Bioethics for Breakfast: Medicare for All: What Should That Mean?

Bioethics for Breakfast Seminars in Medicine, Law and SocietyStacey Hettiger and Rick Murdock presented at the September 26th Bioethics for Breakfast event, offering perspectives and insight on the topic “Medicare for All: What Should That Mean?”

“Medicare for All” has become a contentious political slogan. Advocates for various versions of the slogan want to see everyone have access to needed and affordable health care. Critics see all versions of the slogan as unaffordable and hostile to individual liberty. Is compromise possible? Can we have some level of affordable health care for everyone in our society? Can this be accomplished in ways that are congruent with our most fundamental political values? Event speakers addressed these questions and more, inviting response and discussion from those in attendance.

This year’s Bioethics for Breakfast series centers on the theme “Is There a Cure for Our Sick Health Care System?”

About the Speakers

Stacey Hettiger
Stacey Hettiger is Director of Medical and Regulatory Policy at Michigan State Medical Society. Her responsibilities include developing materials, programming, and member communications in the areas of legal and regulatory compliance and State and Federal quality initiatives. This includes advocacy and outreach on issues affecting the delivery of health care such as HIPAA, physician payment models and incentives, and practice transformation. Prior to joining MSMS, Stacey worked for twenty years in the Michigan State Legislature.

Rick Murdock
Rick Murdock retired from the Michigan Association of Health Plans in 2017 after 12 years as executive director, and has since been consulting with the MAHP Foundation to coordinate the Michigan ACE (adverse childhood experiences) Initiative. Prior to joining MAHP, he spent three years working in the Michigan legislature, followed by 18 years in the State Budget Office (mental health and Medicaid and health planning). Additionally he spent 6 years in Medicaid administering the Medicaid managed care program. He has a master’s degree in public health from the University of Michigan School of Public Health.

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.

Bioethics for Breakfast: Fitness, Frailty, and the Challenges of Successful Aging

Bioethics for Breakfast Seminars in Medicine, Law and SocietyFrancis Komara, DO, and Scott Wamsley presented at the April 25th Bioethics for Breakfast event, offering perspectives and insight on the topic “Fitness, Frailty, and the Challenges of Successful Aging.”

In very concrete terms, what should “healthy aging” mean when we wish to be a just and caring society? We start from these facts: (1) the size of the elderly and hyper-elderly population in Michigan and nationwide is growing rapidly; (2) costly health needs are much more common among the elderly than among the non-elderly; (3) if we are completely responsive to the health needs of the elderly, will we unfairly shortchange the health needs of the non-elderly?; (4) there are great disparities among the health needs of the elderly themselves (so what do we need to do to correct that initial state of affairs?); (5) are family caregivers excessively burdened by things as they are—what can we do socially that is affordable to relieve those burdens?

How does “aging in place” work, given the five challenges listed above, especially for those elderly who are in near poverty conditions? This Bioethics for Breakfast explored these and other questions.

Francis Komara, DO
Dr. Francis Komara is a Professor in the Department of Family and Community Medicine (FCM) and Director of the Geriatric Fellowship Program in the Michigan State University College of Osteopathic Medicine. Dr. Komara is a geriatrician who formerly practiced at the FCM clinic at MSU, and was formerly medical director of the Medical Care Facility and Rehabilitation Services of Ingham County, and medical director of McLaren Visiting Nurse & Hospice. Dr. Komara received his medical degree from the Chicago College of Osteopathic Medicine.

Scott Wamsley
Scott Wamsley is Deputy Director of the Aging & Adult Services Agency in the Michigan Department of Health and Human Services. Mr. Wamsley has more than twenty years of experience in the field of aging services. He holds a master’s degree in public administration and a bachelor’s degree in political science from Eastern Michigan University.

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.

Bioethics for Breakfast: Addressing Maternal Mortality in the Childbearing Year

Bioethics for Breakfast Seminars in Medicine, Law and SocietyEvery woman who dies during or after pregnancy has a story to tell, a story that can teach us how to prevent other maternal deaths.

