Medical workforce diversity research published in ‘Medical Education’

Karen Kelly-Blake photoLibby Bogdan-Lovis photoAn article from a multi-institution research team led by Center Assistant Professor Dr. Karen Kelly-Blake and Assistant Director Libby Bogdan-Lovis has been published in the September 2018 issue of Medical Education.

In “Rationales for expanding minority physician representation in the workforce: a scoping review,” the authors discuss “rationales for and approaches to expanding under‐represented minority (URM) physician representation in the medical workforce” found in their scoping review of fifteen years of literature.

The full text is available online via Wiley Online Library (MSU Library or other institutional access may be required to view this article).

Dr. Kelly-Blake and Libby Bogdan-Lovis further discussed their article in an interview for the Medical Education podcast series.

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New commentary from Dr. Tomlinson in ‘American Journal of Bioethics’

Tom Tomlinson photoCenter Professor Dr. Tom Tomlinson has a new commentary in the September 2018 American Journal of Bioethics. In “Getting Off the Leash,” Dr. Tomlinson discusses “digital medicines” and what such technologies mean for patient privacy. He asks questions such as: do patients have a right to deceive their clinicians? Why would patients be deceptive?

The full text is available via Taylor & Francis Online (MSU Library or other institutional access may be required to view this article).

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Dr. Fleck facilitates ethics workshop at Michigan pediatrics conference

Leonard Fleck photoOn September 14, Center Professor and Acting Director Dr. Leonard Fleck and Dr. Kenneth Pituch, MD, ran an ethics workshop at the Michigan Chapter of the American Academy of Pediatrics (MIAAP) 68th Annual Conference. The workshop, “Ethical Challenges in the Care of Seriously Ill Children,” focused on two cases: a growth attenuation case, and a Trisomy-18 newborn case.

The growth attenuation case involved a 7-year-old boy with severe developmental delay related to a CMV infection in utero. Parents are middle-aged and “not in great health.” They requested growth attenuation hormone therapy so that they would be able to manage the care of their child for many more years. No one doubts that they are devoted parents. The relevant ethical considerations concerned the best interests of this child and parental rights to make medical decisions for their children. On the face of it, it looks like the parents are making this decision for their benefit, i.e., easier care management for this child. While this is true, as the discussion brought out, it is also the case that this would be in the best interest of the child as well. More specifically, this child will not be deprived of any life experiences as a result of growth attenuation because of his severe developmental delay. Hence, growth attenuation does not represent a harm to this child.

Dr. Fleck and Dr. Pituch’s other case involved a Trisomy-18 newborn. In the past these children had dismal prospects. Virtually all of them died before age one, most often because of cardiac anomalies. Today, complex surgeries can be done on these children, all of which are risky. Consequently, some of these children can survive into their twenties, though this will be with severe cognitive deficiencies. The ethical challenge for pediatricians is determining what sort of conversation to have with parents regarding treatment or non-treatment options. In the case discussed, this was complicated by the fact that a representative of a Trisomy-18 support group contacted these parents one day after the birth to “assure” them that they did not have to choose non-treatment. The problem with these support groups is that they tend to be excessively optimistic and do not know the medically relevant and ethically relevant details associated with prospects for a particular infant. This can complicate the conversation that a pediatrician must have with these parents, and can potentially sow the seeds of distrust. What would clearly be the ethically and practically wrong thing to do would be to tell these parents to pay no attention to these support groups. Overall, the discussion in this workshop was lively and thoughtful.

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How can we protect patient rights and improve patient safety?

bbag-blog-image-logoEnding Medical Self-Regulation: Does Less Physician Control Improve Patient Safety and Protect Patient Rights?

Event Flyer

Medicine has long been one of the most self-regulating of all professions. In the 1970s, the new field of bioethics was designed to challenge this prevailing system. As Senator Ted Kennedy explained at the founding of Georgetown’s Kennedy Institute of Ethics, “Human life is too precious and the decisions regarding it too important to leave to any one group of specialists.” Still, even fifty years later, medicine remains largely self-regulating. And patients have suffered. In this presentation, Professor Pope will discuss recent initiatives to constrain the scope of physician discretion and how these initiatives improve patient safety and protect patient rights. He will place particular emphasis on the growing transition from traditional informed consent to shared decision-making with patient decision aids.

