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Fri, March 12, 2010

Peter Ubel, MD, spoke recently at the DeVos Medical Ethics Colloquy at Grand Valley State University in Grand Rapids, Michigan. Dr. Ubel's presentation, "Rationing vs. Rationalizing Health Care," was covered by news outlets in western Michigan. To see a clip from television reports, go to http://www.peterubel.com.

Tue, October 31, 2017

In a recent US Department of Health and Human Services symposium, Kayte Spector-Bagdady discussed the need for consistent informed consent and disclosure regulations for biospecimens and health data.

Sat, March 03, 2018

Reshma Jagsi's work was recently highlighted in Emergency Medicine News: "Special Report: Sexual Harassment a Muddle of Fear, Guilt, and Shame."

Research Topics: 
Fri, March 30, 2018

CBSSM Director, Reshma Jagsi, was one of six innovative women highlighted in Michigan Medicine Headline News for playing a vital role in patient care, education and research.

Ladies and Gentlemen of the Jury (Jun-09)

How should the US judicial system determine compensation for "pain and suffering"  Take a look at a complicated case. 

Ladies and Gentlemen of the Jury

Let's suppose that you're a member of a jury for a court case involving an industrial accident. A 29-year-old employee, Charlie, has suffered brain damage in this accident.

Charlie was once a skilled worker who operated complex machinery. Since the accident, he has functioned cognitively at the level of a three-year-old child, and there is no chance for improvement of his state. Charlie has no visible scars on his body and is not experiencing physical pain from the accident.
 
Furthermore, as a result of the brain damage, Charlie is emotionally happier than he was before the injury. Several witnesses have testified that Charlie was somewhat volatile before the accident—he got angry easily and had bouts of sadness. The witnesses noted that since the accident Charlie is always happy, despite his cognitive impairment.
 
You are now in the jury room. You and your fellow jury members have decided that the factory where Charlie worked had inadequate safety precautions. The jury will return a verdict for the plaintiff, Charlie. The jury has already agreed on a sum to compensate Charlie for his medical expenses, his ongoing medical care, and lost wages for the rest of his life.
 
Charlie's attorney has asked for an additional monetary award for pain and suffering. Which statement below most closely describes your thoughts, as a juror trying to decide on an award for pain and suffering?
 
  • Charlie should get a very large award for pain and suffering, since his life overall has been so adversely affected by the accident.
  • Charlie should get a moderate award for pain and suffering, since he has suffered cognitive impairment, but he does not have ongoing physical pain.
  • Charlie should get a very small award for pain and suffering, since he is actually happier now than he was before the accident.
  • I don't think that the US judicial system should allow awards for pain and suffering at all.
  • I'm not sure what pain and suffering means in a legal sense, and I don't know what to award to Charlie.

How do your answers compare?

In a recent article, CBDSM's Peter A. Ubel and Carnegie Mellon University's George Loewenstein challenge the conventional view that awards for pain and suffering should be made literally as compensation for feelings of pain and of suffering. Ubel and Loewenstein argue from their expertise in the psychology of judgment, decision making, adaptation, and valuation of health states.

They cite many studies showing that people adapt well to very serious disabilities, such as paraplegia and blindness, returning fairly quickly to near-normal levels of happiness after a period of adjustment. Thus, if juries make pain-and-suffering awards literally on the basis of misery, such awards would be unacceptably small.

But Ubel and Loewenstein delve further. Even though people with serious disabilities have normal levels of happiness, they would still prefer not to have the disabilities. "We believe that the reason for this discrepancy between hedonic measures and stated preferences . . . is that people care about many things that are not purely hedonic, such as meaning, capabilities, and range of feeling and experience."

In enlarging the definition of pain and suffering, Ubel and Loewenstein do not propose to merely add to the factors that a jury must take into consideration in the current judicial system. Indeed, the authors find several problems with the current system, including inequities in compensation and the evaluation of injuries in isolation. They include in their article a three-part proposal for a radical change in judicial procedure.

First, they would recruit a random panel of citizens to compile and categorize injuries. Groups of injuries would be ranked on the basis of the appropriate level of compensation for those injuries. This panel would call on experts to inform their decisions. "Decisions about an injury's proper category would take into account not only the emotional consequences of the injury but also the person's ability to function across important life domains—social functioning, work functioning, sexual functioning, sleep, and the like."

This list of grouped and ranked injuries would have some similarities to the list of health conditions that the State of Oregon created in the 1990s to help allocate Medicaid funds. Another existing model for this list would be lists used to make decisions about workers' compensation claims—for example, benefits for loss of a thumb are twice as great as benefits for loss of a second finger.

Second, Ubel and Loewenstein propose a mechanism for determining monetary damages. Using the list produced by the citizen group described above, federal or state legislators could determine a maximum award for pain and suffering. Based on this damage cap, a range of awards would be set for each category of injuries.

Third, the juries would enter in, using the guidelines set up in the steps described above and then tailoring awards to the individual circumstances of each case. Under this plan, juries would do what people tend to do best: compare and rank things. Ubel and Loewenstein note that "juries could help determine if the victim has extenuating circumstances that should drive the award to either the lower or upper end of acceptable compensation for that group of injuries. . . Our proposal does not do away with jury trials but instead enables juries to involve themselves in the kind of judgments they are best suited to make."

