Research & Scholarship

The faculty in the Center for Ethics are committed to research in a broad range of areas within bioethics. Below are recently funded projects that our faculty have been a part of. More information about current projects and other research is available on the MSU Bioethics Blog. Click the "project description" button for each project below to expand or collapse the project description and related publications.

Active Projects

nih logo

Is the Treatment Perceived to be Worse than the Disease?: Ethical Concerns and Attitudes towards Psychiatric Electroceutical Interventions

MSU Researchers: Laura Cabrera (PI), Aaron McCright (Co-I), Robyn Bluhm (Co-I), Eric Achytes (Key Personnel)
Funded by the NIH BRAIN Initiative
September 2018-August 2022
Research Topics: mental health, neuroethics, patient/psychiatrist/public attitudes, psychiatric electroceutical intervention (PEI)
Project Webpage

Mental health disorders cause immense personal suffering and represent a significant societal burden. Recent research emphasizes the potential of psychiatric electroceutical interventions (PEIs) – bioelectronic treatments that employ electrical stimulation to affect and modify brain function – to effectively treat such disorders. Novel PEIs, however, also raise significant ethical concerns. Not uncommonly, they are negatively associated with historically controversial interventions such as electroconvulsive therapy and lobotomy. Moreover, while their goal is to alter the underlying pathophysiology of disease, these interventions can also have unintended effects on cognition, behavior, and emotions. Those effects, in turn, raise ethical concerns regarding autonomy, personal identity, and capacity for informed consent. PEIs also are sometimes perceived to be more harmful than helpful. A large body of scholarly literature addresses ethical concerns about pharmacological psychiatric interventions, yet there is limited research on ethical concerns and related beliefs and attitudes about PEIs among the clinicians, patients, and the broader public. With the attention novel PEIs have garnered, this proposed study addresses that significant gap by (a) examining ethical concerns, beliefs, and attitudes about the use of PEIs among relevant stakeholders, and (b) developing a guide to anticipate future policy challenges regarding PEI innovation and use. Using a pragmatic neuroethics framework together with a responsible research and innovation framework, our goal is to develop a strategy to support responsible and ethical PEI innovation and use.
nih logo

Latinos Perceptions and Concerns about Alzheimer Disease

MSU PI: Laura Cabrera
Funded by the National Institute on Aging
September 2018-June 2020
Research Topics: Alzheimer Disease, care, diagnosis, Latino groups, progression

Current Alzheimer Disease (AD) resources cluster Latinos under a big umbrella neglecting cultural, biological and environmental differences present in different Latino groups. Are concepts of health, aging and wellness similar among different Latino groups? Are the perceived barriers to seeking care the same among different Latinos groups? Are there similar concerns regarding diagnosis, progression and prediction among different Latinos groups? Are the expectations and burdens of caregivers the same?

We anticipate that culturally relevant information will improve the understanding of AD symptoms, diagnosis and care among Latino groups. We will explore their levels of familiarity with symptoms associated with AD, diagnosis and care, as well as their perceptions and concerns about AD and barriers to care.

Completed Projects

neuron era net logo

Media Coverage of Psychiatric Neurosurgery: Cross-national Investigations of Public Reactions and Attitudes

CEHLS Researcher: Laura Cabrera (PI)
Funded by Neuron European Research Area Network (ERA-NET)
April 2016-March 2020
Research Topics: Psychiatry, neurosurgery, public perceptions, media

Our overarching goal is to uncover cross-national themes, trends and values surrounding the use of different psychiatric neurosurgery procedures. To achieve this goal, we have designed a three-year research plan that uses a mix methodology approach: a content analysis followed by interpretative analysis with focus groups. Specifically, we will carry out a hypothesis-driven content analysis of (1) media articles reporting on psychiatric neurosurgery, (2) the sources mentioned in these articles (e.g., scientific articles and regulation documents), and (3) readers’ comments to these articles. Our hypotheses are that: (i) content, focus, tone and values of media articles differ based on country of origin, modality and time period of publication, (ii) sources mentioned in media articles differ based on country of origin, modality and time period of publication, (iii) content themes, focus, tone, expectations and values of readers’ comments differ based on country of origin, modality and time period of publication. We will follow up these analyses with focus groups in each country of the consortium (Canada, Germany, Spain) for expanded, open-ended discourse, feedback on the findings, and the interpretation of results from the content analyses.

