Jennifer Cohen
Welcome to the Voices in Bioethics podcast. I’m Jennifer Cohen and it’s my great pleasure to welcome today Mary Beth Quaranta Morrissey to the podcast.
Mary Beth Morrissey
Thank you, Jennifer. I’m delighted to be here.
Jennifer Cohen
Dr. Morrissey, you are an extremely accomplished researcher, professor and public intellectual in the fields of health policy, and aging. You’re a fellow at the Fordham University Global Healthcare innovation Management Center and, at the Fordham Graduate School of Social Service, you hold adjunct faculty appointments at Fordham Gabelli School of Business and in the doctoral program at Yeshiva Wurzweiler School of Social Work. In addition to numerous scholarly articles, you’ve written two books, a public health strategy for living, aging and dying in solidarity, and the other concentrating on palliative care and end of life ethics. You have a law degree and a master’s in public health and a PhD in health and gerontological social work from Fordham University. I’d like to begin by just asking you to describe broadly your work, what led you to it, and how the ways your commitment to social work, social justice, health law, how all of those intersect in your work.
Mary Beth Morrissey
Well, thank you so much, Jennifer, for your generous remarks. And I’m delighted to have the opportunity to speak a little bit about how I’ve gotten to where I am today. Of course, our careers are never linear. And I started out in law school and my first position was with a bank, the General Counsel’s Office of the bank. And I didn’t last long in that position – about a year. And I realized after several years, that I really wanted to pursue my long standing interest in health. And after earning my law degree, I went back to Pace Law School, and earned a certificate in Health Law. And actually, I, I may not have completed that program. But I did attend for a year and I had the great privilege of meeting and being in the class of Dr. Josephine King, who was a very prominent bioethicists, and I still have her volume of material sitting on my shelf here today. So that’s how I really got launched into healthcare. Shortly thereafter, I accepted the position of General Counsel at the Terrence Corona cook healthcare Center in New York City. And during that experience, I was doing a lot of education and training for physicians, social workers, and I realized that I wanted to expand my education. So I decided to go on for the Master’s in Public Health, which was just a wonderful decision, because I’ve really come to love public health policy, public health law, and it has played a major role in my work. And then just to close this line of conversation, I finally went on to earn my PhD because I realized the importance of research. And that too, has been a wonderful part of my education. The lawyers have really realized late in the game, that research and understanding research evidence are important to the practice of law, and also to policy and influencing policy. So all of those interests intersect. I do do a lot of work in hospice and palliative care. It’s one of my great loves. And of course, the model in hospice and palliative care is an interdisciplinary model. And so in my work, and particularly in designing workforce education and training today, we’re working very hard to integrate that interdisciplinary model into all of the programs that we develop.
Jennifer Cohen
Wonderful. Yeah, that is very helpful. And speaking of the palliative care initiatives and how things intersect. Can you tell us about the collaborative for palliative care in New York, what that is and how that is contributing to education and training?
Mary Beth Morrissey
Yes, I’d love to. Back in 2004, the commissioner of aging in Westchester County, Mae Carpenter held a series of year-long symposia in anticipation of the White House Conference on Aging the following year. And during that process and experience, we did have a subcommittee or a subgroup, engaging in dialogue about palliative and end of life care. And after we concluded that process and the White House Conference on Aging was over, I realized that there was a real gap in the community here in Westchester County, and downstate New York, that we didn’t have any structure for continuing those very important conversations. So I boldly decided to approach both Fordham University and the Pace Women’s Justice Center at Pace Law School to help me in launching a consortium. It was originally an unincorporated Consortium, we drew well over a dozen to 20 people at our meetings, which we held regularly. And it was really the first time in Westchester County that we were able to bring together all of the hospices that five hospices here in this region, as well as the palliative care providers. And originally, I think there was some tension around that. But eventually, as folks got to know each other, they began to share with each other a lot about the experiences in their respective organizations. And it turned out to be just a wonderful opportunity for community building and for providing education and training to support the efforts, particularly of the smaller agencies to give their workers access to quality education and training because, as you probably know, there’s not much funding for that kind of education and training here in New York. We do have two palliative care laws, the Palliative Care Information Act, and the Palliative Care Access Act, which were groundbreaking at the time they were enacted. And I want to thank my colleague, David Levin for having a major role in that policymaking. But regrettably, they are unfunded mandates. So it’s made it very hard to really meaningfully implement palliative care across organizations, and most importantly, to provide that really essential workforce education and training. So that’s where the collaborative for palliative care has stepped in. Most recently, about three years ago, we became affiliated with the Finger Lakes Geriatric Education Center at the University of Rochester Medical Center. And that’s under the direction of my colleague, Dr. Tom Caprio. And we’re very honored to be the center’s downstate partner under a federal HRSA workforce grant. So that has made it really wonderful and a wonderful opportunity for us to really build these education and training programs.
