Let's Get Ethical ™

Should a doctor, nurse, or paramedic ever help the state carry out an execution? It’s a question most of medicine has already answered on paper — and one that keeps happening anyway.

Mike and Rob take on their heaviest subject yet: two recent, failed Tennessee executions, and the ethical fault line they expose. They work through why the AMA, the American Nurses Association, and the national EMT body don’t just discourage but prohibit clinician participation — and why none of those rules is actually legally binding. They get into scope and competency (how does a procedure get “botched”?), conscience and refusal, whether choosing to participate is itself a protected moral choice, and the uncomfortable echo of Nuremberg and “do no harm” that drew this line in the first place.

And the question they keep circling: if a clinician’s conscience can let them refuse an unethical act, does it also let them opt in to this one?

As always — no verdict, no stance for or against the death penalty. Just the questions worth sitting with. And on this one, they genuinely want to hear where you land.

Join the conversation. Let’s get ethical.

In the hospital, you don't ask a patient for their insurancecard before you set up their ventilator. In home care, you can't even walk in the door without one. That gap is where this episode lives.

Mike and Rob sit down with Chrysalis Ashton — RRT, Master'sin respiratory care, Head of Respiratory Clinical Affairs and Industry Relations at Drive Medical, and the AARC's 2026 Specialty Practitioner of the Year for ambulatory and post-acute care — for a look at the ethics almost no one talks about: what happens to respiratory patients after they leave the hospital.

They dig into Medicare's new national coverage determination for non-invasive therapy in COPD, the word Chrysalis "loves and hates" — compliance — and the brutal dilemma it creates: when a patient clearly needs a device but isn't using it enough to satisfy their insurance, does the company take it back (the business call) or leave it in the homeunpaid (the clinical one)? Along the way: why insurance criteria can measure eligibility for payment more than actual health, how DMEs quietly absorb the cost of doing the right thing, and why so many family-owned providers don't survive it.

A rare, honest look at the intersection of clinical need, financial reality, and the patients stuck in the middle.

Join the conversation. Let's get ethical.

We like to pretend autonomy is neat and clean — a signature on a consent form, an advance directive in a drawer. But what happens when saying "no" costs the system something? And what happens when the decision isn't even left in your hands?

In this episode, Mike and Rob take on the pillar they keep circling back to: patient autonomy — your right to say yes, and your right to say no. They lay out what autonomy actually requires (informed consent, capacity, competence), why a treatment can be medically beneficial yet morally unacceptable to the patient, and how autonomy gets quietly stripped away in ways that never make headlines.

Then they connect the threads from recent cases: the Georgia law that overrode Adriana Smith's surrogate decision-maker, the WISeR model where a third party thousands of miles away can deny approved care, and Pete Jacobs — the competent patient who mouthed "suction me," pointed to his airway, and was ignored while staff hid behind scope. Different stories, same erosion.

The uncomfortable question at the center: are we treating the patient's goals, or our own institutional protocol?

Congratulations also to co-host Rob — New Hampshire's Respiratory Care Practitioner of the Year 2026.

Join the conversation. Let's get ethical.

A nurse agrees to be a gestational surrogate. The contract includes a clause: if doctors find a serious fetal anomaly, the intended parents can request termination — and she signs it, with a psychologist involved, fully informed. Then, 20 weeks in, a serious diagnosis comes. The parents invoke the clause. And she says no.

Is that a broken promise, or is it exactly what bodily autonomy is supposed to look like?

Mike and Rob dig into one of the thorniest cases they've covered — a real, ongoing surrogacy dispute now spanning three states and lawsuits over custody, parentage, and breach of contract. They work through the difference between promising to do something and consenting to have something done to you, why almost no legal system will force a medical procedure on someone no matter what they signed, and the eerie echoes of the 1988 Baby M case that drew this same line decades ago.

Then the sharpest question of all: nothing about the ethics changed when she crossed a state line — so why does geography end up deciding a child's entire legal identity? Law and ethics point in different directions here, again and again, and this episode sits right in that gap.

No verdict. No easy answers. Just the questions worth sitting with.

Join the conversation. Let's get ethical.

Who gets to decide whether you receive the care your doctorordered — and what happens when the person deciding is rewarded for saying no?

Mike and Rob dig into WISER, a new Medicare model (theWasteful and Inappropriate Service Reduction model) that pairs AI and machine learning with human reviewers to evaluate whether certain services get approved. Prior authorization isn't new, and reducing genuine waste is a good thing — but this episode is about what happens when financial incentives, algorithms, and blurred accountability get built into that decision.

