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Bioethics Meets COVID-19 Pandemic: Part 1

Written by Andrew Le, MD

PublishedMarch 27, 2021

Welcome to the CEO Corner, where Buoy CEO and Co-founder Andrew Le, MD, sits down with industry leaders to chat about the provocative topics of healthcare today. Andrew recently spoke with Tia Powell, MD, a psychiatrist by training, whose impressive career has been focused around bioethics—the challenges associated with clinical ethics.

This interview has been edited and condensed for clarity.

Andrew Le, MD: Tia, welcome to our Healthy Thoughts blog—I’m so excited to dive into your thoughts on ethics surrounding the pandemic. Maybe we can start off with you sharing a little bit on your background and how you’re currently plugged into the COVID response?

Tia Powell, MD: Andrew, I’m happy to be here. I've been able to move around within bioethics, because it's a small field. For four years, I ran New York State's bioethics commission, the New York State Task Force on Life and Law. In the beginning of my career, I ran the Bioethics Consult Service at Columbia Presbyterian in NYC. And now I run the Center for Bioethics at Albert Einstein College of Medicine and Montefiore Health System up in the Bronx. We're the largest employer by far in the Bronx—and a health system and a community that was brutally hit in the initial peak of COVID. I’ve spent a lot of time wondering: How did the pandemic affect us, as a nation, so powerfully? Why were we so ill-prepared? What are the take-home lessons? What can we think about to do better and what's happening now?

Andrew Le, MD: Tia, there’s no doubt this past year has been quite challenging. But flipping the script a bit, I’m curious, across your different roles within bioethics and then also thinking about what you're charged with now, what brings you the most joy at work?

Tia Powell, MD: I love that question, Andrew, because in medicine, I feel like we're always trying to think about how to keep the bad things from happening. We rarely get to think about what would or could be flourishing. What would make people happy? It’s important to think about joy at work. I love teaching. I love the flexibility and the opportunity for intellectual creativity in academia. So, tying into current events, I quickly put together a seminar on Bioethics for Pandemics this past fall. It was a really rousing class, with great students, frontline clinicians, serious people, everybody together thinking outside the box.

Defoe’s account of the Great Plague of 1665 has startling parallels with today.

For the class, I took Daniel Defoe's part fiction, part historical account of an epidemic in London in the late 1600s, and combined it with contemporary articles from the New England Journal, legal cases, and public health policy. It was incredibly interesting. The ability to explore and to intrigue people brings me joy. I like to compare teaching to the making of a cat toy. You want to intrigue people. You want them to be curious: "Wait, what is that? What is that? What do you mean? That's not right." I love to get everybody’s brains ticking like that. I’d say that's my approach, and why I do what I do. I want the "cat toy" feeling in education.

“I want the 'cat toy' feeling in education.”

Tia Powell, MD

Andrew: I love that. Maybe you could give us the privilege of sitting in on the class that you taught, Bioethics During Pandemics. What do you think was the most interesting question or debate you had during the course?

Tia: I’d have to say it was around Daniel Defoe. We were all blown away reading his work because it felt so contemporary. He approached the piece from a historic point of view, but he fudged it because he wasn't old enough to have remembered. He provided data similar to weekly morbidity and mortality reports. It was clear the government was faking the data. They were trying to keep people calm by hiding how many people in London were actually dying. And, wow, look at that! People in the poor sections were dying in droves. My students couldn't believe how little has changed. How little we've learned, and how similar the panic and the temptation to obscure data and hide what was really going on. Horses became rare, because everybody who was rich enough to have a horse, rode it out of town. That really blew people away. How was that story from 1690?

Illustration from a 17th century pamphlet on the effects of the plague on London. Photograph: Science History Images/Alamy

In Part 2 of the conversation, learn why Tia is dialed into the concept of moral distress around healthcare decision-making, with both patients and clinicians and in terms of policy and population health. What are the things that we could—and should—do better as a society? Tia touches on how and why the field of bioethics has truly missed the boat on issues like systemic racism and has been much more inclined to focus on the simple relationship of one clinician and one patient. In fact, she believes the largest ethical failure of our system is really the whole system overall.

About the participants:

Tia Powell, MD, is a bioethicist, psychiatrist and epidemiologist. She directs the Center for Bioethics and Masters' in Bioethics at Montefiore Health Systems and Albert Einstein College of Medicine Fellow at Hastings Center.

Andrew Le, MD, is the CEO and Co-founder of Buoy Health.

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