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Center for Medical Ethics and Health Policy

Past Speaker Series

Master
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Raising Consciousness - May 30, 2019

Content

Savitri Fedson, M.D.
"I think therefore I am," to take Descartes out of his context, in some ways puts forth the question that many grapple with as we think about consciousness. Does consciousness require an interaction with the environment, or an awareness of oneself? The intentionality of responses and of movement, or the ability to be aroused or awakened. Definitions of consciousness are as difficult to grasp as the memory of a dream. The criteria which became the legal and medical understanding of brain death is now 50 years old, and 15-20,000 people are declared legally dead by this brain death criteria every year in the United States. But awareness of different states of consciousness are evolving, and there are ever more frequent calls to challenge the idea of brain death. During this session we will explore the murky waters of awareness, from comas to vegetative states to the awareness of minimally conscious states and the potential for awakenings.

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Faith and Healing: Patients, Miracle Language and Space for Faith in Medicine - April 11, 2019

Content

Trevor Bibler, Ph.D.
From ancient shamans, through medieval physician-theologians, all the way to today, the relationship between medicine and religion remains dynamic. In America today, patients, parents, and families often appeal to their religious beliefs when making medical decisions. But finding a balance between respecting a patient's faith and allowing healthcare professionals to practice according to the professionals idea of good medicine is often a challenge. What should be done if a family insists that support from a breathing machine should continue while they wait for God to perform a miracle? If medicine is meant to care for the whole person, must hospitals also care for the soul or is this outside of medicine's scope? If those who attend worship services live longer and are move active in their final years, should doctors prescribe religious worship? During our conversation, we will discuss how faith and healing interact in American medicine today.

Background Readings:
In Jahi McMath saga, science and religion clash
Views on end-of-life medical treatments (Religion and End-of-Life Care section)
Waiting for a miracle? Perspectives from health care providers
Medical miracle

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Million Dollar Baby: Surrogacy Contracts, Reproductive Technologies and the Changing Face of Parenthood - Feb. 21, 2019

Content

Claire Horner, J.D., M.A.
The advent of reproductive technologies, spurred by the birth of the first baby through in vitro fertilization in 1978, has expanded our conception of parenthood in myriad ways. Forty years later, we can now welcome babies through uterine transplantation and are exploring the possibility of genetic editing of embryos. The growth of these technologies, from gamete donation to gestational surrogacy, has allowed individuals to have children they otherwise could not have had, but has also caused confusion as our laws struggle to keep up with the ever-changing definition of a parent. In this session, we will explore the modern pursuit of parenthood in the for-profit fertility business and discuss both the reproductive promise it offers to its hopeful clients and the ethically complicated pitfalls inherent to the market.

Background Readings:
The messy complicated nature of assisted reproductive technology
As surrogacy surges, new parents seek legal protections

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The Creature Speaks: What Mary Shelley's Frankenstein Can Tell Us About Humanism In Medicine - Dec. 13, 2018

Content

Andrew Childress, Ph.D.
Mary Shelley's Frankenstein; Or, The Modern Prometheus is often cited as a cautionary tale, one that forecasts the dire consequences of allowing scientific and technological innovation to run amok. While this is a useful reading of the novel, there are other valuable lessons to be learned from the conflict between Frankenstein and his creation. Those of us whose memories of Frankenstein's creation are limited to Halloween costumes or Boris Karloff's grunting monster may not be aware that the novel portrays him as an intelligent, articulate, sensitive being who quotes Milton and implores Frankenstein to consider his human rights. How might his dialogue with Frankenstein provide insights into the experiences of patients who have felt abandoned or have lost trust in the fiduciary relationship? What might the creature be able to teach us about empathy, compassion, and communication in the patient-physician relationship? In this conversation, we will explore issues related to trust in medicine, the acknowledgement of suffering, and the unintended consequences of using advanced life-sustaining technologies.

Background Readings

'Frankenstein' Reflects the Hopes and Fears of Every Scientific Era
How Frankenstein's Monster Became Human
Frankenstein; Or, the Modern Prometheus (1818) [Project Gutenberg, Full Text]

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Prescription for Addiction? Reflections on Managing Pain During America's Opioid Crisis - Sept. 13, 2018

Content

Travis Rieder, Ph.D.
In 2016, opioids contributed to more than 42,000 overdose deaths; prescription opioids were involved in 40 percent of those deaths. Further, the rise in drug overdose deaths in the United States correlated with a decade-long "War on Pain," in which physicians liberally prescribed opioids. This sort of data has led many in the public to associate today's drug overdose epidemic with over-prescribing, and so to see a prescription crackdown as the obvious solution. The situation, however, is rather more complicated than that. In this session, we will explore how both the factors driving today's opioid epidemic, as well as our response to the crisis, raise profoundly difficult challenges for managing pain. Ultimately, we will try to at least begin addressing the question: what does justifiable pain medicine look like in the midst of an overdose crisis?

