Healthcare cost article from Dr. Fleck published in April ‘Cambridge Quarterly of Healthcare Ethics’

Leonard Fleck photoCenter Professor Dr. Leonard Fleck has a new article published in the April 2018 issue of Cambridge Quarterly of Healthcare Ethics. The article, “Controlling Healthcare Costs: Just Cost Effectiveness or “Just” Cost Effectiveness?,” appears in a special section on justice, healthcare, and wellness.

Abstract: Meeting healthcare needs is a matter of social justice. Healthcare needs are virtually limitless; however, resources, such as money, for meeting those needs, are limited. How then should we (just and caring citizens and policymakers in such a society) decide which needs must be met as a matter of justice with those limited resources? One reasonable response would be that we should use cost effectiveness as our primary criterion for making those choices. This article argues instead that cost-effectiveness considerations must be constrained by considerations of healthcare justice. The goal of this article will be to provide a preliminary account of how we might distinguish just from unjust or insufficiently just applications of cost-effectiveness analysis to some healthcare rationing problems; specifically, problems related to extraordinarily expensive targeted cancer therapies. Unconstrained compassionate appeals for resources for the medically least well-off cancer patients will be neither just nor cost effective.

The full text is available online through Cambridge University Press (MSU Library or other institutional access may be required to view this article).

Posted in Articles, Publications, Uncategorized | Tagged , , , , , , , ,

How should we guide the ethical practice of grateful patient fundraising?

bbag-blog-image-logoEthical Issues Related to Fundraising from Grateful Patients

Event Flyer

Health care institutions are becoming increasingly deliberate about philanthropic fundraising given the need to sustain their missions in the face of decreases in governmental research funds and lowering reimbursement for clinical care. Donations from grateful patients constitute 20% of all philanthropic contributions to academic medical centers, totaling nearly $1 billion a year in recent years. Institutions frequently employ development professionals to facilitate philanthropy. The development literature describes various approaches for identifying patients capable of contributing, cultivating potential donors, and engaging physicians in the solicitation of grateful patients, emphasizing that patients themselves may also benefit from exercising altruism in this way. However, little evidence exists to guide the ethical practice of grateful patient fundraising, and concerns exist regarding privacy and confidentiality, patient vulnerability, and physicians’ conflicts of obligations in this context. Therefore, we will discuss how the process of philanthropic development should be structured in order to demonstrate respect for all persons involved, including patients who donate, those who might consider donation, those who do not wish to donate, and those who cannot afford to do so.

April 11 calendar iconJoin us for Dr. Jagsi’s lecture on Wednesday, April 11, 2018 from noon until 1 pm in person or online.

Reshma Jagsi, MD, DPhil, is Professor and Deputy Chair in the Department of Radiation Oncology and Director of the Center for Bioethics and Social Sciences in Medicine at the University of Michigan. She graduated first in her class from Harvard College and then pursued her medical training at Harvard Medical School. She also served as a fellow in the Center for Ethics at Harvard University and completed her doctorate in Social Policy at Oxford University as a Marshall Scholar. Dr. Jagsi’s medical research focuses on improving the quality of care received by breast cancer patients, both by advancing the ways in which breast cancer is treated with radiation and by advancing the understanding of patient decision-making, cost, and access to appropriate care. Her social scientific research includes research into issues of bioethics arising from cancer care and research regarding faculty development and gender issues, including studies of women’s representation in the medical profession. Dr. Jagsi is the author of over 200 publications in peer-reviewed journals, including The New England Journal of Medicine and JAMA. Her research has been funded by the National Institutes of Health through multiple R01 awards, as well as by numerous philanthropic foundations, including the American Cancer Society, the Robert Wood Johnson Foundation, and the Doris Duke Foundation. She has been elected to the Board of Directors of the American Society of Clinical Oncology (ASCO), for which she formerly served as Ethics Committee Chair, and the Steering Committee of the Group on Women in Medicine and Science of the American Association of Medical Colleges (AAMC). In recognition of her research contributions, she was inducted into the American Society of Clinical Investigation.

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 lecturesTo receive reminders before each webinar, please subscribe to our mailing list.

Posted in Bioethics Events, Brownbag & Webinar Series, Center News, Outreach, Uncategorized | Tagged , , , , , , ,

Episode 7: ‘Imaging and Imagining Illness’ with Devan and Darian Stahl

No Easy Answers in Bioethics logoEpisode 7 of No Easy Answers in Bioethics is now available! This episode features guests Devan Stahl, Assistant Professor in the Center for Ethics and Humanities in the Life Sciences and the Department of Pediatrics and Human Development, and Darian Goldin Stahl, artist and printmaker. This episode delves into the intersection of fine art, illness, disability, and self-identity. The recently released book Imaging and Imagining Illness: Becoming Whole in a Broken Body began as a collaboration between sisters Devan and Darian, one with personal origins. The edited volume examines the impact of medical imaging technologies on patients and our wider culture. In this episode, they discuss Darian’s artistic process, how audiences have reacted to the artwork, and how they came to invite other scholars to build on their work.

Ways to Listen

This episode was produced and edited by Liz McDaniel in the Center for Ethics. Music: “While We Walk (2004)” by Antony Raijekov via Free Music Archive, licensed under a Attribution-NonCommercial-ShareAlike License. Full transcript available.

About: No Easy Answers in Bioethics is a podcast series from the Center for Ethics and Humanities in the Life Sciences in the Michigan State University College of Human Medicine. Each month Center for Ethics faculty and their collaborators discuss their ongoing work and research across many areas of bioethics—clinical ethics, evidence-based medicine, health policy, medical education, neuroethics, shared decision-making, and more. Episodes are hosted by H-Net: Humanities and Social Sciences Online.

