Tag: bioethics for breakfast

Bioethics for Breakfast: The Future of Medicaid and the Affordable Care Act: Ethical and Policy Challenges

bioethics-for-breakfastSteve Fitton and Jane Turner, MD, presented at the Bioethics for Breakfast event on February 2, 2017, offering perspective and insight on the topic, “The Future of Medicaid and the Affordable Care Act: Ethical and Policy Challenges.”

We assume that Republicans in Congress will follow through with their promise to repeal the Affordable Care Act. We also assume that there will be some sort of replacement. The expansion of Medicaid coverage represents just about half the increase in newly insured individuals. The proposal that seems to have the greatest likelihood of being enacted would include block-granting Medicaid. From the perspective of the federal government a block grant is a “fixed budget” as opposed to open-ended funding.

Our speakers discussed what this means for those who are dependent upon the Medicaid program for meeting their health care needs. For example, 31 states have expanded their Medicaid programs to 138% of the poverty level, and 95% of those additional costs are supposed to be covered by the federal government. Will those 31 states have those funds included in their block grant but have it denied to the other 19 states? Is it likely that the size of the block grant will be less than what Michigan would otherwise receive under the current funding mechanism? If the size of the grant is reduced, what sort of health care priorities will Medicaid use to determine the allocation of that more limited funding? What do we imagine might be the consequences for hospitals and or long term care facilities if funding is more constrained? These questions and more were addressed by speakers and attendees during the presentations and moderated discussion.

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Left to right: Jane Turner, Leonard Fleck, and Steve Fitton pose for a photo after the Bioethics for Breakfast event. Photo courtesy of the Center for Ethics.

Steve Fitton
Steve Fitton is a principal with Health Management Associates. He has extensive expertise in Medicaid financing, federal waivers and reinventing healthcare delivery systems. As Michigan’s Medicaid director, he oversaw a budget of more than $15 billion with programs that served over two million residents. Steve played a key leadership role in the approval and implementation of the Healthy Michigan program, the state’s expansion of Medicaid. Steve led the creation and implementation of several Medicaid programs and initiatives to improve access and quality of care while increasing efficiencies and lowering costs. He earned his bachelor’s degree from Michigan State University.

Jane Turner, MD
Jane Turner is a general pediatrician and professor in the Department of Pediatrics and Human Development. She enjoys all aspects of caring for children and youth and has a special interest in working with children who have chronic health conditions. She has served on the faculty of the College of Human Medicine for more than 20 years as a teacher, clinician, and administrator. Dr. Turner also works for the Michigan Department of Health and Human Services as assistant medical director of the Office of Medical Affairs and chief medical consultant for Children’s Special Health Care Services. She went to medical school at the Oregon Health Sciences University and completed a pediatric residency at Children’s Hospital of Pittsburgh.

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: Advanced Dementia and the ICU Siren’s Song: When We Build It, Why Do They Come?

bioethics-for-breakfastKevin Foley, MD, and Leonard Fleck, PhD, presented at the Bioethics for Breakfast event on December 8, 2016, offering perspective and insight on the topic, “Advanced Dementia and the ICU Siren’s Song: When We Build It, Why Do They Come?”

When nursing home patients with late-stage Alzheimer’s or other advanced forms of dementia develop sepsis or pneumonia, should they be sent to an ICU and hooked up to a ventilator? This is the question that was posed in a couple recent medical journal articles. This question can be seen as a medical care issue, an ethics issue, and a policy issue. Is this practice in the best interest of these patients? Why does this seem to be happening with greater frequency? Is there an ethically preferable alternative? Given the relative scarcity of ICU beds, is this a good use of an ICU bed? Are there changes in policy and practice that need to be considered? What should those changes look like?

