The Center welcomes Assistant Professor Marleen Eijkholt

m-eijkholt-cropThe Center for Ethics is happy to announce the addition of a new faculty member, Dr. Marleen Eijkholt. Dr. Eijkholt is an Assistant Professor in the Center for Ethics and Humanities in the Life Sciences and the Department of Obstetrics, Gynecology and Reproductive Biology. Dr. Eijkholt is also a clinical ethicist for Spectrum Health System.

Dr. Eijkholt was most recently an Assistant Professor in Medical Humanities at Davidson College in Davidson, NC, and Co-Director of Clinical Ethics Consultation Service & Clinical Ethics at Charlotte Medical Center in Charlotte, NC. She received a JD (or LL.B./ LL.M.) from Maastricht University in The Netherlands, and a PhD in Bioethics & Medical Jurisprudence from University of Manchester in the United Kingdom.

Dr. Eijkholt’s research interests include clinical ethics consultation, reproductive ethics, neuroethics, bioethics and human rights; the broad array of ethical, legal and social issues (ELSI) in biomedicine, including rights in reproduction, stem cells, placebos, deep brain stimulation, and rights to experimental interventions. Visit Dr. Eijkholt’s faculty page to learn more about her work.

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Bioethics for Breakfast: The Future of Medicaid and the Affordable Care Act: Ethical and Policy Challenges

bioethics-for-breakfastSteve Fitton and Jane Turner, MD, presented at the Bioethics for Breakfast event on February 2, 2017, offering perspective and insight on the topic, “The Future of Medicaid and the Affordable Care Act: Ethical and Policy Challenges.”

We assume that Republicans in Congress will follow through with their promise to repeal the Affordable Care Act. We also assume that there will be some sort of replacement. The expansion of Medicaid coverage represents just about half the increase in newly insured individuals. The proposal that seems to have the greatest likelihood of being enacted would include block-granting Medicaid. From the perspective of the federal government a block grant is a “fixed budget” as opposed to open-ended funding.

Our speakers discussed what this means for those who are dependent upon the Medicaid program for meeting their health care needs. For example, 31 states have expanded their Medicaid programs to 138% of the poverty level, and 95% of those additional costs are supposed to be covered by the federal government. Will those 31 states have those funds included in their block grant but have it denied to the other 19 states? Is it likely that the size of the block grant will be less than what Michigan would otherwise receive under the current funding mechanism? If the size of the grant is reduced, what sort of health care priorities will Medicaid use to determine the allocation of that more limited funding? What do we imagine might be the consequences for hospitals and or long term care facilities if funding is more constrained? These questions and more were addressed by speakers and attendees during the presentations and moderated discussion.

fitton-fleck-turner-feb2-2017

Left to right: Jane Turner, Leonard Fleck, and Steve Fitton pose for a photo after the Bioethics for Breakfast event. Photo courtesy of the Center for Ethics.

Steve Fitton
Steve Fitton is a principal with Health Management Associates. He has extensive expertise in Medicaid financing, federal waivers and reinventing healthcare delivery systems. As Michigan’s Medicaid director, he oversaw a budget of more than $15 billion with programs that served over two million residents. Steve played a key leadership role in the approval and implementation of the Healthy Michigan program, the state’s expansion of Medicaid. Steve led the creation and implementation of several Medicaid programs and initiatives to improve access and quality of care while increasing efficiencies and lowering costs. He earned his bachelor’s degree from Michigan State University.

Jane Turner, MD
Jane Turner is a general pediatrician and professor in the Department of Pediatrics and Human Development. She enjoys all aspects of caring for children and youth and has a special interest in working with children who have chronic health conditions. She has served on the faculty of the College of Human Medicine for more than 20 years as a teacher, clinician, and administrator. Dr. Turner also works for the Michigan Department of Health and Human Services as assistant medical director of the Office of Medical Affairs and chief medical consultant for Children’s Special Health Care Services. She went to medical school at the Oregon Health Sciences University and completed a pediatric residency at Children’s Hospital of Pittsburgh.

