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The Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) invited three speakers to provide their insights on the importance of professional ethics and professionalism in neuroscience research on February 10th. The speakers included Nicholas Steneck, Ph.D., Director of the Research Ethics and Integrity Program of the Michigan Institute for Clinical and Health Research; David E. Wright, Ph.D., Director of the Office of Research Integrity at the U.S. Department of Health and Human Services; and Peggy Mason, Ph.D., Chair of the Society for Neuroscience’s Ethics Committee.

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Bioethics Grand Rounds: Janice Firn, MSW; Andrew Shuman, MD; Christian Vercler, MD

Wed, January 27, 2016, 12:00pm
Location: 
UH Ford Amphitheater & Lobby

"Implementation of the Program in Clinical Ethics"

Janice Firn, MSW; Andrew Shuman, MD; Christian Vercler, MD

Abstract: The Program in Clinical Ethics within the Center for Bioethics and Social Sciences in Medicine represents an expansion of existing services designed to promote a culture of patient-centered excellence by developing a comprehensive set of ethics-related activities at UMHS. We will introduce and outline the projects and services available to all members of the UMHS Community.

Bioethics Grand Rounds

Wed, May 25, 2016, 12:00pm
Location: 
UH Ford Amphitheater & Lobby

Kayte Spector-Bagdady, JD, MBioethics

Abstract: In 1966, Dr. Henry Beecher argued that there was no more reliable safeguard for the human research subject than an “intelligent, informed, conscientious, compassionate, responsible investigator.” Considering the current strictures of our human subjects research compliance enterprise, and wide-spread industry hand wringing over the proposed revisions to regulations, we might perhaps long for a simpler time when researchers with “high ethical purposes and completely good morals” were assumed as opposed to compelled. And yet. This presentation will explore the implications and aftermath of the STD experiments conducted by the U.S. Public Health Service in Guatemala in the 1940s.

Bioethics Grand Rounds

Wed, June 22, 2016, 12:00pm
Location: 
UH Ford Amphitheater & Lobby

Timothy Johnson, MD

"Ethical global health engagement: the Michigan Women's Health Model"

Millennial learners are experiencing and want to engage in global issues.  As institutions develop opportunities for their students, ethical issues need to be considered.  Transnational, transcultural, and translational issues as well as issues of equity, bilateral gain, economic transparency, academic values and sustainability must be factored into academic institutional partnerships between Western and low income countries.  The Ghana experience will be used to develop the concept of a “Michigan Model”.

Bioethics Grand Rounds

Wed, July 27, 2016, 12:00pm
Location: 
UH Ford Amphitheater & Lobby

Kunal Bailoor, MD Candidate Class of 2018, Ethics Path of Excellence

"Advance Care Planning: Beyond Durable Power of Attorney (DPOA)"

Abstract: Advance care planning is a crucial part of end of life medical care. It can take many forms, including designation of a surrogate decision maker via a DPOA document. However it can also involve living wills, physicians orders for life sustaining treatment (POLSTs), or even simply clinician patient conversation. The newly revised hospital policy on advance directives reflects this broader approach. The talk will include a brief review of the philosophical and ethical basis of advance care planning before diving into a discussion of the new hospital policy and it's impact on practice.

 

Interim Co-Director Brian Zikmund-Fisher was featured in “Medicine at Michigan.” Brian shared his personal experience with risk and probability in medical decision making.  This experience provided him with the personal career goal of improving patients’ lives by making health information easier to understand.

This is the first featured story in the new section “Gray Matters,” which gives our faculty members the opportunity to write about complex issues in medicine, such as ethics and decision-making.

"A Calculation of Risk"

Bioethics Grand Rounds-Deborah Berman, MD

Wed, January 24, 2018, 12:00pm
Location: 
University Hospital Ford Auditorium

Fetal Therapy: Just Because We can, Should We?

