Ethics Grand Rounds

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https://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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UT Southwestern Medical Center Ethics Grand Rounds - 2023/2024
(2023)
This document lists the schedule of Ethics Grand Rounds events for September 2023 through May 2024.
Ethics and VCA transplants: same issues or new challenges?
(2023-09-12) Kahn, Jeffrey P.
Vascular composite allografts (VCAs) are transplants of hands, face, penis, or uterus from deceased and sometimes (in the case of uterus) living donors. The ethics of solid organ donation and transplant have been discussed for decades, with policies and practices long established and ethics approaches widely discussed. VCAs have many characteristics that make them similar to solid organ transplants, but they also raise novel issues including risk-benefit balance for non-lifesaving therapies, decisions about deceased donation, evaluation of recipients, alternative therapies, and others. This talk will assess the similar and novel ethical issues and propose a framework for assessing the ethics of VCAs.
Substance use in pregnancy: impacts of state policies on maternal and child outcomes
(2023-05-09) Faherty, Laura J.
The opioid crisis has had a substantial effect on pregnant women, with the number of pregnant women with an opioid use disorder diagnosis at delivery quadrupling from 1999 to 2014, and the incidence of neonatal opioid withdrawal syndrome increasing nearly seven fold from 2000 to 2014. The speaker, a clinician-researcher with extensive experience for this population, will discuss (1) the evolution of state policies related to substance use in pregnancy over the past two decades, (2) her research on the effects of these policies on the mother-infant dyad, (3) the rapidly-growing evidence base on the harmful impacts of punitive policies towards substance use in pregnancy, and (4) future research directions and opportunities to improve care for maternal-infant dyads affected by opioid use in the perinatal period.
Structural competency: new frameworks to understand and respond to inequities in health
(2023-04-11) Holmes, Seth M.
Research on disparities in health and in medical care demonstrates that social, economic, and political inequities are key drivers of poor health outcomes. The influence of such inequities on health has long been noted by clinicians and public health practitioners, but such content has been incorporated unevenly into clinical training and clinical ethics. Recently proposed by clinicians, ethicists, and medical social scientists, the framework of "structural competency" offers a paradigm for training health professionals to recognize and respond to the impact of upstream, structural factors on patient health and health care. This lecture will cover key terms and primary domains of structural competency to allow medical practitioners, ethicists, and researchers to perceive and respond to social inequities in health in new ways.
Ethics in academia and the pharmaceutical industry
(2023-03-14) Ghaemi, Nassir
[Note: The slide presentation is not available from this event.] Many academics in medicine assume that they hold a higher ethical standard than the pharmaceutical industry. Some of this assumption has to do with the presumed not-for-profit nature of academia and the for-profit nature of the pharmaceutical industry. In this discussion, based on my personal experience in both settings, I will contrast and compare the ethical standards of the two groups. I will conclude that they are both ethically challenged with different drawbacks. In academia, the usual ethical problem is an excessive focus on power and prestige; in the pharmaceutical industry, as is well known, the ethical problem is the profit motive. Both are highly problematic, with different causes producing the same effects: the interests of the public are sacrificed for the desires of academics and the pharmaceutical industry. Different strengths also exist: Academic freedom of thought allows for free public expression of ideas, but, combined with tenure and the wish for inclusion in the status quo power structure, it leads to self-censorship and a conservatism of thinking. Academic life begins with freethinking and ends in group think. The pharmaceutical industry is much more open to new ideas because it is not attached to any idea; its main test is practical utility in the marketplace. Hence, it is, paradoxically, much more innovative than academia, but this innovation is only tied to commercial results. Many public health needs are ignored due to non-commercial potential.
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.
Exploring the untapped nexus of ethics and health facility design
(2023-01-10) Anderson, Diana C.; Hercules, William J.; Teti, Stowe Locke; Deemer, David A.
Architecture inherently reflects the normative preferences of its time. This certainly applies to healthcare architecture, where design concepts have intentional and decades-long effects on patients, families, and staff. Employing healthcare architecture to alter behaviors, mediate interpersonal interactions, and affect patient outcomes make it an ethical matter. We propose that advances in design science and our understanding of its powerful effects warrant a shift in how we think about space, and that the built environment in healthcare is analogous to a medical intervention. As such, all responsible stakeholders should openly discuss and thoroughly scrutinize the intentional use of the built environment to affect perceptions and change behaviors of patients, residents to a similar standard as conventional medical therapies. We highlight prominent examples of such architectural interventions, analyze their implementation, and offer perspective on how medicine and architecture can create ethically responsible spaces.
The short history and tenuous future of "professionalism"
(2022-12-13) Wynia, Matthew
[Note: The slide presentation is not available from this event.] The concept of professionalism in health care is both newer and more fragile than many assume. The history, strengths, risks, and alternatives to professionalism should be understood if we hope to create a future in which health professionals work well together in teams to effectively and ethically serve our patients and communities.
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.
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?
UT Southwestern Medical Center Ethics Grand Rounds - 2022/2023
(2022)
This document lists the schedule of Ethics Grand Rounds events for September 2022 through May 2023.