Renée Canady, PhD, MPA, and Cheryl Larry-Osman, RN, MS, CNM, presented at the February 21st Bioethics for Breakfast event, offering perspectives and insight on the topic “Just Caring for All Michigan Mothers: Addressing Maternal Mortality in the Childbearing Year.” Drawing from the 2018 Michigan Maternal Mortality Surveillance report, the speakers reminded the audience that “every woman who dies during or after pregnancy has a story to tell, a story that can teach us how to prevent other maternal deaths.” The presenters introduced the session with compelling personal experiences, illustrating the scope and scale of the problem. Using an ethics yardstick Dr. Canady then invited the 33-member audience to respond to graphic depictions of the U.S. maternal mortality death rate – the highest rate within the developed world. Those numbers give evidence of a profound social injustice and a need to modify resource allocation accordingly.

Yet as in much of the U.S., evidence suggests that Michigan has not met the mark. As the speakers noted, race matters – a lot. From 2011-2015 Black women in Michigan were found to be three times more likely than white women to die of a pregnancy-related cause; upon review nearly half (44%) were considered preventable. Black mothers in Michigan were twice as likely to die from a pregnancy-associated cause; upon review, 39% were deemed preventable. Social and medical advances have disproportionately failed to address pregnancy needs for Black mothers. Sociodemographic variables do not fully explain the observed gap – the disparities are rooted in multilevel (system, practitioner, patient) inequalities including place, communication, and discrimination. A health equity approach recognizes that one must comprehensively address institutional racism, class oppression, and exploitative gender discrimination.

As a just and caring society we have an obligation to ensure safe and healthy pregnancy and birth experiences for all mothers. Ms. Larry-Osman noted that a virtue ethics approach leans on the character of health professionals to engage compassion, reason and discipline in the interest of maternal well-being. In concert, a communitarian ethics approach emphasizes shared values, ideals and goals to identify barriers to care as well as interventions and solutions. As reported by attendee Lynette Biery, Maternal Child Health Director at the Michigan Department of Health and Human Services, maternal mortality reviews such as the Michigan Maternal Mortality Surveillance Program provide data necessary to address changes that would improve women’s health before, during and after pregnancy. Michigan has seen some improvement after the 2016 implementation of hemorrhage and hypertension “safety bundles” and the MI-AIM (Alliance for Innovation on Maternal Health) is now working on opioid bundles as well. But given the scale of the problem, are such efforts enough?

Approximately 50% of Michigan women rely on Medicaid for prenatal care and give birth in a Medicaid supported hospital, but that program is targeted for cuts under the current federal administration. What is the state/physician obligation to address this? Should the state ensure the availability of labor support “doulas” as part of standard maternity care as is being done in other states? Mortality reviews help, but are they sufficient to raise awareness and address the multilevel problems? What structural strategies might best pave the way for continuity of care and community care? How can solutions avoid racist calls for “personal responsibility for heath”? What are the effects of pervasive racism and how might the state best address them? Many in audience lingered past the session’s end to continue discussing these questions. Our thanks to health law firm Hall, Render, Killian, Heath & Lyman for generously supporting these important conversations.

Renée Canady
Renée Canady, PhD, MPA, is Chief Executive Officer of the Michigan Public Health Institute. She is a nationally recognized thought leader in health disparities and inequities, cultural competence, and social justice. She additionally is Assistant Professor in MSU’s Division of Public Health within the College of Human Medicine. In her scholarly work, she emphasizes the social context of mental and physical health, and the pregnancy experiences of African-American women.

Cheryl Larry-Osman
Cheryl Larry-Osman, RN, MS, CNM, is a Perinatal Clinical Nurse Specialist at Henry Ford Hospital (Detroit). She additionally is trained as a Healthcare Equity Ambassador for the hospital and serves as a cultural competency and healthcare equity expert within that system. She has over 18 years of experience in obstetrics and is a passionate advocate for the optimal and equitable care of women and children.

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.

Bioethics for Breakfast: Biobanking Tissue: Trash or Treasure?

Bioethics for Breakfast Seminars in Medicine, Law and SocietyJennifer Carter-Johnson, PhD, JD, and Tom Tomlinson, PhD, presented at the Bioethics for Breakfast event on December 6, 2018, offering their perspectives and insight on the topic “Biobanking Tissue: Trash or Treasure?”

“Big data”—repositories of biological, medical and demographic information about large numbers of people—is a critical platform for discovery of the causes of disease and potential new avenues for its treatment.

This data must come from us, the general public. Data about you might end up in a biobank because you’ve generously agreed to provide it, perhaps by agreeing to join the National Institutes of Health’s All of Us project that aims to recruit a broad representative sample of one million Americans.

