Rebecca Jackson Stoeckle has had two lives at EDC. More than a decade ago, she worked in the realm of biomedical ethics, developing a curriculum for Decisions Near the End of Life, a national education program to help health care institutions explore ethical and legal aspects of improving care for their dying patients. After a six-year absence from EDC to be with her family, she returned last year to direct a project that is helping the federal Veterans Health Administration (VHA) embed ethical standards throughout its systems and facilities.
How did you begin working at EDC?
About 20 years ago, when I was fresh out of graduate school, a friend clipped a want ad out of the Boston Globe—that tells you how far back we’re going—and sent it to me with a note that said, “This sounds really interesting!” It was—I started working on the Decisions Near the End of Life program, a groundbreaking initiative that brings biomedical ethics to the forefront of health care, particularly within institutional settings.
I left EDC for a while, and when my children were both launched full-time at school, I began to think about returning to work. Just about that time, Millie Solomon [an EDC vice president] called me about a project with the national VHA.
The project aims to help the VHA address ethical dilemmas throughout its system, from use of pain medication with addicts, to allocation of care and resources between men’s and women’s health care needs, to professionals’ dilemmas in dealing with the unique needs of the veteran population. The VHA is a very large nationwide system; the challenge is to move the topic of ethics higher up on everyone’s list of priorities. We are also developing materials—video, online, and print.
What would the VHA look like if your project is successful?
Currently, ethics is typically discussed mostly by a small group of professionals, usually the ethics advisory team. In our vision, the VHA will be a place where ethics is everywhere; everyone will have ethical questions on their radar and will be familiar with the appropriate mechanisms for addressing their concerns. For example, a nursing assistant who is concerned about offering or withholding nutrition for a moribund patient would understand how to proceed; doctors and nurses would have a venue for sorting out what to do with an HIV-positive patient who doesn’t want her status known, but is about to be discharged to a home where toddlers also live; a facility director evaluating whether the VHA can afford to continue offering on-site mammography would have policies and analysis available to explore the ethical components of the decision—that is, the just use of limited resources.
What is the biggest challenge in your work?
The biggest challenge is that there’s no prototype for creating organizational change around ethics in an organization like the VHA. There is nothing else like the VHA in this country, with its size and magnitude. The points of leverage for change are unique. We always have to be thinking about how to make ourselves maximally credible. We’re constantly asked to show evidence for why our approach is going to make a difference. And we are always asking ourselves, Are we doing the best job we can to collect the evidence, to show that we are proposing the best possible strategy?
How has the field of ethics education changed over the years?
Twenty years ago, ethics was seen as very much an ivory-tower, think-tanky kind of issue. That clearly isn’t the case at the VHA today. People really believe that ethics is an essential part of their work and that they cannot deliver the best care to their patients unless they’re really thinking about ethics.
Has anything in this work surprised you?
I have to confess that I underestimated the excellence of the care offered by the VHA. I had some family members who were eligible for VHA care, but who had opted not to make use of it, because their sense was that the private sector offered better care. Working closely with the professionals in the VHA system has astonished me time and again. Their commitment to providing the very best care is extremely impressive and their sense of mission in giving back to the veterans who have served our country is unique. Some of the smartest doctors I’ve ever talked to, and some of the most forward-thinking nurses, are at the VHA. And they are doing some extraordinary research.
What is the most personally satisfying aspect of your work?
I work with a team of really sharp people and I always feel like I’m learning from my colleagues. And I feel that what we’re producing is really going to make a difference—and that is gratifying.
I know so many people here at EDC who are so smart and committed to what they do and who have such interesting ideas. And over the course of their careers, they have managed to keep alive a passion about what they do. We give each other that energy.