Background Readings:
Doctors prescribed me pain meds but couldn't help me get off them
A pain doctor explains how he balances his patients' needs with the opioid epidemic's lessons
Millions of patients face pain and withdrawal as opioid prescriptions plummet
An ethical dilemma for doctors: When is it OK to prescribe opioids?

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The Burning Question: The Ethics of Medical Marijuana - May 10, 2018

Content

Stacey Berg, M.D.
During this session we explored the controversies surrounding the use of marijuana as a medicine. Twenty-nine states and the District of Columbia have legalized medical marijuana, but the federal government still classifies it like heroin. Why is there such a debate? Should people be able to use pot for hard-to-treat symptoms? In this session we smoked out the facts and discussed the pros and cons of doctor-prescribed marijuana.

Background Readings:
DrugFacts: Marijuana
Marijuana as Medicine
Should Marijuana Be a Medical Option?
Dr. Sanjay Gupta: It's Time for a Medical Marijuana Revolution
Many States Have Legalized Medical Marijuana, So Why Does DEA Still Say It Has No Therapeutic Use?

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In Our Own Backyard: Access to Care in Houston’s Vulnerable Population - April 12, 2018

Content

Ricardo Nuila, M.D.
What can Houston contribute to the national health care debate? The answer—many vital and missing pieces to the puzzle—is surprising when you consider our state’s terrible reputation in this regard. Much of the ill repute is earned from highly political decisions, like not expanding Medicaid, but what the country doesn’t know is that Houston’s safety net hospital system provides affordable and high-quality health care to vulnerable patients. This session delved into how the Harris Health system blends conservative and liberal ideals in healthcare, and how in doing so, achieves a level of cost-saving that can serve as a model for the rest of the country.

Background Readings:
Poor and Uninsured in Texas
Taking Care of Our Own

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Public Policy or Police State? The Appropriate Reach of Government in Health Interventions - Feb. 8, 2018

Content

Stephanie Morain, Ph.D., M.P.H.
During this session on public health, we explored the role of the government in health promotion. What is the role of the government in encouraging healthy behaviors? Does the government have a different responsibility to respond to infectious diseases like Ebola, bird flu, or Zika than it does for chronic diseases like obesity, diabetes, or cancer? Should the government only get involved when diseases present a “harm to others”? If so, should financial harms, like impact on insurance premiums or on Medicare count? We grappled with these questions about the role of government in keeping us healthy—and what role the public should have in shaping government policy for public health.

Background Readings:
Father Mike
An Epidemic of Meddling: The Totalitarian Implications of Public Health
Zika Virus: Floridians Fear 'Pandora's Box' of Genetically Altered Mosquitos

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Facing Ethics Head-On: Neuroethics and Our Growing Understanding of the Brain - Nov. 9, 2017

Content

Gabriel Lazaro-Munoz, Ph.D., J.D., M.B.E.
Neurogenomic information could soon help identify who is at risk of mental health disorders even before symptoms are observed. It could also help prevent the development of disorders, diagnose disorders, select treatment options and improve clinical outcomes. In this session on neuroethics, we examined the current status of psychiatric genomics, how it could profoundly transform the practice of psychiatry, and what are some of the scientific and ethical challenges these technologies may pose for psychiatrists, patients, and society.

Background Readings:
Hunting the Genetic Signs of Postpartum Depression With an iPhone App
My Mental Illness and My Research
New Psychiatric DNA Testing Is Unproven Ground

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In the Path of Harvey: Ethical Issues in Providing Clinical Care During a Natural Disaster - Sept. 14, 2017

Content

Janet Malek, Ph.D.
Resolving ethical disagreements in the clinical setting is both an art and a science. In this session, we discussed a well-established method for reasoning about moral questions in a systematic and rigorous way. The group worked through an actual case from the clinic surrounding Hurricane Harvey, asking: What are the consequences at stake and which are most important? Are there rights that need to be taken into account? How might reflection on virtue or fairness shape our thinking? And what do we do when these various considerations come into conflict? Using this method, we explored the science behind ethical justification and demonstrate that some resolutions really are better than others.

