Ethics Grand Rounds

Permanent URI for this collectionhttps://hdl.handle.net/2152.5/1292

This collection contains Grand Rounds material (videos, presentation slides, or handouts) submitted to the Library from the Ethics Program. This collection also contains material from the annual Daniel W. Foster, M.D., Visiting Lectureship in Medical Ethics.

The annual Daniel W. Foster, M.D., Visiting Lectureship in Medical Ethics brings distinguished scholars in medical ethics to the UT Southwestern Medical Center campus to present and discuss the challenging moral issues in biomedicine. Established in 2007 in honor of UT Southwestern’s Daniel W. Foster, the Lectureship also offers opportunities for faculty, staff, and trainees to discuss medical ethics in an intimate setting.

All lectures are held on the second Tuesday of every month in the academic year (September – May) from 12 noon to 1 p.m. For more information, contact Ruth Vinciguerra.

Unless otherwise noted, videos and presentation slides are publicly-accessible.

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Information about the most recent Daniel W. Foster, M.D., Visiting Lectureship in Medical Ethics is now available.

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Addressing privacy challenges in healthcare through the lens of contextual integrity
(2023-02-14) Nissenbaum, Helen
[Note: The slide presentation is not available from this event.] In healthcare, as in other social spheres, digital technology has posed dire challenges to entrenched approaches to privacy. Yet, as a fundamental cornerstone of ethical healthcare, privacy cannot be allowed to erode. The theory of contextual integrity (CI), which defines privacy as appropriate flow of personal information answers the need for a meaningful concept of privacy that, simultaneously explains its value to individuals and to societies. CI requires that we bend away from one-dimensional ideas, which for decades have gripped the privacy domain, namely, control over information about ourselves, stoppage of flow, or fetishization of specific, "sensitive" attributes (e.g., identity, health). This lecture will review key ideas behind CI, contrast it with alternative accounts, and apply these ideas to the domain of intensive health care and health research domains, distinctive not only for their societal importance but for their ages-long attentiveness to privacy.
Alternatives to whistleblowing, or how to intervene effectively and still have a career and life afterwards
(2013-09-10) Sieber, Joan E.
We have learned that scientific misbehavior (that is, any scientific conduct that causes the scientific record to be inaccurate, not just plagiarism, falsification and fabrication), is very widespread and that persons who report such misbehavior on the part of their colleagues are likely to suffer serious consequences. In-depth interviews of 135 NIH Principal Investigators who have witnessed research wrongdoing illustrates the ineffectiveness of direct confrontation or reporting of wrong-doers, but illustrates effective ways to stop them in their tracks. Although persons who engage research wrong-doing may not have in mind to reform, they are concerned to save face and can often be shamed into behaving properly. Wise and responsible mentoring that involves providing evocative stories about how to effectively shame miscreants is likely to be more effective than reciting rules of proper research conduct. Examples are provided.
The antibiotic era: historical and ethical reflections on seven decades of reform efforts
(2017-11-14) Podolosky, Scott H.
Today, as we increasingly turn our attention to antibiotic resistance and the possibility of a post-antibiotic era, it is important to consider the historical evolution of attempts to implement the "rational" use of antibiotics. Throughout such history, important ethical considerations-from debates in the 1950s over conflict of interest and the role of industry in the "education" of clinicians, through contemporary concerns over our obligations to present versus future patients-have continually simmered under the surface of such broader medical and regulatory concerns. In this talk, Scott Podolsky examines seven decades of reformers who have attempted to change how antibiotics are developed, marketed and prescribed. Tensions between antibiotic development and conservation, and between education and regulation, continue to play out today in medical offices, hospitals, industry, agricultural enterprises, and the halls of government alike.
An argument for a liberal public health: reflections on a discipline in flux after COVID-19 (The Daniel W. Foster, M.D., Visiting Lectureship in Medical Ethics)
(2022-10-11) Galea, Sandro
Health has been in the spotlight in an unprecedented fashion during the COVID-19 pandemic. While there is no question that much that was done during the pandemic saved lives, it is also the case that the pandemic should be cause for reflection about what we did not do as well as we should have. How should we rethink what we do and how we do it in health in the aftermath of COVID-19? What are the key takeaways from the pandemic that can make for better efforts towards the health of populations?
Avoiding harm and improving care near the end of life: what good can ethics do? (The Daniel W. Foster, M.D., Visiting Lectureship in Medical Ethics)
(2013-11-12) Berlinger, Nancy
Patient care situations in which there is uncertainty about how to relieve suffering, make medical decisions on behalf of others, work with families in conflict, resolve disagreements among team members, or respond to institutional priorities and pressures are frequently described as ethically challenging situations. Why do these situations present themselves so often in care near the end of life? How can "ethics," including clinician education, ethics consultation services, and institutional policy development, help professionals and organizations involved in the care of seriously ill patients to anticipate these challenges, avoid harms, and prevent care problems? As our nation's health care system changes, what steps should we take to improve care near the end of life? The publication of a new edition of the landmark Hastings Center Guidelines offers an opportunity to explore these questions.
Being trustworthy in today's medical world
(2014-09-09) Potter, Nancy Nyquist