We start with a statistical picture. About 7.4% of adults over age 75 live in nursing homes; that rises to 16% for adults over age 85. Somewhere between 50% and 70% of nursing home patients have some form of dementia. For the vast majority of these patients who have dementia, their caregivers see comfort care as the goal of care. In spite of that, many of these patients receive more aggressive care than they desire. A common enough scenario is that these patients in late-stage dementia (no longer able to take food by mouth) develop a pneumonia, perhaps related to aspiration as a result of trying to provide food by mouth, and staff at the nursing home cannot provide what they see as necessary medical treatment. Such patients are then sent to a hospital Emergency Department. A palliative care consult would be appropriate at this point but most Emergency Department physicians are reluctant to request such a consult because of pre-existing beliefs and lack of knowledge. This deficiency has more recently been addressed in two publications, one of which is a consensus statement from the Society of Academic Emergency Medicine. See Naomi George et al. “Shared Decision Making to Support the Provision of Palliative and End-of-Life Care in the Emergency Department: A Consensus Statement and Research Agenda.” Academic Emergency Medicine 23 (2016): 1394-1402. See also Jason Bowman et al. “Acceptability and Reliability of a Novel Palliative Care Screening Tool Among Emergency Department Providers.” Academic Emergency Medicine 23 (2016): 694-702.

If these patients with late-stage dementia reach the ICU, then intensivists in the ICU are faced with another set of ethical issues. Very often they will judge that these patients have a very poor prognosis that can be made worse by the surgical placement of feeding tubes to correct for the inability of these patients to be fed by mouth. But the intensivists may have to deal with a family member who is a surrogate decision maker or a court-appointed guardian in the case of an unbefriended patient, and those individuals may, for various reasons, insist on more aggressive life-sustaining care. Those decision makers might represent the earlier expressed wishes by that patient, or fears of legal repercussions in the case of court-appointed guardians. Physicians then might need to be extraordinarily persuasive to prevent what they regard as choices that are contrary to the best interests of those patients. They may feel that they are being paternalistic in considering overriding what might be the preferences of that patient (albeit likely less informed than desirable at the time). Still, the American Medical Association Council on Ethical and Judicial Affairs says explicitly that physicians have as a first obligation not harming their patients in these circumstances. Consequently, they have the professional responsibility to act against the expressed wishes of that surrogate decision maker when that individual wishes to make a medical decision clearly contrary to the best interests of that patient. Obviously, the physician should make every effort to explain sensitively why such decisions are necessary.

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Left to right: Len Fleck and Kevin Foley pose for a photo following the event. Photo courtesy of the Center for Ethics.

These sorts of conversations can be very painful and confrontational. It is clearly better to avoid them through a more preventive approach. At the very least when patients are first diagnosed as being in the very early stages of dementia, conversations regarding various scenarios in late stage dementia should be addressed with both the patient and any surrogate decision maker. It may be difficult for those individuals to imagine vividly enough and accurately enough what those late stages might really be like when the issue of feeding tubes, ICU care, or use of ventilators might be broached. What some research has shown is that videos of patients in late-stage dementia allow for a much more accurate understanding of what choosing life-sustaining care might mean, the consequence of which is that virtually no one is then motivated to want such care in those circumstances.

Kevin Foley, MD, FACP, AGSF
Associate Professor and Associate Chair for Senior Health
Department of Family Medicine
Michigan State University College of Human Medicine
Director of Education and Clinical Operations
Division of Geriatrics and Gerontology
Michigan State University Clinical Center

Leonard M. Fleck, PhD
Professor of Philosophy and Medical Ethics
Center for Ethics and Humanities in the Life Sciences
College of Human Medicine
Michigan State 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: Compassionate Use: What Is in a Name?

bioethics-for-breakfastAnas Al-Janadi, MD, and Jennifer Carter-Johnson, JD, PhD, presented at the Bioethics for Breakfast event on November 17, 2016, offering perspective and insight on the topic, “Compassionate Use: What Is in a Name?”

Jennifer Carter-Johnson notes that The United States has a history of dangerous unregulated “medicines” that led to today’s drug regulations. Indeed, no drug is completely safe, and drug effects must balance safety against efficacy to win market approval for patients. Today’s drug regulatory process, in which 90% of drug candidates fail during clinical trials, and the potential desperation of end-stage patients requires that compassionate use balance protecting the public, encouraging new drug development and respecting patient autonomy. But Dr. Al-Janadi believes that we should think of this issue as an “early/expanded access opportunity” rather than “compassionate use.” One of his concerns is that there are presently lengthy delays in drug approval when drugs have shown some promising efficacy, thereby depriving patients of their benefit.