Ethical issues at the end of life in Catholic bioethics
(2022-09-13) Gremmels, Becket
Since over 20% of Americans are Catholic, and 1 in 7 patients in the U.S. is admitted to a Catholic hospital, Catholic moral theology has a significant impact on medical decisions at the end of life. In this talk, Dr. Gremmels will outline foundational principles and concepts in Catholic moral theology regarding end of life care. He will review the 1,800-year history of the development of these principles, discuss some recent developments in Church teaching, and provide examples of how patients and clinicians might apply them in a clinical setting. Participants will learn concepts and language to talk to patients about end-of-life care and help identify when seeking ethics expertise might be helpful.
Ethical quandaries of direct-to-consumer neurotechnology
(2022-05-10) Kreitmair, Karola V.
The direct-to-consumer (DTC) neurotechnology market, which includes brain computer interfaces (BCI), non-invasive neurostimulation devices, virtual reality systems (VR), wearables, and certain smartphone apps, is rapidly growing. This technology's quasi-clinical domain and its status as a consumer product, raises a number of ethical issues, including safety, transparency, privacy, and epistemic appropriateness. In addition, DTC neurotechnology provokes more fundamental questions regarding what may be thought of as the "responsibilization" of the user/patient. While DTC neurotechnology is standardly touted as a means of empowering users, I argue that such empowerment may not be of the sort that is genuinely beneficial to users.
Medical decision making, ethics, and behavioral economics
(2022-04-12) Blumenthal-Barby, Jennifer S.
Bioethicists have long argued for rational persuasion to help patients with their medical decisions. But the findings of behavioral economics – popularized in Thaler and Sunstein's Nudge and other books – show that arguments depending on rational thinking are unlikely to be successful, and even that the idea of purely rational persuasion may be a fiction. In this talk based on her recent book, "Good Ethics and Bad Choices: The Relevance of Behavioral Economics for Medical Ethics", Dr. Blumenthal-Barby examines how behavioral economics challenges some of the most fundamental tenets of medical ethics. She integrates some of the latest research from both fields and provides examples of how physicians might apply concepts of behavioral economics in practice.
Ethics large and small: moral considerations in response to childhood obesity
(2022-03-08) Hester, D. Micah
Obesity in the U.S. has been described as an epidemic, and in response to such rhetoric, individuals, healthcare providers, public health officials, even state legislatures, and courts have proposed initiatives or enacted consequences either to encourage better eating habits, discourage poor eating habits, or even punish poor nutritional practices. All these actions raise ethical concerns for public health and individual patient care. This talk will explore a number of these issues and will suggest that certain state-based responses do not merit ethical scrutiny, but individual provider directiveness in regards to nutritional counseling, especially with parents of overweight children, is warranted.
Putting the demos in democratic deliberation: the search for public opinion about the ethical use of biospecimens [a meditation in three acts]
(2022-02-08) De Vries, Raymond G.
The creation of sustainable and ethical policies in health care and the life sciences requires soliciting and incorporating the attitudes and opinions of the "public," a difficult task that is even more challenging in a political polarized society and when the policies in question are explicitly normative. Using research on public attitudes about the use of their biospecimens and health data, we will look at various methods used to solicit those attitudes and consider the strengths and limitations of those approaches. We will reflect on the value of empirical data for resolving normative questions (in other words, the age-old is/ought problem) and think together about better ways to incorporate the opinions of the demos in health policy.
Ethical use of surrogate measures in accelerated approval: aducanumab and beyond
(2022-01-11) Kesselheim, Aaron S.
[Note: The slide presentation is not available from this event.] The accelerated approval pathway was designed in the wake of the HIV epidemic to provide a pathway for drugs to reach the market based on showing changes to not-fully-validated surrogate measures. Since then, it has largely been applied to cancer drugs, and became the center of substantial attention with the June 2021 approval of aducanumab for Alzheimer's disease. We will review the ethical tensions at issue in approving drugs based on unproven surrogate measures, and consider how the accelerated approval pathway has been implemented.
UT Southwestern Medical Center Ethics Grand Rounds - 2021/2022
(2021)
This document lists the schedule of Ethics Grand Rounds events for September 2021 through May 2022.
Undocumented patients and physicians: how did we get here? where are we going?
(2021-12-14) Kuczewski, Mark G.
This session will trace the current clinical ethical challenges involving patients who are undocumented immigrants to features of U.S. immigration policy. We will examine the role of physicians and health care professionals in addressing the needs of these patients at the clinic level. Moreover, we will consider the need to advocate for policy reform that supports the health and equitable treatment of these patients.
Race and ethics in the design of biomedical technologies: the pulse oximeter as a case in point (The Daniel W. Foster, M.D., Visiting Lectureship in Medical Ethics)
(2021-11-09) Berne, Rosalyn W.
There were clear indications from studies done in 2005 and 2007 that pulse oximeters overestimate arterial oxygen saturation during hypoxia in dark-skinned individuals. And yet, years later, the device remains essentially unaltered. This disregard has been particularly significant during the coronavirus pandemic. Patients diagnosed with COVID-19 who present with silent hypoxemia, but are not sick enough to warrant hospital admission, have been guided to monitor their arterial oxygenation by pulse oximetry at home, and present for care when they show evidence of hypoxemia. Others in the general public have used the device simply for personal assurance. Whether or not these uses are appropriate is debatable. Nevertheless, that a racial bias is embedded in this technology is indisputable. The pulse oximeter serves as a timely case in point of how race can become a matter of ethics in the design of biomedical devices.

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