February webinar to address Michigan’s vaccine waiver education policy

What’s the point of Michigan’s vaccine waiver education requirement?

Since 2015, Michigan parents have had to attend education sessions at public health offices if they want their unvaccinated or under-vaccinated children to attend school or daycare. This policy seems to have succeeded: the state’s nonmedical exemption rate declined by 35% from 2014 to 2015. But what explains this apparent success? Are parents changing their minds as a result of mandatory vaccine education, or are they choosing to vaccinate rather than be inconvenienced by education sessions? Also, does vaccine education promote additional public health goals, i.e. other than short-term vaccination compliance? This presentation will attempt to answer these questions by drawing on immunization records, interviews with public health staff, and surveys of health department leaders, with the goal of informing arguments about the value of Michigan’s vaccine waiver education policy.

Join us for Dr. Navin’s lecture on Wednesday, February 14, 2018 from noon till 1 pm in person or online.

Mark Navin, PhD, is an Associate Professor of Philosophy at Oakland University. His recent work is primarily in bioethics and public health ethics. His book, Values and Vaccine Refusal, was published by Routledge in 2015.

In person: This lecture will take place in C102 East 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 lectures. To receive reminders before each webinar, please subscribe to our mailing list.

Episode 3: The Medical Ethics Resource Network of Michigan

Episode 3 of No Easy Answers in Bioethics is now available! Guest Dr. Leonard Fleck, Professor in the Center for Ethics and Humanities in the Life Sciences and the Department of Philosophy, sits down with producer Liz McDaniel to discuss his involvement in the Medical Ethics Resource Network of Michigan (MERN), a non-profit organization that existed for about twenty years, beginning in 1986. Dr. Fleck discusses the reasons why there was a need for such a network, and provides insight into the work they did in sharing expertise and helping individuals develop skills that were needed to thoughtfully address ethics issues within a clinical setting.

Ways to Listen

This episode was produced and edited by Liz McDaniel in the Center for Ethics. Music: “While We Walk (2004)” by Antony Raijekov via Free Music Archive, licensed under a Attribution-NonCommercial-ShareAlike License. Full transcript available.

About: No Easy Answers in Bioethics is a podcast series from the Center for Ethics and Humanities in the Life Sciences in the Michigan State University College of Human Medicine. Each month Center for Ethics faculty and their collaborators discuss their ongoing work and research across many areas of bioethics—clinical ethics, evidence-based medicine, health policy, medical education, neuroethics, shared decision-making, and more. Episodes are hosted by H-Net: Humanities and Social Sciences Online.

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

bioethics-for-breakfast Forrest 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.

Bioethics for Breakfast: Fear and Loathing: Ethical and Effective State Responses to Ebola

Matthew 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.

Bioethics for Breakfast: Mother, Midwife, Doctor, State: What to Do About Place of Birth?

Deborah Fisch, JD, and Nancy Herta, MD, presented at Thursday morning’s Bioethics for Breakfast event, offering opposing views on the topic, “Mother, Midwife, Doctor, State: What to Do About Place of Birth?”

The topic of childbirth has recaptured national attention, with questions emerging about high maternal and infant mortality rates, persistent racial disparities in outcomes, high cesarean section rate, necessity of routine interventions, prevalence of childbirth-related trauma, and more. Home births increased markedly between 2004 and 2012 and now account for 1.36% of all births. Together these two phenomena have reignited the debate on whether home birth is to be prohibited, tolerated, advised, or preferred.

Who decides? Legislatures possess a right – and in some states a duty – to enact laws for the protection of the public’s health, but must weigh these protections against accompanying constraints on personal liberties. Medical providers and institutions are bound by both professional ethics and medico-legal standards of care. State medical societies seek to preserve providers’ economic and political survival and to support their members in maintaining scientific and ethical best practices. Women claim both consumer and human rights in deciding their place of birth. Everyone wants what is best for mothers and babies. What bioethical stance can bring these disparate views into proximity, if not into harmony?

Presentations highlighted expanding national conversations concerning US childbirth management. Ms. Fisch and Dr. Herta engaged the audience in considering how these combined phenomena contribute to the debate on whether home birth is to be prohibited, tolerated, advised, or preferred.

Deborah Fisch, JD
Deborah Fisch is affiliated with the University of Michigan Program for Sexual Rights and Reproductive Justice, the Friends of Michigan Midwives and Coalition to License CPMs, and the Birth Rights Bar Association. Her research interests include the role of malpractice liability in determination of standard of care; the legal maternal-fetal relationship in pregnancy, labor and childbirth; demographic outcome disparities in childbirth and the criminalization of pregnancy; regulation of out-of-hospital birth attendants and protocols for their interaction with in-hospital providers; and evolving access to maternity care under the Affordable Care Act. She earned an undergraduate degree in Linguistics from the University of Michigan and a JD from Wayne State University Law School.

Nancy Herta, MD
Nancy Herta is an Assistant Professor of OB/GYN at Michigan State University. She has had a clinical OB/GYN practice in the Lansing area for the last 18 years and has been the Associate Residency Director of the Sparrow OG/GYN residency for the last 12 years. In addition she has been a consultant for the Greenhouse Birth Center, and works with many local midwives as a consultant. She will be addressing the concerns local OB/GYN physicians express over home birth and the barriers to moving toward a more cooperative, mother/baby centered model of care.

Bioethics for Breakfast: Legalizing Physician-Assisted Death: Should Michigan Be Next?

Tom Tomlinson, PhD, and Ed Rivet, MPA, presented at last Thursday morning’s Bioethics for Breakfast event, offering opposing views on the topic, “Legalizing Physician-Assisted Death: Should Michigan Be Next?”

Physician-assisted death (also known as physician-assisted suicide) is now legal in four states, either through legislation (Vermont), ballot initiative (Oregon and Washington) or state supreme court ruling (Montana). With a favorable February ruling by Judge Nan Nash of the New Mexico Second Judicial District (now under appeal by the state Attorney General), New Mexico may be next. An attempt in Michigan in 1998 (Proposal B) was overwhelmingly defeated, 79% to 21%, despite pre-ballot polling that suggested overwhelming support.

In the discussion, speakers and attendees explored this debate and tried to decide: if another proposal were brought before Michigan voters, should it pass this time?

Tom Tomlinson, Ph.D.
Tom Tomlinson is Director of the Center for Ethics and Humanities in the Life Sciences and Professor in the Department of Philosophy, Michigan State University.

Ed Rivet, MPA
Ed Rivet is Legislative Director for Right to Life of Michigan.

Michigan’s New Abortion Insurance Rider Law: Challenges, Spin, and Justice

This post is a part of our Bioethics in the News series. For more information, click here.

By Deborah Fisch, JD

In December 2013 the Michigan legislature passed the Abortion Insurance Opt-Out Act. Because of the Act’s origin as a petition to initiate legislation, the governor possessed no power to veto it. Thus, effective March 14, no health insurance plan offered for sale in Michigan may include coverage for “elective abortion.” Instead, consumers desiring such coverage must purchase an additional rider – before becoming pregnant. No insurance carrier is obligated to sell such a rider, nor is any employer-based insurance plan required to offer employees an opportunity to purchase one.

The outcry against the law has condemned the allegedly undemocratic process of its enactment, the predicted effect on access to abortion for Michigan women, and possible further restrictions on abortion rights. Less attention has been paid to potential challenges to the law, the use of extreme spin on both sides, and the role of abortion restrictions in the larger context of Reproductive Justice.

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