Or it might already have been provided for use in research without your knowledge or consent. Research using specimens and medical information collected during your clinical care, once de-identified, doesn’t count as research on a “human subject” under the Federal regulations. Thus, your consent is not required. This source probably provides the great majority of information used in big data research, and acquiring and distributing it has become a multimillion dollar business.

This practice raises a host of questions. Doesn’t my specimen and my medical information belong to me, rather than to the hospital or clinic that collects it? Or have I thrown it away like my trash sitting on the curb each week? Although many people may feel comfortable providing this information for research, others might not. So isn’t it a simple act of respect to ask first? Or are researchers simply the medical equivalent of college students dumpster diving for cheap furniture that has been thrown away? Additionally, if we ask, and too many people say “no,” won’t critical research be hampered, to the detriment of all of us?

Dr. Tomlinson asked attendees to consider this question: Should clinically-acquired specimens and other medical information be treated like the trash that you have no control of once it has left your curb?

Dr. Tomlinson referred to a national study that his research team conducted in 2014 regarding willingness to give blanket consent, focusing on the fact that people care about more than risk – they have concern about how their materials may be used, and they worry about how much they should trust the research establishment. Dr. Tomlinson’s overarching argument was that respect for persons, a fundamental bioethics principle, requires informed consent.

Dr. Carter-Johnson also offered a question: whose treasure is it? Biospecimens and related data can be donated by patients and the public, can be clinically collected de-identified materials, and they can be samples given to private companies like 23andMe or Ancestry.com. Dr. Carter-Johnson also discussed a new startup offering to sequence your genome for free, and highlighted the variety of health and fitness apps that we give our data too. “When something is free, you are the product,” she said. A show of hands revealed that a minority of the attendees had gotten their DNA sequenced.

Dr. Carter-Johnson offered a legal perspective on tissue and genetic data in relation to property and privacy rights. She explained that individuals do not own their own tissue, citing the cases Moore v. Regents of California and Greenberg v. Miami Children’s Hospital Research Institute. However, there have been exceptions, and there are legal ways to “sell” your body (think plasma, bone marrow, sperm, or clinical trials).

When discussing privacy, Dr. Carter-Johnson used 23andMe and Ancestry.com’s privacy policies as examples. These policies are contractual, they are updated frequently, and they are often ignored by the consumer. However, push from consumers as well as bioethicists have led to these policies being more available and accessible.

Audience discussion brought up the famous Henrietta Lacks case, the future of biobank donor policies, and newborn screening programs and biobanks.

Jennifer Carter-Johnson, PhD, JD
Jennifer Carter-Johnson is an Associate Professor of Law at the Michigan State University College of Law and holds both a JD and a PhD in Microbiology. Professor Carter-Johnson uses her interdisciplinary training to study the intersection of law and scientific research.

Tom Tomlinson, PhD
Tom Tomlinson was Director of the Center for Ethics and Humanities in the Life Sciences from 2000 to 2018, and is a Professor in the Department of Philosophy. He chairs the Ethics Committee at Sparrow Health System, and has published widely on the ethics of biobank-based research.

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.

Bioethics for Breakfast: Values at the End of Life: The Logic of Palliative Care

Bioethics for Breakfast Seminars in Medicine, Law and SocietyRoi Livne, PhD, presented at the Bioethics for Breakfast event on October 4, 2018, offering perspective and insight on the topic “Values at the End of Life: The Logic of Palliative Care.” Leonard Fleck, PhD, moderated this session.

Over the past forty years, “the end of life” has become the center of extensive economic, policy, ethical, and medical discussions. Health economists measure and evaluate its cost; ethicists debate the morality of various approaches to “end-of-life care”; policymakers ponder alternative “end of life”-related policies; and clinicians apply a specialized approach (hospice and palliative care) to treat patients whom they diagnose as being at “the end of life.” How are those many-faceted conversations emblematic of this particular moment in history? How are the limits of what can be done, both medically and financially, to prolong life communicated to severely ill patients and families? Dr. Livne’s analysis drew from a combination of historical and ethnographic work conducted with palliative care clinicians in three California hospitals.

