Ariel Cascio joining Center faculty this fall

Ariel Cascio

The Center for Bioethics and Social Justice at Michigan State University is excited to welcome new faculty member M. Ariel Cascio, PhD, who starts in August. Cascio has an anthropology and neuroethics background, and their work is also oriented around research ethics, disability studies, and medical education.

Cascio received their PhD in anthropology from Case Western Reserve University in 2015. Their research has focused on ethical and social issues related to autism and neurodiversity more broadly. During their dissertation research, Cascio spent almost a year in Italy conducting ethnographic research with youth attending autism-focused services.

Most recently Cascio was an assistant professor at Central Michigan University College of Medicine. Previously they were a postdoctoral researcher at the Pragmatic Health Ethics Research Unit of the Institut de recherches cliniques de Montréal (IRCM), where they conducted a multi-national, multi-lingual survey study that investigated the preferences of autistic people and parents for different types of services, and collaborated with autistic people and other stakeholders to develop person-oriented research ethics suggestions for studies involving autistic people.

Leonard Fleck presents keynote lecture at international precision medicine conference

Leonard Fleck

Leonard Fleck, PhD, recently traveled to Lisbon, Portugal to present the keynote lecture at the conference “Precision Medicine Conference: Ethical and Legal Issues.” This international conference was held at Universidade Nova de Lisboa and sponsored by the Erasmus University School of Health Policy and Management.

Fleck’s address on the ethical and legal issues of precision medicine is available to watch on YouTube, along with other content from the conference. Fleck’s address begins around the 11-minute mark of the video.

An audience of in-person and virtual conference attendees included lawyers, policy expects, and medical professionals. Many countries were represented among attendees, including the Netherlands, Spain, Portugal, Lithuania, Serbia, Italy, France, and Germany. This engaged audience was, in one sense, familiar to Fleck, who has long been collaborating with European researchers, including multiple groups from Erasmus University.

Fleck shared what he describes as a “wow” moment from his presentation:

“I had included a video link to an ad for the drug Opdivo (nivolumab) for non-small cell lung cancer. There are several variants of this ad, all with a common theme: “A Chance to Live Longer.” These ads have been shown (I am sure) thousands of times on U.S. TV. They clearly give the misleading impression that anyone taking this drug can expect significant life-prolongation (leaving it to the viewer’s imagination what that length of time might be). Most of the audience gasped and laughed as they watched the ad. Keep in mind that only in the U.S. and New Zealand may such drug ads appear on TV. So, this was a somewhat startling phenomenon for this audience.”

An hour of discussion followed Fleck’s lecture, exploring the complex questions related to drug costs and public policy. At the heart of these questions is Fleck’s definition of the “wicked problem”: no matter what choices we make, we are at risk of creating new problems that are just as bad, ethically and politically, as the allocation problem we are trying to solve.

Fleck said, “The other concept that was new to most people in the audience was “onco-exceptionalism,” the idea that cancer was morally special and deserving of something close to unlimited resources to provide any degree of benefit from treatment, no matter how small the benefit or how costly the benefit might be.”

Keynote lecture description

Metastatic cancer and costly precision medicines generate highly complex problems of health care justice. Targeted cancer therapies yield only very marginal gains in life expectancy for most patients at a very high cost, thereby threatening the just allocation of limited healthcare resources. Philosophers have high hopes for the utility of their theories of justice in addressing resource allocation challenges; however, none of these theories adequately address the “wicked” ethical problems that have resulted from these targeted therapies.

What we need instead, bioethicist Leonard M. Fleck argues, is a political conception of health care justice, following Rawls, and a fair and inclusive process of rational democratic deliberation governed by public reason. His account assumes that we have only limited healthcare resources to meet unlimited healthcare needs generated by emerging medical technologies. The primary ethical and political virtue of rational democratic deliberation is allowing citizens to fashion autonomously shared understandings of how to fairly address the complex problems of healthcare justice generated by precision medicine. While ideally just outcomes are a moral and political impossibility, “wicked” problems can metastasize if rationing decisions are made invisibly—in ways effectively hidden from those affected by those decisions. As Fleck demonstrates, a fair and inclusive process of democratic deliberation could make these “wicked” problems visible, and subject, to public reason.

By Liz McDaniel

How brain death declarations can harm, and why legal exemptions should be the rule

Bioethics Public Seminar Series green and white icon

The 2022-2023 Bioethics Public Seminar Series will conclude next month with a webinar from Center Assistant Professor Jennifer McCurdy, PhD, BSN, MH, HEC-C, on “How Brain Death Declarations Can Harm, and Why Legal Exemptions Should Be the Rule.” This virtual event is free to attend and open to all individuals.

