ANNALS OF INTERNAL MEDICINE: Authors Matthew DeCamp, MD, PhD, and Lois Snyder Sulmasy, JD, recognize health as a human right based in the intrinsic dignity and equality of all patients and supporting the patient–physician relationship and health systems that promote equitable access to appropriate health care. They propose the U.S. should move closer to respecting, protecting, and fulfilling for all the opportunity for health.
The ACP Ethics Manual states, “The principle of distributive justice requires that we seek to equitably distribute the life-enhancing opportunities afforded by health care. How to accomplish this distribution is the focus of intense debate.”
CU ANSCHUTZ NEWS: As articifical intelligence (AI) technology evolves, ethical questions and challenges arise. CBH faculty Matthew DeCamp, MD, PhD, asks, ‘Who are we forgetting? Who is left out by these tools?’ There’s a place in ethics that puts special emphasis on the way we treat those who are or who may be in the minority and are harmed by what we’re doing,” he says. “It’s important to not assume that just because something is better overall it’s better for everyone. There may still be individuals and groups who are harmed by the technology.”
Addressing those challenges should come in the design process of new AI tools. “We need to start demanding that AI proactively reduce disparities and equities, not design it and wait for that to happen later,” DeCamp says.
NEW YORK TIMES: The debate over aid in dying still rages in the language that medicine and the media use to describe the practice. “There is a significant, a meaningful difference between someone seeking to end their life because they have a mental illness, and someone seeking to end their life who is going to die in the very near future anyway,” said Dr. Matthew Wynia, Director of the Center for Bioethics and Humanites.
JAMA NETWORK OPEN: In an invited commentary, Matthew K. Wynia, MD, MPH, Christine M. Baugh, PhD, MPH, and Eric G. Campbell, PhD, note that academic settings are where physicians-in-training establish their habits and form lifelong professional identities, and interventions to reduce or eliminate gifts from medical and device companies to trainees have long been known to have durable effects. The authors suggest that academic institutions should be exemplars of avoiding COI, by prohibiting gifts from medical and device makers.
CU ANSCHUTZ NEWS: ‘It’s almost impossible to fully describe the harm,’ lawyer says during his keynote address at the Advocating for Children in Migration symposium on September 21st.
It all started with the asylum-seeking mother who escaped violence in the Democratic Republic of Congo in 2018, arriving barefoot and hungry at the border. By the time Lee Gelernt, JD, arrived in San Diego to represent the woman placed in a makeshift detention center, her 6-year-old daughter had been taken from her, shipped off to Chicago four months earlier.
Gelernt, a lawyer with the American Civil Liberties Union (ACLU), promptly filed a lawsuit for her return and began collecting numerous heart-wrenching stories from other affected families. That kicked off his successful class-action lawsuit against the Trump administration’s policy of separating immigrant families at the U.S.-Mexico border.
“There are still some people who think that policy should be reenacted. “The family separation lawsuit is a good lens through which to look at how we try and shape the narrative and how we reach the public: what works, what doesn't work and what are the real challenges.”
JOURNAL OF PERINATOLOGY-NATURE: Jackie Glover, PhD and colleagues in the Pediatrics Department at Children's Hospital Colorado, developed an ethical framework to guide patient care and research for prenatally diagnosed severe renal anomalies. The authors identifiy ethical challenges in communication, timing of decisions and scarce resources.
The framework addresses shared decision-making, establishing trust, managing disagreements, the child’s best interests, the harm principle, and a zone of parental discretion. Glover and co-authors believe that operationalization of this framework affords the support needed to provide comprehensive patient and family-centered care for these complex patients. Read article>>
MEDPAGE TODAY: In a paper published in the Annals of Internal Medicine, Matthew DeCamp, MD, PhD, and co-authors seek to help practicing physicians understand, even more clearly than they already do, just how important the standards for the determination of death are.
Advances in re-establishing postmortem circulation through extracorporeal membrane oxygenation (ECMO) or normothermic regional perfusion -- a transplant protocol emerging in U.S. hospitals -- have made the dichotomy between the circulatory and brain criteria of the 1980 definition in the Uniform Determination of Death Act more consequential.
