Dr. Firn has a BS from Michigan State University, MSW from the University of Michigan, and PhD from Lancaster University (UK). Before CBSSM, Janice worked in oncology and palliative care at Michigan Medicine. In her role as Clinical Ethicist for the Clinical Ethics Service, Janice responds to ethics consultation requests, and participates in preventative ethics rounds and education and research initiatives. Her academic interests include bioethics; self-care, burnout, and resilience; palliative and end of life care; and interprofessional education and collaboration.
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Funded by the National Institutes of Health/Brigham and Women's Hospital/Boston University
Funding years: 2010-2013
The rapid identifcation of genetic risk factors for common, complex diseases poses great opportunities and challenges for public health. Genetic information is increasingly being utilized as part of commercial effors, including direct-to-consumer (DTC) genetic testing to provide risk information on common diseases to consumers. Very few empirical data have been gathered to understand the characteristics of DTC test consumers, the psychological, behavioral and health impact (clinical utility), and the ethical, legal and social issues associated with DTC services.
In the proposed research, we will survey users of the two leading US companies providing DTC genetic testing (23andMe and Navigenics) regarding their response to genetic test s for common diseases of interest, including heart disease, diabetes, Alzheimer's disease (AD), arthritis, and breast, colon, lung and prostate cancers. Each company now has thousands of customers and each anticipates extensive sales in coming years. Each has agreed to allow our group to survey consumers using third-party data collection and analysis procedures that will enable an independent consideration of the benefits and risks of DTC testing in this format. The companies have also agreed to provide genetic test information (with respondents' permission) for analyses. A total of 1000 consumers (500 from each company) website will be surveyed via the Internet at three time points: 1) before receipt of genetic test results; 2) approximately two weeks following receipt of test results; and 3) six months following receipt of results.
More information: http://www.psc.isr.umich.edu/research/project-detail/35031
PI: Scott Roberts
Co-I: Mick Couper
The Program in Clinical Ethics within the Center for Bioethics and Social Sciences in Medicine (CBSSM) represents an expansion of existing services designed to promote a culture of patient-centered excellence by developing a comprehensive set of ethics-related activities. The aims of this program are to: liaise with and provide support to the adult and pediatrics ethics committees; streamline clinical ethics consultation; assist with ethics-related policy development on a regular and proactive basis; organize and administer structured educational programs in clinical ethics; and coordinate empiric research with relevance to clinical ethics within CBSSM.
The Program in Clinical Ethics within CBSSM represents an expansion of existing services designed to promote a culture of patient-centered excellence by developing a comprehensive set of ethics-related activities. The aims of this program are to: liaise with and provide support to the adult and pediatrics ethics committees; streamline clinical ethics consultation; assist with ethics-related policy development on a regular and proactive basis; organize and administer structured educational programs in clinical ethics; and coordinate empiric research with relevance to clinical ethics within CBSSM.
The Program in Clinical Ethics is co-directed by the chairs of the adult and pediatric ethics committees and consultation services, Christian J. Vercler, MD, MA and Andrew G. Shuman, MD. A dedicated clinician ethicist manages the program on a daily basis. A cadre of eight faculty ethicists rotate on service throughout the year and work closely with the clinician ethicist. Trainees and students rotate as well. Dedicated administrative support will be organized through CBSSM.
Clinical Ethics Consultation Service
The Clinical Ethics Program offers adult and pediatric ethics consultation services across UMHS, and are available 24/7/365. More information about the adult and pediatric ethics committees and consultation services can be found on the Adult Ethics Committee and Pediatrics Ethics Committee web pages.
The concept of preventative ethics is critical in anticipating, navigating and mitigating potential conflicts and tensions before they become true ethical dilemmas or crises, and necessitate formal consults. This model facilitates awareness and proactive decision-making on the part of patients, families, trainees and staff, and creates a more visible presence for ethics in the health system. The Program in Clinical Ethics offers regular preventative ethics rounds in a variety of care settings across UMHS.
