About the Center


What is Bioethics?

"No Easy Answers"

no easy answers w border“Bioethics” is a term with two parts, and each needs some explanation. Here, “ethics” refers to the identification, study, and resolution or mitigation of conflicts among competing values or goals. The ethical question is, “What should we do, all things considered?” The “bio” puts the ethical question into a particular context.

Bioethics is commonly understood to refer to the ethical implications and applications of the health-related life sciences. These implications can run the entire length of the bench-to-bedside “translational pipeline.” Dilemmas can arise for the basic scientist who wants to develop synthetic embryos to better study embryonic and fetal development, but is not sure just how real the embryos can be without running into moral limits on their later destruction. How much should the scientist worry about their potential uses?

Once treatments or drugs are in clinical trials involving human subjects, a new set of challenges arise, from ensuring informed consent, to protecting vulnerable research participants to guarantee their participation is voluntary and informed. Eventually, some of these new approaches exit the pipeline and are put into practice, where providers, patients, and families struggle with how to best align the risks and benefits of treatment with the patient’s best interest and goals. The added costs of new therapies inevitably strain available resources, forcing hard choices about how to fairly serve the needs of all, especially those already underserved by the health care system.

Questions in bioethics aren’t just for “experts.” Discussions of bioethical challenges take place in the media, in the academy, in classrooms, but also in labs, offices, and hospital wards. They involve not just doctors, but patients, not just scientists and politicians, but the general public.

Below you will find information on some specific areas within bioethics, as well as connections to a variety of related educational resources.

Clinical Ethics

stethoscope iconClinical ethics is a practical discipline that aims to resolve ethical questions or disagreements that emerge in the practice of health care. Clinical ethicists work to identify, analyze, and resolve value conflicts that arise when providers, patients, families, surrogates, and other stakeholders disagree or are uncertain about the ethically best course of action. For example, patients or their surrogates may refuse recommended treatments or demand non-beneficial treatments, which puts their requests at odds with providers’ medical judgment. Clinical ethicists help to identify and clarify ethical questions, find ethically acceptable courses of action, encourage honest and respectful communication between all parties, and recommend ethically acceptable solutions for the case at hand. Clinical ethics also works to improve institutional responses to ethical dilemmas through education and policy formation.

Health Policy

scales of justice iconHealth policy is about governmental efforts to manage health care as a public good. Government must assure access to needed health care for all, incentivize curative research, protect health quality, and control health care costs. Justice is the moral value most pertinent to health policy, given large public investments in creating our health care system. Consequently, bioethicists ask whether it is just that an individual’s access to needed, costly and effective care should depend upon an individual’s ability to pay, or the willingness of a state legislature to adequately fund the Medicaid program for the poor? Should the genetically healthy and fortunate help pay the health care costs of the genetically unhealthy and unfortunate? A just and caring society must address these questions through thoughtful bioethical inquiry and respectful democratic deliberation.

Genetics

dna helix iconMuch of medicine today is about genetics, whether for disease prevention, diagnosis, treatment, or reproductive decision-making. Emerging genetic technologies and knowledge generate numerous value conflicts. Consequently, bioethicists ask what is ethically appropriate if individuals have a mutation for a serious and now untreatable genetic disorder. Are those individuals ethically obligated to sacrifice their privacy rights to inform at-risk relatives? What are the ethical obligations for the best interests of future possible children on the part of parents considering whether and how to have children, when whole genome sequencing indicates serious potential risks associated with conceiving those children? Should social policies govern such decisions? Should those policies protect parental procreative liberty or enhance social responsibility for the best interests of those future possible children? This is bioethics in the age of genomics.

Neuroethics

brain head iconAs our ability to understand, measure, and manipulate the functioning of the human brain and nervous system rapidly advances, so too does our need to grapple with the ethical, social, and legal implications of these tools and neuroscientific knowledge. Neuroethics is an interdisciplinary research area that involves systematizing, defending, and recommending paths to action to address those issues. Neuroethics is also a platform for engaging different stakeholders to interact and discuss the future of neuroscience and neurotechnologies. That platform can take theoretical but also empirical and pragmatic approaches to the issues it covers, including the use of neuroenhancement drugs, memory dampening techniques, neural prostheses, the clinical and non-clinical uses of neuroimaging, and policy issues around neurotechologies. Neuroethics brings to light theoretical and reflective issues regarding how we think about and treat each other.