They work through the ethics underneath: the appeal processmost patients never use, the human cost of a wrongful denial, the conflict of interest in paying reviewers based on what they save, and the accountability gap when "the algorithm decided." Along the way — the GAO's review, the congressional fight over the model, and two personal stories (including Mike's father's months-long battle over a Medicare eye referral) that put a face on the whole thing.

No easy villains, no partisan axe to grind — just the fourpillars of medical ethics applied to a system where, as Rob puts it, complicated structures can quietly hide who's responsible.Join the conversation. Let's get ethical.

A suction machine sat at the bedside, switched off. Over an eight-hour shift, aides asked more than ten times for the patient to be suctioned. He mouthed that he couldn't breathe. And by morning, an 87-year-old Korean War veteran named Pete was dead — from something as simple, and as preventable, as a machine that was never turned on.

In this episode, Mike and Rob work through one of the hardest cases they've covered: a real preventable death in an Iowa long-term care facility. It's not just a story about one clinician. It's about the ethics underneath — the duty to rescue, scope of practice used as a shield, moral injury, the bystander problem, and the institutional rot that let "that's not my job" end a man's life.

They dig into the legal aftermath (what an Alford plea actually means, why a license was suspended rather than revoked), the aide who says she was fired for speaking up, and the uncomfortable question at the center of it all: when the system fails and one person takes the blame, does anyone actually get justice?

A sobering look at what we owe the patient in front of us — and everyone who could have picked up the phone.

Join the conversation. Let's Get Ethical.

Where does ethics actually come from? Mike and Rob trace the entire arc of medical ethics — from the Code of Hammurabi in 1754 BCE and the Greek philosophers, through Hippocrates and "do no harm," all the way to the four pillars that govern clinical practice today.

Here's the part that surprises everyone: the framework modern healthcare runs on — autonomy, beneficence, non-maleficence, and justice — is barely 40 years old, formalized by Beauchamp and Childress in 1979. Rob walks through the hard history that forced it into being: the Nuremberg Code born from the Nazi doctor trials, the 1964 Declaration of Helsinki, and the Tuskegee Syphilis Study that ran for 40 years until journalist Jean Heller exposed it in 1972.

It's a fast, surprisingly gripping tour through the moral codes, atrocities, and turning points that shaped how we treat patients today — and a look ahead at the next frontier: what AI will do to ethical decision-making in medicine.

Whether you're an RT, a nursing or med student, or just someone who thinks about right and wrong in healthcare, this one reframes how you see the field.

Join the conversation. Let's get ethical.

Is it ever ethical for healthcare workers to walk off the job? When roughly 4,000 nurses at Brigham and Women's Hospital — part of the Mass General Brigham system — staged the largest nursing strike in Massachusetts history, it forced a hard question: where's the line between workers' rights and a clinician's duty to the patients in the beds?

Rob and Mike work through every side of it — the one-day walkout, the multi-day lockout that followed, the contracted "registry" nurses brought in to cover, and the roughly 3.5% raise the Massachusetts Nurses Association was asking for. Then they flip the ledger: a system reporting billions in net income, with a CEO whose total compensation reached $8.4 million — the highest of any hospital executive in the state. Is a modest raise really the unreasonable ask, or does walking out on patients cross a line no paycheck can justify?

Unions, "scabbing," executive compensation, and what actually happens to patients when both sides dig in. No cheerleading, no easy answers — just an honest look at a genuinely hard call.

Join the conversation. Let's get ethical.

Great leaders aren't born knowing how to handle a team that turns on them — they learn it in the trenches. This week, Rob and Mike sit down with Meliza Walsh, Director of Respiratory Care at Children's Memorial Hermann Hospital in the Texas Medical Center, co-host of Sis, Let's Talk Leadership, and a rising voice in respiratory therapy leadership.Meliza opens up about the core values that anchor her (integrity, faith, and family), the year of leadership so brutal she cried the whole drive home, and the "leadership buddy" advice that changed everything. The conversation goes deep on accountability without cruelty, why she refuses to correct staff who mistake her for a new grad, and how "just culture" really works when you're troubleshooting a failing device at 3 AM.Then things get real: Mike shares actual social-media posts from RTs bragging about skipping treatments, faking respiratory rates, and charting therapy they never did — and Meliza explains how a leader should respond when the person misrepresenting the profession is on your own team.Honest, funny, and full of hard-won wisdom on what ethical leadership actually looks like in respiratory care.Join the conversation. Let's get ethical.

Mayo Clinic is replacing overnight respiratory therapists with telehealth in its critical access hospitals — so Rob and Mike revisit the decision with someone who's lived it.

Jill Wolber, an RT with nearly 30 years in critical care and a year as the lone night RT at a rural critical access hospital, takes the conversation into the trenches: running from ER codes to deliveries, managing near-sentinel events, and feeling like her license was on the line every shift.

