ItemMedical ethics related to child abuse: evaluations, diagnoses, and reporting(2024-02-13) Lowen, Deborah E.For medical practitioners encountering situations of child abuse or neglect, the subject matter itself can be difficult and even traumatizing. The ethical issues that arise add to the discomfort for those involved with these cases. Through case vignettes, this webinar will discuss some of the more common ethical dilemmas, such as determining a plan for medical evaluations related to abuse, formulating medical diagnoses, and responding to mandatory reporting laws. The relationship of these ethical issues to concerns about the roles and functioning of child welfare agencies will also be addressed. ItemMedical ethics in the carceral setting(2024-01-09) Kendig, Newton E.In this Ethics Grand Rounds, we will discuss ethical concerns that commonly arise when caring for patients in the carceral setting. Topics include respecting patient autonomy within a public safety setting, obtaining informed consent from patients in an inherently coercive environment, determining medical necessity of correctional health services, and navigating ethical concerns for specific patient populations such as those with behavioral health conditions, hepatitis C, reproductive and gender-related health care needs, the aging, and those living with life-limiting conditions. We will explore the interface of public policy, legal mandates, evidence-based clinical guidance, and ethical decision-making. ItemDignity 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. ItemEthical conundrums of current U.S. funding agency security efforts(2023-11-14) Pritt, StacyResearch security became a focal point for U.S. federal agencies funding academic research in 2018 when NIH started sending notifications to dozens of academic institutions about concerns involving foreign influence in research. The effort to determine the scope and extent of the foreign influence, which started years before 2018, continues today and has culminated in the release of draft Research Security Program (RSP) requirements. Lost in this effort are the ethical conundrums presented by the federal government's shifting requirements, inconsistent responses by academic institutions, and the potential chilling effect that all of this has on international research collaborations. This session will break down the concerns U.S. agencies have with inappropriate foreign influence in research, review how those concerns have evolved since 2018, and identify the ethical conundrums inherent to this topic. ItemPosttrial responsibilities to participants in neural device research(2023-10-10) Hendriks, SaskiaDeveloping new therapeutic devices may reduce the high burden of neurological and psychiatric disorders. In trials in which participants benefit from the device, or explantation is risky, device-related care for participants after the trial ends is a major ethical and practical challenge. Most patients who benefit from a device want to keep it. However, they may need among others, follow-up visits, replacement hardware, and software updates to maintain their benefits and reduce risks. Most posttrial needs are currently inconsistently met, which can lead to major consequences for patients. In some cases, patients have been left with a defunct implant. While some guidance exists for pharmaceuticals, specific guidance or best practices for device trials are lacking. Do researchers, funders, and industry-partners have responsibilities to facilitate posttrial care for research participants? ItemUT 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. ItemEthics 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. ItemSubstance 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. ItemStructural 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. ItemEthics 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. ItemAddressing 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. ItemExploring 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. ItemThe 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. ItemDeep 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. ItemAn 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, SandroHealth 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? ItemUT 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. ItemEthical issues at the end of life in Catholic bioethics(2022-09-13) Gremmels, BecketSince 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. ItemEthical 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. ItemMedical 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. ItemEthics large and small: moral considerations in response to childhood obesity(2022-03-08) Hester, D. MicahObesity 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.