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Pediatric Ethics Committee

The Michigan Medicine Committee advisory groups are appointed by the Hospital's Office of Clinical Affairs. They review ethical or moral questions that may come up during a pediatrics patient's care. The consultants facilitate communication among patients, their families and the treatment team to assist everyone in making appropriate choices when difficult decisions need to be made. The Committee's goal is to help everyone decide the right thing to do. The Michigan Medicine Ethics Committee is a sub-committee of the Executive Committee on Clinical Affairs as determined by the Medical Staff Bylaws. 

About Us


The committee is available for consultation to family members, patients, staff, and health care providers. The committee may help you and your child’s medical team clarify facts, examine ethical issues, and assist in the resolution of disagreements about your child’s care. The committee includes people with additional training in medical ethics, doctors, nurses, social workers, a lawyer, a chaplain, an administrator, and members of the community
The University of Michigan has a Pediatric Ethics Committee because the best medical care requires not only medical skill but good moral judgment. The Committee’s main purpose is to offer help and guidance on moral and ethical questions, such as:

  • Should treatment be started or stopped?
  • How much should a child be told about his or her disease?
  • Is the promise of treatment worth the suffering it may cause?
  • What is the best thing to do when we must face the end of life?
  • What happens when a meeting with the Ethics Committee is requested?

The consultants on call review the patient's medical situation and treatment options. In addition, concerns and feelings of the patient, family members, and the health care team are discussed. Members of the committee may visit with patients, families and medical personnel to discuss these concerns.

Ethics Committee members discuss the information which has been gathered. The Ethics Committee makes suggestions about the best course of action. Often there are a number of options available in the course of a patient's care. Final decisions are made by the patient, family and the health care team.

The Pediatric Ethics Committee meets on the first Tuesday of the month from 12-1:30pm at University Hospital in dining rooms C&D. If you would like to attend as a guest, please contact Amy Lynn @ lynnam@med.umich.edu

Request a Consult

Monday-Friday
8:00 a.m. - 5:00 p.m. Call 734-615-1379
After normal business hours, please call 936-6267 and ask for the clinical ethicist on call to be paged.

Resources

Financial Assistance

Withdrawal and Withholding of Medical Treatment

Committee Bylaws

 

For upcoming Bioethics Grand Rounds see Events

 

Mon, October 08, 2018

Michele Gornick, PhD is lead author on study that finds that a decision support tool "iCanDecide" boosts genetic testing knowledge in breast cancer patients. Co-authors include CBSSM's Reshma Jagsi, MD, DPhil and Sarah Hawley, PhD, MPH.

Naomi Laventhal, MD, MA

Faculty

Dr. Naomi T. Laventhal joined the University of Michigan in August 2009, after completing her residency in pediatrics, fellowships in neonatology and clinical medical ethics, and a master’s degree in public policy at the University of Chicago. She is a Clinical Associate Professor in the Department of Pediatrics and Communicable Diseases in the Division of Neonatal-Perinatal Medicine, and in the Center for Bioethics and Social Sciences in Medicine (CBSSM).

Last Name: 
Laventhal

Susan Goold, MD, MHSA, MA

Faculty

Susan Dorr Goold, M.D., M.H.S.A., M.A., studies the allocation of scarce healthcare resources, especially the perspectives of patients and the public. Results from projects using the CHAT (Choosing Healthplans All Together) allocation game have been published and presented in national and international venues. CHAT won the 2003 Paul Ellwood Award and Dr. Goold is listed in the Foundation for Accountability's database of Innovators and Visionaries. Dr.

Last Name: 
Goold

Supporting information for: 2014 CBSSM Research Colloquium and Bishop Lecture (Myra Christopher)

 

Andrew G. Shuman, MD, Assistant Professor, Department of Otolaryngology, University of Michigan

"When Not to Operate: The Dilemma of Surgical Unresectability"