About Bioethics for Breakfast:
In 2010, Hall, Render, Killian, Heath & Lyman invited the Center for Ethics to partner on a bioethics seminar series. The Center for Ethics and Hall Render invite guests from the health professions, religious and community organizations, political circles, and the academy to engage in lively discussions of topics spanning the worlds of bioethics, health law, business, and policy. For each event, the Center selects from a wide range of controversial issues and provides two presenters either from our own faculty or invited guests, who offer distinctive, and sometimes clashing, perspectives. Those brief presentations are followed by a moderated open discussion.
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Assisted Suicide’s Moral Hostages

Bioethics-in-the-News-logoThis post is a part of our Bioethics in the News series

By Tom Tomlinson, PhD

This isn’t exactly news, but some of you may remember a ripple of controversy surrounding a proposal before the Dutch legislature to legalize assisted suicide (AS) for people over 75 who meet certain other conditions, as reported in October in The New York Times.

I was reminded of it in December, when I stumbled over an item in the UK’s Daily Mirror. (Yes, I’m an avid follower of British tabloids.) The item features a video interview with a 65-year-old man with multiple sclerosis who explains why he would want this option as he becomes more disabled by his MS. He complains he’s losing sight in both eyes, and has difficulty reading or writing. As he loses his independence, he finds it more difficult to be happy with his life. “Where are all the things that make life a pleasure, besides the people that I love?” he asks. “They’re all gone, one-by-one they’ve been stripped away…. I don’t see the point of waiting until one is a virtual corpse that simply breathes.”

Now of course assisted suicide for terminally ill patients is itself a controversial topic, although majorities support it in the U.S., Great Britain, and Western Europe. One can expect that a proposal to expand AS to those who have a collection of chronic and variously disabling conditions just by virtue of being old will be even more controversial, and indeed vigorous opposition is expected in the Netherlands, and the adoption of the proposed legislation is far from certain.

euthanasia-regulations-around-the-world

Image description: this map shows the legal status of Physician Assisted Suicide (PAS) and Voluntary Active Euthanasia (VAE) around the world. The map is a project of the Kennedy Institute of Ethics at Georgetown University. Visit the map on the web to explore its interactive features or to view a text version.

Speaking as a gradually disintegrating 71-year old, here’s a tentative defense. It starts with remembering what the Stoic Seneca taught. There is no need to fear death, since once you are dead there is no you to be afraid or to suffer. It’s the dying that we should fear—which is to say, the living we experience before we are finally released by death.

So if AS is justified for those who are dying from a terminal illness, it is because the quality of the life that remains has become intolerable for that person. But the terminally ill aren’t the only ones who struggle with losses to their capacities and their ability to find enjoyment and meaning in the life they are living. The old may well suffer the same kinds of losses as the terminally ill, as a host of chronic but not (yet) fatal conditions chip away at what before could be taken for granted, as friends and family die or move away and the social world shrinks, as the future begins to lose its allure, and there is nothing more in particular we want to achieve or do. “Dear World, I am leaving because I am bored. I feel I have lived long enough,” read George Sanders’ suicide note. A flamboyant actor, Sanders may have wanted his last lines to be good ones. But there was a lot more to the story. Sanders had suffered many losses before his death, which may happen to many of us in our later years. Under some perhaps narrow conditions, why shouldn’t we have the option of AS?

A common reply to this argument is that killing yourself is an awfully extreme solution to such problems, many of which could be ameliorated in other ways: better, more available primary and palliative care, assistive devices, meals on wheels, age-appropriate social activities and networks, visiting nurses and social workers, etc., etc. Once all this is provided, the need for AS will evaporate.

Now these are all fine options to be pursued in the individual case—when they are in fact available. But too often, these alternatives are used as reasons to not permit the option at all—as an argument against a policy allowing AS.

