“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.
Speakers: 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
- What factors combine to structure particular relations with negative health outcomes?
- What are the health outcomes broadly defined of State actions like police violence, detention, or deportation?
- What combination of political, social, and economic change is needed to positively reconfigure how institutions address marginalized populations?
We invited community members, human rights lawyers, health care professionals, and activists to join together in deliberating issues, networking, and finding potential paths toward better policies and health outcomes.
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.
Speakers: Mary Faith Marshall, PhD, FCCM, Emily Davie and Joseph S. Kornfeld Professor of Biomedical Ethics, University of Virginia; Beth Epstein, PhD, RN, HEC-C, FAAN, Associate Professor, Chair, Department of Acute and Specialty Care, University of Virginia School of Nursing
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: Raymond De Vries, PhD, Professor and Co-Director, Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School
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.
Speaker: Sharon Kaufman, PhD, Chair, Department of Anthropology, History and Social Medicine; Professor Emerita, Medical Anthropology, University of California San Francisco
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
This forum featured three professionals conducting work and research in different regions of Africa and on very different aspects of health and health care. Each of spoke about their work, with an emphasis on how ethics informs it and how their work derives new questions about what ethics means, for whom, and why. After discussion among the three, the audience participated in continuing to debate the meaning of ethics, and how the many issues relating to health care across Africa push us to consider ethics in new ways.
Panelists: Rajesh Panjabi, MD, MPH, CEO, Last Mile Health; Associate Physician, Division of Global Health Equity, Harvard Medical School, Brigham and Women's Hospital; Siri Suh, MPH, PhD, Postdoctoral Fellow, Department of Gender, Women, and Sexuality Studies; Institute for Global Studies, University of Minnesota; Michael Westerhaus, MD, Assistant Professor of Medicine, University of Minnesota; Co-director SocMed; Medical Director, Center for International Health
Cosponsored by: African Studies Initiative | Department of African American and African Studies | Center for Global Health and Social Responsibility | Interdisciplinary Center for the Study of Global Change | Institute for Global Studies |Department of Gender, Women, and Sexuality Studies | Working Group on Health Disparities, School of Public Health
Dr. Sharp examined ethical dimensions of a major Federal research initiative in genetics. He described the research activities proposed and the current status of these new initiatives. Dr. Sharp considered ethical challenges related to data sharing, DNA biobanking, and reporting of research results to participants. Dr. Sharp also considered opportunities for situating bioethical analyses within the Precision Medicine Initiative.
Speaker: Richard R. Sharp, PhD, Professor, Biomedical Ethics and Medicine; Director, Biomedical Ethics Research Program, Mayo Clinic
In the Netherlands, end-of-life decisions are an important issue in societal debate. Euthanasia (the active ending of life by a physician on the patient’s explicit request) has become legalized as a consequence of this debate, but the debate continues. Is euthanasia allowed in dementia or in cases of elderly people for whom life has lost meaning? What is the relationship between euthanasia and palliative care? Sponsored by Department of Political Science and Center for Bioethics, University of Minnesota.
Speaker: Guy A.M. Widdershoven, Professor, Philosophy and Ethics of Medicine; Head of the Department of Medical Humanities, VU University Medical Center, Amsterdam