One of the most anguishing choices a surgeon can make is deciding not to embark upon an operation because a tumor is deemed unresectable.  Despite the widespread acceptance of patient autonomy and transparency in medical practice, there remains an unstated paternalism “behind the mask,” within the confines of the operating room.  The concept of surgical unresectability derives from a complex combination of tumor factors, patient factors, and surgeon factors.  In many cases, these decisions are intensely personal and subjective, with disagreements even among surgeons in the same field.  There is a risk that the voice of the patient may be lost in making these decisions, as surgeons weigh these intangible variables in ways that may be incommunicable.  However, the consequences of proceeding with an operation unlikely to achieve its intended outcome may be similarly terrifying.  In this presentation, a cancer surgeon and reconstructive surgeon will discuss these dilemmas from multiple perspectives using real-life case examples from their practice.  We will collectively try to tease out the inherent biases informing such decisions from the standpoint of doctors, patients, and clinical ethicists.  The theoretical underpinnings of the authority of surgical judgment will be explored, noting that pursuing goods internal to the practice of surgery requires such decisions, and asking whether Polanyi’s concept of tacit knowledge explains (or even permits) a degree of paternalism.  

Phoebe Danziger, BA, MD expected May 2014
 
"Beliefs, Biases, and Ethical Dilemmas in the Perinatal Counseling and Treatment of Severe Kidney Anomalies"
 

Anomalies of the kidney and urinary tract are the most common prenatally diagnosed fetal structural abnormalities, and are a major cause of end-stage kidney disease in children. Severe, prenatally diagnosed cases present a number of unique ethical issues with respect to the care of the pregnant woman, fetus, and neonate. We will use a case-based approach to explore these issues in the context of prenatal counseling, and in the neonatal period. On a case-by-case basis, efforts are made antenatally to coordinate counseling from appropriate consultants such as maternal-fetal medicine, neonatology, and pediatric urology and nephrology. We argue, however, that significant differences exist both between individual physicians and between subspecialties more broadly with regard to beliefs about prognosis, therapeutic interventions available, and appropriate utilization of palliative versus life-prolonging options. Unlike for other high-risk perinatal conditions such as extreme prematurity, no guidelines or standardized interprofessional processes exist for the provision of coordinated, timely, and non-directive care to these patients. This has implications for choices made regarding prenatal care, resuscitation efforts at birth, and utilization of palliative and life-prolonging care options, and we argue that the implicit biases and differences in both counseling and practice must be explicitly addressed and considered in order to facilitate more effective counseling for families facing these diagnoses. We will discuss the prenatal use of the term “lethal pulmonary hypoplasia,” a term that implies an unequivocal outcome but is a tissue-based diagnosis that can only be made after birth, not on the basis of obstetric ultrasound. We will also discuss the strikingly different rates of utilization of and attitudes towards dialysis initiated in the neonatal period, both between individual care providers and between institutions. 

 
Kathryn L. Moseley, MD, MPH, Assistant Professor, Pediatrics and Communicable Diseases, University of Michigan
 
"Electronic Medical Records: Challenges for Clinical Ethics Consultation"
 
Electronic medical records (EMRs) are rapidly replacing their paper counterparts. Their advantages include readability, access, organization, and comprehensiveness. The qualities that make EMRs so attractive also create new challenges for the clinical ethics consultant and the consultation process. This transition from a handwritten record of examinations and diagnoses that resided in close proximity to the patient to an electronic record that can be read remotely creates a number of concerns uniquely problematic for ethics consultation.  
We identify 4 hazards that EMRs present to ethics consultants:
Accessing significant medical information remotely, before face-to-face contact, can bias the consultant and lead to the premature development of conclusions/recommendations.
The ability to access medical information remotely can tempt the consultant to be less thorough in face-to-face information-gathering.
The paucity of nuanced information about the patient/family social and emotional situation and the content of patient/family meetings can misinform and mislead the consultant.
Remotely accessing information can delay communication with the patient and family, potentially undermining their trust in the objectivity of the ethics consultation process.
We propose the following 3 recommendations for training programs and ethics committee members to begin to address the concerns above:
1) Training programs for ethics consultants should emphasize the importance of face-to-face encounters with all stakeholders as soon as possible after receiving a consult.  Telephone only consults should be discouraged.
2) Hospital ethics committees should create procedures and processes that encourage and support face-to-face information gathering.
3) New consultants should be educated about the limitations of the EMR, especially as an accurate source of information about the emotional or social situation of the patient/family and the content of patient/family meetings.
 
