5-125 Moos Tower, U of M East Bank campus
Palliative Care Exceptionalism? A Broader Perspective on End of Life Care and Modern Medicine
Presented by: Jochen Vollmann, MD, PhD
Professor, Medical Ethics, Director, Institute for Medical Ethics and History of Medicine, and President, Center for Medical Ethics, Ruhr University Bochum, Germany
Palliative care is an innovative and growing field focussing on life-threatening illness and on the relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. In this “holistic” approach palliative care differs from science based modern medicine and shows similarities to other “holistic” approaches to the patient as a subject as well as to pre-modern medicine. Professor Vollmann discusses from his ongoing research palliative care exceptionalism and a broader perspective on end of life care and modern medicine and its’ consequences for future health care.
Seminars are free and open to the public.
2-520 Moos Tower, U of M East Bank Campus
Is There a Legal Privilege to Waive Consent for Research?
Presented by: Jon Merz, MBA, JD, PhD
Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania
Waivers of informed consent for research participation are permitted under the Common Rule as well as the Exception from Informed Consent (EFIC) for emergency research rule. We examine waivers as embodiments of legal privilege, which permit actors to violate legal norms in furtherance of greater social goods. The emergency privilege, which allows a caregiver to provide emergency medical care to an incompetent victim of an accident, is the clearest example. But fundamental to the privilege to acting without consent is the presumption that reasonable persons in the patients' position would agree, if capable, and that no evidence exists that the particular patient would not agree. An assessment of what is known about participation and refusal rates in research show that the presumption with respect to standard care is not applicable to research. This suggests that, while researchers may assert the social utility of their studies are high enough to justify waivers,there is reason to suspect that many who would be enrolled under a waiver of consent would not want to be enrolled.Our analysis suggests that waivers should be rare, IRBs and researchers must explicitly address study acceptability, and it should be incumbent upon researchers to establish by clear, sound evidence that proposed studies would be acceptable in the community at large and the target population.
Seminars are free and open to the public.
The Digital Mental Health Industry: New Problems, New Solutions, New Practices
Presented by: Emma Bedor Hiland, PhD Candidate
Department of Communication Studies, University of Minnesota
As our day-to-day lives are increasingly reliant upon (and enmeshed with) digital platforms, it is not surprising that the ways we address and manage our health generally, and mental health in particular, are increasingly digitized as well. Our culture’s generally favorable attitude toward digital solutions for everyday problems has led to the emergence of a digital mental health industry, which includes smartphone applications (“apps”) and telemental health services.
New and largely unregulated, the digital mental health industry presents its toolsets as affordable and a cost and time-effective alternative to many of the problems and barriers associated with the treatment of mental illness: clinician and specialist scarcity, treatment unaffordability, and the geographic remoteness of rural patients. Through a combination of fieldwork and interview analysis, this research addresses these claims and the future of the industry, with findings that are relevant to medical practitioners, technologists, researchers, mental health advocates and activists, and others whose work explores the connections between technology and medicine.
Speaker: Deborah Day Laxson
Founder of the Health Care Agent Literacy Project and author of the award winning book The Gray Zone: When Life Support No Longer Supports Life."
How does a non-medically trained individual respond when life support no longer supports life? Using her own real life example, Deborah brings the audience on her journey as she learned to navigate the complexities of the medical world in order to honor her husband’s choices regarding medical care at end-of-life.
Speaker: Steven Miles, MD
Professor and Maas Family Endowed Chair in Bioethics, Center for Bioethics; and
Department of Medicine, University of Minnesota Medical School
A disappearing arctic ice cap. Rising oceans. Once in a century floods are occurring annually, even as deserts expand. Plastic and chemicals cover the seas and lands. Pollinating bees are disappearing as agriculture defends the chemicals that kill them. Tropical diseases are migrating north into temperate zones that are warming to greet new species of mosquitos. Some say we are living in an “Anthropocene Epoch” where humans rather than natural forces are transforming the planet. Does bioethics have anything useful to say? Dr. Miles will explore the history and future directions for bioethics. This talk is based on a collaboration with Susan Craddock, PhD.