October 10 calendar iconJoin us for Dr. Pope’s lecture on Wednesday, October 10, 2018 from noon until 1 pm in person or online.

Thaddeus Mason Pope, JD, PhD, is Director of the Health Law Institute and Professor of Law and at Mitchell Hamline School of Law in Saint Paul, Minnesota. He is also: (1) Adjunct Professor with the Australian Centre for Health Law Research at Queensland University of Technology; (2) Adjunct Associate Professor with the Alden March Bioethics Institute at Albany Medical College; and (3) Visiting Professor of Medical Jurisprudence at St. Georges University. Professor Pope has over 140 publications in: leading medical journals, law reviews, bar journals, nursing journals, bioethics journals, and book chapters. He coauthors the definitive treatise The Right to Die: The Law of End-of-Life Decisionmaking. And he runs the Medical Futility Blog (with over three million page views).

In person: This lecture will take place in E4 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.

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Dr. Stahl delivers keynote at Western Michigan University Medical Humanities conference

Devan Stahl photoThe Eighth Annual Western Michigan University Medical Humanities Conference was held September 13-14 in Kalamazoo, MI. Center Assistant Professor Dr. Devan Stahl and her sister Darian Goldin Stahl (dariangoldinstahl.com) delivered the keynote lecture on September 14, “Visualizing Chronic Illness in Medicine and the Arts.”

Based on their recently published book, Imaging and Imagining Illness, the presenters discussed the history of anatomical illustrations, the use of contemporary medical imaging technologies in the doctor-patient relationship, and how medical images affect persons living with chronic illness.

To hear more about this work from Darian and Dr. Stahl, listen to their episode of No Easy Answers in Bioethics, the Center’s podcast series: ‘Imaging and Imagining Illness’: Devan and Darian Stahl – Episode 7.

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Making Martyrs of Our Children: Religious Exemptions in Child Abuse and Neglect Cases

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

By Devan Stahl, PhD

On August 2, 2018, Seth Welch called 911 after finding his 10-month-old daughter, Mary Anne Welch, unresponsive in her crib. Mary was pronounced dead at the scene and the medical examiner determined Mary’s death was the result of malnutrition and dehydration. During interviews, Seth Welch and his wife Tatiana Fusari admitted they were aware of Mary’s skinny appearance for at least a month prior to her death, but claimed that they had fed her appropriately and did not believe her to be ill. The parents are now awaiting trial for felony murder and first-degree child abuse.

The case has made national headlines, because the parents claim their decision not to take Mary to a doctor was based, in part, on their religious beliefs. Mrs. Fusari said she failed to reach out for medical help for her daughter because she feared having her children removed by Child Protective Services, a lack of faith in the medical system, and “religious reasons.” Further, Mr. Welch claims he is being unfairly charged in Mary’s death because of his “very strong faith.” Neither Mr. Welch nor Mrs. Fusari have explained their religious beliefs, but in Facebook videos, Mr. Welch claims he is “not opposed to medicine or doctors,” but he believes some doctors are part of a “priesthood of the medical cult.” He also claims not to believe in vaccines, and expressed a desire to live in a “commune of Christian disciples living off the grid somewhere.” The reasons Mary’s parents did not take her to see a physician appear to be multifaceted, but their claims to religious liberty are a hot button issue in bioethics and politics today.

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Image description: a baby is photographed lying down, a hand is holding a stethoscope to the baby’s chest. Image source: Bread for the World/Flickr Creative Commons

The case of Mary Anne Welch is yet another in a long line of child neglect and abuse cases where a religious exemption defense is likely to be mounted. All U.S. states have laws prohibiting child abuse and neglect, but 39 states also have laws protecting parents from abuse and neglect charges (though not murder charges) when they fail to provide medical assistance to their children because of their religious beliefs. Religious exemption laws are meant to protect the religious liberty of individuals who use faith-based practices in place of medical science; although in many states the religious exemption only applies to people who are part of “recognized” religious denominations. These exemptions grew out of a Department of Health, Education, and Welfare (HEW) ruling after the 1974 passage of the Child Abuse Prevention and Treatment Act, which specified that religious exemptions be added to states’ child protection laws. In 1983, HEW adopted new regulations that removed the requirement for religious exemption, however, few states have repealed their religious exemption laws. In many states with exemptions, including Michigan where Mr. Welch and Mrs. Fusari reside, courts can order medical services to be provided to a child whose health or life are at risk without medical care.