Jennifer Cohen
Wonderful. Okay, let’s turn to what the most pressing public health problem is that we’re facing today. Because of your extensive research and experience in healthcare policy and ethics, especially for older adults, you were asked to sit on a number of COVID task forces. Can you describe the COVID task forces, you were asked to sit on what that experience was like and what you were tasked with doing?
Mary Beth Morrissey
Yes, absolutely. Well, I was very honored to be appointed as the Chair of the New York State Bar Association Health Law Section of COVID-19 Task Force in March 2020. You have to think for a moment did make sure I’m in the correct year, everything It feels so compressed today. The chair of the Health Law Section at that time, Hermes Fernandez, appointed me. And I do also want to credit, the president of the New York State Bar Association at the time, Hank Greenberg, for having the vision to really work closely with the Health Law Section and charge us with examining the issues in real time as they were developing and writing a report. So I had the pleasure the great pleasure of working with or about 12 of us sitting on that task force. And we met fevershly and worked feverishly over a period of about two months, and produced a draft report. But you know, it certainly involved a lot of dialogue, a lot of discussion. And it certainly was not much of I say a challenge free process. It certainly involved leadership on my part, as well as on the part of all of the members. We had to work together to really build a consensus around these issues were, which were really issues of first impression in terms of what we were seeing with the pandemic, not certainly in terms of public health law, which is certainly well established in New York and also in terms of public health law, more generally beyond New York. But they were issues of first impression with respect to the pandemic and what we saw happening with the pandemic, the obviously the high rates of infection, the high rates of mortality, the challenges all the providers were experiencing in terms of scarce resources at the peak of the pandemic, as well as decisions about isolation, quarantine and so on and so forth. So it was really a very wonderful experience, a great honor and something that I will look back on for the rest of my career and reflect upon. And I hope that the work that we accomplished will be of some benefit to the community as we move forward.
Jennifer Cohen
I’m sure it will be. I’d like to ask about a couple of the specifics, if I could.
Mary Beth Morrissey
Sure.
Jennifer Cohen
One of the questions that taskforce was addressing, and as you say, many of these issues, many of these questions had been around for a long time.
Mary Beth Morrissey
Right.
Jennifer Cohen
And were then pushed to the forefront because of the pandemic. So one of the issues addressed was the adoption of crisis standards of care. Can you discuss what those look like? And does a crisis standard of care mean that the patient will be treated differently?