Clinical Neuroethics

Clinical neuroethics is a field at the intersection of neuroethics and clinical ethics, two dynamic and exciting disciplines. While neuroethics has developed at a time that neuroscience is making significant discoveries and developments at a rapid pace, clinical ethical questions have been on the table since the beginning of medicine. Clinical neuroethics combines these well-established issues with issues raised by interventions, drugs, and treatments that impact mental and neurological states. For example, the use of ventilators generated questions about who is alive and who is dead, as ventilators could keep blood circulating and oxygen flowing. Now, imaging tools can detect brain functions in those who appear clinically dead, and these questions arise anew. Clinical neuroethics addresses topics such as consciousness, death, deep brain stimulation, pain, and enhancement in the clinical setting.

Precision Medicine

test tube pills iconPrecision medicine is often ethically ambiguous. Precision medicine is about very expensive cancer drugs designed to target the genetic “drivers” of a metastatic cancer. In the U.S., ninety of these drugs have FDA approval and costs of $100,000 or more per year, with some therapies (CAR-T cell therapies) priced at $475,000. Some of these drugs are very effective. Imatinib (Gleevec) for chronic myeloid leukemia will yield more than ten extra years of life for 70% of these patients, but at $135,000 per year. Most, however, yield only extra months of life at very high cost. One goal of precision medicine is identify biomarkers that predict effectiveness in individuals. What then? Do we deny the drugs to patients who very likely (not certainly) will gain no more than three extra months of life? Is that limitation either just or caring? Therein lies the ethical ambiguity.

Reproductive Ethics

sperm egg iconReproductive ethics addresses topics that commonly provoke social and legal controversy, and intimately connect to concerns over reproductive justice. The field looks at issues related to assisting fertility (assisted reproduction, surrogacy, genetic manipulation of offspring), restricting fertility (contraception and sterilization), terminating a pregnancy (abortion), minors and access, and concerns that are more general over maternal and fetal best interests. Reproductive ethics examines perplexing questions: Should we enable people to reproduce after they die? Should we keep a brain-dead pregnant person on life support to allow for the birth of their child, or harvest a dead person’s sperm? Should we manipulate the DNA of our offspring, not only to eliminate entire genetic disorders, but perhaps also to select superficial traits such as intelligence or athletic ability? Reproductive ethics focuses on these questions, and more.

Research Ethics

microscope iconResearch ethics addresses a variety of ethical challenges or questions that arise in the conduct of research, human or animal, clinical or basic science, many of which are not answered by regulations. For example, the distinction between “identifiable” and “non-identifiable” is a critical boundary in human subjects research. Research using data whose human sources are not identifiable is not subject to the requirement of informed consent. But as the amount and variety of data (including genetic data) assembled around one individual increases—as happens in “Big Data” research—the less possible it is to guarantee anonymity to the sources. Then the question is whether the data is “non-identifiable” enough. That requires balancing the nature and magnitude of the risks against the research benefits.

Shared Decision-Making

handshake iconEffective clinical encounters depend on good communication. With the goal of arriving at the best possible decision for the individual patient, shared decision-making is the process whereby a healthcare decision is presented, discussed, deliberated, and negotiated between the provider and patient. In shared decision-making, a physician taps their knowledge about the available evidence and combines it with their experienced clinical judgment to provide balanced information regarding treatment choices. That information then is communicated to the patient – allowing them to clarify and determine their healthcare options in light of their own values and preferences. Shared decision-making evolved from the recognition of a patient’s right to autonomy and reflects ethical medical practice. Recognizing that there are two experts in the room, shared decision-making is the pinnacle of patient-centered care.

Social Determinants of Health

map location iconIn the clinical encounter, patients bring complex social circumstances that are a consequence of their physical and social environment and access to resources. Limitations on those resources determine a patient's ability to prevent illness, maintain health, and recover when illness occurs. Social justice draws our attention to disparities in health and asks not only that we recognize such disparities – it also requires us to actively work toward solutions both for the individual and the population as a whole. Learning about and respecting a patient’s socially-circumscribed access to resources can enhance the patient-doctor relationship. Even with the expanding emphasis on genetics and precision medicine, it remains the case that "it’s zip code not genetic code” – where a person lives as well as their related social experiences have a profound impact on their health.