In nearly all cases, competent adults are free to make medical decisions according to their religious beliefs, and cannot have treatment forced on them for any reason. At the same time, parents have certain obligations toward their children, which restrict their right to exercise their religious beliefs on behalf of their children. In the famous U.S. Supreme Court case Prince v. Massachusetts (1944), the court ruled that “Parents may be free to become martyrs themselves,” but they are not free “to make martyrs of their children before they have reached the age of full and legal discretion when they can make that choice for themselves.”

The case of Mary Anne Welch is a microcosm of a larger debate happening in health care around religious liberty and the rights of children. The American Academy of Pediatrics (AAP) has stated that parental desires regarding their child’s medical treatment should be followed, unless these decisions clearly go against the child’s best interests. At the same time, for decades the AAP has been opposed to religious exemption laws. In cases where parents are acting maliciously or with gross indifference to the well-being of their child, it is easy to see why overriding parental decision-making would be appropriate. Prosecuting parents for neglect and abuse if their child suffers as a result of their decisions feels appropriate as well. Knowing very little about Mr. Welch and Mrs. Fusari, however, it would be presumptuous to make any judgments about their fitness as parents, or about their care for Mary. At this point it is not clear that given Mary’s weight loss, other reasonable parents in a comparable situation would have taken their child to the doctor regardless of their religious beliefs. Time will tell if Mary’s death should have been foreseeable or if it would have been preventable with proper medical care.

What is likely to happen in the meantime, and seems to be happening already in the media, is that Mr. Welch and Mrs. Fusari’s religious beliefs will be scrutinized. (Their concerns about the dangers of hospitalization are supported by recent studies about medical errors.) Religious exemption laws regarding parental neglect are controversial, and critics are right to question the legitimacy of such laws when children die as a result of their parent’s religious beliefs. Despite their religious beliefs, we ought to hold parents to a standard where they are expected to prevent injuries to their children. At the same time, we ought not to hold parents such as Mr. Welch to a higher standard for parental care, simply because he has particular religious beliefs that are not widely held by other parents. Plenty of parents choose to opt out of certain medical treatments for religious and non-religious reasons alike, and it is not clear that medical orthodoxy should always be determinative of a child’s best interest. Time will tell if other prudent parents would have taken a child in Mary’s condition to the doctor. If that is found to be the case, then Mary’s parents should be held accountable for their decisions.

Devan Stahl photoDevan Stahl, PhD, is an Assistant Professor in the Center for Ethics and Humanities in the Life Sciences and the Department of Pediatrics and Human Development in the Michigan State University College of Human Medicine.

Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Thursday, October 4, 2018. With your participation, we hope to create discussions rich with insights from diverse perspectives.

You must provide your name and email address to leave a comment. Your email address will not be made public.

More Bioethics in the News from Dr. Stahl: Mass Shootings, Mental Illness and StigmaDisability and the Decisional Capacity to Vote

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Dr. Cabrera an expert panelist at international neurotechnology event

Center Assistant Professor Dr. Laura Cabrera was an invited expert panelist at the Organisation for Economic Co-operation and Development (OECD) workshop “Minding Neurotechnology: Delivering Responsible Innovation for Health and Well Being,” held September 6-7 in Shanghai, China.

The workshop was focused on exploring some of the unique ethical, legal, and policy challenges raised by health-related applications of brain science and its integration into cutting edge neurotechonologies. Dr. Cabrera’s session on “Identifying gaps in neurotechnology governance: potential roles of the market and the public sector to ensure ‘technology robustness’” was focused on raising potential governance issues associated with emerging neurotechnologies that deserve shared consideration given their public attention as well as their potential economic and social implications.

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Image description: Dr. Cabrera (third from right) is photographed on stage with fellow panelists at the OECD event. Photo by Dr. Judy Illes.

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