Having done telehealth herself, she explains why Mayo's "quality of care" framing crosses a line — and the critical difference between telehealth as a backup versus a replacement. A candid look at staffing, ethics, and what rural communities stand to lose.

Plus: a birthday shout-out to the U.S. Navy Hospital Corps.

New here? Start with our first conversation on the Mayo decision: https://open.spotify.com/episode/3IfjcHYfTodvjtPXV9Eqrv?si=PQImJiX7SeCTLByrxPE6_g

Join the conversation. Let's get ethical.

Recorded live at the California Society for Respiratory Care conference, We are joined by crew from RT Sidebar for a special crossover edition with the Let's Get Ethical crew. And if that wasn't enough, a familiar face makes his long-awaited return — the one and only JB is back in the house.

The crew gets candid about how podcasting has transformed respiratory therapy education, reaching listeners across 14+ countries and platforms like Spotify, YouTube, iHeart, and Amazon Music. They share their funniest, most cringe-worthy podcast memories — from garage recordings about meat marinades to one unforgettable bedside moment involving a bassinet and a very awkward congratulations. Plus, hear how this unlikely group of friends found each other through webinars, word of mouth, and a little bit of fate.

It's laughs, love, and a whole lot of respiratory therapy energy — straight from sunny California.

Is the next pandemic already here, or is it just social media noise? In this episode of Let's Get Ethical, Rob and Mike welcome back Mindy Conklin to discuss the ethical implications of healthcare professionals venting on social media while in uniform. We break down the reality of the Hantavirus "scare," address the toxic culture of negativity facing students and new grads, and discuss what it truly means to uphold the oath in a post-COVID world. If you are feeling burned out, or if you're tired of the bedside "venting" culture, this conversation is for you.

Recorded live at the Missouri Society Respiratory Care Conference with RT Sidebar, this episode features respiratory therapist, educator, and provost Dr. Aaron Light. He opens up about failing algebra twice, landing on academic probation, and ultimately graduating as class valedictorian.

But the real heart of this conversation is legacy. Dr. Light reflects on what it means to train students who go on to care for thousands of patients, help champion compact licensure across 11 states, and build a "coaching tree" of educators who are now shaping the next generation themselves. He also makes a passionate case for why senior therapists have an absolute obligation to mentor those coming up behind them.

A must-listen for anyone who wants to make a bigger impact than just the patients in front of them.

In this special, collaborative episode of Let's Get Ethical , Mike and Rob are joined by the team from RT Sidebar—Matt, JJ, and Mindy—to tackle a pressing and controversial issue in the healthcare industry: the recent announcement by the Mayo Clinic to eliminate overnight respiratory therapist (RT) coverage at three of its smaller facilities.

Coming together to unpack the complex, emotional, and systemic implications of this decision, the panel discusses the reality of the evolving healthcare landscape, the potential for a "trickle-down" effect on other hospital systems, and the urgent need for the profession to define its own value.

In this podcast episode of Let's Get Ethical, hosts Rob and Mike interview Dr. William Croft, the Executive Director of the North Carolina Respiratory Care Board, to discuss the intersection of professional ethics and licensing. Dr. Croft details his multifaceted role, which includes overseeing background checks, lobbying for legislation, and conducting investigations into practitioner misconduct. The conversation focuses on the central question of whether mandatory ethics courses actually improve professional behavior, with the participants suggesting that case studies and active engagement are more effective than passive lectures. They examine common ethical breaches, such as pre-charting and falsifying records, attributing these actions to poor time management, insecurity, or a "monkey see, monkey do" culture. Ultimately, the source emphasizes that maintaining integrity and a patient-first mentality are essential for navigating the complex legal and moral challenges of the respiratory care profession.

In this live episode recorded at the California Society for Respiratory Care (CSRC) 2026 conference in Temecula, hosts Rob and Mike sit down with a trailblazing guest — Mindy Conklin! One of the first seven Advanced Practice Respiratory Therapists (APRTs) in the country.

Mindy shares her remarkable journey from a non-traditional student at 31 who stumbled into respiratory therapy, to becoming a pioneer in an entirely new clinical profession. She opens up about the moment a chance encounter sparked a vision that would reshape her entire career — and eventually lead her to pack up her life and move to Baltimore for the very first APRT job posting.

The conversation dives into what APRTs actually are — think nurse practitioners or physician assistants, but exclusively in the cardiopulmonary space — and why the profession is poised to transform how patients with COPD, asthma, and critical illness receive care. Mindy also discusses the very real challenges of building a new profession from scratch: skepticism from colleagues, lack of legislation, and the long road to CMS reimbursement.

Beyond the professional, listeners get a glimpse of the person behind the pioneer — a proud Swifty, Peloton enthusiast, new grandmother, and self-described loud singer whose husband has reluctantly become a Taylor Swift fan.

