Dr. Tomlinson co-author of medical education article

Tom Tomlinson photoCenter Director and Professor Dr. Tom Tomlinson is co-author of an article in the open access e-journal MedEdPublish. The article, “Reframing Professionalism: The Virtuous Professional,” was written by College of Human Medicine faculty members William Wadland, Margaret Thompson, Donna Mulder, Tom Tomlinson, Steven Roskos, John Foglio, John Molidor, and Janet Osuch.

Abstract: In response to prevalent unprofessional behaviors during the 1990s, the medical school administration at Michigan State University’s College of Human Medicine developed a student curriculum for professional development, called “The Virtuous Student Physician.” However, as students adopted these professional aspirations and attributes, they noted that faculty members were not being held to the same standards.

The medical school’s senior associate dean for faculty affairs and development convened a task force to reframe professionalism for all faculty, residents, and students. Our first step was to survey our faculty regarding their awareness of the student professionalism curriculum and their own perceived professional weaknesses. This survey showed the following: most faculty members were aware of “The Virtuous Student Physician” curriculum, that faculty members identified social responsibility as the most difficult attribute to achieve, and that the most difficult behavior identified was working to resolve problem behaviors with colleagues.

The task force then developed a new curriculum “The Virtuous Professional: A System of Professional Development for Students, Residents, and Faculty.” The task force identified three core virtues (Courage, Humility, and Mercy) and reframed the professional attributes encompassed by these virtues to be aspirational for the entire learning community. The faculty of the College subsequently adopted the new principles and practices, including the use of routine, anonymous student evaluation of faculty professionalism.

We are currently collecting data from student evaluations of their clinical faculty members. We plan to use this feedback to guide faculty development and recognize those who model exemplary professionalism as well as to address those who engage in unprofessional behavior.

The full text is available online from AMEE MedEdPublish.

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Dr. Cabrera speaks at nutrition, enhancement conferences in April

Laura Cabrera photoCenter Assistant Professor Dr. Laura Cabrera recently spoke at the Michigan Academy of Nutrition and Dietetics annual conference, held April 26-27 in Bay City, MI. Dr. Cabrera spoke on “Dietetics and Ethics: What is your Professional Role?” Her talk aimed to provide guidance on understanding and identifying ethical issues that registered dietitian nutritionists (RDNs) and nutrition and dietetic technicians, registered (NDTRs) may face in their practices. Her session was well attended and interactive.

Dr. Cabrera also traveled to New Jersey to speak at the Ethics of Enhancement Workshop at Rutgers University-Camden, held April 27. There she spoke on “Neuroenhancement: Rethinking Human Values.” Her talk aimed to explore the way values affect and are affected by enhancing cognitive, affective and social abilities, and argued that a social responsibility framework could help us bridge the tensions underlying the interplay of values and neuroenhancement practices.

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Dr. Stahl co-author of article in new ‘American Journal of Bioethics’ issue

Devan Stahl photoAuthors Trevor M. Bibler (Baylor College of Medicine), Myrick C. Shinall, Jr. (Vanderbilt University Medical Center), and Center Assistant Professor Dr. Devan Stahl have a target article in the May 2018 American Journal of Bioethics, on “Responding to Those Who Hope for a Miracle: Practices for Clinical Bioethicists.” Additionally, AJOB published correspondence from the authors, “Response to Open Peer Commentaries on “Responding to Those Who Hope for a Miracle: Practices for Clinical Bioethicists”,” where the three authors discuss significant points of disagreement, clarification, and agreement from the responses to their article.

Abstract: Significant challenges arise for clinical care teams when a patient or surrogate decision-maker hopes a miracle will occur. This article answers the question, “How should clinical bioethicists respond when a medical decision-maker uses the hope for a miracle to orient her medical decisions?” We argue the ethicist must first understand the complexity of the miracle-invocation. To this end, we provide a taxonomy of miracle-invocations that assist the ethicist in analyzing the invocator’s conceptions of God, community, and self. After the ethicist appreciates how these concepts influence the invocator’s worldview, she can begin responding to this hope with specific practices. We discuss these practices in detail and offer concrete recommendations for a justified response to the hope for a miracle.

