12. Ethics of Vaccine Mandates w/ Charles Binkley, MD, FACS

In this episode, we discuss the ethics of mandating people to receive the COVID vaccine (vaccine  mandate) and whether this is prudent. Nothing is black and white in this episode and our guest is Charles E. Binkley, M.D., F.A.C.S., Director of Bioethics at the Markkula Center for Applied Ethics at Santa Clara University.

Dr. Charles Binkley, an experienced cancer surgeon, bioethicist, and health care quality leader, directs the bioethics program at the Markkula Center. Dr. Binkley attended Georgetown University School of Medicine and completed his surgery training at the University of Michigan where he was awarded an NIH fellowship in pancreatic cancer research. Dr. Binkley has served on the Committee on Ethical, Legal, and Judicial Affairs of the California Medical Association, as well as on the Board of Directors of the San Francisco Medical Society.

Dr. Binkley is a Fellow of the American College of Surgeons and also directs the Health Care Ethics Internship and Honzel Fellowship in Health Care Ethics at Santa Clara University. His research is focused on the ethical application of AI clinical decision support systems as well as surgical ethics. His research and writings have been published in Cancer Research, Annals of Surgery, Journal of the American College of Surgeons, STAT News, and America Magazine.

Dr. Charles Binkley, MD, FACS links:

https://www.linkedin.com/in/charlesbinkley/

https://www.scu.edu/ethics/about-the-center/people/charles-binkley/

Twitter: @CharlesBinkley

 

Music Credit:

Jason Shaw from www.Audionautix.com 

 

THE IMPERFECT SHOW NOTES

To help make this podcast more accessible to those who are hearing impaired or those who like to read rather than listen to podcasts, we’d love to offer polished show notes. However, Swift Healthcare is in its first year. 

What we can offer currently are these imperfect show notes. The transcription is far from perfect. But hopefully it’s close enough - even with the errors - to give those who aren’t able or inclined to audio interviews a way to participate.  Please enjoy!

Patrick Swift, PhD, MBA, FACHE: [00:00:00] Folks, welcome to another episode of the Swift healthcare video podcast.

[00:00:03] I'm Patrick Swift. I'm delighted that you're here and I have a wonderful guest for you for this episode, Dr. Charles Binkley, Charles. Welcome to the show.

[00:00:11] Charles Binkley, MD, FACS: [00:00:11] Thank you, Patrick. It's a real pleasure to be here.

[00:00:14] Patrick Swift, PhD, MBA, FACHE: [00:00:14] Yes, I'm delighted. And, and Charles, Dr. Brinkley is, is, uh, based out of currently California. So you can feel the warmth for those of you watching this episode can feel the warmth. And if you're listening, I just want to encourage you to feel that California warmth and those rays. So Dr. Charles Binkley is.

[00:00:32] Listen to this. He's an experienced cancer surgeon, bioethicist and healthcare quality leader. He directs the bioethics program at the Markkula center at Santa Clara university, the Jesuit university of Santa Clara of Jesuit university of the silicone Valley. I'm happy to throw that in there cause I love the Jesuits.

[00:00:50]Dr. Binkley attended Georgetown university school of medicine, go G-town. And completed a surgery training at the university of Michigan awarded an NIH fellowship in pancreatic cancer research. Do you hear the theme here of ethics and care? Dr. Brinkley has served on the committee on ethical, legal and judicial affairs of the California medical association, as well as the board of directors of the San Francisco medical society.

[00:01:14] He's a fellow of the American college of healthcare surgeons. He also directs. The healthcare ethics, internship, and Honzel fellowship in healthcare ethics at Santa Clara university. Dr. Brinkley, thank you so much for being on the show.

[00:01:27] Charles Binkley, MD, FACS: [00:01:27] Patrick. It really is a pleasure to be with you this afternoon. And it is 70 and sunny out here in San Francisco. You can see the sun coming through the window here, but after having spent seven long, cold years in Ann Arbor, I feel like I deserve at least a couple of decades of California sunshine.

