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Woll Family Speaker Series: Debate on Conscience Protection

Fri, March 09, 2018, 12:00pm to 1:00pm
Location: 
Med Sci II, West Lecture Hall

The Woll Family Speaker Series on Health, Spirituality and Religion

We are excited to be hosting a debate on Conscience Protection on Friday March 9th from 12-1 as part of the UMMS Program on Health, Spirituality and Religion. Please save the date! CME Credit provided (see below).

Point: Healthcare professionals are "obligated to provide, perform, and refer patients for interventions according to the standards of the profession.” NEJM, 2017

Counterpoint: Healthcare professionals have the right to opt out of performing or referring for procedures they view as objectionable in accord with their religious or personal values.

Join Dr. Naomi Laventhal and Dr. Ashley Fernandes in this academic discussion as part of the University of Michigan Program on Health, Spirituality and Religion.

Reshma Jagsi, M.D., D.Phil. and Andrew Barnosky, D.O., M.P.H. were recognized by Michigan Medicine faculty for two distinct awards. Jagsi received the American Medical Women's Association Gender Equity Award for promoting equality in the education and training of physicians by assuring equal opportunities for women and men to study and practice medicine. Barnosky received the Gold Foundation's Leonard Tow Humanism in Medicine Award for excellence and outstanding compassion in the delivery of care and respect for patients, their families, and healthcare colleagues. Their awards were presented by Raj Mangrulkar, M.D., Marguerite S. Roll Professor of Medical Education, and Carol Bradford, M.D., M.S., executive vice dean for Academic Affairs at the Medical School, both pictured below.

 

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

Emily Sippola, BA

Research Associate

Emily joined CBSSM as a Research Associate in 2018 after a circuitous journey in social science research from academia to industry and back. She has worked with mental health research at the Institute for Social Research, medical education and health disparities at UM Medical School’s Global REACH, and spent more than a decade supporting pharmaceutical quantitative and qualitative survey research. Emily works with Dr.

Last Name: 
Sippola
Tue, April 10, 2018

In light of the #MeToo campaign denouncing sexual assault and harassment, Reshma Jagsi, MD, DPhil has written a perspective piece in the New England Journal of Medicine about sexual harrassment in academic medicine. This perspective piece and a recent survey published in JAMA related to sexual harassment and gender bias in academic medicine has been highlighted in multiple media outlets.

Bioethics Grand Rounds "Clinical Innovations Near the Boundary of Viability- The Artificial Placenta"

Wed, September 26, 2018, 12:00pm
Location: 
Univerisity Hospital Ford Auditorium

Ryan Antiel, MD, MSME, Department of General Surgery, Biomedical Ethics Program, Mayo Clinic

Extreme prematurity is the leading cause of infant death and morbidity.  The urgent need for a better way to support the extremely premature infant led to the development of an extrauterine system to better bridge the transition from fetal to postnatal life.  The goal of this “artificial womb” is to maintain prenatal physiology in the extremely premature neonate to support normal development and reduce the complications associated with prematurity.  In this presentation, we will discuss the development and applications of the artificial womb, as well as the limitations of this technology.  We will focus on three current ethical challenges: ectogenesis, the boundary of viability, and the difference between physiological and clinical success.  
 

Tue, June 19, 2018

In a study led by Susan Goold, published in the Journal of General Internal Medicine, researchers surveyed 2104 Michigan primary care providers who provide care for patients insured by the Healthy Michigan Plan. According to surveyed providers, extending medical insurance to low-income Michigan residents meant better access to health care, earlier detection of serious illnesses, better care for existing health problems and improved ability to work, attend school and live independently.

Research Topics: 

Bioethics Grand Rounds -Alexander Langerman, MD

Wed, December 19, 2018, 12:00pm
Add to Calendar
Location: 
Univerisity Hospital Ford Auditorium

"Transparency in Surgery"

 

The operating room shifted over the last century from a historically open "theatre" to a sequestered space, and the proceedings of surgery became a mystery to those outside the surgical profession. The more recent and increasing societal interest in transparency suggests  professions such as surgery must develop new strategies to engender trust and inform the public and patients about what happens behind closed doors. Simultaneously, video and sensor technology has evolved to enable ubiquitous recording and analysis of surgical activities, creating a new source of data and the potential to reinstate a virtual surgical theatre. Such openness of a previously hidden space has implications for patients and surgical teams. This presentation will discuss the important ethical, technological, and regulatory considerations and challenges of a transition to greater transparency in surgery.

 

 

The Privileged Choices (Jan-08)

What's the difference between opting in and opting out of an activity? Who decides if people will be put automatically into one category or another? Click this interactive decision to learn how default options work.

Scenario 1

Imagine that you're a US Senator and that you serve on the Senate's Committee on Health, Education, Labor, and Pensions. The Infectious Diseases Society of America has come before your committee because they believe that too many health care workers are getting sick with influenza ("flu") each year and infecting others. As a result, your Senate committee is now considering a new bill that would require that all health care workers get annual influenza vaccinations ("flu shots") unless the worker specifically refuses this vaccination in writing.

