Recorded Webinars

Reshma Jagsi photo

Ethical Issues Related to Fundraising from Grateful Patients

Health care institutions are becoming increasingly deliberate about philanthropic fundraising given the need to sustain their missions in the face of decreases in governmental research funds and lowering reimbursement for clinical care. Donations from grateful patients constitute 20% of all philanthropic contributions to academic medical centers, totaling nearly $1 billion a year in recent years. Institutions frequently employ development professionals to facilitate philanthropy. The development literature describes various approaches for identifying patients capable of contributing, cultivating potential donors, and engaging physicians in the solicitation of grateful patients, emphasizing that patients themselves may also benefit from exercising altruism in this way. However, little evidence exists to guide the ethical practice of grateful patient fundraising, and concerns exist regarding privacy and confidentiality, patient vulnerability, and physicians' conflicts of obligations in this context. Therefore, we will discuss how the process of philanthropic development should be structured in order to demonstrate respect for all persons involved, including patients who donate, those who might consider donation, those who do not wish to donate, and those who cannot afford to do so.
Reshma Jagsi, MD, DPhil
Professor and Deputy Chair, Department of Radiation Oncology; Director, Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School
Recorded April 11, 2018

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Pain But No Gain: Pain as a Problematic and Useless Concept?

References to the human experience of “pain” are common, but those references are often ambiguous and vague. Such ambiguity creates conceptual and practical challenges, especially in the work of clinical ethics consultation. Conceptual challenges arise, for example, from the distinction between pain and suffering. Practical challenges arise from tensions between objective and subjective components of pain, and clinical ethical challenges arise in cases like Charlie Gard’s. Here, on the one hand, the court argued that Charlie was in such extreme pain and suffering, he should be allowed to die. Alternatively, others stated that we could not truly know about the experience of his pain, and that treatment therefore should be made available. While pain is a relevant clinical problem, it is also a social construct shaped by culture, environment and gender. These distinctions however get lost in a simple “pain” reference. With several clinical ethics scenarios, Dr. Eijkholt asks if references to pain help us with anything, or if we should perhaps abandon pain as a “useless concept.”
Marleen Eijkholt, JD, PhD
Assistant Professor, Center for Ethics and Humanities in the Life Sciences and Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine; Clinical Ethics Consultant, Spectrum Health System
Recorded March 14, 2018
Note: Technical issues arose during this event that resulted in no audio in some places. Audio begins about 8 minutes in.
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Prospects, Promises and Perils of Human Mind-Reading

In recent years, several research groups have been able to infer the contents of subjects' thoughts from fMRI scans. E-commerce sites are tracking customers' purchases and making ever better predictions about what people will buy. What are the prospects for such technology to be widely used? Are there fundamental technical limitations?
We may readily imagine dystopian scenarios for such technology, where privacy as we have known it is no longer meaningful, and the powerful monitor the thoughts of everyone else. We may also imagine that therapists could better communicate with autistic or troubled people, or to detect incipient mental illness.
Mark Reimers, PhD
Associate Professor, Neuroscience Program, College of Natural Science, Michigan State University
Recorded November 29, 2017

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What's the point of Michigan's vaccine waiver education requirement?

Since 2015, Michigan parents have had to attend education sessions at public health offices if they want their unvaccinated or under-vaccinated children to attend school or daycare. This policy seems to have succeeded: the state’s nonmedical exemption rate declined by 35% from 2014 to 2015. But what explains this apparent success? Are parents changing their minds as a result of mandatory vaccine education, or are they choosing to vaccinate rather than be inconvenienced by education sessions? Also, does vaccine education promote additional public health goals, i.e. other than short-term vaccination compliance? This presentation attempts to answer these questions by drawing on immunization records, interviews with public health staff, and surveys of health department leaders, with the goal of informing arguments about the value of Michigan's vaccine waiver education policy.
Mark Navin, PhD
Associate Professor of Philosophy, Oakland University
Recorded February 14, 2018

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Christopher Contag photo

Crossing the Biology to Pathobiology Threshold: Distinguishing Precision Health from Precision Medicine

Diseases have long been defined by their symptoms, and therefore patients have typically been treated when they are symptomatic. However, through advances in “omics,” wearable sensors, insertable microscopes, liquid biopsies, point-of-care pathology, and other innovations, it is possible to make a molecular diagnosis prior to apparent symptoms. These tools will enable a transition from Precision Medicine where the molecular etiology is determined after symptoms appear, to Precision Health in which the molecular etiology of diseases can be anticipated and symptoms averted. However, is it ethical to treat “asymptomatic disease” and at what cost to the healthcare system? What level of risk will be tolerated for interventions that are developed for treating “pre-diseased” patients? Since many of these assays will predict likelihood of disease and not absolute progression to disease, what level of certainty is needed to intervene at all? Medicine is being redefined and we are behind in understanding what is meant by the simple terms health and disease.
Christopher H. Contag, PhD
John A. Hannah Distinguished Professor of Biomedical Engineering and Microbiology & Molecular Genetics; Chair, Department of Biomedical Engineering; Director, Institute for Quantitative Health Science and Engineering, Michigan State University
Recorded October 11, 2017

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