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Program to Close Gap between Thinkers, Doers

Andrews Hunt photoThe gap between thinkers and doers is sometimes a wide one.

If philosophers are the thinkers and physicians are the doers, can their polarized positions meld to produce a thinking doer? More practically, can medical educators aided by humanists, produce a physician who treats more than the disease -- one who treats the whole person?

This is the crux of a new program on medical humanities, headed by MSU’s long time Dean of the College of Human Medicine, Andrew Hunt.

Officially approved by the Board of Trustees in September, the fledgling formal program is based on an approach to medical education that has been in the informal seminar-discussion-study stage at the University for several years.

Its proponents believe that medicine is one of the humanities. In a small, but growing national trend, educators are beginning to look at the totality of the education a medical doctor receives and the subtleties that should be included in that education.

MSU’s earliest plans for the College of Human Medicine emphasized a multidisciplinary approach to medical education, the core on which the new program is based. Hunt calls the interdisciplinary effort “an almost characteristic Michigan State way. At Michigan State,” he says, “we have fairly low department barriers -- a long history of easy collaboration.”

But Hunt himself confesses a little surprise at the early innovative plans. “They were talking about utilizing the existing departments of anatomy, physiology and biochemistry which were already here for vet medicine,” Hunt says, explaining that medical schools normally have their own departments in these areas.

“This was very innovative at the time,” he continues. “Actually, it was a little scarey because it was so new, but President Hannah was very dynamic and compelling -- and it was going to work.”

Hunt’s inclinations were the same as Hannah’s, however, and when he found that the behavioral sciences were interested in participating in the same ways as the biological sciences, he remembers, “I made it almost a condition of recruitment that I'd come if they would add these (anthropology, sociology, psychology) to the pre-clinical 2-year program.”

The curriculum of the college from the beginning was more related to social needs Hunt says, and in the process of its formation, innovative faculty and students looking for this approach were attracted.

About four or five years ago, Hunt says, MSU faculty began to get interested in some of the issues being talked about nationally -- issues he calls “really enormous.” He lists “obvious ethical decisions and serious technological problems, the life and death of mentally deficient infants, old people kept alive by machines.

“There’s a whole area of informed consent,” he continues, “doctor-patient relationships, respecting the feelings of the patient which we haven’t done very well in the past, ethics of research programs, ethical issues of controlled experiments on human subjects, public policy issues like abortion, and so on.”

“During that period, Martin Benjamin, associate professor of philosophy and his departmental colleagues began holding ethics conferences in area hospitals,” Hunt says. A medical student on campus, Howard Brody, became well known nationally with his deep involvement in the expanding informal medical humanities program. “Potchen came,” Hunt says of James Potchen, chairman of radiology, “and he was interested in it and it was under his department’s aegis that the evening seminars on the subject of medical humanities began.”

Now after two years of these multidisciplinary seminars which have created a growing interest among students and other faculty, came the formalized program “complete with coordinator, an office and an account number,” says Hunt.

The changes planned for this year are minimal. “We’ll continue much the same this year,” Hunt says. “We will try to create a policy board, with representation from the colleges of medicine, nursing, University College, arts and letters, the Honors College and others.” The evening seminars and ethics conferences will continue.

But as the years progress so will the emphasis on humanities in training physicians and Hunt believes that other disciplines will benefit from their involvement in the process.

Potchen, a firm believer in “treating the sick people instead of their diseases” says “one thing we've never done is to effectively crystallize a lot of the resources of this institution to bring to bear on problems in medical education.

“Of all the institutions I’ve been in, this institution has the biggest chance of pulling off the big difference,” Potchen says.

Hunt believes that this sharing of the medical student’s education can offer shadings to doctors not previously experienced.

“Philosophers approach problems in a different way,” he says. “In a scholarly way, they understand the history, human thought, the logic and morality of a subject. They argue conceptually about problems and disagree violently with each other, but still maintain respect for each other,” he says. “They dissect issues logically, which physicians just don’t do.”

