When Gov. Mike DeWine proposed new administrative rules at the start of 2024 requiring transgender adults to obtain a detailed care plan and medical consent from a bioethicist before the “prescription, initiation, or provision of treatment for a gender-related conditions” can take place, it left Ohioans with two questions:
- Why are Ohio Republicans inserting themselves into healthcare decisions of adults?
- What the heck is a bioethicist?
Although the first question continues to be a difficult one to answer, the second question was a bit easier to tackle.
We spoke with Marcie Lambrix, clinical ethicist and research supervisor in MetroHealth’s Center for Biomedical Ethics and senior research associate in the Department of Bioethics at Case Western Reserve University, to find out more about how bioethics works, why it’s important and what LGBTQ+ Ohioans need to be thinking about with regards to advance directives.
To listen, click play directly below or read our (edited) conversation beneath the audio link.
Using words that even I can understand, Marcie, what actually is a bioethicist?
Marcie Lambrix: Bioethics is a field of study of medicine that really looks at ethical issues. We know that there are tons of ethical issues embedded in medicine and healthcare more broadly. So our training is basically through either bioethics or philosophy – or in my case, sociology – to help examine different medical issues and come up with some recommendations on how to deal with those ethical issues.
Tell us why this career route for you. I picture you on the playground as a child explaining to everyone the pros and cons of risky see-saw decisions.
[laughs] That’s hysterical. I am a worrier and I do like to think about things a lot. So you do have that pretty much right.
This was not a career plan that I intended or even thought about really. I did my training in sociology, but it was in healthcare and medical sociology. I ended up in this role in a very serendipitous way, really. It was through COVID. I was doing research with Case Western in the department of bioethics. And when COVID hit, things got crazy.
As everybody knows, the hospitals were very, very busy and our department itself was getting slammed with consults. My supervisor said, “Hey, can you help us out and assist with the clinical ethics pager?” I said, “Sure, no problem. Always happy to jump in.”
From there, I fell in love with the whole role of a clinical ethicist. And so I continued on and moved more into that role as a primary clinical ethicist with MetroHealth and have been doing that for several years now.
Bioethicists really came into the political realm earlier this year with some rules proposed by Governor Mike DeWine. How did it feel to have your field be so politicized?
Oh, gosh, that was really frustrating. There’s no other group that has been subjected to this having to have these types of care plans created for them as adults. It violates a patient’s autonomy and it goes against any sort of principle of justice. It’s just really very frustrating, and I’m being kind in that description.
Well, let’s talk about one area of bioethics that I know we rarely discuss: dedicated initiatives for advanced care planning. Break it down for us on why this is so important for the LGBTQ+ community.
So important, Ken. And thank you for asking that.
Advanced care planning in a very simple way is thinking about preventative health care and thinking about what your wishes are if you are not able to communicate those yourself. Say you’re incapacitated for whatever reason, there’s got to be somebody that serves as your surrogate.
Ohio law has next of kin hierarchy. And for some people, that’s great. It works well, it’s what they would want. But for others, maybe not so much.
The queer community would like to have some level of autonomy in saying who would make those decisions, because not all of our families are going to know us well enough. Some of us have chosen families. Some of us would like to have others designate who would make those really critical healthcare decisions for us if we are unable to.
So for me, as somebody who is a member of this queer community, I want to help educate and empower others to think about what is it that we can do to help preserve and protect our autonomy when it comes to those scary situations of having to make decisions. That’s why we’ve been trying to attend every single possible event to reach out to the queer community to get this information out there.
I can’t tell you the number of times people have been like, “Are you kidding me?” when I go over the next of kin hierarchy. They say, “That’s who would make my decisions? No, no, no, no. I’m not interested in that. Let me get that paper and let me fill that out.”
Give us some next steps that people should be aware of. As someone myself who doesn’t know my next of kin hierarchy, I’m now a little nervous about that. Where should I start?
I always stress to people, there are so many different documents for advanced care planning. But the biggest, most important one is the healthcare power of attorney. So I would suggest that people take a few minutes to download one offline and complete it so you can name who you would want to make to serve as your surrogate.
When you have that on file, you can put it into your medical record.
But before you even complete that document, let’s just start having conversations about what we would want. This is not a fun and uplifting conversationsto be having at a dinner party. But start talking about what you would want. We all know stories of people who were like, “Ooh, I wouldn’t want that. I wouldn’t want to be intubated and put into a long term care facility for ten months.”
Start having these conversations and then let that person that you trust know what you would want. Because it matters and it matters at a time when you can’t speak for yourself.
Marci, all your worrying is paying off. Thanks so much for chatting with me.
It’s a pleasure. Thank you so much. 🔥
IGNITE ACTION
- Check out MetroHealth’s page on Advance Care Planning here.
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