[00:01:43] Patrick Swift, PhD, MBA, FACHE: [00:01:43] Absolutely. That is good karma. That is a, the universe coming through and I can feel that warm. So thank you. I'm broadcasting out of Maplewood, New Jersey. We're still hoping for that. Uh, in the New York city tri-state area, we're still hoping for that warm weather. So, uh, I'm glad you're here, Charles. And, and we're talking in this episode about ethics of vaccine mandates with Dr.

[00:02:04] Charles Binkley MD. So. Let's jump right into this. And how did you get into this work overall?

[00:02:11]Charles Binkley, MD, FACS: [00:02:11] Well, my involvement with ethics really spans my entire career and it's taken different forms from, , chairing clinical ethics, consult committees and, and major hospitals. , to working on ethics, education, you know, how do you teach, , healthcare providers, ethical behavior? How do you instill in them? , the things that we profess and that patients expect from us.

[00:02:32]and then also, how do you create policies that guide, , healthcare professionals, when they face ethical dilemmas? And so I haven't been involved with it in my entire life. And also thinking about, you know, some of their specific ethical issues that cancer patients face that physicians caring for cancer patients face, , that surgeons face.

[00:02:51] You know, I used the opportunity, , to segue into a different phase of my career where I'm dedicating most of my time to, , ethics, to teaching. , to writing and research and then also doing a clinical ethics consultation in healthcare quality consultation. So that's really, you know, my path, , to my current position.

[00:03:11] Patrick Swift, PhD, MBA, FACHE: [00:03:11] and I love the path that this, , this thread that you have shared is from the clinical care to the surgical care, to then integrating that into what we do and, and supporting healthcare providers and leaders and being ethical in what we do. So help me unpack ethics because, , you know, I've got a PhD.

[00:03:30] People argue as stands for piled higher and deeper (LOL). Um, when we talk about ethics, , it means different things to different people. So, , could you share with the audience what you mean by ethics?

[00:03:42] Charles Binkley, MD, FACS: [00:03:42] Yeah, absolutely. And it's a great question. So I always start from the idea of a profession. So, , healthcare is considered a profession, whether that be as a healthcare provider, a healthcare leader, a healthcare executive. It's considered a profession. And so a profession begins by an assumption. There are things to which members of that profession, profess , and things that the community that the public can expect of members of that profession.

[00:04:09]And so what are the things that the community of healthcare providers, the healthcare leaders profess. So first of all, it's to do good and avoid harm, and that's sort of the cornerstone of the profession. So based on that profession, , then you can distill certain ethics. And so again, the ethical translation of that is that, you know, we will prioritize our patients that we will do good to them, and the tools of medicine can be used for good and for harm, you know, everything that we do as a surgeon, I was, you know, acutely aware of that.

[00:04:36] Every time I wilted. A scalpel, it can, can heal and it fell so harm. And so what we profess is that these tools that we've inherited will use for good and avoid harm to the best of our abilities. And also in that is that we will not necessarily define. Benefit and harm by our value system, but by the patient's value system.

[00:04:59]And we'll, we'll come to a place where we use the tools of our training and our experience, our professional responsibility, but also really listen to the patients and engage them and their decision-making. And so that it's, it's not, it's not only joint. , but it really is. We each guide the other to come to what is right in that situation.

[00:05:18] And then, you know, we oftentimes think of justices, you know, am I treating the patient in front of me the same way that I treated the last patient that I saw and the next patient that I'll see. But I really think that, that our challenge as healthcare providers is to think about justice much more broadly. And it's not only, it's not just about the individual patient in front of you, but our all patients having the same level of access to care that I'm providing. And I think about this, particularly in the context of cancer care and right now in the context of vaccinations for COVID, but you know, to think about cancer care, right.

[00:05:50] You know, are we concentrating high quality cancer care only in large academic medical facilities and taking it away from public hospitals, , in an attempt to improve care. So the idea is, is that healthcare quality, you know, the more you do, the more you concentrate, the more you have different disciplines and interdisciplinary discourse, a higher quality of the care is, but as you, as you move some of those resources.

