Center Assistant Professor Dr. Devan Stahl and co-author Christian J. Vercler (University of Michigan) have an article in the April 2018 issue of the AMA Journal of Ethics. Their article, “What Should Be the Surgeon’s Role in Defining “Normal” Genital Appearance?,” appears in the journal’s issue on ethical considerations in plastic and reconstructive surgery.
Abstract: The recent rise in women seeking cosmetic surgery of their genitalia (labiaplasty) coincides with the increasing number of surgeons posting videos of these operations on social media accounts and websites. Sociocultural influences significantly contribute to our ideas of what constitutes healthy and pathologic, and surgeons have historically played a role in defining “normal” and “abnormal” anatomy. In the nineteenth century, Saartjie Baartman—a woman with a large posterior and unusually long labia minora—was used by physicians to “educate” the public about these differences. We examine the parallels with the twenty-first century practice of surgeons using social media to educate patients about the operations they perform and discuss ethical and professional hazards associated with this practice.
The full article text is available online via the American Medical Association.
An ethics case by Center Professor Dr. Leonard Fleck and co-author Marion Danis, MD, was published in the February 2017 issue of the AMA Journal of Ethics. Their commentary is titled “How Should Therapeutic Decisions about Expensive Drugs Be Made in Imperfect Environments?”
Clinicians must inevitably make therapeutic decisions under nonideal conditions. They practice in circumstances that involve incomplete evidence. They deliver care in health care systems that are complex and poorly coordinated. Each of the patients that they take care of is unique while research offers evidence regarding relatively homogeneous populations of patients. Under these circumstances, many parties—medical scientists, reviewing agencies, insurers, and accountable care organizations—can and should contribute to optimizing the development, approval, funding, and prescription of therapies—particularly expensive and marginally beneficial therapies. In aggregate, they should aspire to achieve a pattern of fair, cost-effective therapeutic decisions to ensure a sustainable health care system. Here we offer some suggestions regarding decisions that physicians might pursue to facilitate fair and cost-effective patient care.
Visit the AMA Journal of Ethics website to read the full article.