Roi Livne
Roi Livne is an Assistant Professor in the Department of Sociology at the University of Michigan. He received his PhD in sociology from the University of California, Berkeley in 2016. An economic sociologist at heart, he studies everyday economic life and its somewhat awkward intersections with morality. His book, Values at the End of Life: The Logic of Palliative Care is forthcoming this February in Harvard University Press. The book develops a historical and ethnographic account of the deeply personal relationships between financial considerations, emotional attachments, and moral arguments that motivate end-of-life decisions in American hospitals. Livne’s other research is on the techno-politics of sovereign debt management. He has published in the American Sociological Review and Socio-Economic Review.

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.

Bioethics for Breakfast: Health Care Consolidations: Good News, Bad News, Fake News?

Bioethics for Breakfast Seminars in Medicine, Law and SocietyJohn Goddeeris, PhD, and Michael Herbert presented at the Bioethics for Breakfast event on May 10, 2018, offering perspective and insight on the topic, “Health Care Consolidations: Good News, Bad News, Fake News?” Leonard Fleck, PhD, moderated this session.

At the national level as well as in our state, the macro-level restructuring of health care delivery is impacting physician-patient clinical encounters, clinics, hospitals and health systems. As the engaged moderator for this session, Dr. Fleck guided those in attendance in examining downstream consequences of such restructuring and consolidations by posing questions to the two presenters: Dr. John Goddeeris, Professor of Economics, and Michael Herbert, Chief Executive Officer for the MSU HealthTeam.

Dr. Fleck asked the presenters to respond to the following questions: What are the basic statistics regarding health care consolidation? How does consolidation affect medical practice (and the core values of medicine)? Are patients better off as a result of consolidation? Does consolidation save the health care system money? Alternatively, does it give more pricing power to the hospital industry (against insurers who wish to demand discounts of various sorts)? Does this process have any significant effects for rural health care? Does this process increase or decrease disparities in the health care system, i.e., access to needed care for those less well off?

John Goddeeris
John Goddeeris, PhD, is a Professor of Economics in the Department of Economics in the College of Social Science at Michigan State University. Dr. Goddeeris’ expertise includes economic issues in health care, including health insurance and government programs. His research has been published widely in journals in economics, medicine, public health, and health policy. Dr. Goddeeris is a nonresident fellow in the Health Policy Center at the Urban Institute.

Michael Herbert
Michael Herbert, Chief Executive Officer for the MSU HealthTeam, is a consultant dedicated to assisting Academic Medical Centers in organizational design and operations, including hospital and faculty group practice operations, as well as Medical School operations, leadership development, strategic plan design and implementation and government policy development. He has served in a variety of high-level medical school and health system leadership positions in Michigan as well as in many other states, and was the Associate Deputy Regional Director in the Department of Veterans Affairs.

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.

Bioethics for Breakfast: Medicaid Work Requirements: Blood, Sweat and Tears Too?

Bioethics for Breakfast Seminars in Medicine, Law and SocietyAdrianne Haggins, MD, presented at the Bioethics for Breakfast event on February 8, 2018, offering perspective and insight on the topic, “Medicaid Work Requirements: Blood, Sweat and Tears Too?” Leonard Fleck, PhD, moderated this session.

The Trump administration has proposed giving states permission to attach work requirements for Medicaid eligibility. So far, ten states are seeking that permission. Is this a good idea, either from an ethical perspective or a policy perspective? Our speaker, Dr. Adrianne Haggins, is part of a research team at the University of Michigan that evaluated the impact of Michigan’s Medical expansion on employment—as reported in JAMA Internal Medicine (Dec. 11, 2017)—as well as health, and healthcare utilization.

A researcher at Kaiser Health News has added, “States will have to figure out how to define the work requirement and alternative options, such as going to school or volunteering in some organizations; how to enforce the new rules; how to pay for new administrative costs; and how to handle the millions of enrollees likely to seek exemptions.” Dr. Haggins also discussed some of her own research regarding health disparities and emergency department utilization.

Audience participants questioned such things as the administrative costs associated with implementation as well as the value and accuracy of labeling individuals as able-bodied with its attendant underlying stigma of deserving/undeserving of medical care. It was noted that much of the national conversation is linked to racialized assumptions that those utilizing Medicaid benefits are largely persons of color. Finally, many audience members argued the point that all people unconditionally deserve access to health care and some observed how that point too often gets lost in the semantics.