Mary Beth Morrissey
Well, let me start by providing some context, Jennifer, if I may, and explain why I had knowledge of crisis standards of care, you know, when the pandemic descended upon u. I had the privilege in my capacity as chair of the bioethical issues committee of the New York City Bar Association, to reach out and work with Professor Lawrence Gostin, who is the founding director of the O’Neill Institute at Georgetown Law School. And Professor Gostin I think everyone knows him. He’s just an extraordinary person. And one of his areas of expertise, of course, is public health and emergency preparedness. So we had invited him to come to speak to the city bar community, and he had done so on at least one occasion. I was also at the time serving as the president of the Public Health Association in New York City. And he also honored us with his presence at an event there. And so through Professor Gostin, I really became deeply immersed in these issues of emergency preparedness. We did have a forum on it, which I presented a few years before the pandemic. So that’s really how I became immersed in this area of public health law. And so when the pandemic arrived in such an unexpected and unforeseen manner, I did have some foreign knowledge of these legal issues in terms of crisis standards of care. And I’ll identify for you one issue in particular, that will not come as a surprise that I was most interested in. And that was: Professor Gostin, who was one of the principal authors along with Professor James Hodge at the network for public health law, they had done just an extraordinary job in mapping out in the model Institute of Medicine Crisis Standards of Care, that were issued in 2012, of mapping out the minimal standards for palliative care during an emergency, public health emergency. And I would encourage you or any of our listeners to go to the model Institute of Medicine Crisis Standards of Care, and take a look at that particular section. They also addressed in tandem with palliative care and in the same section, issues of mental health. So I think that those model crisis standards that were written by Gostin and Hodge were really groundbreaking. And given my commitment to palliative care, that was something of course, that I brought to the New York State Bar Association Health Law Section COVID Task Force. And I have to be perfectly honest, that my colleagues were not entirely pleased about my introducing the standards themselves, because they’re voluminous. And they did, however, take time to read them and go through them. So very briefly, what happened is that we worked through the process of the New York State Bar Association House of Delegates level, many of the delegates also, you know, had the same issue with the recommendation we had written about the crisis standards of care, as developed by the Institute of Medicine that it was too big, was too much for them to take on. So as a result, what we did was to simply say that we were recommending adoption of crisis standards of care, drawing on the crisis standards of care, in caps, developed by the Institute of Medicine in 2012. So, again, I thought it was very, very important to the work we were doing. And I’m pleased that we were able to get that particular recommendation adopted by the House of Delegates in that form.
Jennifer Cohen
For lay people can I generalize by saying it involves a shift to a public health standard during the peak of the emergency rather than an individual patient standard of care? Is that a way to understand crisis standards of care?
Mary Beth Morrissey
Let me reframe it a little bit, if I may, Jennifer, but that’s certainly moving in the right direction. Really, it involves a shift in what we would consider the regular normal standards of care to what we call these crisis standards when normal healthcare operations are disrupted, in this case because of the pandemic. And we did as a task force and I hope this is helpful in responding to your question, we did conduct conversations and hold dialogues with two physicians in particular. I mentioned Dr. Tom Caprio, who was upstate who was very immersed in the crisis. He is not only in hospice and palliative care, but he also works with all the nursing homes at the University of Rochester Medical Center. So we were able to get his perspective on what was happening in terms of the crisis, the disruption in the normal health care operations. And we also spoke with Dr. Joseph Fins at Weill Cornell, about the issues and he was also in the midst of the crisis being called upon as a bioethicist. And since then, he has written extensively about these issues. And so the ethical issue that arises in a pandemic, such as the one that we live through at its peak, is what we call scarce resources, and decisions about how to allocate scarce resources. So that’s why it’s very important to have crisis standards of care, as well as resource allocation guidelines that are written and adopted in advance. I will comment historically that the Public Health Law committee of the New York State Bar Association Health Law section had done much of this groundwork for over a decade. And I do want to acknowledge the Chair of the Public Health Committee who worked on this with me and our other colleagues during that period. Avitta Comber. And we have actually collaborated with researchers at Columbia University and done a whole gap analysis of public health law in New York. And we had, as I recall, shared that analysis with a number of the legislators and policymakers. But it’s a very contentious issue. I don’t think the legislators are eager to take this on for the reasons that you and our listeners would realize, because when we’re talking about a limited pot of resources, and who gets walk when there’s not enough supply, you know, those are very difficult decisions. I will say that in some states, where there were the steps taken in terms of crisis standards of care and resource allocation guidelines, there was at least one enforcement action by the Federal Office of Civil Rights on the basis of age discrimination. So that’s an area of course of great concern to me as a gerontologist, most of my work is with the older adult population. And you know, I’m very concerned about that as of course many colleagues and policymakers and so on and so forth.
Jennifer Cohen
Yeah, at the beginning of the pandemic, that was almost the story. Was this resource allocation issue that you’ve been discussing?
Mary Beth Morrissey
Right.