A must-listen for anyone in respiratory care who wants to understand where the profession is headed and how to get involved.

In this episode, hosts Mike and Rob sit down with Jake Miller, RRT-ACCS, MBA, just before the California Society for Respiratory Care (CSRC) annual conference. Jake is the Manager of Respiratory and Interventional Pulmonary at Keck USC Medical Center and the current president of the CSRC.

Jake shares his 13+ year journey in respiratory care, starting out in EMS doing Orange County 911 work before transitioning into hospital-based practice. He opens up about how the burnout and exhaustion of working six to seven days a week during COVID pushed him to seek something more — leading him to get involved with the CSRC, where he found renewed purpose through committees, advocacy, and leadership.

The conversation digs into the real challenges facing state respiratory societies, including member burnout, retention struggles, and the push to grow initiatives like the Advanced Practice Respiratory Therapist (APRT) designation in California. The hosts also tackle the big question of why more of California's estimated 30,000 licensed respiratory therapists aren't engaged with their state society — and why they should be, given the legislative and professional issues directly affecting their licenses and patient care.

Jake's message is welcoming and low-pressure: show up to one committee meeting, give some feedback, and see what happens. A great listen for any respiratory therapist thinking about getting more involved in their profession.

What happens when an accidental Google search completely derails your life plan — in the best possible way? Ask Rachel Jenkins.

In this episode, Rob and Mike sit down with the MSRC Vice President and Ozarks Technical Community College faculty member ahead of the Missouri Society for Respiratory Care conference, and things get real fast. Rachel went from psychology and criminology student to respiratory therapist in the middle of a global pandemic, then pivoted to education, landed a spot in the AARC Emerging Leaders Program, and somehow still found time to plan a conference around Renaissance Fairs and dragon-themed ventilators. Yes, really.

But underneath the fun, Rachel pulls no punches about the state of the profession — calling out the therapists who want higher pay and a bigger scope of practice without doing the work to earn it, breaking down what it actually costs to get legislation moving, and making the case for why the next generation of RTs needs to be as comfortable talking to a physician as they are sending a text.

If you care about where respiratory care is headed and who's going to take it there, this is the episode for you.

Some lessons can't be taught in a classroom. They come from the bedside of a dying grandmother, from the weight of holding someone's hand when there's nothing left to do medically, from years of fighting to save lives and slowly learning that sometimes the most compassionate thing you can offer is peace.

In this deeply personal episode, Mike sits down with co-host Rob to trace the journey that shaped not just his career, but his humanity. From 14 years serving in the United States Navy — carrying skills that the civilian world didn't know what to do with — to becoming a pioneer in neonatal flight care, Rob's path has always been driven by a profound desire to help people in their most vulnerable moments. But it was the quiet, painful moments outside of the clinical setting that taught him the most.

Rob opens up about the experience of becoming his grandmother's healthcare decision maker, and how that deeply human moment forced him to confront the very questions he now dedicates himself to exploring — what does it really mean to do right by someone? When does fighting for a life become prolonging suffering? And how do we sit with families in their grief without losing ourselves in the process?

Together, Rob and Mike reflect on why ethics isn't just a policy or a licensure requirement — it's the thread that connects every difficult conversation, every family meeting, every moment a clinician chooses to pull up a chair, get to eye level, and truly listen. They also shine a light on a striking gap in the profession — only 11 states currently require ethics as part of licensure renewal — and make the case that checking a box is not the same as having the conversation that actually needs to happen. Because at the end of the day, our patients and their families don't need our sympathy. They need to know that someone genuinely sees them.

In this heartfelt and candid episode, hosts Rob and Mike getpersonal, stepping back from case discussions to share the "whys" behind their passion for healthcare ethics. Mike, a 30-year respiratory therapy veteran and expert witness on over 26 medical malpractice cases, opens up about what drives his commitment to ethical patient care — from seeing every patient as someone's family member to recognizing that even routine bedside tasks carry life-or-death consequences.

The two dig into questions that don't have easy answers — when should instinct override protocol? How do you hold colleagues accountable without losing compassion? And what separates a genuine ethical decision from simply following the rules? Rob reflects on his own defining moments, including a harrowing triage decision involving a child that tested the limits of ethical instinct.

Together, they explore why ethical thinking needs to become"muscle memory" for healthcare professionals, and how ethics extends far beyond medicine into our laws, relationships, and everyday choices. At the core of it all is a simple but powerful belief: that respectful disagreement and genuine compassion are the foundation of any meaningful ethical conversation.

Honest, unscripted, and occasionally interrupted by a barking dog, this episode captures exactly why these two started the podcast in the first place.