Related Reading:

Adrianne Haggins, MD
Adrianne Haggins is a clinical assistant professor in emergency medicine at the University of Michigan Medical School, and alumnus of the MSU College of Human Medicine class of 2007. She is a member of a research team at the University of Michigan evaluating the impact of Michigan’s Medicaid expansion, the Healthy Michigan Plan, using a mixed-methods approach. This evaluation provides rich data on enrollee and health care provider experiences with the Michigan Medicaid program, as well as health care utilization. Dr. Haggins’ specific interests are related to examining the impact of health care reform on emergency department utilization.

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.

Bioethics for Breakfast: Autism Spectrum Disorder: Fair Sharing of the Therapeutic Pie?

Bioethics for Breakfast Seminars in Medicine, Law and SocietyJeanette M. Scheid, MD, PhD, and Connie Sung, PhD, presented at the Bioethics for Breakfast event on November 30, 2017, offering perspective and insight on the topic, “Autism Spectrum Disorder: Fair Sharing of the Therapeutic Pie?”

Autism Spectrum Disorder (ASD), as the name implies, occurs across a broad spectrum of cognitive, psychological, behavioral, and social interactive manifestations. There is a genetic component to the disorder, though the precise pathology remains something of a mystery. There is no cure for the disorder, though there are some behavioral therapies that address what might otherwise be lifelong manifestations. A number of ethical issues might be raised regarding ASD. First, given some genetic connection to the disorder, should parents be strongly advised to have genetic testing (maybe Whole Genome Sequencing) to inform future reproductive decisions. Second, there are resource allocation issues related to potential therapies. There are at least two evidence-based behavioral interventions that have demonstrated effectiveness in improving aspects of the disorder. There are also a number of “therapies” that have little formal evidence-based support but strong advocates who expect insurance coverage. Third, the two accepted therapies require strong parental involvement in providing/ maintaining these therapies at home (which reduces social costs for these therapies). How might we best ensure such involvement? Fourth, therapeutic resources for ASD are disproportionately available across the lifespan. Is that an injustice? These questions and more were discussed by speakers and attendees.

Jeanette M. Scheid, MD, PhD
Jeanette M. Scheid, MD, PhD, is an Associate Professor of Psychiatry at Michigan State University. She is board certified in general and child and adolescent psychiatry. In that role she teaches medical students and residents and provides clinical care to children, adolescents and adults. Her primary practice sites are in community mental health and child residential treatment facilities. Dr. Scheid sees patients with a broad range of mental health concerns. She has particular interest in the systems of care and issues facing children and adolescents exposed to maltreatment.

Connie Sung, PhD
Connie Sung, PhD, is an Assistant Professor of Rehabilitation Counseling and co-director of Spartan Project SEARCH at Michigan State University. She received her PhD in Rehabilitation Psychology from University of Wisconsin-Madison and completed a pre-doctoral psychology internship at Waisman Center, Madison, WI. Previously as an occupational therapist and now as a rehabilitation counseling educator and researcher, she has over 10 years of experience working with individuals with autism spectrum disorder throughout the lifespan and has a special interest in working with the transition youth population. Currently, she is a principal investigator of several community-based participatory research projects, including evaluation of intervention strategies to improve psychosocial and vocational outcomes of transition-age individuals who are on the autism spectrum.

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.

Bioethics for Breakfast: Charlie Gard and Solomon’s Dilemma: What are the limits of parental medical decision making?

Bioethics for Breakfast Seminars in Medicine, Law and SocietyHonorable Laura Baird, JD, and Marleen Eijkholt, JD, PhD, presented at the Bioethics for Breakfast event on September 28, 2017, offering perspective and insight on the topic, “Charlie Gard and Solomon’s Dilemma: What are the limits of parental medical decision making?”

Charlie Gard’s tragic life and death came to light in a UK case that garnered considerable worldwide media attention in July. To recall the basic medical details of the case, Charlie Gard suffered from an extremely rare mitochondrial DNA depletion syndrome (infantile onset encephalomyopathy). This results in a gradual weakening of all the muscles in the body, including the lungs, which is why Charlie had his life sustained by a ventilator since October of 2016 (he had been born in early August). In addition, he suffered multiple seizures in late 2016, which resulted in brain damage. In early March of 2017, Charlie’s doctors recommended the removal of life-support and that he be allowed to die. In their judgment nothing more could be done in Charlie’s best interest, as his brain and muscle damage were irreversible. His parents rejected the hospital’s recommendations. The parents had located Dr. Hirano at Columbia University, after surfing the web in late 2016, whose primary area of research was mitochondrial depletion syndrome. Dr. Hirano was prepared to offer an experimental treatment called nucleoside therapy, which had yielded some marginal benefit for children with a condition similar—but not genetically identical—to Charlie’s condition. Given Charlie’s massive brain damage, it was unclear whether he could feel any pain. What were Charlie’s best interests? Was that a judgment that only parents had an ultimate right to make? And what are the ethical obligations of physicians in cases such as this?