  • Cabrera LY, Bittlinger M, Lou H, Müller S, Illes J. Reader comments to media reports on psychiatric neurosurgery: past history casts shadows on the future. Acta Neurochirurgica. December 2018;160(12):2501-2507. Available online October 24, 2018. PMID: 30357485. DOI: 10.1007/s00701-018-3696-4.
  • Cabrera LY, Bittlinger M, Lou H, Müller S, Illes J. The re-emergence of psychiatric neurosurgery: insights from a cross-national study of newspaper and magazine coverage. Acta Neurochirurgica. March 2018;160(3):625-635. Available online December 21, 2017. PMID: 29264778. DOI: 10.1007/s00701-017-3428-1.
Michigan State University seal image

Buffers, Barriers, and Resiliency in Breastfeeding Behaviors of Asian American Mothers

CEHLS Researcher: Libby Bogdan-Lovis (Co-I)
Funded by the Trifecta Initiative for Interdisciplinary Health Research
December 2018-November 2019
Research Topics: breastfeeding, cultural values, maternal/infant health, pregnancy, social stigma

While Asian American (AA) mothers are described as high initiators of breastfeeding, no previous studies have conducted a randomized trial of AA mothers’ breastfeeding and formula use behaviors and whether these mothers continue to breastfeed exclusively for the recommended six months. Using an online Qualtrics customized panel, we will conduct a systematic investigation of the breastfeeding behaviors and timing of the introduction of complementary foods, and use of formula of AA mothers over a one-year period. We will recruit 1200 women between the ages of 18 and 35, as follows: 400 AA mothers with children one-year or younger; 400 pregnant AA women; and 400 American mothers from all race/ethnic groups will serve as the control group. This longitudinal study will track pregnant AA women through the birth of their babies, and will assess breastfeeding support and behaviors after the initial data collection, at 3-months, 6-months, and at one-year.

Building Skills for End-of-Life Discussions in the Intensive Care Environment

CEHLS Researchers: Devan Stahl (PI), Tom Tomlinson
Funded by the Norman Kagan Endowed Scholarship in Graduate and Professional Studies
July 2018-June 2019
Research Topics: Communication, end-of-life, education, goals of care, intensive care

When patients come into the intensive care unit, it is important to establish not only what medical treatments will be necessary, but also the goals of those treatments. The goals for medical treatment ought to reflect the patient’s own goals and values. Intensive communication about goals of care has been shown to reduce ICU length of stay and the duration of use of non-beneficial advanced life support in critically ill patients as well as a lower prevalence of posttraumatic stress symptoms, anxiety, and depressive symptoms in family members. Unfortunately, few physicians are trained in how to have goals of care discussions with patients or their family members. To respond to this challenge, Drs. Stahl and Tomlinson are creating teaching modules which will enhance providers’ skills and confidence in having productive conversations with families about medically and ethically complex plans of care for seriously ill, incapacitated patients in the ICUs. They will evaluate the effectiveness of this education and assess the impact and effectiveness providers’ goals of care communication skills.

Demonstration of a Community System of Care for Medicaid Insured Pregnant Women

PI: LeeAnne Roman; CEHLS Researcher: Margaret Holmes-Rovner
Funded by the Agency for Healthcare Research and Quality
August 2012-May 2018
Research Topics: system of care, Medicaid, pregnant women

Improving health care services for low income women continues to be a challenge in Michigan and across the nation. This demonstration project aims to develop and test a system of care for pregnant women. The demonstration aims to coordinate services throughout pregnancy and in the early phase of the family’s life. It focuses on Kent County, and brings together primary community partners Spectrum Health, Cherry Street Health Services, Kent County Health Department, Arbor Circle (mental health), Priority Health Plan, and the Michigan Department of Community Health. The system aims to help providers share information and to help patients actively participate in their care. The project will test the impact on the health of the population of women eligible to participate.
s3 logo

Coworker Stigma Towards Lactating Mothers in the Workplace

CEHLS Researcher: Libby Bogdan-Lovis
Funded by Science and Society at State
January 2017-December 2017
Research Topics: Breastfeeding, maternity leave, social stigma, workplace culture

This project examines mechanisms underlying coworkers’ stigma towards lactating mothers in the workplace and the impact of coworker disapproval on the duration of breastfeeding. While benefits and barriers to breastfeeding have been studied extensively, less is known about the role coworkers play in the continuation of breastfeeding after maternity leave. Around 57% of mothers with young children in the U.S. work (Rojjanasrirat, Wambach, Sousa, & Gajewski, 2010). While private space and break time is a right under the Affordable Care Act (2010), frequent breaks challenge timely completion of work tasks and the ability to meet deadlines; coworkers may have to do more work to compensate for a missing team member. This could cause resentment and the perception of unfairness.


