The podcast for respiratory therapists and the future of the RT profession. Hosts Mike Sheahan and Rob Fishwick — bioethics experts and lifelong RTs — break down the real ethical, professional, and licensure battles shaping respiratory care today. Honest conversations, live conference episodes, and the field's leading voices, from APRT pioneers to state board directors. Whether you're a student, a 20-year bedside vet, or a leader fighting for the profession, pull up a chair.
New episodes every two weeks.
Join the conversation. Let's Get Ethical!
What Is Autonomy When the System Decides You Don't Get to Have It?
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.
22 Sept 2026
She Signed the Contract. Then She Said No. Surrogacy, Autonomy & When Consent Can Be Revoked
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.
8 Sept 2026
The WISER Model: When Denying Medicare Claims Pays. Prior Authorization, AI & the Ethics of "No"
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.
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