 
Helen Morgan, MD,  Department of Obstetrics and Gynecology, University of Michigan
 
"Academic Integrity in the Pre-Health Undergraduate Experience"
 
Introduction: There is evidence that academic misconduct early in a student’s career can initiate a continuum of later unethical behaviors.  Multiple studies have reported that the best predictor of whether a student will cheat in medical school is whether they had a history of cheating in college.   Cheating in medical school has been found to be the strongest predictor of disciplinary action by state medical boards for practicing physicians. There is a paucity of data on perceptions of academic integrity in pre-health students. Methods: In the fall of 2013, we administered a survey on academic integrity to first-year pre-health students in the Health Science Scholars Program.  The curriculum for their course included sessions on academic integrity in the health care profession, and in the pre-health experience.  Follow-up assessments in the spring of 2014 included a re-administration of the same integrity survey, as well as a survey on students’ perceptions of what pressures and justifications lead to cheating behaviors. Results:  In the fall, students reported that 7.5% had cheated already in college, 26.2% had witnessed cheating in college, and 59.4% believed that academic misconduct was a problem at the University of Michigan.  In the spring, the percent of students who reported cheating in college was unchanged at 7.1%, and there was an increase in the number of students who reported witnessing cheating in college at 40.8% (p=0.027).    Students cited admissions requirements for graduate programs as the highest sources of pressure to cheat. Conclusion: This pilot data demonstrates that there is a need for curriculum development that could potentially prevent academic misconduct in vulnerable pre-health students.
 
 
Tanner Caverly, MD, MPH, Health Services Research Fellow, Ann Arbor VA Medical Center and Clinical Lecturer, University of Michigan
 
"How transparent are cancer screening & prevention guidelines about the benefits and harms of what they recommend?"
 
Transparent risk information -- that is, presenting absolute risks on both benefits and harms -- is essential for medical decision making. Without this information clinicians and policy-makers cannot know how much an intervention helps, whether the potential benefit is worth the potential harms, or whether one service is more helpful than another service. We recently did a structured review of clinical practice guidelines and two widely-used clinical resources. We found that few recommendations are accompanied by transparent risk information on the benefits and harms of the recommended cancer prevention service (only 23%). This talk focuses on how risk information WAS presented and the implications of our findings.
 
 
Susan D. Goold, MD, MHSA, MA , Professor of Internal Medicine and Health Management and Policy, School of Public Health, University of Michigan
 
"Controlling Health Costs:  Physician Responses to Patient Expectations for Medical Care"
 
Background: Physicians have dual responsibilities to make medical decisions that serve their patients’ best interests but also utilize health care resources wisely.  Their ability to practice cost-consciously is particularly challenged when faced with patient expectations or requests for medical services that may be unnecessary. Objective:  To understand how physicians consider health care resources and the strategies they use to exercise cost-consciousness to respond to patient expectations and requests for medical care. Design:  Exploratory focus groups of practicing physicians were conducted.  Participants were encouraged to discuss their perceptions of resource constraints, experiences with redundant, unnecessary and marginally beneficial services, and asked about patient requests or expectations for particular services. Participants:  Sixty-two physicians representing a variety of specialties and practice types participated in 9 focus groups in Michigan, Ohio, and Minnesota in 2012. Measurements:  Iterative thematic content analysis of focus group transcripts. Principal Findings:  Physicians reported making tradeoffs between a variety of financial and nonfinancial resources, considering not only the relative cost of medical decisions and alternative services, but the time and convenience of patients, their own time constraints, as well as the logistics of maintaining a successful practice.  They described strategies and techniques to educate patients, build trust, or substitute less costly alternatives when appropriate, often adapting their management to the individual patient and clinical environment. Conclusions:  Physicians often make nuanced trade-offs in clinical practice aimed at efficient resource use within a complex flow of clinical work and patient expectations.  Understanding the challenges faced by physicians and the strategies they use to exercise cost-consciousness provides insight into policy measures that will address physician’s roles in health care resource use.
 
 
 
 

Bioethics Grand Rounds

CBSSM’s Clinical Ethics Service sponsors the monthly Bioethics Grand Rounds, focusing on ethical issues arising in health care and medicine. This educational session is open to Michigan Medicine faculty and staff and CME credit is available.

