Krystal Pence, LMSW, has had a front row seat watching the growing impact of the Ethics Committee on patient care and institutional policies at AdventHealth Kansas City in Shawnee Mission, KS.

Krystal joined Advent as Care Management Manager in 2015 after eight years as social work case manager at The University of Kansas Hospital. She and her staff work with the most complex patients to facilitate safe care plans.

Complex Cases

“Before the Center for Practical Bioethics was involved at Advent, the work of our Ethics Committee was pretty disjointed,” said Krystal. “I remember a very complex case where I was the one figuring out the plan with a nurse who was on our ethics team. We spent hours on the case because we didn’t feel like we had the knowledge or experience to make a decision.”

What does Krystal mean by “complex case?” She offers a few examples where ethics consultation services provided by the Center made a big difference:

• The fetus had a terminal condition. Mom set a plan with her OB for comfort measures only. On the day she delivered, the different OB on call thought it would be unethical to withhold treatment.
• A middle-aged woman during the pandemic clearly made known that she did not want to be placed on a ventilator. When she became unresponsive, her family demanded the ventilator.
• A patient with factitious disorder, previously called Munchausen syndrome, demanded more antibiotics even though they would worsen her condition.
• The patient was dying from complications arising from dementia, however, the son – who was not aware of the dementia diagnosis – insisted on aggressive measures.

In all of these cases, the Center bioethicist, Ryan Pferdehirt, met with all parties involved – patients, family members and clinicians – listened to their concerns, and took time to explain and help them understand the pros and cons of all options.

Time, Focus and Expertise

“I’m the manager of 33 staff members overseeing the needs of 300-plus patients,” said Krystal. “Neither I nor my staff can give the extra time, nor do we have the knowledge and experience, to address the most complex situations, of which on any given day there are many.

“That’s where I truly value the Center’s involvement because they can give cases the time and focus they deserve. They can help move the case along to achieve outcomes that are compassionate for patients and families, respectful of clinicians’ moral values, and protective of the institution.”

Ethics Services offered by the Center also include help with policy development and standards for development, selection and deployment of AI technologies. The Center specializes in writing, implementing and educating on policies, from initial drafting and presenting to executives for approval to providing staff education and adoption guidance.

At Advent, Dr. Pferdehirt has helped develop policies for withholding and withdrawing non-beneficial treatment and a process for making decisions for unrepresented patients.

In addition to “a lot of big words,” Krystal said the most important thing she’s learned from working with Dr. Pferdehirt is that listening – not having an agenda or letting herself prejudge – is key.

Ethical Dilemmas Today

A graduate of Mid-America Nazarene University in Olathe, KS, who earned her Bachelors in Psychology in 2005 and Masters of Social Work in 2007 from the University of Kansas, Krystal lives in Olathe with her husband and 16- and 12-year old twin daughters. At home, she says, this is the moment in motherhood where she doesn’t have much spare time.

At work, she sees her mission as walking beside her patients, making sure they have the best outcomes possible. Given the complexity of patients’ situations, it’s not getting any easier.

“Patients that I dealt with 18 years ago in the hospital, today they would be outpatients,” she said. “They are sicker and more likely to have less support from their families. The ethical dilemmas that arise from these cases make clinical ethics services more valuable than ever.”

Learn More about Clinical Ethics Services

Written by Trudi Galblum, Marketing, Communications, and Grant Writing