Medical ethics is an integral component of contemporary education for all clinicians. There is a vibrant program for longitudinal ethics education within the medical school, and a more intensive curriculum as part of its path of excellence program. The Program in Clinical Ethics provides a robust program for longitudinal education and awareness of clinical ethics for UMHS staff and trainees.
Christian J. Vercler, MD MA
Andrew G. Shuman, MD
[more to be named soon!]
Co-Directors of the Program in Clinical Ethics: Christian J. Vercler, MD, MA & Andrew G. Shuman, MD
Administrative contact: Valerie Kahn – email@example.com 734-615-5371
Kayte Spector-Bagdady, JD
CBSSM Postdoctoral Fellow
From the Guatemala STD Experiments to the NPRM for Revisions to the Common Rule: Why We Still Don’t Have Human Subjects Research Ethics Right
While much has been made of scandals, and academics zealously deliberate nuances, we still find ourselves revisiting the most basic of human subjects research ethics questions: What is a research subject? What is informed consent? This talk will address this ongoing debate but also the less often asked question of why—what are the structural pressures that bring us time and again to step one and is human subjects research ethics a zero sum game?
The new, enhanced UMHS Ethics committee was featured in the Office of Clinical Affairs "Chief Brief." According to the article, "ECCA members complimented the committee’s improved access to ethics consultation services, focus on proactive and preventative ethics education, and unification of adult and pediatric efforts. Since the programmatic rollout, there has been a 45 percent increase in clinical ethics consultation volume from the prior year, and an 82 percent increase from average of the prior five years." Dr. Andrew Shuman and Dr. Christian Vercler are the co-directors of CBSSM's Program in Clinical Ethics. Dr. Janice Firn is the clinical ethicist who manages the program on a daily basis.
Raymond G. De Vries, Ph.D., together with M. Nieuwenhuijze, gave a talk at the 7th International Conference on Clinical Ethics and Consultation in Amsterdam, Netherlands, in May 2011.
The 2012 Research Colloquium presentations by U-M faculty, fellows and students highlighted research on medical decision making. The colloquium presenters and their topics were as follows:
- Melissa Constantine, PhD: Making a baby in the 21st century: An updated user manual
- Vida Henderson, PharmD, MPH, MFA, and Deliana Ilarraza: Using community-based participatory research and user-centered design approaches in developing an interactive diabetes decision aid
- Naomi Laventhal, MD, MA, and Stephanie Kukora, MD: Resident attitudes toward ethical and medical decision-making for neonates born at the limit of viability
- Kathryn Moseley, MD, MPH: Distrust of pediatricians' sleep advice: Focus group results from the Project for African American Infant Safety
- Laura Scherer, PhD: What's in a name? The effect of a disease label on parents' decision to medicate a colicky infant
- Lauren Smith, MD: Cracking the code: Ethical issues involved in the decision to undergo genetic testing
- Ralph Stern, MD: The myth of individual risk
- Wendy Uhlmann, MS, CGC: The swinging gate: Genetic testing and ethical issues
Consider this scenario:
Alfred woke up at 4 am on Sunday morning with pain in his left foot. That place where his new running shoes had rubbed a raw spot earlier in the week was getting worse. By 9 am, the foot was red and swollen, with a large oozing sore, and Alfred decided to go to the Emergency Room at his local hospital.
Late on Sunday afternoon, Alfred returned home from the ER. He crutched his way into the house and collapsed on the sofa. His teenage son quizzed him.
How do your answers compare?
- Emergency care that was given
- Post-ER care needs
- Symptoms that would require a return to the ER
Michele Gornick, PhD
VA HSRD Fellow & CBSSM Research Investigator
Title: The public’s preferences for the return of secondary findings identified through genome sequencing: Information and deliberation make a difference
Summary: Genomic sequencing is becoming a part of clinical practice. Existing studies are limited and conclude that people would like unrestricted access to all of their genetic information. However, we do not know the extent to which respondents in these studies took into account the complex scientific and ethical issues that attend genome sequencing. In order to address this gap, we organized a deliberative democracy (DD) session to educate members of the public on genome sequencing, to engage them in dialogue about the benefits and risks of the clinical implementation of this technology, and to elicit their informed perspectives about policies governing the return of secondary findings.