Wednesday, April 19, 2023
1:30-2:30 PM EDT (UTC−04:00)
Zoom webinar registration: bit.ly/bioethics-mccurdy

According to U.S. law and The Uniform Determination of Death Act (UDDA), an individual can be declared dead by either cardiac or neurological criteria. The latter, known colloquially as brain death, allows a physician to withdraw patients from medical devices against the wishes of families and other surrogates. While once seemingly settled, the concept of death by neurological criteria has increasingly become a topic of controversy, both technically and philosophically.

This seminar will argue that the UDDA should make New Jersey-style legal exemptions to brain death declaration a national guideline, thus allowing individuals to claim a religious exemption when they disagree that brain death is, in fact, death. Why? Because the concept of brain death is based on a specific eurochristian worldview that is not held in common by many reasonable people in U.S. society. The imposition of those unshared worldviews on patients and their loved ones through force of law causes unjustified and avoidable trauma, furthers epistemic injustices, and generates distrust.

Jennifer McCurdy with Spartan helmet graphic in bottom right corner.

Jennifer L. McCurdy is an assistant professor in the Center for Bioethics and Social Justice within the Michigan State University College of Human Medicine. She is a clinical and social bioethicist and educator whose work focuses on understanding and eliminating racial and colonial injustices in contemporary health settings and communities. She currently engages medical students at MSU in curricula related to social context and ethics issues in healthcare. Her current research focuses on brain death policy, Black birthing family safety, and Indigenous representation in bioethics.

Can’t make it? All webinars are recorded and available in our archive of recorded lectures. To receive reminders before each webinar, please subscribe to our email list.

Examining how doctors and patients distinguish between normal and pathological events through the case of epilepsy

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The 2022-2023 Bioethics Public Seminar Series continues this month with a webinar from Center Assistant Professor Megh Marathe, PhD, on “Expedient Classification: Diagnosis in Lived Experience and Medical Practice.” This virtual event is free to attend and open to all individuals. This event will be available as a live broadcast only.

Wednesday, March 22, 2023
1:30-2:30 PM EDT (UTC−04:00)
Zoom webinar registration: bit.ly/bioethics-marathe

This talk examines how doctors and patients distinguish between normal and pathological events through the case of epilepsy. Epilepsy is a chronic illness and disability characterized by recurrent and unpredictable seizures. Seizures are transient events during which people lose control over parts of body-mind function. The talk shows that the diagnostic boundary between seizure and non-seizure events is fluid, dynamic, and porous in lived experience and medical practice. Calling an event a seizure has consequences well beyond treatment, also affecting a patient’s financial stability, social participation, and life aspirations. Hence, doctors and patients take an expedient approach to classifying seizures, informally modifying the very definition of seizure to postpone or avoid severe consequences. Doing so enables doctors and patients to bend rigid classification schemes to suit the complex realities of people’s lives. This work advances scholarship on classification and expertise in information studies, science and technology studies, and disability studies.

Megh Marathe with Spartan helmet graphic

Megh Marathe is an assistant professor in the Center for Bioethics and Social Justice in the College of Human Medicine and the Department of Media and Information in the College of Communication Arts and Sciences at Michigan State University. Marathe’s research seeks to foster inclusion in expert practices and technologies by centering the perspectives of marginalized people. They do this by studying the experiences and practices of multiple stakeholders – doctors and patients, citizens and civic officials – that is, laypeople and professionals, people who are marginalized as well as those in powerful positions, to generate critical theory and practical interventions for inclusive practice and technology design. Marathe adopts an ethnographic approach that is inflected by their computer science training and software industry experience.

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What do clinicians think about using deep brain stimulation to treat obsessive-compulsive disorder in pediatric patients?

Bioethics Public Seminar Series green and white icon

The 2022-2023 Bioethics Public Seminar Series continues next month with a webinar from Center Assistant Professor Michelle T. Pham, PhD, on “Clinician Perspectives on the Potential of DBS for Pediatric Patients with Treatment-Resistant OCD.” This virtual event is free to attend and open to all individuals.