Center for Bioethics Seminar
Don Brunquell, PhD, LP
Affiliate Faculty, Center for Bioethics
Christopher Michaelson, PhD
David A. and Barbara Koch Distinguished Professor of Business Ethics and Social Responsibility
Associate Professor, Ethics & Business Law
University of St. Thomas, Opus College of Business
“Moral hazard” is a term familiar in economics and business ethics that illuminates why rational parties sometimes choose decisions with bad moral outcomes without necessarily intending to behave selfishly or immorally. The term is not generally used in medical ethics. Decision makers such as parents and physicians generally do not use the concept or the word in evaluating ethical dilemmas. They may not even be aware of the precise nature of the moral hazard problem they are experiencing, beyond a general concern for the patient’s seemingly excessive burden. Our seminar will bring the language and logic of moral hazard to pediatrics. The concept reminds us that decision makers in this context are often not the primary party affected by their decisions. It appraises the full scope of risk at issue when decision makers decide on behalf of others and leads us to separate, respect, and prioritize the interests of affected parties.
5-125 Moos Tower
Center for Bioethics Seminar Series
Mary Faith Marshall, PhD, FCCM
Emily Davie and Joseph S. Kornfeld Professor of Biomedical Ethics, University of Virginia
Beth Epstein, PhD, RN
Associate Professor, Chair, Department of Acute and Specialty Care, University of Virginia School of Nursing
Healthcare professionals, hospital administrators, and clinical ethics consultants are increasingly aware of the existence of moral distress in the workplace and the potentially damaging long-term effects of burnout, moral distancing, and intent to leave a position or profession. Studies indicate that 15-20% of physicians and nurses are considering leaving their positions due to moral distress. Strategies to address moral distress are needed but few have been proposed. Such strategies are necessarily different from those used in clinical ethics consultation where the objective is to resolve a patient-focused problem. In morally distressing situations, the problems are often at the unit, team, and/or organizational level; solutions require interprofessional collaborative effort and buy-in at different levels of the organization.
Professors Brunnquell and Michaelson have argued for the deleterious effects of moral hazard in the clinical setting. Moral hazard occurs when those who are empowered to parse risk and fashion responses to it are not those who suffer its burdens. It involves a power differential between the decision maker and the decision bearer. The presenting problem in most situations that occasion moral distress is a real or perceived power imbalance. Professors Marshall and Epstein argue that moral distress is inherently occasioned by moral hazard (not vice-versa) and that moral hazard is, indeed, a background condition for moral distress.
They will discuss the relationship between moral distress and moral hazard, and show how building an interprofessional Moral Distress Consult Service is one strategy to address morally distressing (and thus morally hazardous) situations in the health care setting.
Should we take the moral concerns of biobank donors seriously?
Speaker: Raymond De Vries, PhD, Professor and Co-Director
Center for Bioethics and Social Sciences in Medicine
University of Michigan Medical School
Biobanking is becoming an increasingly important component of genomic and medical research. President Obama’s Precision Medicine Initiative ― which proposes the collection of genetic and clinical data for upwards of 1 million Americans ― is just one example of this trend in medical science. Because biobanks depend upon donations from a willing public, it is important that potential donors trust that their donations are being used to promote goals they endorse. Earlier research has shown that some Americans have significant moral concerns about the kinds of research that might be done with their donations, hence the current default model of “blanket” or “broad” consent used by biobanks ― which ignores these concerns ― may diminish willingness to donate. In an effort to better understand the extent and implications of these moral concerns, we fielded a survey examining associations between moral concerns and willingness to donate to a biobank. We found that most people do have moral concerns that significantly affect their willingness to donate to a biobank using blanket consent and that these moral concerns vary across subgroups of the population. But should we care? After all, donors to biobanks rarely learn how their donations are used and “what you do not know cannot harm you.”
Speaker: Sharon Kaufman, PhD
Chair, Department of Anthropology, History and Social Medicine; Professor Emerita, Medical Anthropology, University of California San Francisco
In today’s aging society, the line between life-giving therapies and too much treatment is hard to see — it is obscured by a perfect storm created by private industry, insurance reimbursement and the promises of evidence and new technologies. The lecture reveals what drives the storm’s “more is better” approach to medicine: a nearly invisible chain of social, economic and bureaucratic forces that has made once-extraordinary treatments seem ordinary and necessary. The lecture provides a map to the socio-cultural sources of our health care dilemmas.
While the adoption of the electronic health record (EHR) seems to have improved the efficiency and safety of healthcare practices, it has also raised significant ethical concerns. Confidentiality issues related to data theft and hacking are often in the news. There are complaints of the computer’s intrusion into the clinician-patient relationship. Clinicians cite their frustration with the EHR, and some attribute professional burnout to their encounters with the EHR.
How can Karl Marx help us understand the alienation providers experience when working with and for the EHR? Can the EHR be humanized?
Speaker: Don Postema, PhD
Program Director of Medical Bioethics, HealthPartners; Affiliate Faculty, Center for Bioethics; Professor, Department of Philosophy, College of Arts & Sciences, Bethel University