How do you believe a balance ought to be struck? Should there be public policies that reflect this balance? Or should this be left to the judgment of clinicians and patients, or the pharmaceutical industry? Does the current “right to try” legislation in many states need to be amended? These and other questions were addressed by the speakers and guests, creating a respectful and thoughtful discussion.

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Left to right: Len Fleck, Jennifer Carter-Johnson, Anas Al-Janadi, and Libby Bogdan-Lovis pose for a photo following the event. Photo courtesy of the Center for Ethics.

Anas Al-Janadi, MD
Anas Al-Janadi is Associate Professor and Section Chief of the Division of Hematology and Oncology in the Department of Medicine at the Michigan State University College of Human Medicine.

Jennifer Carter-Johnson, JD, PhD
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.

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: Eye on the Prize: The Goal of Protecting College Football Players’ Best Interests

bioethics-for-breakfastLeonard Fleck, PhD, and Randy Pearson, MD, FAAFP, FACSM, presented at the Bioethics for Breakfast event on May 12, 2016, offering perspective and insight on the topic, “Eye on the Prize: The Goal of Protecting College Football Players’ Best Interests.”

In order to reduce the incidence of traumatic brain injury, should the profession of medicine advocate for further “best practice” changes in the way football is played and injuries managed? If so, what enforcement powers might physicians wield when facing a player’s desire to stay with the team and a college’s desire to have a winning team? Kathleen Bachynski writes in the New England Journal of Medicine (2/4/16), “Repetitive brain trauma can have serious short- and long-term consequences, including cognitive and attention deficits, headaches, mood disorders, sleep disturbances, and behavioral problems.” The NCAA notes that over 200,000 college athletes are injured in competition or practice each year, with 36.3% being in college football. Who should be concerned? Physicians? Parents? Players?

The media has focused on professional football players and the effect of repeated concussions later in life. What are the lifelong risks for college football players who may never play professional football? Is it one chance in a thousand that their life might end prematurely with chronic traumatic encephalopathy? Or is it one chance in ten? Problematically, thus far medical research cannot provide a definitive answer to these questions. Given that, should we (society) say that parents and players should be informed of risks to the extent that they are known, then allowed to judge whether the risks are worth whatever they see as potential benefits? Until clearer evidence is available regarding the actual level of risk to players should medical groups advocate for further protections in the game itself aimed at minimizing potential for brain trauma? And if so, should similar precautionary approaches be taken with other “risky” sports?

Leonard Fleck, PhD
Professor of Philosophy and Medical Ethics
Center for Ethics and Humanities in the Life Sciences
College of Human Medicine, Michigan State University
Dr. Fleck is the author of Just Caring: Health Care Rationing and Democratic Deliberation (Oxford University Press, 2009).

Randy Pearson, MD, FAAFP, FACSM
Professor, Department of Family Medicine, MSUCHM
Senior Associate Director, Sparrow/MSU Family Medicine Residency
Associate Director, MSU/Sparrow Sports Medicine Fellowship
Assistant Dean for Graduate Medical Education, MSUCHM

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: A Snip Here and a Tuck There: Are There Limits to Editing Life?

bioethics-for-breakfastSean A. Valles, PhD, and Corey Washington, PhD, presented at the Bioethics for Breakfast event on February 18, 2016, offering perspective and insight on the topic, “A Snip Here and a Tuck There: Are There Limits to Editing Life?”

In 2015 a form of gene-editing technology called CRISPR-cas9 garnered considerable media attention. In principle it will give researchers the ability to edit individual genes in plants, animals or humans. The editing could have the intent of correcting mutated genes that would otherwise result in serious disease, or, alternatively, enhancing a normal gene to produce a superior version of that gene that would yield some superior health state. This technology is not perfected as yet, but researchers are actively engaged in moving that technology toward perfection so that it can have clinical applicability. In the United Kingdom Dr. Kathy Niakan has applied for government approval to use this technology to edit human embryos at the earliest stages of development, though none of those embryos would be allowed to be implanted in a uterus.