In utero fetal treatment is a complex undertaking that involves Maternal Fetal Medicine as well as a multidisciplinary team that focuses on prenatal diagnosis of specific pregnancy related complications and subsequent fetal therapy with the aim to improve fetal and neonatal outcomes. Several issues, including ethical and legal considerations, are particular to fetal medicine. This talk aims to highlight specific fetal complications in which fetal interventions are an option. In addition, the complex nature of the consultations, interventions, and implications for the patient, family, fetus in the present and future will be discussed.

Bioethics Grand Rounds- Katelyn Bennett- Social Media and the "Medutainment" Phenomenon

Wed, March 28, 2018, 12:00pm
Location: 
Univerisity Hospital Ford Auditorium

Social media is characterized by online spaces of rapid communication, advertising, professional development, and advocacy, and these platforms have revolutionized the way we interact with people and our culture. In surgery, platforms like Facebook, Snapchat, and Instagram are especially attractive for practice promotion and instantaneous connection with potential patients. However, considerable risks and ethical dilemmas lie in wait for the surgeon who attempts to use patient photographs and videos for advertising. It is critical for surgeons to facilitate fully informed consent, consider both context and the patient-physician power differential, and put patients’ interests ahead of their own.

Bioethics Grand Rounds: Naomi Laventhal, MD "Pediatric Care Before Birth: Complex Perinatal Care Coordination and Decision-Making at Michigan Medicine"

Wed, May 23, 2018, 12:30pm
Location: 
University Hospital Ford Auditorium

Expectant parents all hope for an uneventful pregnancy and a healthy baby, but a wide variety of maternal conditions and fetal problems necessitate comprehensive and complex care before birth. This session will offer a review of the nature and outcomes of these conditions, and describe the role of pediatricians in perinatal anticipatory guidance and decision-making, with an exploration of the commonly encountered bioethical issues. The session will include a  review of decision making at the margin of gestational viability, common complex genetic disorders, and technology intense interventions available before, during, and after birth.

Funded by National Institutes of Health

Funding Years: 2014-2016

Nearly half of patients undergoing coronary artery bypass grafting (CABG) nationwide are exposed to red blood cell (RBC) products. While large volumes (3+ units) of transfusions may be delivered to a given patient to preserve life in cases of acute blood loss, evidence suggests that even small amounts (1-2 units) of RBCs often transfused to address poor oxygen delivery are associated with a 16% increase in a patient's risk of mortality and a 27% increase in morbidity, even after case mix adjustment. It is vitally important to allocate RBC products appropriately, given both that cardiac surgery utilizes between 20-25% of the total national blood supply, and the Red Cross reports that 32 of their 36 regions had less than a day's supply available to meet hospital needs. In short, it is important to improve our understanding of how and in what context decisions are made regarding 1-2 units of RBCs, given its association with morbidity, mortality and resource utilization. Growing evidence suggests that some transfusions may be discretionary. In the state of Michigan, nearly 40% of CABG patients are exposed to 1-2 units of RBCs, although the absolute rate varies 32% across institutions. Center-specific variation in transfusion practices is likely attributed to thelack of consensus regarding the indications, setting and hematocrit trigger for transfusions. Given this uncertainty, transfusion rates may be the consequence of differences in organizational (e.g. protocols, types of decision-makers, lack of performance feedback regarding transfusion practice) and provider (e.g. knowledge, beliefs concerning the benefit/harm of transfusions, and inclination to transfuse) factors. Interventions to reduce the rate of unnecessary transfusions first require identifying the set of determinants (at the organizational or provider level) that mot fully explain the observed variation in RBC utilization across regional medical centers. We will use the prospective data and infrastructure of the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative (MSTCVS-QC), a consortium of all 33 cardiac surgical programs in Michigan, to: (1) Develop, pilot, and implement surveys to hospitals and clinical providers within the state of Michigan to describe determinants of 1-2 units of RBC transfusions during cardiac surgery, and (2) Identify the primary organizational and provider characteristics contributing to variability in transfusions. Results from this study will set the sage for a behavioral modification study aimed at reducing the rate of RBC transfusions in the setting of cardiac surgery.

PI(s): Richard Prager, Donald Likosky

Co-I(s): Darin Zahuranec, Min Zhang, Marc Zimmerman, Milo Engoren

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