[00:06:13] Away from, , public hospitals away from rural hospitals, you may actually be cutting off your nose to spite your face. So the very patients who need that may not have access to it. So the intentions again are based around beneficence non-maleficence, , but you may not really be considering autonomy and justice in that equation.

[00:06:32]Patrick Swift, PhD, MBA, FACHE: [00:06:32] I appreciate the thread of what you spoke to about. What we profess as professionals. It connotes what we profess in our faith and our belief system, which drives us and the, the profession itself. And then the, the coming together of the heart and mind about recognizing a clinician, a physician, a therapist may have a different set of ethics and to acknowledge that , those that we take care of may have a different set.

[00:07:00] Charles Binkley, MD, FACS: [00:07:00] Oh,

[00:07:00] Patrick Swift, PhD, MBA, FACHE: [00:07:00] do we come together? I love that point. I mean, I love all you said, but I, that stands out to me as the, the heart of what we do, because we are human beings caring for human beings. And if we're truly being that kind of clinician leader, whatever it may be, we're acknowledging the humanity of the other person.

[00:07:18] Charles Binkley, MD, FACS: [00:07:18] That's absolutely right. And that's what binds us all together, but it becomes tricky is when those of us professing this. Um, really incorporates other, other people, other entities, other businesses that don't have that expectation. So for instance, you know, healthcare and technology now are forming lots of relationships and technology doesn't necessarily have that professional or that societal obligation that healthcare does to do good and avoid harm.

[00:07:46] So we, we have to be very excited. Listen about these relationships. Yeah, we have to be very explicit. , the other thing that's happening, , is how this idea of justice. , is effecting vaccine rollout and, , lots of places. , there's this balance between, you know, how stringent are you, how much do you require people to prove their age or proved their profession or proved they're in their correct here?

[00:08:09] Which disincentivizes people. So had you read there, let a few bad players in. , or create a very rigid system that keeps some really good people out. Particularly people who may be undocumented, people who may be elderly and not able to, , produce the sorts of documents they need in order to get vaccinated.

[00:08:27] So in my way of thinking about it, you're always going to have the people who tried to cut the line. We learned that in kindergarten. Right. But what you really want to do is make sure you lift up those people who may not ordinarily have access and make sure that they get in, and then they're also, , have their place in that line.

[00:08:45] Patrick Swift, PhD, MBA, FACHE: [00:08:45] one of my other guests on the show has been Dr. Steve and Rumery. And we had an episode on restorative leadership and Dr. Rumery is helping supporting the one campaign and, , equity and distribution of the vaccine. And you're touching on the fact that there's that human nature, that there's always the.

[00:09:03] Person who. Attempts to jump in line or who does jump in line. And, , what's coming up for me is do we base our rules on fear that there may be a jerk or do we base our rules on add my arm DEI. Gloriam helping. To the greatest glory to the greatest good are rules-based on helping the most and doing the most good or our rules based on fear to make sure someone can't edge the system.

[00:09:28] It's it's uh, this is delicious. What you're saying is, and I want to talk about the, the, the, the ethics of vaccine mandates too. And so how does that fit in with this to Dr. Brinkley?

[00:09:38] Charles Binkley, MD, FACS: [00:09:38] So the idea behind vaccine mandates (vaccine mandate) is it really is the most efficient way to reopen certain parts of, , society, , certain benefits that society has come to expect, , in a way that is safe. , and that protects everyone particularly the most vulnerable. So th th just going back to the vaccines, you know, part of getting a vaccine is not just to protect yourself, but it's to protect the rest of the society is a reciprocal relationship.

[00:10:04] So I do this not only for my good, but also for your good, and so, There are certain sectors of society that simply can't always engage in risk reducing activities. So let's take, for instance, getting on an airplane and , , you just, you can't socially distance. There are medical emergencies on airplanes that require close contact between flight attendants.

