Spring 2003 Brown Bag Series
January
22, 2003 -- Renee Anspach, Ph.D
In this paper I explore the role of emotions in the moral choices
of women undergoing genetic testing and those of parents and professionals
deciding whether a critically ill infant will live or
die.Typically these decisions evoked powerful emotions, suggesting a strong
link between everyday morality and the emotions—a link that has received
little attention from those who study medical decision making.All too often,
both medical ethics and social science treat emotions either as irrelevant
to moral choices or as barriers to dispassionate decision making. By contrast,
a growing body of theory and research in philosophy, feminist theory, and
the social sciences suggests that emotions are fundamental ingredients of
moral life that can be a source of as well as an impediment to valid knowledge.
Basing my arguments on this literature, I emphasize three points. First, many
of what are ostensibly conflicts over ethical principles actually have an
emotional subtext. Second, social and institutional arrangements shape the
level of emotional engagement participants bring to the decision. Third, emotions
can both reflect and be used to sustain power relations. I conclude by suggesting
that bringing emotions to the foreground may lead to a deeper understanding
of the ethics of everyday life. By exploring the role of emotions in medical
decision making, this paper will illuminate an often neglected yet important
part of the context of medical culture and explore the emotional subtext of
patient beliefs, values, and
behaviors
February
11, 2003 -- Joel Howell, M.D., Ph.D.
Joel D. Howell is the Victor
Vaughan Professor of the History of Medicine at the University of Michigan,
where he also holds appointments in the departments of Internal Medicine (Medical
School), History (College of Literature, Science, and the Arts) and Health
Management and Policy (School of Public Health). He is Co-Director of the
University of Michigan Robert Wood Johnson Clinical Scholars Program and Director
of the University of Michigan Program in Society and
Medicine. He has written widely on the use of medical technology, examining
the social and contextual factors relevant to its clinical application and
diffusion, analyzing why American medicine has become obsessed with the use
of medical technology. He has also written and spoken widely on the history
of human experimentation, especially the policy implications of that history.
His current research is an attempt to analyze the implication for health policy
of factors that have both contributed to and slowed the diffusion of medical
technology into clinical practice, using both a sociology of knowledge and
a comparative approach. His most recent book is Technology in the Hospital:
Transforming Patient Care in the Early Twentieth Century,
(Baltimore: Johns Hopkins University Press, 1995). Dr. Howell's research has
been recently supported by a Robert Wood Johnson Foundation Investigator Award
in Health Policy Research and by a Burroughs Welcome Foundation Award in the
History of Medicine. He was recently named to the University of Michigan Society
of Fellows.
March 12,
2003 -- Doris Zallen, Ph.D.
It is generally assumed
that genetic information is effectively conveyed to consumers through the
usual interlocking medical networks -- networks involving family physicians;
specialists who treat
individuals with genetic disorders; and genetic professionals, such as genetic
counselors. However, in an extended series of interviews carried out with
people who were dealing with genetic disorders in their lives, it
became apparent that another pathway exists whereby genetic information is
acquired and distributed, and which is called upon when genetic decisions
need to be made. This informal, but nonetheless powerful, mode of information
sharing is what I have called the "genetic grapevine". My
talk will describe the genetic grapevine, its strengths and shortcomings,
and the challenges that it presents to the medical community. Participants
can expect to gain an understanding of the ways in which genetic information
is acquired, interpreted,
and used by consumers as they make decisions about matters such as genetic
testing; and understanding of the ways in which genetic information is acquired,
interpreted,
and used by consumers as they make decisions about matters such as genetic
testing; and an appreciation of the ways in which genetic information differs
from other types
of medical information and the responsibilities that the special status of
genetic information presents to the practicing physician and to policy-makers.
Doris Teichler Zallen is
professor of science and technology studies at Virginia Tech and is the
founding director of the Choices and Challenges forum project. As
a laboratory scientist, Zallen worked on the development of early forms of
genetic linkage testing. In recent years, she has turned her attention to
the humanistic issues arising from recent advances in genetics, particularly
medical genetics. She is the author of Does It Run in the Family? A Consumer's
Guide to DNA Testing for Genetic Disorders and other works exploring
ethical, social, and policy issues in genetics. She was a member of the NIH
Recombinant DNA Advisory Committee (1992-1996) and chaired its Working Group
on Informed Consent
April 2,
2003 -- Clarence H. Braddock
III, MD, MPH
What’s in a Name?