*This session featured the Ethics Work-Up which guides case analysis and serves as the foundation for analyzing the ethical issues future sessions address.

Background Readings:
What Happens When a Hurricane Hits a Hospital
Can Moral Disputes Be Resolved?
Would You Pull the Trolley Switch? Does it Matter?

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(Un)natural Selection - May 11, 2017

Content

Amy McGuire, J.D., Ph.D.
During this session on genetics, we focused on lessons from the past. We explored the eugenics movement in the United States during the 1920s-1930s followed by modern day debates about gene editing and designer babies. How similar or different are the issues from 1927 to 2017? How can we avoid going down the slippery slope of eugenics with these new technologies? We grappled with the concept of genetic determinism and what it means for science and society.

Background Readings:
The Forgotten Lessons of the American Eugenics Movement
Engineering the Perfect Baby
What's the Difference Between Genetic Engineering and Eugenics?

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(Un)natural Selection - May 11, 2017

Content

Amy McGuire, J.D., Ph.D.
During this session on genetics, we focused on lessons from the past. We explored the eugenics movement in the United States during the 1920s-1930s followed by modern day debates about gene editing and designer babies. How similar or different are the issues from 1927 to 2017? How can we avoid going down the slippery slope of eugenics with these new technologies? We grappled with the concept of genetic determinism and what it means for science and society.

Background Readings:
The Forgotten Lessons of the American Eugenics Movement
Engineering the Perfect Baby
What's the Difference Between Genetic Engineering and Eugenics?

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No Country for Old Men: Can You Stop What is Coming? - April 13, 2017

Content

Christopher Scott, Ph.D.
Aging research has a new face: longevity. Baby boomers are living longer and longer lives but are faced with the real possibility that some of those years will be spent in suffering decline. A quiver of solutions is proposed, including stem cell transplants, new gene therapy, and precision medicine. Where does the hyperbole stop and the evidence begin? How will we grapple with what bioethicist Ezekiel Emanuel calls the era of “The American Immortal”? This session explored how this frontier area of the life sciences prompts new ethical questions and forces us to reconsider our relationship with new technologies, our fear of death, and our hope for a long, productive life.

Background Readings:
Is Silicon Valley Birthing the Next Pro-Lifers?
Treating the Aged with Young Blood
Why I Hope to Die at 75

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Beats, Breathes, and Brainwaves: Defining Death - March 9, 2017

Content

Savitri Fedson, M.D.
During this session on defining death, we explored how we have changed the determination of death. We looked historically at how death has moved out of the home and been made a medical subject. What is the effect of the Uniform Determination of Death Act in 1981? How has organ transplantation changed how we think of death? How and why death is not a simple fact.

Background Readings:
Clinically Dead? The Blurred Line Between Life and Death
The Premature Burial

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1984 or 2016: Big Brother and Big Data - Nov. 10, 2016

Content

Mary Majumder, J.D., Ph.D. and Christi Guerrini, J.D.
This session on health privacy featured a lively debate on the business of selling private health information. We considered both the sale of patient information by the biomedical-industrial complex (which some might view as an incarnation of “Big Brother”), including health insurance companies, provider networks, and researchers, as well as the sale of personal information by patients utilizing new digital platforms that allow them to share in the profits. What are the ethical and legal limits to selling private health information? What are social expectations and norms regarding health privacy, and are they changing?

Background Readings:
Privacy Or Profit? These Firms Want To Help You Sell Your Data
You Should Share Your Health Data: Its Value Outweighs the Privacy Risk
Health Secrets for Sale
Selling Health Data: De-Identification, Privacy, and Speech
Q&A: Privacy Maven Deborah Peel, MD

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Reading the Medical Tea Leaves: Divining Decisions - Oct. 13, 2016

Content

Jennifer Blumenthal-Barby, Ph.D.
During this session on behavioral economics and medical decision making, we focused on the quirks of human decision making and how they impact medical decision making. What are the implications for informed consent? How can doctors use knowledge of these quirks in a way that promotes patient best interests and autonomy rather than slipping into ethically worrisome territory of manipulation and coercion?

Background Readings:
Richard Thaler And 'The Making Of Behavioral Economics'
Thinking, Fast and Slow by Daniel Kahneman – Review
Guiding Forces