DR SCAVELLA: Hello, everyone. I’m pleased to announce Dr. Toby Schonfeld,
who serves as the executive director of the National Center for Ethics in Health Care. She
served in this role for one year, and previous to that, she served as the deputy director,
and then she served as the acting executive director from 2016 to 2018. Welcome, Toby.
DR SCHONFELD: Thank you. Happy to be here.
DR SCAVELLA: April 16th is National Healthcare Decisions Day.
Would you talk a little bit about this day- what it is and what VHA is doing to
ensure that Veterans are informed about the decisions they make about end-of-life care?
DR SCHONFELD: Absolutely. So National Healthcare Decisions Day is not a VA
specific activity. It's actually endorsed by a number of national organizations.
The idea is to ensure that individuals are having conversations with their loved ones and with their
health care providers about their preferences for health care if they are unable to make their
own health care decisions. So we are working with a number of groups at VA, in particular
the group that does advanced care planning group visits, which is the opportunity to bring Veterans
together in groups to educate them about making advance directives or expressing their wishes
in advance of them being unable to do so. So in partnership with them, one of the things that
we have done is we've created a set of four vignettes directed at Veterans. They're super
cute animations, that my team has been very creative and innovative in producing, to give
Veterans at different ages and different stages information about why they might want to talk to
their health care providers and loved ones about their choices and what those choices might be.
DR SCAVELLA: If you were to give Veterans the top three things that they should be
taking care of when it comes to advanced care planning, what would those top three things be?
DR SCHONFELD: So the first thing I’d want to say is make sure that all Veterans,
regardless of age, stage, or health situation, have thought about what they want for choices.
The second thing I would say is that- the phrase I like to use is “proxy is better than paper”,
which means that it is important to have a written advance directive if you have very specific ideas
about the kinds of things you would and would not want. However, we're pretty bad at anticipating
what's going to come in the future, and so what a better situation is is for you to talk to a person
that person will become your proxy decision maker or your surrogate decision maker. Sometimes we say
when you are not able to make the decisions, so you need to have identified the person
whom you want to make that decision or those decisions for you. And, related to that, you have
to have talked to that person, and it's not enough just to say “Dr. Scavella, will you please serve
as my proxy” because if you have no idea what my priorities, what my goals, what my values are, you
won't be able to make a decision consistent with those values and goals. So it's really important
to talk to your proxy as well. The third thing I would say is that it's really important to revisit
your choices, both your choice of individuals who make these decisions and the decisions themselves.
Those are all really, really great suggestions and rules for folks to follow up on.
DR SCAVELLA: Speaking about yourself, Dr. Schonfeld, what would you say you are most
excited about or proud of, related to your work in the National Center for Ethics?
DR SCHONFELD: So, since I got here a year ago, I essentially parachuted in right
in the middle of the pandemic surge, right? COVID had just started to attack the country in earnest,
and we at VA were trying to do the best we could for Veterans while information was changing in
real time. And one of the things that I’m most proud of is how my team at the National Center
for Ethics in Health Care have been able to be responsive to the needs of Veterans, to the
needs of health care providers all throughout this pandemic as the information has changed.
DR SCAVELLA: I have one final question for you, and this is a little bit
different from the questions I’ve asked before. It's really about you personally.
DR SCHONFELD: Okay.
DR SCAVELLA: As you know, March was Women's History Month. As a woman leader yourself, do you
have advice that you can offer to women who are either embarking on or continuing their careers?
DR SCHONFELD: We often are either stereotyped or characterized as having softer skills or different
skills than do our male counterparts, and often that is used against us, right- that women can't
be stronger, can't rise to the challenge. What I would recommend that women
consider is the fact that these softer skills are actually necessary in order to be a strong
leader. Leadership is all about developing and maintaining relationships, and so it's
really a skill to be able to take that capacity and use that to our advantage, rather than see
it as a limitation. And so I’d encourage women to embrace that aspect of themselves as well.
DR SCAVELLA: That's very good advice. I appreciate the fact that you are one of the strong
women leaders in VHA, and I’m glad that you're part of our team. Thank you, Dr. Schonfeld.
DR SCHONFELD: Thank you.