A GVSU clinical ethicist reflects on lending expertise during a once-in-a-century health crisis

For generations of Jeffrey Byrnes's predecessors in philosophy, a pandemic such as the one we have experienced remained a thought experiment used to contemplate ethical issues surrounding emergency clinical decisions, scarce medical resources, vaccination protocols and more.

Fate held a different professional path for Byrnes, an assistant professor of philosophy who has been called upon repeatedly to put his training into action for the COVID-19 pandemic.

As he reflected on his work, in particular during the intensity of the pandemic's darkest times, he said: "The philosophical education was the right preparation and the ethical theory principles led to the right approach, but there are always bumps in the application. We learned a ton of things and most of those things were about exactly the kind of logistical barriers we would face in putting that theory to work."

Observing and advising on the application of those ethical principles provided a wealth of knowledge for Byrnes, his colleagues, and the students he worked with during the pandemic. His pandemic work has ranged from individual patient cases in hospital settings to the community guidelines provided by public health departments. That work continues, including a deepening collaboration with the Kent County Health Department on updated ethical guidelines.

A recurring thread in the knowledge gleaned from the pandemic is how essential it is for those in the health care field to be transparent about what they're doing and why when it comes to such a public event, Byrnes said.

"Often, when officials were tempted into acting with expediency and being less transparent, they paid a price for that," Byrnes said. "Think about how sometimes organizations refer to their ‘messaging’ as opposed to their ‘communication.’ Communication implies simply revealing what the institution is doing, while messaging suggests directing listeners to a desired conclusion or behavior. But, the minute the public feels that they are being steered toward some end without having been given the relevant information, they will resist. Once that trust is lost, it may take generations to get it back."

Byrnes said the issues encountered during the pandemic also underscored the broad importance of clinical ethics in the health care field. 

He answered middle-of-the-night calls from rural hospital administrators agonizing over temporarily closing overwhelmed emergency departments and the impact on patients who would need to travel greater distances to get help. He said when hospitals halted surgeries, he witnessed surgeons desperately advocating for groups of patients who didn't have coronavirus but needed immediate intervention for other problems.

And ethical considerations around vaccines were a continuous conundrum, from determining priority to ensuring access to working through issues involving those who were unvaccinated.

Byrnes said the pandemic has spurred an increase in interest in GVSU's health care ethics minor. One person who as a philosophy student had an interest in health ethics before the pandemic started, then finished studies as it was taking hold, is now working as a clinical ethicist and peer review specialist for the Sparrow Health System.

Julia Mariotti, '20, said the work as a Grand Valley student provided a base for learning how to communicate effectively and with empathy, keeping in mind that ethicists are working with people at their worst moments. Mariotti said work during the pandemic involved difficult conversations with patients and family members about treatments and sometimes accepting what interventions could be offered.

"Training during the pandemic gave me confidence in my skills and my abilities and it gave me confidence in my ability to explain why clinical ethics is so relevant," Mariotti said. "I will likely not encounter anything this difficult throughout the rest of the career, so I appreciate the opportunity to use the knowledge I have found and to make some positive changes in a post-pandemic world."

Also looking ahead with the aid of insight from Byrnes is the Kent County Health Department. Karla Black, deputy administrative health officer, said Byrnes was a valuable colleague as the department navigated pandemic-related situations.

Now, department officials are working with Byrnes to develop a comprehensive ethics process that includes the optimal composition of an ethics committee and what factors would send an issue to that committee. Byrnes is providing counsel, as well as research and data, to support the process.

"It's been really great to have him help us look at these problems through a whole different lens," Black said. "We're all trying to help the public but there is this push and pull of personal freedoms and potentially the law, but also how to distribute resources in a way that's ethical. There are so many pieces and parts of ethics that we live in every day."