Dr. Andrew R. Barnosky is an Associate Professor in the Department of Emergency Medicine and the former Chair of the Adult Ethics Committee for the University of Michigan Hospitals and Health Centers. In the College of Literature, Sciences, and the Arts, he is the director of the Health Sciences Scholars Program for undergraduate students. He is a graduate of the A. T. Still University of Health Sciences - College of Osteopathic Medicine (Missouri), and holds a master's degree (MPH) in public health and health policy from the Harvard School of Public Health.
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This month's grand rounds features: Michael Jibson, MD, Psychiatry Department speaking about "Psychiatry, Law, and Society: Ethical and Legal Issues in Mental Health"
Please join us for a lively discussion of medical ethics. The Bioethics Grand Rounds is co-sponsored by the Center for Bioethics and Social Sciences in Medicine, the UMHS Adult and Pediatric Medical Ethics Committee, and the Program of Society and Medicine. This educational session is open to all faculty and staff and members of the public. CME credit is available.
To meet ACCME requirements for Faculty Planner disclosure and Presenter Disclosure to participants of CME activities at UM, please be advised that the following faculty planner(s)/co-planner(s) and presenter have no personal financial relationships relevant to the activity listed below:
- Andrew Shuman, MD
- Christian Vercler, MD
Meredith Walton presents "Opting In or Opting Out: The Ethical Principles Underlying Two Methods of Organ Donation."
Abstract: Recent legislation in France adopting an opt-out system of organ donation has again brought the issue of presumed consent in organ donation to the forefront of ethical discussion. Proponents of the legislation have used the idea of ‘normative consent’ to justify it, as well as the expected increase in donation rates. But those opposed have argued that it strips the individual of their autonomy and does not in fact increase donation rates.This presentation seeks to define opt-in and opt-out systems of organ donation, explore principles of autonomy and consent surrounding the issue and reflect on whether adopting an opt-out system will truly increase the rate of organ donation
Devan Stahl, Assistant Professor, Center for Ethics and Humanities in the Life Sciences, Department of Pediatrics and Human Development Adjunct Assistant Professor, Department of Philosophy
Title – Responding to Hopes for a Miracle
Abstract: How should clinicians respond to patient’s or family’s hope for a “miracle”? What if the family wants to continue aggressive care that clinicians believe is non-beneficial in the hopes that a miracle will occur? The presentation will frame the discussion of miracle language and offer practical guidance on working with patients and families who invoke miracle language during a patient’s hospital stay.
At the end of this presentation participants will be able to:
1. Classify and distinguish between the most common ways patients/families use miracle language
2. Describe the ethical tensions that emerge when families request that clinicians continue non-beneficial care in the hopes a miracle will occur
3. Identify a set of strategies for productively engaging with patients/families who expect miracles
Autumn Fiester, PhD, Division of Medical Ethics, Department of Medical Ethics & Health Policy, Perelman School of Medicine University of Pennsylvania
Title – The “Difficult” Patient Reconceived: Learning the Skills of Mediators in Managing Challenging Clinical Encounters.
Abstract: Between 15%-60% of patients are considered “difficult” by their treating physicians. Patient psychiatric pathology is the conventional explanation for why patients are deemed “difficult.” But the prevalence of the problem suggests the possibility of a less pathological cause. I argue that the phenomenon can be better explained as responses sourced in conflicts related to healthcare delivery and that the solution to the “difficult patient” is to teach better conflict management skills to clinical providers.
1. Apply the mediator's concepts of "positions" and "interests" to patient-provider conflicts
2. Identity the moral emotions and explain their significance in managing the "difficult" patient
3. Learn seven maxims for diffusing conflict in clinical encounters
Available via live stream at: https://connect.umms.med.umich.edu/bioethics_3_22_17
Professionalism, Ethical Obligations, and the Moral Imperative of Self-Care
Healthcare providers are inevitably called to participate in and bear witness to emotionally challenging cases. Combined with time constraints, competing responsibilities, the urgent nature of these cases, healthcare providers risk burnout. The consequences of burnout have been shown to be increased staff turnover, substandard patient outcomes and increased likelihood for errors. As part of competent clinical practice, healthcare providers must not only attend to the needs of the patient and family but also themselves. However, a tension exists between making enough time for patients and taking enough time for oneself. But, engaging in self-care activities can help address clinician distress; this practice is essential for remaining compassionate, providing competent patient care services, and avoiding harm. Healthcare providers, therefore, have an ethical duty to engage in personal self-care. This presentation makes a case for why self-care is a key component of competent clinical practice. Several ways in which a lack of self-care can undermine professional competence, thus risking burnout and poor patient outcomes, are discussed. Strategies for recognizing and addressing burnout are also reviewed.
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.
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
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
The University of Michigan School of Public Health has received federal funding to launch an integrated, interdisciplinary fellowship program that will provide training in the ethical, legal, and social implications (ELSI) of genomic science.
Led by Scott Roberts, professor of health behavior and health education at Michigan Public Health, the ELSI Research Training Program is funded by a T32 training grant from the National Institutes of Health’s National Human Genome Research Institute and will launch in fall 2018. Raymond De Vries, Wendy Uhlmann, Brian Zikmund-Fisher, Jodyn Platt, Kayte Spector-Bagdady are among the faculty who will serve as faculty mentors.
More information can be found here.