Jennifer Cohen
We’re not hearing about that now. Do you attribute that to reduce numbers in hospitals? Or do you think some of these guidelines that have now been adopted and addressed are working?
Mary Beth Morrissey
Well, I’m not sure. In fact, I am sure, I should put that way, that these steps have not been taken at the state level. I should also mention and acknowledge the work that had been done for many years by the New York State Task Force on life and the law, of which I believe Dr. Joe Fins served as a member, along with a number of the other very prominent bioethicists here in New York. And they had issued in 2015 ventilator allocation guidelines. And actually, the first step that I took as chair of the COVID-19 task force for the Bar’s Health Law Section was to approach Chair Hermes Fernandez about writing a letter and sending it to the governor and the Commissioner of Health, addressing really the urgent need to adopt resource allocation guidelines. And we sent that letter out in the first couple of weeks of our service on the task force, and we received no response. So again, I think there was great resistance and reluctance to taking any kind of action on those fronts.
Jennifer Cohen
Fascinating.
Mary Beth Morrissey
So to my knowledge, to go back to your question to my, you know, very best knowledge. At the state level, no action has been taken hospital systems and, you know, providers, some of those hospitals, systems and providers did create guidelines of their own, of course, to the extent that that was done and they provided education and training to their Staff, of course, that would have been seen as a positive step. But I think in those institutions where that did not happen, the real concern was and continues to be as we move through the pandemic – I don’t think it’s over. And we don’t know what awaits us in terms of the future – but I think the real concern is that physicians and practitioners are left in a very vulnerable position to make decisions at the bedside, without any protection in the absence of any uniform guidelines. And, of course, there’s the issue of liability for those physicians who are making those decisions. You’ve probably seen and I think many of our listeners may have seen a lot of media coverage on the issue of DNRs, and whether physicians could make a decision at the bedside about a DNR. In other words, not to resuscitate a patient, if that resuscitation would have no benefit, even in the absence of, you know, a DNR order or perhaps against the wishes of the family, if there were family. So, again, just a sense of how challenging these decisions are, and really what it means on the ground, when there are no uniform guidelines, or standards upon which practitioners and physicians can rely.
Jennifer Cohen
Yeah, there was so much media coverage about the New York legislature’s decision to provide a liability shield on April 6, that was repealed.
Mary Beth Morrissey
Yes.
Jennifer Cohen
What are your thoughts on that decision to repeal the immunity shield now?
Mary Beth Morrissey
Well, I think it was an unfortunate decision. I think, of course, we live in a highly politicized world. And I think that the legislators probably got a lot of heat about that and had to change direction. But I think it was a mistake. And I do think that there should be certain protections for physicians or practitioners and providers in these unusual circumstances, as we’ve discussed, when normal healthcare operations are disrupted. Another example, Jennifer, that we can talk about, if you’d like is the vulnerability of the nursing homes now, in terms of liability. As you probably know, and I should mention in that context, that after Hank Greenberg completed his term as President, Scott Carson became the president of the New York State Bar Association. And shortly into his term of office, I think it was in August, he appointed a second task force on long term care. And Hermes Fernandez and Sandra Rivera are co-chairing that task force. It’s a State Bar wide Task Force, not a task force of the Health Law Section. And it’s a diverse group. And we’ve talked about this issue. But, of course, I think it’s well known now that in New York, the nursing home residents were disproportionately impacted by the pandemic. And I think there are a number of reasons for that. And I don’t think the nursing homes themselves and I’m speaking now generically, not about any particular nursing homes, but I think to a large extent, it’s my view, that the nursing home providers do not have responsibility to a large extent for these adverse outcomes. It’s tragic. And I do want to say here that the issues we’re discussing, Jennifer, not just legal issues, policy issues and bioethical issues, but it’s a humanitarian crisis, to the extent that many persons but especially vulnerable older adults, and I want to recognize also the racial disparities in outcomes, older people of color, who have been disproportionately impacted by this pandemic. So I think there have been policy decisions at the state and the federal level, that historically that have contributed to pre existing inequities that heightened risk during the pandemic.