The full text as well as the response are available online through Taylor & Francis Online (MSU Library or other institutional access may be required to view these articles).

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Should we improve our memory with direct brain stimulation?

This post is a part of our Bioethics in the News seriesBioethics-in-the-News-logo

By Laura Cabrera, PhD

Should we be worried about the use of direct brain stimulation to improve memory? Well, it depends. If we think of people with treatment refractory memory conditions, or those situations where drugs are not helping the patient, such an approach might seem like the next sensible step. There is reason, however, to remain skeptical that this strategy should be used to improve the memories of people who function within a normal memory spectrum.

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Image description: The illustration “Light Bulb” by Alvaro Tapia is a colorful abstract depiction of the human head/brain as a light bulb. Image source: Alvaro Tapia/Flickr Creative Commons

The quest to improve memory is hardly new. Throughout time people have engaged in ways to improve their memories, such as eating particular foods, employing mnemonic strategies, or taking certain drugs, but the quest does not end there. A recent New York Times article discussed findings from a direct brain stimulation study (Ezzyat et al., 2018) on the possibility of using brain stimulation to rescue functional networks and improve memory. In that study, 25 patients undergoing intracranial monitoring as part of clinical treatment for drug-resistant epilepsy were additionally recruited with the aim of assessing temporal cortex electrical stimulation on memory-related function.

The prospect of using brain stimulation to improve memory, initially introduced in the 1950s (Bickford et al., 1958) re-emerged in 2008 when a study using hypothalamic continuous deep brain stimulation (aka open-loop DBS) to treat a patient with morbid obesity revealed an increased recollection capacity in that same patient (Hamani et al., 2008). Subsequent studies have attempted to prove that direct brain stimulation is useful for memory improvement. However, the data on open-loop deep brain stimulation currently remains inconclusive.

The approach by Ezzyat and colleagues, wherein neural activity is monitored and decoded during a memory task, suggests an improvement over open-loop approaches. In this treatment modality stimulation is delivered in response to specific neural activity, detecting those times when the brain is unlikely to encode successfully and rescuing network activity to potentially improve overall performance.

In that study stimulation was triggered to respond exclusively to those patterns of neural activity associated with poor encoding, effectively rescuing episodes of poor memory and showing a 15% improvement in subsequent recall. Indeed, those results might sound promising, but this type of memory intervention raises a number of ethical issues.

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Image description: Computer memory components are shown inside a model of a human skull. Image source: © Michel Royon/Wikimedia Commons

In a very direct fashion memory is related to the core of who we are. It allows us to build an interpretation of ourselves and our environments, and in so doing gives us orientation in time as well as in our moral life. As surrealist Luis Bunuel put it, “Life without memory is no life at all … Our memory is our coherence, our reason, our feeling, even our action. Without it, we are nothing …” Equally, memory plays a crucial role in cognition, learning, and performance, and as such it is not a surprise that many people feel particularly drawn to memory improvement strategies. Yet there are salient, concerning issues when directly meddling with the human brain, including those risks associated with deep electrode insertion such as infection, hemorrhage, seizure and hardware complications. One might reasonably question whether a 15% memory improvement is worth such high stakes risks?

Another concern is the potential for undesirable – but as yet undetermined – side effects. Those uncertainties are why it seems unlikely that such an approach will be used in healthy individuals or for mild memory dysfunction cases. Still and yet, closed-loop deep brain stimulation has alternative utility. It can be used to improve understanding about the specific brain target most centrally related to certain memory functions, and then use that information to employ less invasive interventions, such as transcranial magnetic stimulation (TMS).

The sorts of studies engaged by Ezzyat’s team and others overlook the fact that memories are not just physically located within the cranial cavity. We have external technologies such as photographs, videos, and agendas to help us remember, and so one might reasonably ask if we really need invasive brain implants to achieve the same ends? The brain’s plasticity is equally overlooked, erroneously assuming that the same brain targets will bring equivalent outcomes for healthy individuals as well as for those with memory impairments. Moreover, the identified interventions improve memory encoding, but do not help with the many errors to which memory is perplexingly prone, such as misattribution, suggestibility, and bias. For healthy individuals, addressing those common memory errors could potentially be more helpful than improving encoding with brain stimulation.