Do you think you would support this bill for mandatory flu shots for health care workers?

  • Yes
  • No

Scenario 2

Imagine that you're the human resources director at a mid-sized company that's initiating an employee retirement plan. Management is concerned that many employees are not saving enough for retirement. They're considering a policy that would automatically deduct retirement contributions from all employees' wages unless the employee fills out and submits a form requesting exemption from the automatic deductions.

Do you think a policy of automatic retirement deductions is reasonable for your company to follow?

  • Yes 
  • No

Scenario 3

Organ transplants save many lives each year, but there are always too many deserving patients and too few organs available. To try to improve the number of organs available for donation, the state legislature in your state is considering a new policy that all people who die under certain well-defined circumstances will have their organs donated to others. The system would start in three years, after an information campaign. People who do not want to have their organs donated would be given the opportunity to sign a refusal of organ donation when they renewed their drivers' licenses or state ID cards, which expire every three years. Citizens without either of these cards could also sign the refusal at any drivers' license office in the state. This is a policy similar to ones already in place in some European countries.

Does this seem like an appropriate policy to you?

  • Yes 
  • No

How do your answers compare?

For many decisions in life, people encounter default options-that is, events or conditions that will be set in place if they don't actively choose an alternative. Some default options have clear benefits and are relatively straightforward to implement, such as having drug prescriptions default to "generic" unless the physician checks the "brand necessary" box. Others are more controversial, such as the automatic organ donation issue that you made a decision about.

Default options can strongly influence human behavior. For example, employees are much more likely to participate in a retirement plan if they're automatically enrolled (and must ask to be removed, or opt out) than if they must actively opt in to the plan. Researchers have found a number of reasons for this influence of default options, including people's aversion to change.

But default options can seem coercive also. So, an Institute of Medicine committee recently recommended against making organ donation automatic in the US. One reason was the committee's concern that Americans might not fully understand that they could opt out of donation or exactly how they could do so.

The policy scenarios presented to you here have been excerpted from a 2007 article in the New England Journal of Medicine titled "Harnessing the Power of Default Options to Improve Health Care," by Scott D. Halpern, MD, PhD, Peter A. Ubel, MD, and David A. Asch, MD, MBA. Dr. Ubel is the Director of the Center for Behavioral and Decision Sciences in Medicine.

This article provides guidance for policy-makers in setting default options, specifically in health care. Generally, default options in health care are intended to promote the use of interventions that improve care, reduce the use of interventions that put patients at risk, or serve broader societal agendas, such as cost containment.

In this NEJM article, the researchers argue that default options are often unavoidable-otherwise, how would an emergency-room physician decide on care for an uninsured patient? Many default options already exist but are hidden. Without either returning to an era of paternalism in medicine or adopting a laissez-faire approach, the authors present ways to use default options wisely but actively, based on clear findings in the medical literature.

Some examples of default policies that may improve health care quality:

  • routine HIV testing of all patients unless they opt out.
  • removal of urinary catheters in hospital patients after 72 hours unless a nurse or doctor documents why the catheter should be retained.
  • routine ventilation of all newly intubated patients with lung-protective settings unless or until other settings are ordered.

Drs. Halpern, Ubel, and Asch conclude, "Enacting policy changes by manipulating default options carries no more risk than ignoring such options that were previously set passively, and it offers far greater opportunities for benefit."

Read the article:

Harnessing the power of default options to improve health care.
Halpern SD, Ubel PA, Asch DA. New England Journal of Medicine 2007;357:1340-1344.

The Google of Healthcare: Kayte Spector-Bagdady

Wed, March 14, 2018, 2:00pm to 3:30pm
Location: 
Hatcher Graduate Library Gallery (913 S. University Avenue)

The Google of Healthcare: Making Big Data Work for—As Opposed to Against—Our Patients’ Best Interest
Pesenter:  Kayte Spector-Bagdady

Our data are collected at every turn: where we drive, who we email, what we google, what we buy. Perhaps a last bastion of expected privacy protections surrounds our health data—but while some systems (like healthcare providers) have stringent governance, others (like wellness apps) do not. Ready access and linkage of medical information can help us provide better care to our patients, but it can also serve to harm, alienate, and erode trust. This talk will explore how health data are currently being collected and by who, as well as ways we can both serve and protect our patients in the future.

Kayte Spector-Bagdady, JD, MBE, is an Assistant Professor in the Department of Obstetrics and Gynecology at the University of Michigan Medical School and the Service Chief of the Research Ethics Service in the Center for Bioethics and Social Sciences in Medicine (CBSSM). She is a former drug and device attorney and Associate Director of President Obama’s Presidential Commission for the study of Bioethical Issues.

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