Is there still a place for trust in today's health care practices? Is it even possible to make time for trusting relations? The short answer is, yes -- depending on how we think about issues of trust. The framework for arguing that trust is still an inviolable quality in health care is that of trust and trustworthiness as virtues. Despite time pressures and the dominance of technologies, being trustworthy is part of professional ethical practices. We will talk about what trust is, when and why there are reasons to care about being trustworthy, and consider what should be done when trust goes wrong. Cases for discussion will be presented.
Bioethics and COVID-19: lessons for a post-pandemic future
(2024-03-12) Brendel, Rebecca Weintraub
[Note: The slide presentation is not available from this event.] The COVID-19 pandemic presented a critical need for bioethics engagement as the U.S. (and the world) faced the stark reality that the demand for critical care resources would exceed supply. This session begins by reviewing general approaches to bioethical challenges through an overview of major philosophical approaches with attention to Beauchamp and Childress' (Four) Principles of Biomedical Ethics. Using the COVID-19 pandemic as a paradigm, it will explore the successes and lessons learned from the work of bioethics in the pandemic context. The experience of COVID-19 and the disparities laid bare will serve as an introduction to a variety of lenses, strategies, and opportunities through which bioethics can strive to chart a path forward to achieve health care justice in its broadest forms. The presentation concludes with practical guidance regarding both identifying ethical challenges and approaches in health care generally and candidate opportunities for progress in the future.
Biomedical ethics considerations stemming from limb loss/difference care and prosthetic enablement
(2018-04-10) Bastas, Gerasimos
This talk explores the biomedical ethics considerations that currently surround limb loss and prosthetic functional enablement. The biomedical ethics consult is re-examined operationally, bringing into focus how aspects of intentionality and current limits of knowledge distill imperatives for overall professional conduct. We will examine i) how to deal with the patient who is requesting the amputation of a healthy limb, ii) how and when an amputation may be proffered as medically advisable, and iii) contextualize emerging amputation procedures and prosthetic technologies.
Biomedical technologies and human dignity
(2016-03-08) Melo-Martín, Inmaculada de
Current biomedical advancements are presenting us with difficult moral and policy decisions. Indeed, from questions about the morality of cloning human embryos, to concerns about human genetic modifications, to worries about chimera research, biomedical science and technology is inextricably tied to moral responsibilities and public policy concerns. Scholars and institutions struggle to evaluate these technologies in ways that attend to both the moral difficulties they raise and the promises they offer. Despite criticism that the concept of human dignity is vague, several national and international bodies and a number of scholars have argued that human dignity is a useful criterion to determine the permissibility of particular biomedical technologies. Here, I explore the meanings of this concept, examine the ways in which biomedical technologies can be said to threaten human dignity, and evaluate whether and under which conditions this concept can serve as a meaningful criterion for public policy.
The challenge of precision medicine: ethical, legal & clinical issues in genomic medicine (The Daniel W. Foster, M.D., Visiting Lectureship in Medical Ethics)
(2015-11-03) Wolf, Susan M.
Genomics is advancing at a tremendous rate, bringing powerful new capabilities but also big challenges to clinical practice and research. With the federal government launching the Precision Medicine Initiative, the time to face those challenges is now. Genomic medicine raises fundamental issues including the role of patient choice, the development of quality standards, the privacy of sequence data, return of results and incidental findings, protection of patient privacy, and responsibilities to share information with the family. This lecture will analyze those challenges and suggest a way forward in biomedical research as well as clinical care.
Conceptual controversies in death determination
(2017-04-11) Bernat, James L.
There is an intractable disagreement over whether the organ donor after the circulatory determination of death (DCDD) is dead at the time death is ordinarily declared. A rigorous analysis of death determination illuminates the cause of the controversy. Death determination can be conceptualized in two distinct ways: the biological approach in which cessation of vital functions must be irreversible and the medical approach in which cessation of vital functions must be permanent. The two noncongruent standards lead to determining death at different times and explain the current controversy over death determination in the DCDD donor. By the biological standard, the organ donor is not dead but by the medical standard, the organ donor is dead.
Conflicts of interest in clinical research: lessons from the Minnesota Markingson case
(2015-09-08) Brown, E. Sherwood; Reisch, Joan S.; Sadler, John Z.; Wright, J. Gregory
The nationally-publicized Markingson case from the University of Minnesota involved a tragic suicide in the context of a university-based, industry-sponsored clinical trial. A panel of UT Southwestern faculty and staff consider the lessons emerging from the Markingson case, identify areas of risk and opportunities for prevention, and map the multiple layers of policy and practice that could prevent such events in the future.
Corruption in clinical research: what is it? -- and why it matters
(2019-12-10) Sadler, John Z.
Despite the seriousness of charging corruption in clinical research, the literature offers little about what corruption means in this setting. This lecture presents a technical/formal definition of 'corruption' in clinical research. I then present examples from the literature which illustrate clear-cut corruption, maybe cases, and non-corrupt deviations from good clinical research practices. I discuss clinical implications about evaluating clinical research quality as well as what corruption means for our evidence base of practice.
CRISPR and gene editing: one tool to rule them all
(2017-05-09) Wolinetz, Carrie D.