As one examines the
literature on informed consent and shared decision making, other
terms have emerged as competitors in the quest to characterize the ideal vision
of patient and physician as partners in making health decisions. Even the
term “shared decision making” is
used quite differently in the bioethics literature compared to its use in
the realm of decision analysis and decision theory. Such a plethora of terms
to describe what at first glance is the
same phenomenon raises an interesting question: are these terms synonymous?
If they are, then we can go about our business of studying shared decision
making. If they are not, we should have a consistent set of definitions and
conceptual understanding. In this talk, I will compare and contrast several
different conceptual models of doctor-patient decision making. I will then
argue that there is a preferred model, with which scholars should consistently
work as they study and write about this phenomenon. At the end of this session,
participants will be able to (1) describe differences in how patient-physician
decision making is conceptualized in the literature; (2) discuss the elements
of informed decision making; and (3) restate an argument for a preferred
conceptual model for patient-physician decision making.
Clarence H. Braddock
III is Associate Chairman in the Department of Medicine and an Associate Professor
in the Departments of Medicine, Medical History and Ethics (School of Medicine),
and Health Services (School of Public Health and Community Medicine) at the
University of Washington. He received his M.D. from the University of Chicago,
received internal medicine training in the US Navy, and his MPH with a concentration
in Health Care Ethics from the University of Washington. Dr. Braddock is Director
of the Bioethics Education Project at the UW School of Medicine, an initiative
to expand and integrate more ethics education into the curriculum. Dr. Braddock
has research interests in physician-patient communication and informed decision
making. He has published numerous papers and book chapters, including a study
in JAMA, in which he and colleagues analyzed audiotapes of over 1000
physician-patient encounters, the
largest direct observational study of informed decision making.
April
9, 2003 -- April M. Herndon
Is the “war on obesity”
really a war against disease, or is it instead a battle against fat people?
With newspaper headlines decrying the “epidemic of obesity” and
the threats to the United States’ economic well-being as well as future
generations of children, obesity ranks as a formidable public enemy. Obesity,
however, is not faceless; rather, it is an embodiment more and more closely
associated with the working class, poor, and/or people of color. Investigating
representations of obesity that portray the disease as a problem of race and/or
class, I parse out the social and ethical implications of the arguments that
follow. Ultimately, I suggest that socio-medical discourse fights the “war
against obesity,” much like our current “war against terrorism,”
not at theabstract level of unseen disease and adipose tissue but instead against already socially beleaguered people. In short, the same people who have historically been characterized as threats to our nation, the poor and/or people of color, are once again conveniently targeted in the “war against obesity.” Participants will be exposed to the possible sociocultural impacts of the “war on obesity” and the ways certain medical discourses can be culpable in obfuscating deeper social problems; be encouraged to question whether or not a “war on obesity” is justified and ethical in light of current medical data on obesity and overweight; and be asked to consider who is targeted in the “war on obesity.” The presentation will pay careful attention to fatness alongside other social locations such as race, gender, class, and nationality and how the people living at the intersections of these embodiments might be affected by the medicalization of weight.
April
M. Herndon is a Ph.D. candidate in the American Studies Program at Michigan
State University. Ms. Herndon is currently working on her dissertation, entitled
“(Un)American Fatness
and the Political Body”. She has presented parts of her dissertation
at national conferences such as The American Studies Association, American
Society for Bioethics and Humanities, and the National Women’s Studies
Association.
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Michigan State University, College of Human Medicine and the Center for Ethics and Humanities in the Life Sciences. The Michigan State University College of Human Medicine is accredited by the ACCME to provide continuing medical education for physicians.
Michigan State University College of Human Medicine, designates this educational activity for a maximum of 1 hour in category 1 credit per session towards the AMA Physician's Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the activity.