Public Preferences for Addressing Donors' Moral Concerns about Biobank Research

CEHLS Researchers: Tom Tomlinson (PI), Karen Kelly-Blake
Funded by the National Institutes of Health
September 2013-June 2017
Research Topics: Biobank, bioethics, public deliberation, biobank donor, informed consent

This project is a collaboration with colleagues at the Center for Bioethics and Social Science in Medicine at University of Michigan, and continues the line of research started by the earlier R25, Ethics and Public Attitudes Concerning the Use of Archived Biological Samples. The first component is a large, nationally representative survey designed to answer two questions: What effects will presentation of possible future projects that might worry some donors have on the public’s willingness to give a blanket consent to all future research using their de-identified donations? And, once made aware of the possibility research that might affect their “non-welfare interests”, what degree of information and control does the public want regarding future research uses of biobank donations. Since the policy trade-offs are complex and not easily presented in a survey, the second component will be a set of democratic deliberations that enlist ordinary citizens in discussions leading to a set of policy recommendations for balancing respect for individual values with the need to conduct large-scale biobank research efficiently and economically.

  • De Vries RG, Tomlinson T, Kim HM, Krenz C, Haggerty D, Ryan KA, et al. Understanding the Public’s Reservations about Broad Consent and Study-By-Study Consent for Donations to a Biobank: Results of a National Survey. PLoS ONE. July 14 2016; 11(7). doi: 10.1371/journal.pone.0159113. PMC4944938.
  • De Vries RG, Tomlinson T, Kim HM, et al. The moral concerns of biobank donors: the effect of non-welfare interests on willingness to donate. Life Sciences, Society and Policy. March 11 2016;12(3). doi: 10.1186/s40504-016-0036-4. PMC4788662.
  • Tomlinson T, De Vries R, Ryan K, Kim HM, Lehpamer N, Kim SYH. Moral Concerns and the Willingness to Donate to a Research Biobank. Journal of the American Medical Association. January 27 2015;313(4):417-419. doi: 10.1001/jama.2014.16363. PMC4443895.
s3 logo

Psychiatric Interventions: Values and Public Attitudes

CEHLS Researcher: Laura Cabrera (PI)
Funded by Science and Society at State
January 2016-May 2017
Research Topics: Psychiatry, psychiatric interventions, pharmacology, neurosurgery, public perceptions

Psychiatry raises ethical debate for a number of reasons: diagnoses are complex and controversial; treatments target the human brain with the goal of changing behavior, emotions, or cognition; and the etiology and pathophysiology of brain dysfunction and therapeutic mechanisms of action are still largely speculative. The focus of this project is the use of somatic psychiatric interventions (i.e., pharmacological and surgical treatments, as opposed to psychotherapy). With the support of the S3 initiative, we will conduct a systematic literature review of the main concerns and challenges faced by pharmacological and neurosurgical psychiatric interventions, and gather preliminary data by using social scientific methodology to carry out a media discourse analysis. This will enable us to characterize the portrayal of somatic psychiatric interventions in the scientific and philosophical literature and in the media, and examine the values, reactions and attitudes expressed in these. We will also organize a one-day workshop in Fall 2016 titled “Pharmacological and Neurosurgical Psychiatric Interventions: through the looking glass”. This workshop will serve as an opportunity to foster further collaborations and explore other grant proposal venues, as well as explore issues that need to be addressed regarding somatic psychiatric interventions.

Read about the workshop on the MSU Bioethics blog.

  • Bluhm R, Cabrera L, McKenzie R. What we (Should) Talk about when we Talk about Deep Brain Stimulation and Personal Identity. Neuroethics. Epub March 11, 2019. DOI: 10.1007/s12152-019-09396-6.
  • Cabrera LY, Bluhm R. Interpreting Patients’ Beliefs About Deep Brain Stimulation for Treatment-Resistant Depression: The Need for Caution and for Context. AJOB Neuroscience. 2018;9(4):230-232. Epub February 25, 2019. DOI: 10.1080/21507740.2018.1553900.
  • Cabrera LY, Brandt M, McKenzie R, Bluhm R. Online comments about psychiatric neurosurgery and psychopharmacological interventions: Public perceptions and concerns. Social Science & Medicine. January 2019;220:184-192. PMID: 30453110. DOI: 10.1016/j.socscimed.2018.11.021.
  • Cabrera LY, Brandt M, McKenzie R, Bluhm R. Comparison of philosophical concerns between professionals and the public regarding two psychiatric treatments. AJOB Empirical Bioethics. 2018;9(4):252-266. Available online November 6, 2018. PMID: 30398397. DOI: 10.1080/23294515.2018.1512534.
  • Bluhm R, Cabrera LY. It’s Not Just Counting that Counts: a Reply to Gilbert, Viaña, and Ineichen. Neuroethics. Available online October 27, 2018. DOI: 10.1007/s12152-018-9391-6.
  • Cabrera LY, Boyce HMK, McKenzie R, Bluhm R. Conflicts of interest and industry professional relationships in psychiatric neurosurgery: a comparative literature review. Neurosurgical Focus. August 2018;45(2):E20. DOI: 10.3171/2018.4.FOCUS17399. PMID: 30064327.
  • Cabrera LY, McKenzie R, Bluhm R. Beyond the Technology: Attribution and Agency in Treatments for Mental Disorders. AJOB Neuroscience. June 2017;8(2):92-94. DOI: 10.1080/21507740.2017.1326410.

