Leonard M. Fleck

Leonard Fleck photo


University Distinguished Professor

Center for Bioethics and Social Justice

Department of Philosophy

  • C-202 East Fee Hall
  • (517) 355-7552
  • fleck@msu.edu
  • Pronouns: he/him/his
  • PhD 1975 St. Louis University
  • BA 1966 Loyola University


Leonard Fleck's interests focus on medical ethics, health care policy, priority-setting and rationing, social and political philosophy, and reproductive decision-making. He explores the role of community dialogue (rational democratic deliberation) in addressing controversial issues of ethics and public policy related to emerging genetic technologies as well as problems of health care justice related to precision medicine. In that latter connection, he is the author of Precision Medicine and Distributive Justice: Wicked Problems for Democratic Deliberation (Oxford University Press, 2022). He is also the author of Bioethics, Public Reason, and Religion (Cambridge University press, 2022). In that volume he addresses several contemporary issues related to bioethics and religion from a Rawlsian public reason perspective such as research with human embryos, preimplantation genetic diagnosis, and the use of artificial wombs for reproduction.

Selected Publications

Fleck LM. The Dobbs Decision: Can It Be Justified by Public Reason? Cambridge Quarterly of Healthcare Ethics. July 2023;32(3):310-322. DOI: 10.1017/S0963180122000822.

Fleck LM. Abortion and “Zombie” Laws: Who Is Accountable? Cambridge Quarterly of Healthcare Ethics. July 2023;32(3):307-308. DOI: 10.1017/S0963180122000810.

Fleck LM. ECMO: What Would a Deliberative Public Judge? The American Journal of Bioethics. June 2023;23(6):46-48. Epub May 23, 2023. DOI: 10.1080/15265161.2023.2201197.

Fleck LM. Abortion, Artificial Wombs, and the “No Difference” Argument. The American Journal of Bioethics. May 2023;23(5):94-97. Epub May 2, 2023. DOI: 10.1080/15265161.2023.2191019.

Fleck LM. Bioethics, Public Reason, and Religion. Cambridge University Press, 2022. DOI: 10.1017/9781009086684.

Fleck LM. Precision Medicine and Distributive Justice: Wicked Problems for Democratic Deliberation. Oxford University Press, 2022.

Danis M, Hurst SA, Fleck L, Forde R, Slowther A, eds. Fair Resource Allocation and Rationing at the Bedside. 1 ed: Oxford University Press; 2014. This volume is comprised of over twenty essays addressing various aspects of the issue of bedside rationing from both European and American perspectives. Dr. Fleck also contributed “Just Caring: The Ethical Challenges of Bedside Rationing,” Chapter 10, 171-203.

Fleck L. Just Caring: Health Care Rationing and Democratic Deliberation. Oxford University Press; 2009.

Fleck LM. Full Reciprocity: An Essential Element for a Fair Opt-Out Organ Transplantation Policy. Cambridge Quarterly of Healthcare Ethics. July 2022;31(3): 310-20.

Fleck LM. Precision Medicine and the Fragmentation of solidarity (and justice). Medicine, Health Care, and Philosophy: A European Journal. June 2022;26: 191-206.

Fleck LM. Precision Health and Ethical Ambiguity: How Much Cancer Can WE Afford to Prevent? In Precision Oncology and Cancer Biomarkers: Issues at Stake and Matters of Concern, edited by Anne Bremer and Roger Strand (Springer, 2022), 205-34.

Fleck LM. Ultimate Price: The Value We Place on Human Life. [Book review, Thomas Friedman, author]. Public Health Ethics. October 2021;14 (2): 218-20.

Fleck LM. Alzheimer’s and Aducanumab: Unjust Profits and False Hopes. Hastings Center Report. July/August 2021;51: 9-11.

Fleck LM. Should Whole Genome Sequencing be Publicly Funded for Everyone as a Matter of Health Care Justice? (with Leslie Francis) Cambridge Quarterly of HealthCare Ethics. Jan. 2022;31 (1): 5-15.

Eli Adashi, Burgess M, Burall S, Cohen IG, Fleck LM, Harris J, Holm S, LaFont C, Moreno JD, Neblo MA, and seven others. Heritable Human Genome Editing: The Public Engagement Imperative. The CRISPR Journal. 2020;3 (6): 434-39.

Fleck LM. Just Caring: Screening Needs Limits. Journal of Medical Ethics. 2020;46: 253-54.

Fleck LM. Medical Ethics: A Distinctive Species of Ethics. Cambridge Quarterly of Healthcare Ethics. July 2020;29: 421-25.