Link to previous Bioethics Grand Rounds:

Michael Fetters, MD, MPH, MA

Faculty

I serve as Professor of Family Medicine, Director of Japanese Family Health Program, and Co-Director of the Michigan Mixed Methods Research and Scholarship Program at the University of Michigan. In addition to being a family/general doctor fluent in Japanese, I have long been interested in the influence of culture on medical decision making and ethics, and have conducted numerous health research projects, and published numerous papers in English and Japanese.

Research Interests: 
Last Name: 
Fetters

Kathryn Moseley served as one of the judges at "The Big Ethical Question Slam 5" hosted by a2ethics.org. In addition, Naomi Laventhal, Michele Gornick, Christian Vercler, Lauren Smith, and Lauren Wancata served as judges at the "Michigan Highschool Ethics Bowl 2."

Thanks to all the CBSSM folks who contributed their time!

For more information about these events and other great ethics-related activites, go to a2ethics.org.

A short video about the Highschool Ethics Bowl can be found here.

Policy and Public Outreach

The Bishop Lectureship in Bioethics

Together with the Bishop endowment, CBSSM sponsors the Bishop Lecture in Bioethics.  The Bishop Lecture in Bioethics was made possible by a generous gift from the estate of Ronald and Nancy Bishop, both graduates of the University of Michigan Medical School (Class of ‘44). The Bishop lecture typically serves as the keynote address for the CBSSM Research Colloquium. The Bishop Lecture selection committee is headed by Susan Goold, MD, MHSA, MA. Click here for more details.

CBSSM Research Colloquium

The Center for Bioethics and Social Sciences in Medicine (CBSSM) Research Colloquium features presentations focusing on bioethics and social sciences in medicine across multiple disciplines. Click here for more details.

CBSSM Seminar Series

Building upon the very successful “joint seminars” of past years sponsored by the Bioethics Program and the Center for Behavioral and Decision Sciences in Medicine (CBDSM), CBSSM hosts seminars on a bimonthly basis throughout the academic year, inviting investigators to present both developing and finished research topics. Click here for more details.

Sponsored Events

In addition to the Bishop Lecture in Bioethics, CBSSM has sponsored and co-sponsored a number of other events.

Bioethics Grand Rounds

With support from the UMHS Office of Clinical Affairs and C.S. Mott Children’s Hospital and Von Voigtlander Women’s Hospital, CBSSM’s Program in Clinical Ethics sponsors the monthly Bioethics Grand Rounds, focusing on ethical issues arising in health care and medicine. This educational session is open to UMHS faculty and staff.

Film Screening & Moderated Discussion

CBSSM also sponsors film screenings and moderated panel discussions. In 2017, CBSSM sponsored a free film screening of "Concussion." The moderated panel included Ellen Arruda, PhD, Mechanical Engineering; Karen Kelly-Blake, PhD, Bioethics, MSU; & Matthew Lorincz, MD, PhD, Neurology. The moderator was Raymond De Vries, PhD.

In 2015, CBSSM co-sponsored a free film screening of "Still Alice." The panel included Nancy Barbas, MD and J. Scott Roberts, PHD and the moderator was Raymond De Vries, PhD. The event was co-sponsored by the Michigan Alzheimer's Disease Center.

Current Event Panels

In 2014, CBSSM co-sponsored the panel "Incidental Findings in Clinical Exome and Genome Sequencing: The Drama and the Data" featuring Robert C. Green, MD, MPH, Associate Professor of Medicine, Division of Genetics at Brigham and Women’s Hospital and Harvard Medical School, as the keynote speaker. The panel included Jeffrey W. Innis, MD, PhD, Morton S. and Henrietta K. Sellner Professor in Human Genetics and Director, Division of Pediatric Genetics, and Wendy R. Uhlmann, MS, CGC, Clinical Associate Professor, Department of Internal Medicine and Department of Human Genetics. The panel was moderated by Sharon L.R. Kardia, PhD, Director, Public Health Genetics Program and the Life Sciences and Society Program, School of Public Health, University of Michigan. This event was also co-sponsored by the Department of Human Genetics, Genetic Counseling Program and Life Sciences and Society, Department of Epidemiology.