Jennifer Cohen
Thank you for that. That’s incredibly helpful. Okay, let’s turn to yet another one of your initiatives, a certificate program in aging, public health and palliative care that is run in partnership with the University of Rochester. Can you talk a little bit about how that got started? The types of students who take this course and I think our listeners would be interested in when we were discussing this podcast, I was using terms such as elderly elder law, and you suggested we use aging adults, older adults, that sort of language instead, can you talk about your feelings about the way language can frame issues concerning aging adults and how they might even affect outcomes?
Mary Beth Morrissey
Well , thank you so much, Jennifer, for your sensitivity and attunement to those issues and raising them this afternoon. I do think that how we use language is very, very important. And I’m happy that you use the term framing. Actually, in the certificate program and in my law and social work classes, I do spend a lot of time teaching this concept of framing and what framing means. And I’ll say here that I’ve been very heavily influenced by my Social Work background. My PhD, as you may have mentioned, when you introduced me, is in gerontological, Social Work research. But I should also mention that I grew up with a social work educator, Mary Ann Quaranta, who was dean of the Fordham Graduate School of Social Service for many, many years. And so I was, again, shaped by Social Work values, social justice, and really sensitivity and attunement to the needs of vulnerable persons and populations. So with that in mind, I think we have to be careful not to use language that is stigmatizing, objectifying, but rather always focused on the older person, as person. And of course, I think since the enactment of the Affordable Care Act, there has been a lot of progress in terms of focusing on and implementing a person-centered care models today. So I think that’s a very positive development. I do want to mention also that there is a whole initiative that we actually have a CLE on it this coming Sunday. It’s called Reframing Aging. And there are eight to 10 national organizations involved in that Institute, one of which is the Frameworks Institute, which has done a lot of research on attitudes toward older adults, social and cultural attitudes. And the goal of the Reframing Aging project is really social change, and providing education and training to positively influence attitudes toward older adults. So I think that’s a very, very important thing. So again, yes, I do think it’s important for us to be very sensitive to how we address people how we describe the people who we are serving, and also to avoid paternalism, and any kind of hierarchical structures. This has come up, Jennifer, if I may bring it up at this time, in the work that I’ve done with many wonderful colleagues, in serving immigrants, and mothers seeking asylum who are coming across the border. And in that work, we need to be very mindful that we’re not imposing ourselves, or coming into this work as experts, quote, unquote, but rather really in service and learning about the experiences of persons who are migrating persons who are seeking asylum from their first-person perspectives. And if I may mention quickly, I did have a wonderful project in the American Psychological Association where I’m active. I had gotten a grant in 2019, and it was renewed was an APA grant from one of their sub units, to really understand better the experience of the advocates on the ground in their service to immigrants and refugees. And so what we did in order to access those experiences was to use oral histories, we interviewed the volunteers. And I have a link to that if there’s any way that you can provide that, but some people may wish to hear some of those interviews, one in particular that was done with Michelle Fine, who’s a leading activist in the immigration space, I think would be really wonderful to hear. But there are so many ethical issues in the work that we do and I hope that example gives some insights into those ethical challenges.
Jennifer Cohen
I’d love to get your thoughts about one of the most difficult ethical issues in aging, and that is dementia.
Mary Beth Morrissey
Yes.
Jennifer Cohen
The linchpin of modern bioethics is autonomy and the ability, the right to consent or refuse to medical treatment, and the duty of healthcare professionals to provide informed consent so that a person can make that decision to accept or refuse treatment. And an important threshold to being able to make that decision is capacity, which is roughly defined as sort of the ability to understand risks and benefits of a proposed course of treatment. How do healthcare workers deal with this issue of capacity when treating a person suffering from dementia, how should they go about that decision tree with a person who is suffering from dementia?