Wednesday, February 15, 2023
1:30-2:30 PM EST (UTC−05:00)
Zoom webinar registration: bit.ly/bioethics-pham

The World Society for Stereotactic and Functional Neurosurgery has argued that at least two successful randomized controlled trials should be available before deep brain stimulation (DBS) treatment for a psychiatric disorder is considered “established.” DBS is currently offered to children ages 7 and older with refractory dystonia under an FDA-humanitarian device exemption. No randomized control trials were conducted – practitioners relied on evidence from DBS use in adults. In addition, accumulated research supports the safety and effectiveness of DBS for obsessive-compulsive disorder (OCD) in adults (Wu et al. 2021).

Approximately 10-20% of children with OCD have treatment-resistant presentations, so it is likely that there will be interest in offering DBS for some children (POTS 2004). Both ethical and empirical anticipatory work is needed to evaluate whether, and if so, under what conditions it might be appropriate to offer DBS in this context. This seminar will present qualitative data from semi-structured interviews with 24 clinicians with expertise in this area regarding: (a) acceptable levels of evidence to offer DBS in this patient population and (b) institutional policies or protocols needed to effectively provide care for them.

Michelle Pham with Spartan helmet graphic

Michelle T. Pham is an assistant professor in the Center for Bioethics and Social Justice and the Department of Medicine in the Michigan State University College of Human Medicine. She conducts research in the interdisciplinary field of Neuroethics and connected issues in the Philosophy of Science. Some recent topics include promoting post-trial care for patient-participants in experimental brain implant studies and decision-making in the context of pediatric deep brain stimulation. Pham also researches ways to promote engagement with patient-participants who contribute to neuroscience and neurotechnology research; and she has raised the concern that patient-participants in these brain implant studies may be exploited.

Can’t make it? All webinars are recorded and available in our archive of recorded lectures. To receive reminders before each webinar, please subscribe to our email list.

Jennifer McCurdy presents at Michigan State Medical Society 26th Annual Conference on Bioethics

Jennifer McCurdy with Spartan helmet graphic in bottom right corner.

Center Assistant Professor Jennifer McCurdy, PhD, BSN, MH, HEC-C, presented “Beyond Patient Behavior: Using Structural Competency to Create Health Equity” at the Michigan State Medical Society (MSMS) 26th Annual Conference on Bioethics: Contemporary Challenges in Clinical Bioethics in November. McCurdy’s presentation explored the social, political, and economic contexts that act as barriers to patients care and impede physicians’ ability to effectively treat them.

McCurdy asked those in attendance the following questions: Have you ever experienced moral distress or frustration associated with the medical “system?” Have you ever been unable to treat a patient for whom treatment exists, based on factors that are out of your control? What were those factors?

Using a case example, McCurdy discussed factors that determine the health status of an individual, such as behaviors, cultural norms, and biology. She also discussed social determinants of health, such as poverty, inadequate or no housing, lack of access to education, and lack of access to healthcare. McCurdy also outlined structural determinants of health, pointing to social structures, political structures and policy, and economic structures and policy—the “causes of the causes.”

How can physicians help? They are uniquely positioned in spaces that connect the medical world and the patients’ worlds, where they can observe recurrent barriers to care. They can work to create change at individual, interpersonal, and institutional levels. McCurdy also outlined how physicians’ involvement in the community, in policy, and in research can create structural change and therefore improve health equity.

Related reading

  • Neff J, Holmes SM, Knight KR, Strong S, Thompson-Lastad A, McGuinness C, Duncan L, Saxena N, Harvey MJ, Langford A, Carey-Simms KL, Minahan SN, Satterwhite S, Ruppel C, Lee S, Walkover L, De Avila J, Lewis B, Matthews J, Nelson N. Structural Competency: Curriculum for Medical Students, Residents, and Interprofessional Teams on the Structural Factors That Produce Health Disparities. MedEdPORTAL. 2020 Mar 13;16:10888. doi: 10.15766/mep_2374-8265.10888. PMID: 32342010; PMCID: PMC7182045.
  • Gruen RL, Campbell EG, Blumenthal D. Public roles of US physicians: community participation, political involvement, and collective advocacy. JAMA. 2006 Nov 22;296(20):2467-75. doi: 10.1001/jama.296.20.2467. PMID: 17119143.

By Liz McDaniel

Bioethics for Breakfast: Medical Legal Partnerships: A Tool to Help Address the Social Determinants of Health

Bioethics for Breakfast Seminars in Medicine, Law and Society

Megan Hoberg and Pamela Hoekwater of Legal Aid of Western Michigan presented at the December 1st Bioethics for Breakfast session, offering their insight and expertise on the topic “Medical Legal Partnerships: A Tool to Help Address the Social Determinants of Health.” Bioethics for Breakfast is generously sponsored by Hall, Render, Killian, Heath & Lyman.