In 2013, CBSSM sponsored the panel "What does the Supreme Court ruling on gene patents mean for public health?" The panel featured panelists, Rebecca Eisenberg, JD, Robert and Barbara Luciano Professor of Law; Sofia Merajver, MD, PhD, Professor, Department of Internal Medicine; and Shobita Parthasarathy, PhD, Associate Professor of Public Policy, Gerald R. Ford School of Public Policy. The panel was moderated by Edward Goldman, JD, Associate Professor, UM Department of ObGyn Women's Hospital and Adjunct Assistant Professor, Department of Health Management and Policy.

Decision Consortium

Each year, CBSSM sponsors one Decision Consortium speaker with a focus on health-related decision making. Decision Consortium, hosted by the Department of Psychology, is a University-wide distributed center for scholarship on decision making. Each session involves a vigorous discussion of new ideas and research on problems that have significant decision making elements. CBSSM-sponsored speakers included Kevin Volpp, MD, PhD, UPenn (2015), Karen Sepucha, PhD, Harvard (2013), and Ellen Peters, PhD, OSU (2012). In 2016, CBSSM will sponsor Lisa Schwartz, MD, MS and Steven Woloshin, MD, MS from the Dartmouth Institute.

The Waggoner Lecture

In November of 2010, CBSSM co-sponsored the 15th annual Waggoner Lecture, an annual event in honor of the late Dr. Raymond Waggoner, former chair of the Department of Psychiatry.  The lecture was presented by Bernard Lo, MD,  Director of the Program in Medical Ethics at the University of California-San  Francisco, and was entitled, “Stem cells: Intractable ethical dilemmas or  emerging agreement.”

In November 2011, CBSSM co-sponsored the Waggoner Lecture breakfast.  The lecture was presented by Laura Roberts, MD, chair of the Department of  Psychiatry and Behavioral Sciences at Stanford University School of Medicine, and was entitled, “Becoming a Physician: Stresses and Strengths of Physicians- in-Training.”

Deadly Medicine: Creating the Master Race

In 2012, in conjunction with Taubman Health Sciences Library and the UM Center for the History of Medicine,  CBSSM co-sponsored the  United States Holocaust Memorial Museum’s traveling exhibition, “Deadly Medicine: Creating the Master Race.” The exhibition illustrates how Nazi leadership enlisted people in professions traditionally charged with healing and the public good, to legitimize persecution, murder and, ultimately, genocide.

MICHR Research Education Symposium

In 2013, CBSSM co-sponsored the Michigan Institute for Clinical & Health Research (MICHR) Research Education Symposium, "Life at the Interface of Genomics and Clinical Care." The symposium included a series of talks on topics with implications for translational and clinical research. The keynote speaker was Dr. Ellen Wright Clayton, JD, MD, Rosalind E. Franklin Professor of Genetics and Health Policy; Craig-Weaver Professor of Pediatrics; Professor of Law; and Director, Center for Biomedical Ethics and Society, at Vanderbilt University. Dr. Wright Clayton’s topic was “Addressing Biomedical Ethics.” 

 

Bioethics Grand Rounds: “Examining the Ethics of Victors Care”

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

Michigan Medicine has launched Victors Care, a concierge medical care model designed to deliver increased access, convenience and individually-tailored support within a primary care practice for patients who pay for membership. Like all concierge care programs, Victors Care raises ethical issues relating to justice, fairness, access, and consistency with the mission of Michigan Medicine. This Bioethics Grand Rounds will address the ethical issues of concierge care in a panel format with institutional leaders. The panel will address your questions directly. Questions will be solicited during the session, and can be submitted in advance via: https://umichumhs.qualtrics.com/jfe/form/SV_b4nJWM70ahHQtjD.

Panelists
Marschall S. Runge, M.D., Ph.D., EVPMA and Dean
Reshma Jagsi, M.D., D.Phil, Director, Center for Bioethics and Social Sciences in Medicine
David J. Brown, M.D., Associate Vice President and Associate Dean for Health Equity and Inclusion

Facilitators
Andrew Shuman, M.D., F.A.C.S & Christian J. Vercler, M.D, M.A, F.A.C.S – Service Chiefs, Clinical Ethics Service, Center for Bioethics and Social Sciences in Medicine

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