The discussion started with this case, but other cases were introduced that raised similar issues.

Honorable Laura Baird, JD
Judge, Ingham County Circuit Court
Laura Baird is an Ingham County Circuit Court Judge serving in the Family Division, where they decide child custody as well as related domestic issues, abuse and neglect, delinquency, paternity, name changes, guardianships, and parental consent waivers. Much of her professional life has been devoted to children and their families and trying to find the best outcomes for them. Prior to joining the Ingham County Circuit Court in 2001, Judge Baird served as a State Representative from 1995-2000 and participated in the enactment of the Family Court Act. Judge Baird and her husband are parents of three children; their middle child was injured at birth and rendered severely disabled, which caused them to experience many interfaces with pediatric medical care.

Marleen Eijkholt, JD, PhD
Assistant Professor, Center for Ethics and Humanities in the Life Sciences and Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine
Clinical Ethics Consultant, Spectrum Health System
Marleen Eijkholt focuses on a wide range of Ethical, Legal and Social Implications (ELSI) in health care ethics, including neurotechnology, reproductive medicine, clinical medicine and clinical research. Her work is eclectic like her background, including projects on stem cell research for spinal cord injury, deep brain stimulation, experimental treatments, placebos, and reproductive rights. She combines ethical, legal and philosophical theories in her research and scholarship. Additionally, she engages these in her professional life as an ethics consultant at Spectrum Health System. Marleen also contributes her expertise to the College of Human Medicine’s Shared Discovery Curriculum.

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.

Bioethics for Breakfast: Treating Pain Without Feeding Addiction: Is There a Goldilocks Solution?

bioethics-for-breakfastForrest Pasanski, JD, and Steven Roskos, MD, presented at the Bioethics for Breakfast event on April 20, 2017, offering perspective and insight on the topic, “Treating Pain Without Feeding Addiction: Is There a Goldilocks Solution?”

In August 2016 the Michigan Department of Licensing and Regulatory Affairs (LARA) created a permanent Drug Monitoring Section to stem the state’s prescription drug abuse epidemic, tightening its monitoring of physicians’ opioid prescribing. Certainly as the ones who write the prescriptions, physicians should help remedy the prescription opioid epidemic. But they also have a responsibility to effectively manage the pain their patients experience. In striving to meet one of these responsibilities, will they fail to meet the other? Or is there a place in the middle that is ethically “just right?” How might they optimally collaborate with the state to ensure the best interests of its citizens?

Mr. Pasanski discussed the scope of the opioid epidemic in Michigan as well and the state’s response, highlighting efforts to identify, investigate, and take substantial licensing actions against overprescribers. Dr. Roskos offered a physician perspective, touching on trust in the doctor-patient relationship and how state regulations may create tension within that relationship.

Forrest Pasanski, JD
Forrest Pasanski, JD, is Regulation Section Manager, Drug Monitoring Section for State of Michigan, Michigan Department of Licensing and Regulatory Affairs, Bureau of Professional Licensing where he oversees the Michigan Automated Prescription System (MAPS) and staff who identify, investigate, and bring administrative actions against health professionals who overprescribe, overdispense or divert controlled substances. He studied philosophy and political science at Grand Valley State University and graduated from the Michigan State University College of Law.

Steven Roskos, MD
Steven E. Roskos, MD, is an associate professor in the Department of Family Medicine in the Michigan State University College of Human Medicine, where he also serves as associate chair for academic affairs. He received his MD from Temple University School of Medicine, Philadelphia, Pennsylvania and completed a family medicine residency at Lancaster General Hospital, Lancaster, Pennsylvania. Dr. Roskos practiced in southern Appalachia for seven years, then taught at the University of Tennessee before completing a fellowship in academic medicine at Michigan State and then joining the faculty. He has a clinical interest in treating patients with chronic pain and served on the Michigan Advisory Committee on Pain and Symptom Management for five years.

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.