Hunt says the medical profession is in trouble with “what looks like greed . . . with what looks like callousness . . . with what looks like a very conservative political position.”

His idea is not to basically change the doers that physicians must be, but to tone them with colors from the humanists and to offer them culture within the medical school
complex. “Medical school has a way making people into terrible drudges and that isn't what we want,” he says.

If this humane approach to educating a physician is working or will work Hunt doesn't know. “Whether it really makes a measurable difference, in our graduates, I don't know, but we can really get our faculty thinking in these kinds of terms and imparting them to students.”

“Somehow it’s bound to make a difference.”

The next evening seminar is tonight (Thursday, Nov. 10) 105 Kellogg Center. Hunt and Harold Blumenstein, Bay City radiologist, will speak on “The delivery of health care: physician’s, patient’s and society’s rights.”

-- JANICE HAYHOW

Michigan State University News-Bulletin
November 10, 1977

Center History

Andrew Hunt photo

Founding

With support of a grant from the National Endowment for the Humanities, in 1977 the Medical Humanities Program hired several new faculty who developed required ethics curricula in the Colleges of Human Medicine, Osteopathic Medicine, Nursing, and Veterinary Medicine. Supported at the time by six different colleges, the program had the additional advantage of functioning as a cross-university resource with an interdisciplinary approach.

Read an interview with Dr. Hunt about the formation of the Medical Humanities Program.

Howard Brody photo

Evolving

When Dr. Hunt retired in 1985, Howard Brody, MD, PhD, assumed the helm. In 1988 the program was granted "Center" status, and renamed the Center for Ethics and Humanities in the Life Sciences (CEHLS) to mark its involvement in disciplines beyond biomedicine. 

Under Dr. Brody’s 15-year guidance, CEHLS expanded its identity, its faculty, and its scope. The Center’s mission statement opens with the words, "committed to supporting reflective practice in health care and in science, by bringing to these fields the resources of ethics and humanities."

The discipline of medical ethics and humanities evolved from those seminal ethical issues associated with the doctor-patient relationship, life-extending technologies, and the ethical treatment of human subjects to include micro/macro level social policy questions such as: What economic issues most affect health care? How can physicians best deliver health care in a pluralistic society? How can physicians contain costs while preserving a trusting relationship with their patients? And legal questions as well: Who should make medical decisions for minors? What should be the relationship between industry and medicine? Notably, issues that had the appearance of exotic science fiction in the 1970s, such as cloning, and mapping the human genome, are today’s twenty-first century realities. These and other developments in medicine and health introduce ever-more challenging questions for bioethics consideration.

Read Dr. Brody's farewell article, published in the Medical Humanities Report; Volume 28, No. 1, Summer 2006.

Tom Tomlinson photo

Today

In 2000, Tom Tomlinson, PhD, became the Center’s Director. He served as Director until August 2018, and under his guidance the Center’s core faculty members directed their ongoing attention to understanding varied aspects of the human condition including chronic illness, birthing, aging, disability, international research ethics, spirituality, and neuroethics, to name only a few.

To address the rapidly expanding bioethics agenda, and also to meet its many teaching responsibilities, CEHLS highly values the collaborative support from within as well as outside of the University.

Center Professor Leonard Fleck, PhD, who has been with the unit since 1985, became Acting Director in August 2018. Read a message from Dr. Fleck.

A Quarter Century's Worth of Furniture

Howard Brody photoWhat is it like leaving the place that has been my home for the past quarter century? I grew up here, as a professional and in other ways. New vistas and new challenges are exciting, but it is very difficult to leave behind my housemates who have been with me this for so long.

One of the colleagues in the new home I am going to paid me a nice compliment. He had last spent time with me up close about 14 years ago. He had thought that back then I showed a number of good qualities, but he was also pleased to see that today some of the rough edges had been rubbed off. If he’s right, I have no doubt that my housemates helped a lot with the sandpaper.

As much as I will miss my housemates, they have made me a very handsome offer. They are going to let me take some of the furniture from the old place with me. In my new home, I’ll be able to look fondly at these furnishings and remember my former associates all the more clearly.

So what do I plan to take with me?

