rays and
scans and things like that whereyou're trying to identify a
(31:58):
disease.
Right, maybe you need it.
Earlier you can identify it,the better, and you know we're
gonna have better patientoutcomes as it gets integrated,
we're gonna have less inaccuratediagnosis, right.
So it's a tool.
We just went through a pandemic, right?
Would it be used to be able topredict future outbreaks?
(32:20):
You know, if we have a largeenough database, if we have
enough resources in there, canwe look at waves of demand and
healthcare.
So there's lots of like thingson the horizon, but you know, I
don't wanna be the Pied Piper ofAI.
Right, I mean, there arenegatives.
There's things.
We have to look at both sidesof the coin, right.
So we just we talked abouttechnology being good.
(32:44):
I mean, hey, at the same time,we have an entire generation
that does not have a spellbecause we use word processors.
You got too much screen time,you know, for your kids,
everybody's face is stuck in aphone.
We rely on copy and paste toomuch, right.
So we have all thesetechnologies, but things that
are legitimate concerns One ofthe big ones in AI I think that
(33:06):
we've talked about at a higherlevel is gaps in privacy.
Right, we take that veryimportant.
You have private healthinformation and it is your
information, and so, as we givegreater access to these systems,
that's gonna be a challenge.
That I don't know, that we havefigured that out yet, right?
(33:27):
So I don't think we're gonnamarch directly to just creating
these gigantic databases untilwe look at what are the real
concerns of people's privateinformation remaining private.
Another thing I thought aboutis AI is never going.
I don't think AI will ever beable to duplicate the insight
(33:47):
and empathy of a human being,and you know, I think that
people bring that to theirdecision making, and so there
are nuances in healthcare.
So AI as a tool can be helpful,but we don't want to rely on it
.
And then another thing that wetalk about and I think this is a
(34:11):
legitimate concern is jobreplacement.
Right, we have a lot of jobs inhealthcare that are routine and
task, and do we really wannareplace humans, you know, with
technology?
and at what rate, and so thoseare real things we have to
consider.
I think we talked about thisbefore.
(34:34):
I think I kind of said and Iwouldn't first say this but
we're like lying to plane whilewe're building it, because AI
came on the scene so fast.
But I can assure you that, at asystem level, ethics has a seat
at the table before weimplement this type of stuff.
Speaker 1 (34:52):
That's good to hear, because that is one of the areas
where, you know, I'm kind ofitching my head about is like,
okay, you know there's a lot ofgood, but there's a lot of you
know whose hands it's in andwhat it's being used for, and
that makes it kind of, you know,piques my interest into
(35:12):
thinking about it more deeply.
Sure and even-.
Speaker 2 (35:17):
I can't even imagine being a high school English
professor right now.
I'd probably be pulling my hairout.
Speaker 1 (35:22):
Yeah, well, that's you know, I adjunct.
And one of the things is it'slike when all of a sudden
somebody's writing is just sopristine where before it wasn't
you know, I kind of have to say,okay, is it because of my
wonderful feed forward feedbackthat I'm giving you, or-.
Speaker 2 (35:42):
Right, or did a computer writer for you, but
it's still, to this point, rightand maybe this will change.
I still think there's nuance,there's humanity that I don't
know, that they can duplicatethat.
Speaker 1 (36:01):
No, I mean we each uniquely made, you know, and we
are creative beings and ofcourse you know it's helped
create these.
Speaker 2 (36:10):
You know crazy things that were Look everybody has
had a curiosity went on a chatGPT and put a command in there.
I think I put in there one timeto like I have a comedian I
can't remember his name butthere's a couple of comedians I
like I think they're prettyfunny and I said write a joke
about a particular subject inthe style of this comedian.
(36:36):
And it was not funny, it wasawful and it was nothing like
them.
So now we're not quite thereyet.
Speaker 1 (36:44):
Well, speaking of chat, gpt, you know there's so
many others.
That's the one that everybodytalks about.
There's many out there now andthat have been coming and then,
all of a sudden, you know, withopening eye, that's really been
the one that people talk about.
But I was in the car yesterdayand they were saying that they
(37:04):
were actually talking about CPRand they had said how, you know,
don't rely on you know yourvoice, you know asking how to do
CPR, because I think it waslike nine out of 20 didn't say
automatically call 911, you know, I always want to be doing that
, and so there are somedownfalls, and if we as a
(37:27):
society are constantly relyingjust on that, I think we're
going to be a law society.
We need to still have ourthinking caps on, as my mother
100%.
Speaker 2 (37:37):
I couldn't agree more .
Speaker 1 (37:41):
Oh well, joe, this has been a great conversation.
I appreciate you and yourknowledge, your wisdom around
ethics and you know the goodwork that you're doing within
the hospital system and, gosh,just really good.
Was there anything left thatmaybe we didn't touch on that
you just want to share?
Speaker 2 (38:01):
No, I mean, I think I think we got most of it.
You know, I think you know AIis a good thing to end on
because it reminds us that youknow you're always going to have
to have the human touch.
You know, and as long as thiswhole world is spinning around,
my thoughts is you know, whetherit's ethics or whether it's
(38:22):
patient care or whether it's AI,is something simple, always
apply.
So I always think the goldenrule right Do unto others as you
would have them do unto you.
If you can keep that justsimple thing in focus, I think,
any of the challenges we face inlife or in healthcare if you
(38:44):
remember that, that you need toalways treat people with dignity
and respect at the core of whatyou're doing, because you know
we have values that underpineverything we do in this health
system and I think if you cankeep those values, you can
always do things well.
Speaker 1 (39:05):
Absolutely, Absolutely.
That's a great note to end onConnect with you.
Maybe it's like, hey, I want toknow how he does what he does.
This is an interesting you knowfield maybe I'd like to get
into, or something like that.
How can people connect with you?
Speaker 2 (39:22):
So they can always drop me an email.
That's fine.
So it's mrjoeid at iCloudcom.
I don't mind sharing that.
So, mrjoeivei at iCloudcom, orthey can find me on LinkedIn.
It's under Alfred Joe Ivey.
(39:44):
I think that's where we connect.
It's with LinkedIn whereeveryone connects.
But you know, drop me a messageand I'll be happy to respond.
Speaker 1 (39:53):
Yeah, I mean, maybe there's a medic out there who's
like hey.
Speaker 2 (39:57):
I'm going to go.
Hey, you never know.
Speaker 1 (39:59):
I want to be a missions director.
Speaker 2 (40:02):
You never know.
We're always planning for whoreplaces us, hopefully.
Speaker 1 (40:08):
You're feeding into the next generation.
All right.
Well, you keep doing greatthings and we'll see you soon,
all right.
Speaker 2 (40:14):
God bless.
Good talk to you, bye, thankyou.
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