Mary Beth Morrissey
So thank you so much for introducing this into our dialogue, Jennifer and I are very pleased to have the opportunity to share my thoughts with you. I’d like to just step away for a moment from the issue of capacity per se, in healthcare decision making. And talk a little bit, again, about some of the critical theories we’ve been using in aging that I think are problematic and have contributed to limited understanding of the experience of persons with dementia. And one of those theoretical models is called successful aging. And it’s been the dominant theoretical model in aging for quite some time. It’s been challenged, more recently. I certainly have challenged it in my work, because I think it’s a highly flawed model. How many of us, and I count myself among those persons who are aging, how many of us are aging, quote, unquote, successfully, but so many, you know, not only in the United States, but across the globe. So many aging persons and older adults are dealing with limitation, with challenges. I also am active in an international group called the International Network for the prevention of elder abuse. And we just had a meeting with leaders across the globe. And so many of them, many of them, women leaders spoke to the experience of heightened violence against older women during the pandemic. And this apparently is a major crisis and really an invisible one that we haven’t spoken enough about. So getting back to the issue of persons with dementia, I would say that one of the major problems we have is that we don’t have really any meaningful research on the lived experience of persons with dementia. Now, I do have a colleague in the American Public Health Association, his name is Michael Lapore, who’s doing some groundbreaking research in this area. And it’s called participatory research because he is inviting persons with dementia, to participate in the design of the research, I think this will be very helpful to us in better understanding this type of research project, in better understanding those living with dementia. I think also we suffer from having a one sided view of that experience, which is that it is predominantly an experience of suffering. And I’ll share with you and our listeners that I had the great honor of taking care of my mom with the generous support of my daughters. In her very last year of life, she experienced a loss of you know, her cognitive capacity, which was very difficult because she had been in, you know, an educator all her life. And of course, it was very unexpected, and very difficult for all of us. But she lived with us in my home and had many moments of joy that we witnessed and had the great pleasure to participate in from just sitting with us sitting outside and reflecting back upon her days when she was younger, going to the beach, enjoying, you know, meals. So again, I think we have very biased and skewed views of the experience of dementia. So I think the very first step is doing a lot more work in terms of research. And not just quantitative research. Of course, most of the research on the quantitative side has been on brain research, I’m talking about qualitative research that really is accessing the lived experience of persons with dementia and those who are taking care of them. So I hope that’s helpful, a little bit.
Jennifer Cohen
That is such an incredible point you’re making and one that is so obvious, as soon as you raise it that there is no research on the experience of patients with dementia, and it ties in so beautifully with your statement about your work with immigrants, that to refrain from being the expert who comes in assuming they understand the experience, and to see the research as a type of service. That is a really beautiful paradigm. And I think one is surprising, you know, of course, realize that this research isn’t being done. Wow. I’d love to hear your views on advanced directives. The last time I looked up the research on this, I think it said about one in three Americans have any kind of advanced directives. And I think it’s so difficult for people, especially when you’re contemplating the possibility of dementia because that, in a sense, I think people feel well that won’t be me anymore. Almost a different type of person I watched a documentary on Bill Gates a few years ago. And in the first two minutes, he’s asked the question, what’s your greatest fear? And he said, I don’t want my brain to stop working. And people have an idea that they couldn’t continue or something, if that occurred to them. Can you talk about this very philosophical and difficult subject of the ways our current self should think about our future self, the duties our current self owes to our future self, especially if that future self will be cognitively different from the way we are now?