First off, there is competence and professional responsibility. My housemates are teachers down to the marrow of their bones. They care deeply that those who come into contact with us take away something of value. I have never done teaching with any of them when I have not taken away some new tips on how to become a better teacher.

Next, I had thought of taking honesty. When I was starting to think about leaving, I took the first opportunity to talk with all my housemates about my thoughts, plans, and concerns. It would have been unfathomable to treat them any other way. Any hesitation or prevarication on my part would have been a churlish recompense for the way that they have treated me for so many years.

I definitely want to take compassion. This past year, which caused me to consider leaving the place that had been my home for so long, was in some ways very painful. At every step, I felt the support of my housemates. When one of our beloved housemates died recently, the sense of loss and the concern for her family were palpable as one walked though the rooms of our house. I hope to live up to this standard of compassion in how I treat all my new colleagues in my new place.

Respect for others is another thing I want to bring with me. In our house, we have taken many actions and made many decisions. I cannot recall when, if ever, we did anything by vote. We have talked and discussed and listened, and always have found ways to agree on what was best. Again, I hope to be able to rise to that standard in how I treat my new colleagues.

Finally, there is social responsibility. My housemates have always been concerned for those who are ignored by our society, those whose voices have not been heard. They have taught me that this thing we call bioethics and humanities in health care is not worth calling as such if it does not welcome the voices that have not been heard and adopt the concerns that have not been addressed.

I hope that some of our students in the College of Human Medicine read what I have written here. They will, I trust, recognize my furniture inventory. In the College, we call this list the virtues of professionalism. We hope that they will strive toward these virtues in how they treat their patients.

I hope that my faculty colleagues in other departments are as fortunate as I have been. I hope you can say that you treat each other the same way that my housemates have treated me—that as faculty, we model for ourselves and our colleagues, as well as for our students, this list of virtues. (If not, I invite you to imagine how things could change.)

There is one immensely rewarding thing about my furniture inventory. I can take as much of this furniture with me as I can possibly haul away, and plenty will still remain in the house that I am leaving.

-- HOWARD BRODY

Medical Humanities Report
Volume 28, No. 1, Summer 2006

Mission

The Center is committed to supporting reflective practice in health care and in science, by bringing to these fields the resources of ethics and the humanities. We do this through teaching, writing, public speaking, conducting research and working in many other ways with students, practitioners, and the general public. Our work is integrative: each activity informs the others, and all draw upon (and draw together) the humanities, the arts, and the sciences. We seek to deepen our field's response to cultural diversity and to increase the diversity of those active within it. We are an educational resource for the university and the state, and for national as well as international audiences.

Teaching

Our principal teaching commitment is to medical, nursing, and veterinary students at Michigan State University; we also teach other groups, especially graduate students, medical residents, and undergraduates. In all of our teaching, from semester-long courses through one hour lectures, from drawing up curricula to conducting workshops, we try to collaborate with other faculty in the colleges we serve. In our teaching, as in all our work, we emphasize the ways in which theory and practice illumine one another. Having helped establish bioethics curricula in several colleges, we now seek to strengthen the presence of other humanities and disciplines in the health care and science programs. Learn more on our teaching page.

Research and Scholarship

Our writing and research projects are intrinsically interdisciplinary, drawing upon the insights of the humanities and the findings of science to support reflective practice. Because of our practical and integrative commitments, we highly value collaborative work which reaches a diverse audience, both professional and public. Learn more about current and recently completed projects.

Public Service

Community outreach is at the core of all we do: we are proud to be part of a major land grant institution and of health care colleges which are community-based. Our public service activities -- workshops, public speaking, advising or consulting, and so on -- are varied, chosen in part for their contribution to our teaching and scholarship, but also for their usefulness to practicing health care professionals and researchers. These involvements help us understand the institutions about which we teach and write, and help us develop fruitful working relationships with practitioners. We especially hope to deepen the level of public, democratic deliberation about health and science policy. Learn more about outreach activities.

CEHLS faculty staff Aug 2018

Pictured above: Center faculty and staff. Left to right: Peggy Anderson, Karen Kelly-Blake, Leonard Fleck, Laura Cabrera, Tom Tomlinson, Larissa Fluegel, Devan Stahl, Libby Bogdan-Lovis, Liz McDaniel.