But when they are not readily available to all, or are not effective in the individual case, those who after due consideration believe that AS would serve their interests become moral hostages to an ideal world: a world where every deeply felt need motivating a desire for AS can be met in some other way. When we’re fixated on the ideal, the person in front of us is sacrificed to our vision of a better world. Paradoxically, the real world becomes a worse place as a result.

So I think this style of moral argument is deeply problematic. And assisted suicide is not the only context in which it’s found. For example, parents of children with familial short stature may want to use human growth hormone for children so their child may grow to something closer to the average height, and perhaps avoid the real social disadvantages short people face (men especially). Now there may be lots of good reasons to object to this treatment—e.g., it’s expensive, it is a crapshoot whether it will increase height by any significant amount, etc. But this use of growth hormone is also opposed on the grounds that what really needs to change are discriminatory social attitudes toward very short persons. By all means, let’s work on that. But in the meantime, what about this kid?

Another moral hostage, as we await the Millennium.

tomlinson-crop-2016Tom Tomlinson, PhD, is Director of the Center for Ethics and Humanities in the Life Sciences in the College of Human Medicine, and Professor in the Department of Philosophy at Michigan State University.

Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Thursday, February 9, 2017. With your participation, we hope to create discussions rich with insights from diverse perspectives.

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What are key ethical concerns surrounding the use of psychiatric deep brain stimulation?

bbag-icon-decRecurrent and Neglected Ethical Issues in the Psychiatric Brain Stimulation Discussion

Event Flyer

What are key ethical concerns surrounding the use of psychiatric deep brain stimulation (DBS)? Are those concerns shared broadly for all aspects of DBS or alternatively are they specific to the intended targeted use of that intervention? Dr. Cabrera will discuss results from a recent study conducted by a multidisciplinary research team in which they examined ethical issues discussed in both the scientific and ethics literature around psychiatric DBS. Dr. Cabrera will make the case that understanding the ethics of DBS for psychiatric interventions provides important insight into the way in which ethical concerns for a single technology might vary depending on their intended use.

feb15-bbagJoin us for Dr. Cabrera’s lecture on Wednesday, February 15, 2017 from noon till 1 pm in person or online.

Dr. Cabrera is an Assistant Professor of Neuroethics at the Center for Ethics and Humanities in the Life Sciences. She is also a Faculty Affiliate at the National Core for Neuroethics at University of British Columbia. Her research focuses on the exploration of attitudes, perceptions and values of the general public toward neurotechnologies, as well as the normative implications of using neurotechnologies for medical and non-medical purposes. She received a BSc in Electrical and Communication Engineering from the Instituto Tecnológico de Estudios Superiores de Monterrey (ITESM) in Mexico City, an MA in Applied Ethics from Linköping University in Sweden, and a PhD in Applied Ethics from Charles Sturt University in Australia. Her career goal is to pursue interdisciplinary neuroethics scholarship, provide active leadership, and train and mentor future leaders in the field.

In person: This lecture will take place in C102 East Fee Hall on MSU’s East Lansing campus. Feel free to bring your lunch! Beverages and light snacks will be provided.

Online: Here are some instructions for your first time joining the webinar, or if you have attended or viewed them before, go to the meeting!

Can’t make it? All webinars are recorded! Visit our archive of recorded lectures. To receive reminders before each webinar, please subscribe to our mailing list.

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Coworker Stigma Towards Lactating Mothers in the Workplace

bogdanlovis-crop-facLibby Bogdan-Lovis, MA, Assistant Director of the Center for Ethics and Humanities in the Life Sciences, was recently awarded funding for the project “Coworker Stigma Towards Lactating Mothers in the Workplace” by Science and Society at State (S3). Ms. Bogdan-Lovis is a team member on the collaborative project.

The project’s team is led by Mary Bresnahan of the Department of Communication, and members include Steven Haider of the Department of Economics, Joanne Goldbort of the College of Nursing, and Jie Zhuang of the Department of Communication.