[00:10:27], and sometimes passengers with each other. , these aren't always anticipated there. They're usually, , surprises that happen. Just the flight attendants in their job. Can't always socially distance, between passengers, , mask mandates, , flight attendants have been forced in this really uncomfortable position of.

[00:10:47] Performing the job of police in the air and making sure that people have on their masks and, and the, the, the airline industry has been decimated. In terms of its income. You know, people are afraid to fly the CDC, you know, putting out warnings about flying about travel. And so people aren't flying. So in my mind, the most efficient way for the airline industry.

[00:11:11] To both meet its ethical obligation to ensure the safety of passengers and its employees, because really that's, that's the foundational ethical obligation of airlines. That's why we cancel flights. When the, when it's, when there are tornadoes, there's this? Why, if the engine isn't forming performing well, we cancel flights.

[00:11:30]So safety is the cornerstone of the airline industry. And what better way to ensure the safety of its employees and the passengers. Then to mandate that they receive a COVID 19 vaccine and there are some legitimate exemptions, , for instance, you know, there's, we haven't completely proven the safety of the vaccine and pregnant persons.

[00:11:50], and so there would need to be a conversation there. , some people may have, , some objections to the vaccines, , on religious grounds. However, the Catholic church. , one of the most, , ardent critics of abortion has been very clear that all of the vaccines are morally permissible and has even gone so far as to say that Catholics have a moral obligation to receive the vaccine as an act of charity.

[00:12:13]but, but, but it's not reasonable for passengers to claim autonomy. So you can claim autonomy when it comes to making healthcare decisions with your healthcare professional, but airlines have no obligation to respect an individual's autonomy. And in fact, you lose some of your autonomy when the door's closed, you can't get up and walk around where you want to.

[00:12:33] You can't smoke when you want to, you can't sit where you want to. So. If someone doesn't want to get the vaccine, that's fine. There's no ethical loss from not flying you. There's no obligation to provide service to people who don't want to cooperate with the rules.

[00:12:49]Patrick Swift, PhD, MBA, FACHE: [00:12:49] I love it and being, gosh, you, the way you put this together is so eloquent to acknowledge the, the greater whole of us. Right. That,

[00:13:01]professionals healthcare professionals, non-healthcare professionals that are stridently adamant that they have rights. And this is an oppression of the rights and you make a beautiful point that enjoy your rights. Just don't get on a plane. If you're going to be a risk to others. And the notion that there's the, the greater, the greater whole of us.

[00:13:19]

[00:13:19] Charles Binkley, MD, FACS: [00:13:19] Exactly. And I'd rather incentivize people to get vaccines than punishing them for not. Right. And, and I, I would probably have greater concern if the government came out and mandated vaccines (vaccine mandate), because then how do you enforce that? What do you do to people who don't get vaccines instead, incentivize them and say, so you want to fly great.

[00:13:36]This is what you need to do. You need to be able to show the true, safe to fly and the way that you do that as a, to show proof of your vaccination. I think there are other sectors in which it would be, uh, Ethical. And in some ways, , desirable, , to require vaccines. I published an article recently looking at churches and saying that, you know, churches have really, , they've, they've raised a ruckus to say, we want people to be present.

[00:14:03] And people have said, I want to be able to worship in person. And I think those are admirable goals, but it also has to be done safely. You don't want to kill people in the process. , and so one way to reopen churches, , safely and efficiently is to, , essentially require the church goers be vaccinated.

[00:14:20] You know, I think about my own family, , we're uh, going to be visiting my in-laws. We haven't seen them. We've seen them distanced several times that we haven't actually. Then with them physically to hug them, , to sit at a table with them in a, over a year. And so we're, we're going to hit that point where we've all been vaccinated in about three weeks and we've had two weeks after our last vaccinations.

[00:14:43]And we're really looking forward to being with them in a way that's safe for everyone. Uh, and that we don't have to, to worry quite as much, , about, , getting infected manufacturing, someone else.