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Left to right: (standing) Corey Washington, Sean Valles, and Tom Tomlinson. Image courtesy of Libby Bogdan-Lovis.

How should this technology be assessed from an ethical point of view and from a public policy point of view? It is easy to conclude that this technology is ethically unacceptable so long as there are clear risks for bad outcomes for people due to imperfections in the technology. But if those imperfections can be eliminated so that we can say the technology is safe and effective, then are there any other ethical concerns that should govern or prevent the deployment of this technology to shape the genetic endowment of future children as well as other life forms? Or, to ask a question in the present, is it ethically acceptable to genetically alter the embryos of various primates now in order to have scientific confidence that the technology may be applied to human embryos? These questions were addressed and discussed by the event speakers and attendees during Thursday’s program.

Sean A. Valles, PhD
Sean Valles is Assistant Professor in the MSU Lyman Briggs College and Department of Philosophy, as well as an affiliate faculty member in the Ecology, Evolutionary Biology and Behavior program. He received his PhD in History and Philosophy of Science from Indiana University. His work examines the interplay between ethical and evidentiary issues in a variety of population health science areas. His research on medical genetics includes a critique of FDA policies on direct-to-consumer genomic testing technologies and examinations of how normality concepts and reproductive rights concepts developed during 20th century eugenics and medical genetics research programs.

Corey Washington, PhD
Corey Washington currently serves as Director of Analytics and Strategic Projects in Office of the Vice President for Research and Graduate Studies (OVPRGS) at MSU. He holds a PhD in Philosophy from Stanford University as well as a PhD in Neuroscience from Columbia University. Before coming to Michigan State in 2013, he taught Philosophy and Cognitive Science at both the University of Washington and the University of Maryland. Washington also worked in the private sector as a consultant at McKinsey and Company in New York, New York.

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: Direct-to-Consumer Healthcare: “Disrupting” Consent

bioethics-for-breakfastJim Dearing, PhD, and Kayte Spector-Bagdady, JD, M.Bioethics, presented at the Bioethics for Breakfast event on December 3, 2015, offering insight and perspective on the topic, “Direct-to-Consumer Healthcare: “Disrupting” Consent.”

If one were to conduct a public poll we imagine that a majority of respondents would cite autonomy and a right to informed consent as bioethics’ mainstays, reflecting the entrenched primacy of doctor-patient clinical interactions. In that familiar model, the doctor is the gatekeeper who determines health service needs and regulates necessary and appropriate access. But today’s health care has expanded far beyond the clinic. The public can now independently purchase health services online and readily obtain them at storefronts in a mall or on the internet – absent the traditional physician gatekeeper. While products and services such as ‘keepsake’ prenatal ultrasounds and genetic testing are not necessarily marketed as medical services, their results certainly have potential clinical consequences. How should such products and services be regulated? What ethical and legal responsibilities accompany the marketing of such goods? Who should be responsible for distinguishing “typical product hype” from the dangerous and disingenuous touting of product pseudo-benefits? How can we strike a fair and just balance between the free market or free speech and regulation aimed at protecting patient interests?

During the presentation, speakers examined those questions from ethical, legal and communication perspectives.

Jim Dearing, PhD
Jim Dearing (PhD, University of Southern California) studies and practices the diffusion of innovations. He studied under and collaborated with Everett M. Rogers for 20 years. Jim has led research projects funded by the U.S. National Cancer Institute, the National Science Foundation, the Agency for Healthcare Policy Research, the Centers for Disease Control and Prevention, and private foundations including the John D. And Catherine T. MacArthur Foundation, the Robert Wood Johnson Foundation, the W.K. Kellogg Foundation, and the Bill & Melinda Gates Foundation. Jim is a Professor and Chairperson in the Department of Communication Michigan State University.