Fleck LM. Healthcare Priority-Setting: Chat-Ting Is Not Enough; Comment on “Swiss-CHAT: Citizens Discuss Priorities for Swiss Health Insurance Coverage”. International Journal of Health Policy and Management. October 2018;7(10):961-963. Available online July 28, 2018. PMID: 30316250. PMCID: PMC6186469. DOI: 10.15171/ijhpm.2018.66.

Fleck LM. Precision QALYs, Precisely Unjust. Cambridge Quarterly of Healthcare Ethics. July 2019;28(3):439-449. DOI: 10.1017/S0963180119000367.

Fleck L. Ethical Considerations Related to Obesity Intervention. In: Davies HD, Fitzgerald HE, Silk KJ, eds. Obesity in Childhood and Adolescence, 2nd Edition. Vol 2: Praeger; November 2018:3-35.

Fleck LM. Controlling Healthcare Costs: Just Cost Effectiveness or “Just” Cost Effectiveness? Cambridge Quarterly of Healthcare Ethics. April 2018;27(2):271-283. Available online March 6, 2018. PMID: 29509125. DOI: 10.1017/S0963180117000603.

Fleck LM, Murphy TF. First Come, First Served in the Intensive Care Unit: Always? Cambridge Quarterly of Healthcare Ethics. January 2018;27(1):52-61. PMID: 29214960. DOI: 10.1017/S0963180117000391.

Fleck LM. Just caring: Do we need philosophical foundations? Ethics, Medicine and Public Health. Available online June 9 2017. April-June 2017;3(2):221-232. This is the official journal for the International Academy of Medical Ethics and Public Health, jointly sponsored by the Sorbonne and Université René Descartes.

Fleck LM. Just Caring: Precision Medicine, Cancer Biomarkers and Ethical Ambiguity. In: Blanchard A, Strand R, eds. Cancer Biomarkers: Ethics, Economics and Society. Kokstad: Megaloceros Press; 2017:73-94.

Fleck LM, Danis M. How Should Therapeutic Decisions about Expensive Drugs Be Made in Imperfect Environments? AMA Journal of Ethics. February 2017;19(2):147-156.

Fleck LM. Choosing Wisely: Is Parsimonious Care Just Rationing? Cambridge Quarterly of Healthcare Ethics. July 2016;25(3):366-376.

Fleck L. Critical Care Limits: What Is the Right Balance? American Journal of Bioethics. Jan 2016;16(1):48-50.

Fleck LM. Just Caring: The Insufficiency of the Sufficiency Principle in Health Care. In: Fourie C, Rid A, eds. What Is Enough? Sufficiency, Justice, and Health: Oxford University Press; 2016:223-243.

Fleck L. Just Solidarity: The Key to Fair Health Care Rationing. Diametros. 2015;43(March 2015):44-54; an online European Philosophy journal.

Fleck L. Just Caring: Fair Innings and Priority Setting. In: Nagel E, Lauerer M, eds. Prioritization in Medicine: An International Dialogue: Springer International Publishing; 2016.

Fleck L. Just Caring: Do the Indolent, the Inebriated and the Irresponsible Deserve Equal Access to Needed Health Care? Indiana Health Law Review. July 2014;11(2):553-587.

Fleck L. Pharmacogenomics and Personalized Medicine: Wicked Problems, Ragged Edges, Ethical Precipices. New Biotechnology. Sept 2012 (special issue “Personalized Medicine and Diagnostics"):757-768.

Fleck L. Liberty and the Individual Mandate. In: Kronenfeld J, Parmet W, Zezza M, eds. Debates on U.S. Health Care: Sage Publications; 2012:132-145.

Fleck L. Just Caring: In Defense of the Role of Rational Democratic Deliberation in Health Care Rationing and Priority Setting. In: den Exter A, Buijsen M, eds. Rationing Healthcare: Hard Choices and Unavoidable Trade-offs. Antwerp: Maklu Press; 2012:19-36.

Fleck L. Just Caring: Health Care Rationing, Terminal Illness, and the Medically Least Well Off. Journal of Law, Medicine, and Ethics. Summer 2011;39:156-171.

Fleck L. Just Caring: Defining a Basic Benefit Package. Journal of Medicine and Philosophy. Dec 2011;36:589-611.

Selected Achievements and Awards

  • Elected Fellow of the Brocher Foundation (Geneva), 2011
  • University Distinguished Faculty Award, 2003
  • Distinguished Faculty Award, College of Human Medicine, 2003
  • Elected Fellow of The Hastings Center, June 2002

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