[00:14:55] Patrick Swift, PhD, MBA, FACHE: [00:14:55] Yeah. Yeah. And thinking about again, the greater good, and that's an act of charity as an act of love that you're going through this vaccine in order to not only take care of oneself, but also to take care of others. So I love, I love that example. Do you, um, please go ahead.

[00:15:11] Charles Binkley, MD, FACS: [00:15:11] no, it's also, so we can take care of other people too, because if we get sick, it's not just our own illness, but it's also the people who depend on us for care and so many different ways.

[00:15:21] Patrick Swift, PhD, MBA, FACHE: [00:15:21] Yeah. Beautiful. So, Dr. Brinkley, what would the take home message be for a listener as we've covered a lot of ground, different shades and implications about this? What's the nugget of the take home message here.

[00:15:33] Charles Binkley, MD, FACS: [00:15:33] Yeah. So I really get at this idea that you don't just learn ethics once and assume that they're always going to be there.

[00:15:41] Patrick Swift, PhD, MBA, FACHE: [00:15:41] It's not a one and done.

[00:15:43] Charles Binkley, MD, FACS: [00:15:43] it's not a one and done, and ethics are also not binary, right? You're very seldom, either ethical or unethical. They're all shades of gray. One of the, one of the most alarming things somebody ever told me was, uh, was another physician saying, well, I consider myself an ethical person.

[00:15:57] Well, that's, that's problematic in and of itself. If you're so confident and confident in your, your ethicalness or your, your ability to be ethical, you know, it comes from a place of humility, always asking, always reviewing. Now wondering if we've done the right thing and not to torture ourselves with it, but not to take it for granted either.

[00:16:18] And to be intentional about ethics. And it's going to, it's going to vary from person to person situation, to situation. And there's not a book that you can go to. And it's really about in many ways in my mind, , ongoing formation of the conscience, uh, in a way is a virtue based ethic where you try to not only be.

[00:16:39] And ethical physician and ethical nurse and ethical, uh, neuropsychologist, but an ethical human being who happens to be a physician, a nurse, a neuropsychologist.

[00:16:49] Patrick Swift, PhD, MBA, FACHE: [00:16:49] love it. It's good to reminds me of Teilhard de Chardin's famous quote. We're not human beings having spiritual experiences, but spiritual beings, having human experiences and, and you speak to living in the gray and recognizing the gray. The ethics is not. Binary. It's not an either or it's not black and white, but there are gray areas that we have to navigate in the work you've done in the ethics committees and the work I've done as part of ethics committees in hospitals, in a leadership position and a clinical care position.

[00:17:19]There are many gray areas that we have to navigate, and the key is to hold up the patient, the care, and also doing it ethically in the way that we're drained.

[00:17:30] Charles Binkley, MD, FACS: [00:17:30] Oh, absolutely. And that, that gray area can be both life taking and life giving. And when our gray area, when we get punished for being in the gray area, when we, , are disincentivized for asking questions and for wondering. Uh, as a clinician, as a healthcare leader, that's where physician burnout comes from is the loneliness of the gray area, because we don't like the gray area.

[00:17:52] It, it doesn't, it's not, it doesn't generate funds. It doesn't create good quality scores. , and it doesn't perhaps make us look good in front of our peers, but we all face that gray area. And to be able to sort of share that gray area and to be able to say, gosh, we're all in this together. Let me help you.

[00:18:08] And you will help me in turn. I really think that that, that gray area is. The sink for physician happiness, that a lot of professional fulfillment is sucked up by the loneliness of that gray area produces.

[00:18:20] Patrick Swift, PhD, MBA, FACHE: [00:18:20] did you say sink? Like,

[00:18:22] Charles Binkley, MD, FACS: [00:18:22] It seems like it pulls it out of you. Yeah. Like a sink hole.

[00:18:26] Patrick Swift, PhD, MBA, FACHE: [00:18:26] Um, so it's a powerful image and, and, , one that speaks to , the call to. Do something actively to not be drawn into that sink hole, , to, to be able to lift, lift yourself up and in. So doing lift others when we're burnout at whether we're healthcare leaders, providers, um, , supporters, caregivers of a loved, one of a, of a healthcare professional.