Mary Beth Morrissey
Yes, that’s wonderful. The way you framed it, Jennifer, and I’m happy to do that. Let me again step back. I always like to start out with a policy perspective. And I will say that as much as I recognize the progress that we’ve made in the area of advanced care planning, when I was serving as general counsel to Terence Cardinal cook healthcare center, back in the late 80s, and early 90s, I was there at the time, the Cruzan decision was handed down from the Supreme Court, and when the patient self determination Act was passed. And as I mentioned, I did all the education and training for the physicians and the social workers and the staff at that time. So I think we have made great progress, of course, in the decades since those milestones occurred. However, I do think from a policy perspective, meta policy perspective, I’ll say, in a meta theoretical perspective, that we have invested too much in advanced care planning, at the cost of not investing in other very important systems, such as public health. And I’ll just add here, parenthetically, I wouldn’t want to conclude our experience today without saying that, I think one of the major failures that we’ve seen, that has been highlighted by the pandemic is the failure of our public health infrastructure. So I think that there are many things that we’ve not invested in. Yet there is, I think, a belief that advanced care planning can solve all the problems, you know, of health care and public health. So with that background, I’ll say that, I do think advanced care planning is very important. And I do want to recognize the work done here in New York, particularly by Dr. Patricia Bomba, in terms of designing the MOLST tool, which I think is a wonderful advanced care planning tool. It is not an advanced directive. It is a medical order. And I think, in working with the New York State Department of Health, Dr. Bomba has really created a very, very important system and tool that healthcare providers, healthcare practitioners and social workers can use effectively, you know, for the purposes of planning in advance for one’s health care. So, in my critical theoretical work, I have raised ethical issues about the new advanced directives for dementia that have been developed. And I do have very serious ethical concerns about them. And there are several iterations of them. But the main goal of this advanced directive for dementia, which by the way is not legal in New York, because it addresses feeding in terms of drinking and eating food, it is not artificial nutrition and hydration does not fall under the definition of healthcare under the New York Public Health Law. But putting that aside, I do think there are serious ethical concerns about I, Mary Beth Morrissey today, on April 21, I believe 2021, making a decision in advance about Mary Beth Morrissey, perhaps 20 years from now, who is experiencing cognitive loss and directing my healthcare agent to withhold all food and water from me at that future point in time. First of all, I’ll say that I think it’s a really unacceptable burden to place upon the agent to carry out this kind of directive. And I think it unethically so really shifts a burden to the agent that, you know, I’m not comfortable with. In addition, I think that in the same vein that I spoke of earlier that we don’t really understand the experience of dementia. For that reason, I don’t think we’re in a position to legislate in advance the experience of that person in the future who’s living with dementia. So I think it’s in my view, ethically unacceptable. And I think that this kind of advanced care planning for persons with dementia requires a great deal more study and dialogue before we take any steps to, you know, make that a legal option in New York or in any other state.
Jennifer Cohen
Thank you for that. Finally, Dr. Morrissey, as we start make our way out of the pandemic and start looking to the future of the many problems the pandemic has exposed that you’ve discussed with us today, Which do you think is the most important for our society to address?
Mary Beth Morrissey
Well, that’s a very difficult question. I’ll mention a couple of things. Jennifer, I already spoke about public health. I think it’s a tragedy that we’ve really chosen not to, and they have been deliberative decisions that have been made both at the federal level and the state level, not to invest in our public health infrastructure. So I think that’s a serious problem that has to be corrected, you know, as soon as possible. And I think that we also need to invest in education and training for our workforce, not only specialist level education training, but generalist level education and training. You asked me earlier about my certificate program, that is the education and training we are developing and sharing and disseminating in the certificate program, generalist level education in ageing, public health and palliative care. And I think that meets a very, very important need in New York, and also should be funded in other states. So other issues that we have to make a priority are really addressing the disparities, the racial disparities that we have seen so glaringly during the pandemic. And I mentioned also ageism, and age discrimination. So these are issues really, again, at the structural level, that require structural reform. But again, we saw during the pandemic, the downstream consequences of the failures, the policy failures to really address these issues. And I think it’s quite heart rending, that older people of color have been so detrimentally impacted by the pandemic, because of issues such as the neighborhood they live in, the resources they have access to, the incomes they have or do not have, housing insecurity, food insecurity. Those, by the way, are all social and economic determinants of health, which is the classic public health perspective. So I think these are the very serious issues we have to address at the policy level, before we can begin to really prepare adequately for the next pandemic, and there will be others. So I hope that we may all work with our colleagues, certainly here in New York, our legislators and policymakers to really make meaningful change on these issues that affect vulnerable populations.
Jennifer Cohen
Dr. Morrissey, thank you for sharing your expertise with us today, and for your tireless work on behalf of aging adults in New York and across our country. Best of luck in the future.
Mary Beth Morrissey
Thank you so much, Jennifer. I’ve really been honored to have this opportunity.
Transcribed by https://otter.ai