Ubel and Loewenstein conclude, "The determination of pain-and-suffering awards should be revised to take account of recent advances in understanding human judgment and decision making."

Read the article:

Ubel PA, Loewenstein G.Pain & suffering awards: It shouldn't be (just) about pain & suffering. Journal of Legal Studies 2008;37(2):S195-216.

Geoffrey Barnes, MD, MSc

Faculty

Geoff Barnes is a cardiologist and vascular medicine specialist at the University of Michigan Health System. He completed his undergraduate degree in biomedical engineering at Washington University in St. Louis (2003) followed by medical school at the University of Michigan (2007).  He then completed a residency (2010), chief residency (2011) in internal medicine, cardiology fellowship (2014) and vascular medicine fellowship (2014) at the University of Michigan.  His areas of research interest include anticoagulation, venous thromboembolism, quality improvement and shared decision making.

Research Interests: 
Last Name: 
Barnes

Wendy Uhlmann, MS, CGC

Faculty

Wendy R. Uhlmann, MS, CGC is the genetic counselor/clinic coordinator of the Medical Genetics Clinic at the University of Michigan. She is a Clinical Professor in the Departments of Internal Medicine and Human Genetics and an executive faculty member of the genetic counseling training program. Wendy Uhlmann is a Past President of the National Society of Genetic Counselors and previously served on the Board of Directors of the Genetic Alliance and as NSGC’s liaison to the National Advisory Council for Human Genome Research.

Last Name: 
Uhlmann

Funded by: NIH

Funding Years: 2016-2021

 

There is a fundamental gap in understanding how Mild Cognitive Impairment (MCI) influences treatment and Decision Making for serious illnesses, like Cardiovascular disease (CVD), in older patients. Poor understanding of Clinical Decision Making is a critical barrier to the design of interventions to improve the quality and outcomes of CVD care of in older patients with MCI. The long-term goal of this research is to develop, test, and disseminate interventions aimed to improve the quality and outcomes of CVD care and to reduce CVD-related disability in older Americans with MCI. The objective of this application is to determine the extent to which people with MCI are receiving sub-standard care for the two most common CVD events, Acute myocardial infarction (AMI) and acute ischemic stroke, increasing the chance of mortality and morbidity in a population with otherwise good quality of life, and to determine how MCI influences patient preferences and physician recommendations for treatment. AMI and acute ischemic stroke are excellent models of serious, acute illnesses with a wide range of effective therapies for acute management, Rehabilitation, and secondary prevention. Our central hypothesis is that older Adults with MCI are undertreated for CVD because patients and physicians overestimate their risk of dementia and underestimate their risk of CVD. This hypothesis has been formulated on the basis of preliminary data from the applicants' pilot research. The rationale for the proposed research is that understanding how patient preferences and physician recommendations contribute to underuse of CVD treatments in patients with MCI has the potential to translate into targeted interventions aimed to improve the quality and outcomes of care, resulting in new and innovative approaches to the treatment of CVD and other serious, acute illnesses in Adults with MCI. Guided by strong preliminary data, this hypothesis will be tested by pursuing two specific aims: 1) Compare AMI and stroke treatments between MCI patients and cognitively normal patients and explore differences in Clinical outcomes associated with treatment differences; and 2) Determine the influence of MCI on patient and surrogate preferences and physician recommendations for AMI and stroke treatment. Under the first aim, a health services research approach- shown to be feasible in the applicants' hands-will be used to quantify the extent and outcomes of treatment differences for AMI and acute ischemic stroke in older patients with MCI. Under the second aim, a multi-center, mixed-methods approach and a national physician survey, which also has been proven as feasible in the applicants' hands, will be used to determine the influence of MCI on patient preferences and physician recommendations for AMI and stroke treatment. This research proposal is innovative because it represents a new and substantially different way of addressing the important public health problem of enhancing the health of older Adults by determining the extent and causes of underuse of effective CVD treatments in those with MCI. The proposed research is significant because it is expected to vertically advance and expand understanding of how MCI influences treatment and Decision Making for AMI and ischemic stroke in older patients. Ultimately, such knowledge has the potential to inform the development of targeted interventions that will help to improve the quality and outcomes of CVD care and to reduce CVD-related disability in older Americans.

PI: Deborah Levine

CO(s): Darin Zahuranec, MD & Ken Langa, MD, PhD

At our October Bioethics Grand Rounds, we had the wonderful opportunity to do something a bit different. This BGR involved a musical program of songs and readings reflecting various perspectives on death and dying. Performers included Charlotte De Vries, Jeanne Mackey, Merilynne Rush and friends.

Research Topics: 

Lisa Szymecko recently presented, “Community Voices: Mental Health Research Needs by Consumers and Non-consumers of Mental Health Services” at WMU's Medical Humanities Conference.

Further conference details, including electronic copies of the program and abstracts of each presentation, as well as links to previous conference pages, can be found on the conference website: http://www.wmich.edu/medicalhumanities/conference2016/

 

 

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