Kayte Spector-Bagdady, JD, M.Bioethics
Kayte Spector-Bagdady is a Postdoctoral Research Fellow at the University of Michigan’s Center for Bioethics & Social Sciences in Medicine. There she focuses on the collective impact of laws, institutional policies, and ethics on equitable access to healthcare. Previously she served as Associate Director at the Presidential Commission for the Study of Bioethical Issues. There, she supervised staff work on the ethics of the U.S. response to the Ebola epidemic, returning incidental findings, and whole genome sequencing, and was a lead staff investigator and author for the report “Ethically Impossible”: STD Research in Guatemala from 1946 to 1948. Kayte began as an attorney advising drug and device companies on FDA compliance. She received her J.D. and M. Bioethics from the University of Pennsylvania Law School and School of Medicine respectively after graduating from Middlebury College.

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: Is it just the money? Reimbursement for Advance Care Planning

bioethics-for-breakfastRose Seavolt, BSN, RN, CCP, presented at the Bioethics for Breakfast event on October 8th, offering insight perspective on the topic, “Is it just the money? Reimbursement for Advance Care Planning.”

In 1991 Congress passed the Patient Self Determination Act as a way of encouraging individuals to do advance care planning for future situations in which they, as patients, were incapable of making health care decisions for themselves. The law required hospitals and other health care facilities to inquire whether patients already had such directives, or would like the opportunity to complete such a directive. But no one would be paid to spend time with a patient to help them formulate more thoughtful directives. In 2009 the Obama Administration proposed paying physicians to provide this service as part of the health reform effort, but inflammatory “death panel” rhetoric resulted in that proposal’s quick demise. The innuendo was that physicians would counsel patients to accept an earlier death in order to save money for their hospital or health care system.

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Left to right: Tom Tomlinson, Rose Seavolt, Libby Bogdan-Lovis, and Devan Stahl pose for a photo after the discussion concluded.

The Centers for Medicare and Medicaid Services (CMS) is again proposing to pay physicians and other health care providers to offer this service. In this Bioethics for Breakfast session we considered a more thoughtful assessment of this proposed legislation, both from a policy perspective and from the perspectives of patients, families, and health care professionals charged with carrying out this responsibility.

Rose Seavolt, BSN, RN, CCP
Rose Seavolt is an Advance Care Planning Coordinator and Next Steps Organizational Faculty for Spectrum Health System, Grand Rapids, MI, and certified in the Respecting Choices® model of advance care planning as a facilitator in all three steps and an instructor in First and Last Steps. Rose has clinical and leadership experience with individuals across the lifespan from neonates to geriatrics and various levels of engagement within healthcare systems. Rose has been instrumental in the development and introduction of each of the steps of advance care planning within Spectrum Health and the greater Grand Rapids area.

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: Boundaries: Do Public Health Interests Trump Individual Parent Prerogatives?

bioethics-for-breakfastDean G. Sienko, MD, MS, and Mark Largent, PhD, presented at last Thursday morning’s Bioethics for Breakfast event, offering opposing views on the topic, “Boundaries: Do Public Health Interests Trump Individual Parent Prerogatives?”

Given the recent measles, pertussis, and ongoing chickenpox outbreaks, there are a number of people who have called for expanded authoritarian responses. At the most aggressive end of the spectrum are people who call for laws forcing people to vaccinate (often referencing using the century-old Jacobson case for justification). The Jacobson case was a 1902 Massachusetts case in which a minister refused to have his children vaccinated. But the Massachusetts Supreme Court ruled that the freedom of individuals must sometimes be subordinated to the common welfare. More moderate views call for the elimination of all non-medical exemptions to mandated vaccines. Which approaches are prudent and which might be unintentionally counterproductive? Could efforts to curtail parents’ ability to opt out of mandated vaccines inadvertently feed further resistance? Are there any reasonable compromises that might be forged? The speakers offered their views on these issues.

Dean G. Sienko, MD, MS
Dean G. Sienko is the MSU College of Human Medicine Associate Dean for Prevention and Public Health and the Division Director of the Division of Public Health.  In addition Dr. Sienko serves as the Acting Director of CHM’s Institute for Health Policy. The mission of the Institute is to improve the health care available to Michigan residents through research, policy analysis, education and outreach, and support of quality improvement activities.