Posted in Center News, Outreach, Podcasts, Uncategorized | Tagged , , , , , , , , , , ,

Dr. Stahl and co-authors published in ‘Journal of Pain and Symptom Management’

Devan Stahl photoCenter Assistant Professor Dr. Devan Stahl is co-author of an article published in the February 2018 issue of the Journal of Pain and Symptom Management. “Addressing a Patient’s Hope for a Miracle” was written by Myrick C. Shinall Jr. (Vanderbilt University Medical Center Section of Palliative Care), Dr. Stahl, and Trevor M. Bibler (Baylor College of Medicine).

Abstract: Ill patients may make decisions to continue aggressive life-prolonging care based on hope for a miraculous recovery, and clinicians can find goals of care discussions with these patients extremely challenging. Thus, palliative care providers may be asked to help in these discussions. The concept of “miracle” can express a multitude of hopes, fears, and religious commitments. Effective, sensitive engagement requires the palliative care provider to attend to these variegated hopes, fears, and commitments. This case presents a typology of ways patients express hope for a miracle along with analysis of the motivations and beliefs underlying such hopes and suggestions for tailored responses by palliative care providers.

The full text is available online through Elsevier/Journal of Pain and Symptom Management (MSU Library or other institutional access may be required to view this article).

Posted in Articles, Center News, Publications, Uncategorized | Tagged , , , , , , , ,

Dr. Cabrera and co-authors published in ‘European Journal of Neurosurgery’

Laura Cabrera photoCenter Assistant Professor Dr. Laura Cabrera is first author of the article “The re-emergence of psychiatric neurosurgery: insights from a cross-national study of newspaper and magazine coverage,” published in the March 2018 issue of Acta Neurochirurgica, The European Journal of Neurosurgery. The work of Dr. Cabrera and co-authors Merlin Bittlinger, Hayami Lou, Sabine Müller, and Judy Illes was supported by their European Research Area Network (ERA-NET) NEURON project “Media Coverage of Psychiatric Neurosurgery: Cross-national Investigations of Public Reactions and Attitudes.”

Abstract: Background: Surgical approaches to treat psychiatric disorders have made a comeback. News media plays an essential role in exposing the public to trends in health care such as the re-emergence of therapeutic interventions in psychiatric neurosurgery that were set aside for decades, and in shaping attitudes and acceptance to them. Method: We conducted an analysis of media articles covering all types of psychiatric neurosurgery published in Canada, USA, Germany, and Spain between the years 1960 and 2015. We applied both quantitative and qualitative methods to elucidate patterns of reporting for conditions, themes and tone, across geographic regions, time, and for type of intervention. Results: Coverage of psychiatric neurosurgery has surged since 2001 and is largely consistent across the countries examined. It focuses on depression and deep brain stimulation, and is explicit about historical context. The tone of coverage becomes more positive for Canada, USA and Spain over time; the tone of coverage from Germany remains cautious. Identity and privacy are among the few ethical and philosophical issues raised, notably in the German press. Conclusions: The focused and optimistic attention to contemporary psychiatric neurosurgery in the media, but inattention to ethical issues, places an extra burden on functional neurosurgeons, psychiatrists, and other frontline health professionals to attend to queries from patients and policy makers about the full range of relevant emergent and emerging interventions and the mental health issues to which they may beneficially apply.

The full text is available online through Springer Nature (MSU Library or other institutional access may be required to view this article).

Posted in Articles, Center News, International, Publications, Uncategorized | Tagged , , , , ,

Article from Dr. Stahl in ‘Journal of the Christian Institute on Disability’

Devan Stahl photoCenter Assistant Professor Dr. Devan Stahl and co-author John F. Kilner (Trinity International University) have an article in a special bioethics themed issue of the Journal of the Christian Institute on Disability, volume 6. Their article, “The Image of God, Bioethics, and Persons with Profound Intellectual Disabilities,” is available as a free download on the journal’s website.

Posted in Articles, Center News, Publications, Uncategorized | Tagged , , , ,

Dr. Tomlinson and co-authors published in ‘European Journal of Human Genetics’

Tom Tomlinson photoCenter Director and Professor Dr. Tom Tomlinson is first author of the article “Effect of deliberation on the public’s attitudes toward consent policies for biobank research,” published in the February 2018 issue of the European Journal of Human Genetics. The work of Dr. Tomlinson and co-authors Raymond G. De Vries, H. Myra Kim, Linda Gordon, Kerry A. Ryan, Chris D. Krenz, Scott Jewell, and Scott Y. H. Kim was supported by the NIH-funded project “Public Preferences for Addressing Donors’ Moral Concerns about Biobank Research.”

Abstract: In this study, we evaluate the effect of education and deliberation on the willingness of members of the public to donate tissue to biobank research and on their attitudes regarding various biobank consent policies. Participants were randomly assigned to a democratic deliberation (DD) group, an education group that received only written materials, and a control group. Participants completed a survey before the deliberation and two surveys post-deliberation: one on (or just after) the deliberation day, and one 4 weeks later. Subjects were asked to rate 5 biobank consent policies as acceptable (or not) and to identify the best and worst policies. Analyses compared acceptability of different policy options and changes in attitudes across the three groups. After deliberation, subjects in the DD group were less likely to find broad consent (defined here as consent for the use of donations in an unspecified range of future research studies, subject to content and process restrictions) and study-by-study consent acceptable. The DD group was also significantly less likely to endorse broad consent as the best policy (OR = 0.34), and more likely to prefer alternative consent options. These results raise ethical challenges to the current widespread reliance on broad consent in biobank research, but do not support study-by-study consent.

The full text is available online through Springer Nature (MSU Library or other institutional access may be required to view this article).

Posted in Articles, Center News, Publications, Uncategorized | Tagged , , , , , , , , ,