Putting Bioethics into Practice

Bioethics is a rapidly evolving, more-relevant-every-day kind of field. And for Kate Luenprakansit, MD, clinical assistant professor of hospital medicine and clinical bioethicist, it has become a major part of her life’s work.

Luenprakansit’s interest in ethics was sparked when she studied molecular cell developmental biology as an undergraduate at UCLA. “I always felt there was something more to becoming a physician than just knowing the biology, the physiology, the math, and the science. There was even more fundamental knowledge I needed to gain in order to be the best physician I could be,” she says.

Her first ethics course during a study abroad program in medical practice and policy in Denmark provided the framework for her higher calling. Questions started to materialize for her about autonomy, beneficence, non-maleficence, and justice and how they play into the doctor-patient relationship. “How do I actually strive to uphold those ideals and principles in medicine?” she asked herself. That first ethics course became the “compass” for her career.

When Luenprakansit started at Stanford as part of the surgical co-management hospitalist group, she brought her interest in ethics with her. “I needed a way to figure out how I could effect change on a larger level,” she explains, “and I think Stanford is a phenomenal institution for that work.”

Her leaders were Mark Cullen, MD, director of the Center for Population Health Sciences and professor of primary care and population health, and Neera Ahuja, MD, clinical associate professor and division chief of hospital medicine. They encouraged and supported her ethics work. David Magnus, PhD, professor of medicine and biomedical ethics, and director of the Stanford Center for Biomedical Ethics, helped deepen her understanding of ethics and philosophy. In 2016 she was a summer fellow at the University of Chicago’s MacLean Center for Clinical Medical Ethics, and she’s been a clinical ethicist and consultant at Stanford ever since.

Luenprakansit’s work varies on a day-to-day basis. She fulfills her clinical duties as a hospitalist; conducts research; teaches students, residents, and fellows; and co-teaches two ethics courses — all on top of her ethics consulting work. This past year, she was also one of the ACES (Advancing Communication Excellence at Stanford) facilitators.

I always felt there was something more to becoming a physician than just knowing the biology, the physiology, the math, and the science

Luenprakansit was formally trained in mediation and conflict resolution, both at Stanford and during her summer in Chicago. She now takes part in clinical ethics consults at Stanford Hospital. She helps patients, doctors and families “reconcile the many ethical concerns and dilemmas that arise in a patient care setting.”

Often this means sitting in a room with physicians and patients, trying to work out an “optimal” solution. “Conflict often arises because of a misunderstanding,” she says. “And how we are all communicating with one another can lead to the misalignment of goals and expectations.”

“We strive to elicit each party’s perspective so that we can achieve some level of mutual understanding,” she says.

Mutual understanding is important, but the next step, consensus, may be harder to achieve. Ethics consultants help facilitate a plan and a resolution. “Decisions still need to be made,” Luenprakansit states. “At the end of this, there’s a patient at the center of all of these discussions.”

One of only a few physician ethicists at Stanford, her ultimate goal is to make ethics a part of the larger medical conversation. She wants to engage people, starting as early as medical school, to discuss “the practicality of understanding ethics, and how that affects our decision making: the what, why, and how of medical decision making as clinicians.” She concludes,  “Through my practice, I have come to appreciate how fundamental ethics is in my role as a physician.”