Learn more about “Coworker Stigma Towards Lactating Mothers in the Workplace” on S3’s 2016-2017 Funded Projects page.

S3 is an interdisciplinary research institution at Michigan State University. Learn more about their mission.

Learn more about Libby Bogdan-Lovis’ research.

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Covert Costs of Racial and Ethnic Concordance in the Medical Workforce

bbag-icon-decCovert Costs of Racial and Ethnic Concordance in the Medical Workforce

Event Flyer

Over the past century US medical workforce demographics have shifted. Moving away from a white male dominated profession, there is a welcomed push towards increasing gender, ethnic, racial and linguistic representation. Commonly, that push is linked to notions of desirable doctor/patient identity matching – described here as “concordance.” That demographic shift is accompanied by policy initiatives and rhetoric shaping the professional futures of Native American, African American, and Latino underrepresented minority (URM) physicians. Do these policy initiatives carry social costs that inadvertently influence URM’s futures in the medical workforce? This analysis considers the nature of medical workforce policy strategies. Findings suggest that selectively placing service expectations not similarly placed on their non-minority physician colleagues along with unexamined assumptions of racial/ethnic concordance between patient and physician may place an undue burden on URMs.

jan18-bbagJoin us for Ms. Bogdan-Lovis and Dr. Kelly-Blake’s lecture on Wednesday, January 18, 2017 from noon till 1 pm in person or online.

Dr. Kelly-Blake is an Assistant Professor in the Center for Ethics and the Department of Medicine. Ms. Bogdan-Lovis is the Assistant Director for the Center for Ethics. Bogdan-Lovis and Kelly-Blake are co-leading a multi-institutional research project on Doctor-patient Race/Ethnic Concordance in the Medical Workforce. They are interested in unpacking the complexities surrounding underrepresented minority service to the underserved and how that service may distract those physicians from pursuing other medical professional opportunities.

In person: This lecture will take place in C102 East Fee Hall on MSU’s East Lansing campus. Feel free to bring your lunch! Beverages and light snacks will be provided.

Online: Here are some instructions for your first time joining the webinar, or if you have attended or viewed them before, go to the meeting!

Can’t make it? All webinars are recorded! Visit our archive of recorded lectures. To receive reminders before each webinar, please subscribe to our mailing list.

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Dr. Stahl presents at American Academy of Religion Annual Meeting

Devan Stahl photoCenter Assistant Professor Dr. Devan Stahl is currently the Vice President of the North American Paul Tillich Society and the Co-Chair of the Tillich: Issues in Theology, Religion and Culture Group at the American Academy of Religion. In November Dr. Stahl attended meetings held by the North American Paul Tillich Society (NAPTS) and the American Academy of Religion in San Antonio, TX. Dr. Stahl gave a paper for NAPTS titled “Tillich and the future of interdisciplinary ethics,” discussing the difficulties in doing Christian ethics in non-religious fields, such as medicine, business, and law. Dr. Stahl discussed both why ethics is becoming an interdisciplinary field in the academy and why it is difficult for Christian ethicists to engage in interdisciplinary work. Dr. Stahl proposed Tillich’s method of correlation can help Christian ethicists be true to their Christian message while adapting it to the current situation and culture in which they live.

Dr. Stahl also gave a paper at the American Academy of Religion in a joint session between the Human Enhancement and Transhumanism Group and the Religion and Disability Studies Group titled “Does Transhumanist eschatology eradicate disability?” Dr. Stahl contended there is a tension at the heart of the transhumanist agenda and disability theology: transhumanists aim to enhance “normal” human traits through novel biotechnologies, whereas disability theologians desire a world wherein disability is accepted rather than eradicated. However, because both disability theologians and transhumanists believe bodily variation or modification cannot sever our connection to God, there is room to creatively imagine ways to modify the body that might be beneficial to persons with disabilities. Dr. Stahl argued “radical prosthetics” might be a point of convergence between the two camps and a way to creatively and jointly signal the kingdom of God through human creations.

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