Men’s Health and Masculinity: Implications for Colorectal Cancer Screening

CEHLS Researcher: Karen Kelly-Blake (PI)
Funded by the Norman Kagan Endowed Scholarship in Graduate and Professional Studies
July 2014-June 2015
Research Topics: Colorectal Cancer Screening, Male Health, African American

There are numerous potential contributors to the disparate burden of CRC on African Americans including clinician counseling practices, patient perceptions, access to care, and financial considerations. There are recent studies identifying a CRC screening barrier that is unique to men in general, but may be especially pertinent for African American men; that barrier is a perceived threat to masculinity and male sexuality. This is a secondary data analysis (DATES, M. Jimbo, PI, R01CA152413) of transcribed clinical encounters of men discussing colorectal cancer screening options with their primary care physicians. It will describe what men say about masculinity and male sexuality in the context of decision making about CRC screening in real world clinic visits with their primary care physicians. It will provide an enhanced understanding of what is important to men in determining their participation in screening for colorectal cancer. The insights gained from this study will not only have important implications for CRC screening but can also be applied to other health behaviors among men where discussions about masculinity and male sexuality inform screening and/or treatment decisions.

Clinical Communication Following a Decision Aid

CEHLS Researcher: Margaret Holmes-Rovner (PI)
Funded by the Agency for Healthcare Research and Quality
September 2012-February 2014
Research Topics: Physician communication, decision aids, shared decision-making, informed
decision-making, qualitative analysis, prostate cancer

Informed decision making is the standard of care in preference sensitive clinical decisions like localized prostate cancer, where patient survival is similar across competing treatments, including no treatment or watchful waiting. However, little is known about the quality of informing physicians provide in routine practice. This study aims to describe and evaluate the nature and completeness of informing for patients and physicians making treatment decisions when patients receive a diagnosis of localized prostate cancer.
In this study we will analyze previously audio-recorded encounters of 252 men with localized prostate cancer (PSA<20; Gleason 6 or 7) seen in outpatient urology clinics in four Veterans Affairs Medical Centers. Data collected from a randomized trial of two patient decision aids. Treating physicians were urology residents and fellows who received no intervention. Results will allow description of the state-of-the art of informed decision making and identify areas for improvement.

Decision Aid to Technologically Enhance Shared Decision Making (DATES)

CEHLS Researcher: Karen Kelly-Blake (PI)
Funded by the National Institutes of Health
September 2012-September 2016
Research Topics: Colorectal cancer, clinician communication, shared decision making

The Specific Aims of this study are 1) to describe physician communication about colorectal cancer screening (CRCS) options and assess the impact of shared decision making (SDM) on patient screening decisions and 2) to perform an exploratory interview analysis to describe how patients perceive use and acceptability of interactive technology (IT) to improve clinical care, such as decision aids (DAs), within and outside the clinical encounter. Aim 1 will be achieved through qualitative content analysis of transcribed audio-recorded clinical encounters coming from the DATES parent grant (M. Jimbo, PI, R01CA152413) affording an in-depth description of what happens between the physician and patient and how information is conveyed, received, and acted upon. Aim 2 is a pilot study achieved through patient interviews with DATES study participants. The long-term goal of this research is to help describe communication patterns surrounding informing and collaborative discussion in the clinical encounter in order to design appropriate interventions to facilitate shared decision-making, decrease health disparities and ultimately to lead to better patient outcomes.

Ethics and Public Attitudes Concerning the Use of Archived Biological Samples

CEHLS Researcher: Tom Tomlinson (PI)
Funded by the National Institutes of Health
April 2010-September 2012
Research Topics: Bioethics; biobanks; research ethics; public attitudes; non-welfare interests

Biobanks—collections of various kinds of biological specimens like blood and tissues—are an increasingly important platform for advancing knowledge about human health and disease. These specimens are usually donated under a “blanket consent,” in which donors agree that their specimen can be used in any future research without any further consent from them. Since the specimens are provided to researchers with no personal information attached, the research done on them poses no real risk to the donors. So do donors care at all about what might later be done with their tissue? Conducted with Stan Kaplowitz and Meghan Faulkner, this project aimed to find out. The research team used a survey of Michigan residents designed to test whether disclosure of possible research uses that might raise moral, cultural or religious concerns for some donors would have an effect on people’s willingness to give a blanket consent. The results showed that these “non-welfare interests” do affect the willingness to give a blanket consent, although perhaps not as much as would be expected. The magnitude of this effect is related to several factors, including individuals’ trust in the medical profession and in researchers.