The session provided an overview of medical legal partnerships (MLPs) and their impact, discussing the Legal Aid of Western Michigan (LAWM) partnership with Cherry Health—Michigan’s largest Federally Qualified Health Center that operates in six counties. Speakers Hoberg and Hoekwater defined a medical legal partnership as “an integration of lawyers into the health care setting to help clinicians, case managers, and social workers address structural problems at the root of so many health inequities.” MLPs are increasing in popularity across the U.S. and can result in patient success stories, provider satisfaction, and increased recognition and reputation from organizations in the community.

They explained that a big part of MLPs involves screening for issues that might not have an obvious legal component to them. They shared four legal aid practices that relate directly to different social determinants of health: family law, housing, public benefits, and individual rights. One component of an MLP is training the health organization’s work force to help identify potential legal needs in the patient setting.

A memorandum of understanding (MOU) between the relevant stakeholders is generally a starting point to form MLPs. Hoberg and Hoekwater shared that there are a variety of ways that MLPs are funded, including AmeriCorps/Equal Justice Works, private donors, law firms, bar associations, health organizations, and foundations. They shared the evolution of their partnership with Cherry Health, which started with a pilot program and now includes a full-time on-site attorney and community health worker. The MLP currently focuses on maternal infant health and the senior population. The MLP operates as a multi-step process that begins with a referral to the MLP team through the electronic health record which leads to a meeting between the patient and attorney.

Hoberg and Hoekwater also shared challenges associated with MLPs, such as stability of funding, balancing legal and medical ethics, systems integration, and internal communication. Challenges aside, they shared both quantitative and qualitative data that supports the positive impact of MLPs. One example of a specific impact is patients reporting improved mental health and lower levels of stress and anxiety.

It was clear during the question and answer potion that attendees were interested in learning more about how they can pursue forming MLPs at their organizations, and how they can help their patients receive the legal support they need.

Related items

About the speakers

Megan Hoberg is a Staff Attorney with Legal Aid of Western Michigan (LAWM). Previously, she worked as the Medical Legal Partnership Attorney, for the MLP LAWM maintains with Cherry Health. Megan’s perspective sheds light on how MLPs operate on a daily basis and the impact they produce for patient/client communities. Megan was drawn to MLPs during her time at Wayne State University Law School, when she served as a student attorney for The Legal Advocacy for People with Cancer Clinic and earned the 2020 Outstanding Clinical Student Team Award from the Clinical Legal Education Association (CLEA). Starting her career in healthcare and bioethics, working with MLPs and poverty law allows her to use her legal training to advance public health goals in an interdisciplinary setting. She is a member of the following organizations: State Bar of Michigan Professional Ethics Committee, Women Lawyers Association of Michigan, and American Society for Bioethics and Humanities.

Pamela Hoekwater serves as the Executive Director for Legal Aid of Western Michigan (LAWM). She has over 20 years’ experience in poverty law work since starting her legal career as a Staff Attorney in 2001 and has developed innovative partnerships with local agencies to integrate legal services in the community, including the YWCA, Goodwill Industries, and Hope Network. Having helped launch LAWM’s first medical legal partnership (MLP) in 2017, Pam holds a unique perspective and expertise as to the challenges of maintaining and advancing MLPs. Notably, she contributed to the formation of the Medical Legal Partnership with Cherry Health, which has been fully funded and staffed since 2019. Pam strives to advance social justice and equity through her participation/leadership in the following organizations: Resource Committee for Michigan Justice For All Commission, State Bar of Michigan Diversity and Inclusion Advisory Committee, Michigan State Planning Body, and Legal Services Association of Michigan.

By Liz McDaniel

Microaggressions have big impacts for disabled users online

Originally published by Cornell University Cornell Ann S. Bowers College of Computing and Information Science

By Patricia Waldron

In person, people with disabilities often experience microaggressions – comments or subtle insults based on stereotypes – but similar interactions, as well as new types of microaggressions, play out online as well.

A new study by researchers at Cornell and Michigan State University finds that those constant online slights add up. Interviews revealed that microaggressions affect their self-esteem and change how people with disabilities use social media. Ideally, digital tools will one day reduce the burden for marginalized users, but due to their subtlety, microaggressions can be hard for algorithms to detect.