Mark Largent, PhD
Mark Largent is an historian of science, technology and medicine and Associate Dean at Lyman Briggs College at MSU. His research and teaching focuses on the role of scientists and physicians in American public policy. He has written Breeding Contempt: The History of Coerced Sterilization in the United States (2008), Vaccine: The Debate in Modern America (2012), and Keep Out of Reach of Children: Reye’s Syndrome, Aspirin, and the Politics of Public Health (2015).

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: Is Sterilization for Developmentally Disabled Girls Ever Justified?

bioethics-for-breakfastTom Tomlinson, PhD, and Elmer L. Cerano presented at Thursday morning’s Bioethics for Breakfast event, offering opposing views on the topic, “Is Sterilization for Developmentally Disabled Girls Ever Justified?”

Developmentally disabled people have been, and continue to be, stigmatized and mistreated. The history in the US (and other countries) is especially shameful when it comes to the sterilization of “mental defectives,” commonly done for “eugenic” reasons in various states, even into the 1970’s.

It is not uncommon, however, for the parents of developmentally disabled girls to request sterilization (sometimes including hysterectomy) for their child. Are there circumstances when these requests should be granted, despite the lessons of history? The speakers led a discussion of the pros and cons on this question.

Tom Tomlinson, PhD
Tom Tomlinson is Director of the Center for Ethics and Humanities in the Life Sciences and Professor in the Department of Philosophy at Michigan State University. Dr. Tomlinson presented arguments in favor of granting some of these requests.

Elmer L. Cerano
Elmer L. Cerano serves as executive director of Michigan Protection and Advocacy Service, Inc. the independent, private, nonprofit organization designated by the governor of Michigan to advocate and protect the legal rights of people with disabilities. Mr. Cerano is also a member of the Michigan Developmental Disabilities Council and the The Michigan Behavioral Health Advisory Council.

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: Fear and Loathing: Ethical and Effective State Responses to Ebola

bioethics-for-breakfastMatthew M. Davis, MD, MAPP and Leonard Fleck, PhD, presented at Thursday morning’s Bioethics for Breakfast event, offering opposing views on the topic, “Fear and Loathing: Ethical and Effective State Responses to Ebola.”

In the early days of the AIDS virus, public fears generated extreme public policies – including quarantine proposals. Today we would regard those responses as seriously inappropriate and disproportionate to what we know to be true about AIDS contagion. Are we at risk of making similar mistakes regarding Ebola? What are optimal ethical policies, and strategies for communicating about Ebola to be used by public officials that would effectively protect public safety, stave off panic, and ensure a measured response?

The speakers for this session addressed tensions in navigating the delicate ethical balance needed to protect/but not unduly alarm and which take into consideration the multiple stakeholders. How much should officials emphasize what they know with certainty vs. uncertainty? What sorts of actions are ethically defensible and how then should those actions be communicated? What are the limits to medical care providers’ duty to care?

Matthew M. Davis, MD, MAPP
Matthew M. Davis, MD, MAPP, is Chief Medical Executive at the Michigan Department of Community Health; Professor of Pediatrics and Professor of Internal Medicine at the University of Michigan Medical School, and Professor of Public Policy at the Gerald R. Ford School of Public Policy, University of Michigan. Dr. Davis has focused his research on three major areas of health policy: vaccines and vaccine financing, regulation and financing of government-sponsored health programs, and characterization of public attitudes and opinions about health and health policy. He trained in public policy and health services research as a Robert Wood Johnson Foundation Clinical Scholar and Irving Harris Child Policy Fellow at the University of Chicago.

Leonard Fleck, PhD
Leonard Fleck, PhD, is a Professor of Philosophy and Medical Ethics in the Philosophy Department and the Center for Ethics and Humanities in the Life Sciences at Michigan State University. He is a past recipient of the University Distinguished Faculty Award. Dr. Fleck served on the State of Michigan Emergency Preparedness Taskforce. He will discuss ethics issues related to managing infectious diseases such as Ebola as they emerge in a clinical context. For example, should any nurse or physician be allowed to refuse to care for an Ebola patient, despite having available all the protective equipment and practices that ought to assure their safety? Should a hospital have as a policy refusing to do CPR on an Ebola patient in order to protect hospital personnel?

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.