[00:18:49]This is something that healthcare is a team sport and we need to lift each other up.

[00:18:54] Charles Binkley, MD, FACS: [00:18:54] Absolutely. Absolutely. Yeah.

[00:18:57] Patrick Swift, PhD, MBA, FACHE: [00:18:57] So I'd love to then ask you my, um, it looked like you were about to say something, so it was, you're going to add something to that.

[00:19:03] Charles Binkley, MD, FACS: [00:19:03] Well, it's just, it's, it's a matter of, yeah, exactly. It's lifting each other up, uh, so that we can all help each other be the best possible selves that we can be.

[00:19:13] Patrick Swift, PhD, MBA, FACHE: [00:19:13] Um, Hmm. I love that because it speaks to when we are, we are being our best possible selves when we are lifting each other up and, and by so doing, by reaching out. We are becoming better people and healthcare professionals. I was speaking with Dr. Dike Drummond on another episode of the show and talking about the culture in healthcare, where, , there's pressure to work autonomously independently, have no faults.

[00:19:36]And, , it, it dehumanizes the physician experience. It dehumanizes a healthcare person experience that we actually need to ask for help. We need to acknowledge our weaknesses and, and seek support. And so I'm certain. , by people hearing your voice and finding comfort in what you have to share with us, Dr.

[00:19:53] Brinkley, that people are being uplifted and I'm grateful for that. And that leads me to my favorite question, which is if you were standing at the top of the world and you for a brief moment, had the attention of all the healthcare folks on the whole planet for a brief moment, what would you say to them?

[00:20:09] Charles Binkley, MD, FACS: [00:20:09] Gosh, you know, it would really have something to do with, um, relax, trust yourself, trust your patients. , listen to your inner voice, , and to trust that.

[00:20:22] Patrick Swift, PhD, MBA, FACHE: [00:20:22] Hmm. Hmm. We're talking about ethics and you're talking about our conscience. And here you are talking about listening to your voice, listening to the heart, listening to the. to that voice and trusting, I love, , the notion of trust. And just by you saying that it relaxes me, I can take a deeper breath.

[00:20:40]The being reminded to trust, trust, oneself, trust, trust others, and we can do this together. So thank you, Dr. Brinkley. And if folks are interested in following up, I know there's some amazing resources. So all going through out there, there's amazing resources at the Markkula center. Uh, but how can folks follow up with you?

[00:20:57] Charles Binkley, MD, FACS: [00:20:57] So, , you can follow me on Twitter. It's at Charles Binkley. , you can also connect with me on LinkedIn, , Charles Binkley, , and I can through either source, , you can also visit the Mark listeners website and learn more about the work of, , the bioethics, , division at the Marcus center and at Santa Clara university.

[00:21:15] Patrick Swift, PhD, MBA, FACHE: [00:21:15] awesome. Well, I will include that in the show notes and, , certainly I encourage folks to follow, uh, Dr. Brinkley on Twitter, LinkedIn, and, , the links will be on the episode show notes as well. So Dr. Brinkley, thank you so much for being part of the show. I'm deeply grateful for your heart and wisdom, and I pray that listeners, , takeaway some support , , comfort and compassion, courage, joy, and hope.

[00:21:37] In, uh, in this message, , in this episode. So thank you.

[00:21:40] Charles Binkley, MD, FACS: [00:21:40] Thank you, Patrick. It's been a real pleasure to be with you. And now we're heading to the beach for the afternoon.

[00:21:44] Patrick Swift, PhD, MBA, FACHE: [00:21:44] Outstanding. All right. Thank you so much, artistically.

[00:21:49] Charles Binkley, MD, FACS: [00:21:49] You're welcome. Be well.

[00:21:51]

Ethics of Vaccine Mandates w/ Charles Binkley, MD, FACS

Vaccine Mandate podcast episode