“This paper brings a new perspective on how social interactions shape what equitable access means online and in the digital world,” said Sharon Heung, a doctoral student in information science. Heung presented the study, “Nothing Micro About It: Examining Ableist Microaggressions on Social Media,” Oct. 26 at ASSETS 2022, the Association for Computing Machinery SIGACCESS Conference on Computers and Accessibility.

Previously, little was known about online microaggressions. “If you look at the discourse around harms emanating from social media use by communities that are vulnerable, there is almost no work that focuses on people with disabilities,” said co-author Aditya Vashistha, assistant professor of information science in the Cornell Ann S. Bowers College of Computing and Information Science. “It’s surprising because about one in seven people in the world has a disability.”

When microaggressions occur in live settings, they are often ephemeral, with few bystanders. In contrast, “when they happen on social media platforms, it’s happening in front of a large audience – the scale is completely different,” said Vashistha, “and then they live on, for people to see forever.”

Additionally, social media platforms can amplify microaggressions, potentially spreading misinformation. “Online microaggressions have the ability to shape the understandings of disability for a lot of people who are not even involved in the situation,” said co-author Megh Marathe, assistant professor of media, information, bioethics, and social justice at Michigan State. “We’re very concerned about how it’s shaping the way the broader audience thinks about disability and disabled people.”

Heung and co-author Mahika Phutane, a doctoral student in computer science, interviewed 20 volunteers who self-identified as having various disabilities, and who were active on social media platforms. They asked the participants to describe subtle discrimination and microaggressions they had experienced, and the impact on their lives.

Patronizing comments like, “You’re so inspiring,” were the most common, along with infantilizing posts, like “Oh, you live by yourself?” People also asked inappropriate questions about users’ personal lives and made assumptions about what the person could do or wear based on their disability. Some users were told they were lying about their disability, or that they didn’t have one, especially if that disability was invisible, such as a mental health condition.

The researchers categorized the responses into 12 types of microaggressions. Most fit into categories previously recognized in offline interactions, but two were unique to social media. The first was “ghosting,” or ignored posts. The second was ways that the platform was inaccessible for people with various disabilities. For example, some users said they felt unwelcome when people did not add alt text to photos or used text colors they couldn’t discern. One person with dwarfism said her posts were continually removed because she kept getting flagged as a minor.

After experiencing a microaggression, users had to make the tough choice of how to respond. Regardless of whether they ignored the comment, reported it, or used the opportunity to educate the other person, participants said it took an emotional toll and damaged their self esteem. Many took breaks from social media or limited the information they shared online to protect themselves.

“Addressing this problem is really hard,” said Phutane. “Social media is driven to promote engagement, right? If they educate the perpetrator, then that original post will just get more and more promoted.”

Most social media platforms already have moderation tools, but reporting systems are sometimes flawed, lack transparency, and can misidentify harassment. The participants proposed that platforms should automatically detect and delete microaggressions, or a bot could pop up with information about disabilities. 

However, microaggressions can be hard for automated systems to detect. Unlike hate speech, where algorithms can search for specific words, microaggressions are more nuanced and context-dependent.

Once the scope and types of microaggressions experienced by people from various marginalized groups are better understood, the researchers think tools can be developed to limit the burden of dealing with them. These issues are important to address, especially with the potential expansion of virtual reality and the “metaverse.”

“We need to be especially vigilant and conscious of how these real-world interactions get transferred over to online settings,” said co-author Shiri Azenkot, associate professor of information science at the Jacobs Technion-Cornell Institute at Cornell Tech and Cornell Bowers CIS. “It’s not just social media interactions – we’re also going to see more interactions in virtual spaces.”

This work was partially supported by the National Science Foundation Graduate Research Fellowship and the University of California President’s Postdoctoral Fellowship.

Patricia Waldron is a writer for the Cornell Ann S. Bowers College of Computing and Information Science.

Bioethics for Breakfast: Demystifying End-of-Life Care

Bioethics for Breakfast Seminars in Medicine, Law and Society

Leonard M. Fleck, PhD, and Karen Smith, LMSW, PhD, HEC-C, presented at the October 13 Bioethics for Breakfast session, offering their insight and expertise on the topic “Demystifying End-of-Life Care.” Bioethics for Breakfast is generously sponsored by Hall, Render, Killian, Heath & Lyman. The presentation portion of the session was recorded and is available to watch on our website.

The State of Michigan has recently approved the MI POST (Michigan Physician Order for Scope of Treatment), which allows a patient and physician to have in place directions (orders) on care to go between levels of treatment. Such orders typically specify the kind of care a terminally ill patient would want or refuse in an emergency situation outside a hospital setting. Such orders are agreed to by a competent patient or their representative and the attending physician. A POST document is often part of a larger advance care planning document.