Advances in gene editing, particularly the development of CRISPR-cas9, have allowed for new applications of this technology, ranging from gene drives to development of new animal models for research. This emerging biotechnology is pushing the boundaries of science, even as it provides new and evolving challenges to our policy framework and oversight mechanisms. How do we ensure responsible and feasible oversight while not constraining scientific progress that expands our knowledge base and improves human health? What are the intersection points between new gene editing applications and the current policy landscape?
Deep brain stimulation enhances control and restores valued personality characteristics
(2022-11-08) Kubu, Cynthia S.
Questions related to what constitutes personality, and how those conceptualizations interface with notions of self, identity, and autonomy, have fascinated psychologists, philosophers, and ethicists for hundreds of years. Since 2008, several studies have asserted that deep brain stimulation (DBS) results in patients’ loss of control, particularly related to undesired personality changes. Inherent in this argument is the thesis that DBS negatively impacts patients’ identity, autonomy, and personality. Our lab has relied on empirical methods to examine questions related to control in patients who undergo DBS to treat motor symptoms. Our data refute the claims that DBS results in a loss of control. We rely on the American philosophical tradition of pragmatism to conduct our work, particularly the emphasis on different ways of knowing, including the perspectives of various disciplines as well as different stakeholders in understanding, studying, and ultimately implementing practices based on good data.
Defining professionalism in the digital age: barriers and opportunities
(2014-05-13) Farnan, Jeanne
The overwhelming popularity of Web 2.0 technologies, such as social networking sites, media sharing sites and blogging, has significantly changed the manner in which trainees interact with educators, colleagues, and the lay public. Individual and institutional representation, the absence of existing policies and the perception of the lay public are some of the salient issues that arise when considering the "digital images" displayed by trainees and faculty alike. Little guidance exists for medical educators on preventing misuse of digital media and ensuring standards for professional conduct. Similarly, the positive potential of these media, within medical education, are only beginning to be realized. While many of these issues are also faced by colleagues in other areas of higher education, medical educators and their institutions are faced with the additional challenge of ensuring that graduates exemplify the ideals of medical professionalism. This lecture will address educators' understanding of the currently available technology, the threats that they pose to trainee professionalism and strategies to protect the trainees' and the program or institutions' digital image.
The "difficult patient" reconceived: an expanded moral mandate for clinical ethics
(2020-10-13) Fiester, Autumn M.
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 to problematic interactions related to healthcare delivery. If there are grounds to reconceive the "difficult" patient as reacting to the perception of ill treatment, then there is an ethical obligation to address this perception of harm. Resolution of such conflicts currently lies with the provider and patient. But the ethical stakes place these conflicts into the province of the ethics consult service. As the resource for addressing ethical dilemmas, there is a moral mandate to offer assistance in the resolution of these ethically charged conflicts that is no less pressing than the more familiar terrain of clinical ethics consultation.
Dignity in later life (The Daniel W. Foster, M.D., Visiting Lectureship in Medical Ethics)
(2023-12-12) Jecker, Nancy S.
Some argue dignity is a useless concept that bioethics can do without. Against this view, I show dignity is a central concern for bioethics, particularly for older people. Dignity's importance during later life is part of a broader view I call the life stage relativity of values. It holds that different values emerge as central at different periods of our lives. During early life, caring, trust, and nurturing figure prominently due to vulnerabilities that characterize infancy and childhood. By adulthood, greater physical and emotional independence leads to autonomy and self-reliance taking center stage. During later life, heightened risk for chronic disease and disability makes keeping dignity intact a critical concern. Across the lifespan, the highest value for an individual relates to their life stage circumstances. Ignoring this can lead to life stage bias, especially midlife bias, which occurs when we apply values central during midlife to all life stages.
The disclosure dilemma: when adverse events affect multiple patients
(2015-01-13) Dudzinski, Denise M.
Imagine that endoscopes had not been properly processed for a period of several months. Once discovered, the problem is immediately corrected, but patients scoped during those months are more likely to even though the majority are unlikely to have been harmed? This presentation will explore the ethical and practical dimensions of this question by examining several cases.
Disorders of consciousness and neuroethics: why rights must come to mind (The Daniel W. Foster, M.D., Visiting Lectureship in Medical Ethics)
(2016-09-13) Fins, Joseph J.
[Note: The slide presentation and video are not available from this event.] Over the past two decades neuroimaging has revealed the possibility of covert consciousness in patients once thought vegetative. This knowledge coupled with the ability of drugs, devices and neuroprosthetics to restore functional communication in patients with disorders of consciousness has the potential to reintegrate patients into the nexus of family and community. A worthy scientific pursuit, I will argue that this effort is a moral imperative which links respect for persons with the reemergence of voice out of covert consciousness. As I describe in my recently published book, "Rights Come to Mind: Brain Injury, Ethics and the Struggle for Consciousness" (Cambridge University Press, 2015), this is a human rights issue for a population too long marginalized. For rights to come to mind, patients will need greater access to medical care and research, the skilled engagement of the clinical community, and fuller protections under of the law.

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