"The determination of death is something that happens every day. It is a profound and solemn act that physicians and other clinicians engage in," DeCamp said. "They intersect the fundamental values of the profession -- values like honesty, transparency, integrity, and respect."
DALLAS MORNING NEWS: “It raises questions about justice and fairness, because now the burden of providing medical education is falling disproportionately on vulnerable and marginalized members of society,” said Matthew DeCamp, MD, PhD. “Anatomy lab is often one of the most profound and important experiences a student can have, not just because of learning anatomy but also because of learning some of the fundamental values of the medical profession and respecting human dignity,”
Just how many unclaimed bodies are used in medical education is difficult to pinpoint. DeCamp co-authored a 2019 study that surveyed 146 U.S. medical schools on the use of unclaimed bodies, of which only 89 responded. Eleven schools reported possible use of unclaimed bodies, although programs differed on whether they believed students should be informed of unclaimed body use.
RADx-UP/NIH: "Research, Engagement, and Action on COVID-19 (REACH-OUT) is a community-based study,” said Matthew DeCamp, MD, PhD. “We involve the community in both design and the implementation of our study to address social, ethical, and behavioral barriers to COVID-19 testing.”
The team, including Quatisha Bailey, MA, from Children’s Hospital Colorado, conducted 250 surveys in a three-week timeframe,” and found themes that stuck out were trust and distrust, health care access, and awareness around COVID-19. “Trust is everything,” said Bailey. “And how to establish trust, regain trust, and maintain trust is language. We have to speak in a language that people understand.”
COLORADO SUN: When the state of North Dakota passed a law requiring abortion providers to inform patients that it may be possible to “reverse” a medication abortion, Center Director, Matthew Wynia, MD, MPHspoke out against it. “It's a terrible idea to try to legislate medical practice.” says Wynia.
“This misrepresentation will serve to mislead or coerce patients who want to ‘undo’ a medication abortion to participate in an unethical experiment without their knowledge,” Wynia wrote in a declaration filed in a lawsuit seeking to stop the law. “For physicians who are forced to deliver a misleading and inaccurate message that might cause their patients to enroll in an experiment without their full knowledge, doing so is highly unethical.”
CU ANSCHUTZ TODAY: “The laws we have and the laws we don't have… have an enormous impact on who gets sick to begin with. And they determine, literally, who lives and who dies sometimes, and who lives with what degrees of preventable illness." said Daniel Goldberg, JD, PhD, director of education at the Center for Bioethics and Humanities and director of the new Public Health Ethics & Law Program (PHEAL) at the Colorado School of Public Health.
The experience of living and breathing through a pandemic brought many ethical and legal issues to the forefront, and we have to deal with these as a society in order to try to keep ourselves and the world healthy and protect the most vulnerable. That's why now is precisely the right time for the Colorado School of Public Health and Center for Bioethics and Humanities to launch the Public Health Ethics and Law Program.
CU SCHOOL OF MEDICINE WHITE COAT CEREMONY: Matthew Wynia, MD, MPH, FACP Professor, Department of Medicine and Director of the CU Center for Bioethics and Humanities delivered the keynote address to the incoming 184 aspiring physicians, as well as hundreds of family, friends, and faculty who will join them on their journey. Dr. Wynia also was recognized with the 16th Annual Faculty Professionalism Award, which was presented by Abigail Lara, MD, Associate Professor, Department of Medicine Director, Office of Faculty Relations.
NATURE: Investigations suggest that, in some fields, at least one-quarter of clinical trials might be problematic or even entirely made up, warn some researchers. They urge stronger scrutiny. Lisa Bero, PhD and colleagues acknowledge trustworthiness checks are sometimes unfair to the authors of randomized controlled trials, and exactly what should be checked to classify untrustworthy research, is still up for debate. Bero and a team of research-integrity experts have developed a set of red flags that might serve as the basis for creating a widely agreed method of assessment.