Most patients do not have an advance directive or a POST. What happens when that patient is actively dying and the attending physician believes a Do Not Attempt Resuscitation order (DNAR) is in the best interest of that patient? Should that decision by the physician require the written consent of the patient’s family for that DNAR order? And what are the consequences for the patient if the family cannot reach agreement? If you were that patient, what would you regard as the most reasonable course of action? How would you ensure your wishes are followed?

Presenters Fleck and Smith gave some background on what it means to have a natural death and a managed death, noting that the majority of Americans today die a managed death. Smith explained that durable power of attorney and MI POST are the two state-authorized methods for directing end-of-life wishes. Fleck asked attendees to consider the following questions: Are the policies and practices in place regarding terminally ill incapacitated patients good enough? Are they the best we can do? What might we do better? What do we see as the main deficiencies in current policy and practice?

The presentation also explored how policy can protect patients and prevent suffering at the end of life and presented multiple case examples regarding terminal care in the ICU. Discussion during the Q&A portion focused on family disagreements in the ICU, the value of healthcare literacy and common misconceptions that stem from popular culture, and what happens when the court system is involved with end-of-life decisions.

Related items

About the speakers

Leonard M. Fleck, PhD, is a Professor in the Center for Bioethics and Social Justice and the Department of Philosophy at Michigan State University. Fleck’s interests focus on medical ethics, health care policy, priority-setting and rationing, and reproductive decision-making. He explores the role of community dialogue (rational democratic deliberation) in addressing controversial issues of ethics and public policy related to emerging genetic technologies. More recently, he has completed a book-length manuscript that addresses a number of ethical and policy issues related to precision medicine, primarily in a cancer treatment context. He also completed another book that addresses several contemporary issues related to bioethics and religion from a Rawlsian public reason perspective.

Karen Smith, LMSW, PhD, HEC-C, has been a member of hospital ethics committees for over 20 years. She is currently the Director of Ethics Integration for Henry Ford Health, a six-hospital system in metro Detroit. Smith publishes on issues related to clinical ethics the hospital setting. She specializes in death and dying issues and often works to educate the public on Advance Directive issues. She has been on the National Board for the Funeral Consumers Alliance which is a non-profit organization dedicated to providing the public education and advocacy related to after death needs.

Addressing the complex problems of health care justice generated by precision medicine

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The 2022-2023 Bioethics Public Seminar Series begins next month with a webinar from Center Professor Leonard M. Fleck, PhD, on “Precision Medicine and Distributive Justice: Wicked Problems for Democratic Deliberation.” This virtual event is free to attend and open to all individuals.

Wednesday, November 16, 2022
1:30-2:30 PM EST (UTC−05:00)
Zoom webinar registration: bit.ly/bioethics-fleck

Metastatic cancer and costly precision medicines generate extremely complex problems of health care justice. Targeted cancer therapies yield only very marginal gains in life expectancy for most patients at very great cost, thereby threatening the just allocation of limited health care resources. Philosophic theories of justice cannot address adequately the “wicked” ethical problems associated with these targeted therapies. Following Rawls, Fleck argues for a political conception of health care justice, and a fair and inclusive process of democratic deliberation governed by public reason. The virtue of democratic deliberation is that citizens can fashion autonomously and publicly shared understandings to fairly address the complex problems of health care justice generated by precision medicine. “Wicked” problems can metastasize if rationing decisions are made invisibly. A fair and inclusive process of democratic deliberation can make these “wicked” problems visible, and subject, to fair public reason constraints. What constrained choices do you believe you would endorse with your fellow citizens as being “just enough”?

Leonard M. FLeck

Leonard M. Fleck, PhD, is a professor in the Center for Bioethics and Social Justice and the Department of Philosophy at Michigan State University. Dr. Fleck’s interests focus on medical ethics, health care policy, priority-setting and rationing, and reproductive decision-making. He explores the role of community dialogue (rational democratic deliberation) in addressing controversial issues of ethics and public policy related to emerging genetic technologies. More recently, he has completed a book-length manuscript that addresses a number of ethical and policy issues related to precision medicine, primarily in a cancer treatment context. He also completed another book that addresses several contemporary issues related to bioethics and religion from a Rawlsian public reason perspective.

Can’t make it? All webinars are recorded and available in our archive of recorded lectures. To receive reminders before each webinar, please subscribe to our email list.