In addition, certain types of memory enhancement could bring new perspectives on one’s life, and even affect the ability to understand the past and imagine the future. In fact if we truly were to remember everything we encounter in our lives we might well be overburdened with memories, unable to focus on current experiences and afflicted by persistent memories of those things that we deem unimportant.

Open-loop neural implants already bring a different configuration of human agency and moral responsibility. Closed-loop implants with their ability to both stimulate and continuously monitor neural patterns bring further issues for consideration, such as neurosecurity (e.g. brain hacking) and mental privacy. Improved connectivity of this type of implant further enables the potential for malicious interference by criminals. Concerns about mental privacy figure prominently in other neurotechnologies, which, similar to brain implants, have the ability to access neural data correlated with intentions, thoughts, and behaviors. This enhanced proximity encroaches on the core of who we are as individuals, providing access to mental life that in the past was accessible only to oneself.

Finally, the media hype in itself is problematic. The New York Times’ article mentioned that the 15% improvement observed in the Ezzayt study was a noticeable memory boost. This sort of inflated media coverage does a disservice to the good intentions and professional rigor of scientists and engineers, and misleads the reader to be either overly-optimistic or overly-worried about the reported developments.

With these many considerations in mind, it is clear that direct brain stimulation will replace neither pharmaceuticals nor less invasive memory improvement options anytime soon. Those who crave memory improvement through memory intervention technologies might best be mindful of the aforementioned ethical and social considerations.

Laura Cabrera photoLaura Cabrera, PhD, is an Assistant Professor in the Center for Ethics and Humanities in the Life Sciences and the Department of Translational Science & Molecular Medicine 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, May 10, 2018. With your participation, we hope to create discussions rich with insights from diverse perspectives.

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More Bioethics in the News from Dr. Cabrera: Can brain scans spot criminal intent?Forgetting about fear: A neuroethics perspective

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Dr. Stahl gives advance care planning talk at Muskegon Community College event

Devan Stahl photoOn Monday, April 16, Center Assistant Professor Dr. Devan Stahl presented a lecture titled “Ethical Challenges to Advance Care Planning” to Muskegon Community College as part of their annual lecture series. The event was also in conjunction with National Healthcare Decisions Day. Dr. Stahl discussed the ethical challenges that patients, surrogates, and health care providers face when drafting and implementing advance directives, how those challenges are resolved, and strategies for enabling patients to creative effective and clinical useful advance directives. The event was attended by students and local health care providers.

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Dr. Cabrera and colleagues on cross-cultural diversity in the field of neuroethics

Laura Cabrera photoVisit The Neuroethics Blog, hosted by the Center for Ethics, Neuroethics Program at Emory University, to read “Global Neuroethics and Cultural Diversity: Some Challenges to Consider.” The piece was written by Karen Herrera-Ferrá, founder of the Mexican Association of Neuroethics, Arleen Salles, Senior Researcher at the Centre for Research Ethics and Bioethics at Uppsala University in Sweden, and Laura Cabrera, Assistant Professor at the Michigan State University Center for Ethics and Humanities in the Life Sciences.

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“Where does responsibility lie if a person acts under the influence of their brain implant?”

Laura Cabrera photoJennifer Carter-Johnson photoVisit The Conversation to read “It’s not my fault, my brain implant made me do it,” a collaborative article from Center Assistant Professor Dr. Laura Cabrera and College of Law Associate Professor Dr. Jennifer Carter-Johnson. They combine their neuroethics and legal expertise to address questions such as: “Where does responsibility lie if a person acts under the influence of their brain implant?” The article was also published in Scientific American.

In November 2017, Drs. Cabrera and Carter-Johnson participated in a Brews and Views event of the same name, “It’s not my fault: my brain implant made me do it.” Brews and Views events, moderated discussions addressing the most fascinating and provocative areas of bioscience and engineering, are a collaboration between the Institute for Quantitative Health Science and Engineering and the Center for Ethics and Humanities in the Life Sciences at Michigan State University.

Bioethics in the News from Laura Cabrera:

Bioethics in the News from Jennifer Carter-Johnson:

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