SCIENCE: Artificial intelligence (AI) shows promise for improving basic and translational science, medicine, and public health, but its success is not guaranteed. Numerous examples have arisen of racial, ethnic, gender, disability, and other biases in AI applications to health care. Co-authors Matthew DeCamp, MD, PhD and Charlotta Lindvall, MD, PhD write that ensuring equity will require more than unbiased data and algorithms. It will also require reducing biases in how clinicians and patients use AI-based algorithms—a potentially more challenging task than reducing biases in algorithms themselves.
AMERICAN MEDICAL ASSOCIATION: Center Director Matthew Wynia, MD, MPH, received the AMA Foundation Award for Leadership in Medical Ethics and Professionalism. Matt is one of 11 physicians to recieve an Excellence in Medicine Award at the AMA's June, 2023 meeting in Chicago, where he was recognized for his altruism, advocacy and professional skill, The award honors people dedicated to the principles of medical ethics and the highest standards of medical practice and who have made an outstanding contribution through active service in medical ethics activities.
Dr. Wynia also was named as co-chair, along with Niva Lubin-Johnson, MD, MPH, of a task force to guide organizational transformation within and beyond the AMA toward restorative justice to promote truth, reconciliation, and healing in medicine and medical education.
HARVARD HUMAN RIGHTS JOURNAL: As we approach the 100th anniversary of children’s rights, in which the Geneva Declaration of the Rights of the Child stated that humanity “owes to the child the best that it has to give," this commentary by Warren Binford, JD, Ed.M, affirms the U.S. has a moral duty to more fully integrate children into our national priorities and decision-making.
Children comprised 22.1 percent of the U.S. population in 2020 and yet just 7.4 percent of the federal budget was allocated for their needs. It is only when children are able to fully exercise their political rights that their needs will start to be addressed by a system that too often has dismissed them as merely children, and as a result, under-resourced them and their future.
WASHINGTON POST: Withholding information for the patient’s best interest was the norm in medicine for centuries. Doctors were the gatekeepers of health and their duty was to provide hope and comfort. Currently the doctor-patient partnership model has replaced that sort of medical paternalism. Yet doctors still make routine judgments about how much to tell patients.
Too much information can be unhelpful and confusing, said CBH Research Director, Eric Campbell, PhD. Should a doctor decide that medical choices are over a patient’s head so they shouldn’t be mentioned or that a patient is too fragile to handle difficult news? Such assumptions can reflect an implicit bias that can lead to health disparities. Poorer outcomes can result when a doctor’s unconscious feelings about skin color, gender, disability, age or ethnicity influence what gets shared.
CU ANSCHUTZ NEWS: Senator John Hickenlooper and Federal Drug Administration (FDA) Commissioner Robert Califf, MD, visited our campus on June 23rd. Following a tour of the Gates Manufacturing Facility, a group of researchers and CBH Director Matthew Wynia, MD, MPH, came together to discuss insights into pandemic preparedness with Hickenlooper and Califf, whose son graduated from the University of Colorado School of Medicine and practices in Colorado.
Hickenlooper, is a member of the Senate Health, Education, Labor & Pensions Committee, is currently working on the reauthorization of the Pandemic and All Hazards Preparedness Act (PAHPA). That legislation addresses agencies, including preparedness programs at the FDA, Biomedical Advanced Research and Development Authority, the Administration for Strategic Preparedness and Response and other public health infrastructure programs.
NASEM: Chief Scientist Lisa Bero, PhD was the keynote presenter at a 3-day National Academies of Sciences, Engineering and Medicine Workshop on the many ways that funding sources (especially corporate funders) can influence and impair research quality and outcomes.
THE MESSENGER: Researchers Nadia Gaber, Lisa Bero, and Tracey J. Woodruff analyzed a trove of previously secret documents initially uncovered during litigation by Robert Bilott, the first attorney to successfully sue DuPont over PFAS. Bero and colleagues found that by “suppressing unfavorable research and distorting public discourse, 3M and DuPont were able to tamp down wider concern for decades, using strategies similar to Big Tobacco to keep the risks quiet."
Their findings and implications for policy makers & the public were published in an article in the Annals of Global Health entitled, The Devil they Knew: Chemical Documents Analysis of Industry Influence on PFAS Science.