S u m m e r E d i t i o n 2 0 1 4 M E D I C A L E T H I C S I N U T A H

Publ ished by the Divis ion of Medical Ethics and Humanit ies of the Department of Internal Medicine at the Universi ty of Utah School of Medicine

Innovative Changes in Teaching for Division of Medical Ethics and Humanities

at the School of Medicine

Not so very long ago, our Summer Newsletter featured excerpts from an “Ethics Best Essay” award paper that

had come from the final papers written for the Medical Ethics Course taught by the Division of Medical Ethics

and Humanities, and required for all 4th year medical students at the University of Utah School of Medicine.

With curriculum reform in recent years, that course is no longer taught as a single unit, but its contents are

interspersed throughout all four years of the medical school curriculum, beginning with the unit, “Foundations

of Medicine,“ for first year students. The DMEH continues to be involved in the education of fourth year

students, as we teach sessions in their “Transitions” unit, and teach 4th year elective courses. This year, we

have taught four different electives: “Imagining Medicine” and “Medicine in Art/ Art in Medicine” (both taught

by Gretchen Case), “Writing the Physician-Patient Relationship,” (taught by Susan Sample), and “Clinical

Ethics.” (taught by Jay Jacobson.)

Creative thought and innovative teaching possibilities for ethics and humanities

abound at the School of Medicine. We would like to update our readers on two

exciting changes coming in the 2014-15 year to medical education. First, is the

“Layers of Medicine” course, co-directed by Gretchen Case, PhD, DMEH, Ben Lewis,

MD, Psychiatry, and Karly Pippitt, MD, Family Medicine. This will be introduced as a

required course and is intended to highlight and emphasize, not replace, medical

ethics and humanities content that is already being taught. The “Layers of Medicine”

curriculum, which will extend longitudinally through the first and second years of

medical school, will have students engage in ongoing dialogue about the

interdisciplinary complexities and challenges of health care.

From the “Layers of Medicine” course description:

“Medical education in the preclinical years is designed largely to simplify,

synthesize, and mentally organize vast amounts of discrete knowledge. While

this is a necessary task in medical training, it is not sufficient. The practice of

medicine is complex, messy, and challenging on interpersonal, ethical, and so-

ciocultural levels. Students will study and discuss a broad range of issues that

do not have easily formulated answers, with the fundamental assumption that

reflective skills are critical to the development and practice of being a physician.

Students will attend to the 'big picture' conceptualization of what medical care

means and the broader socio-cultural factors that shape its delivery, and, at the

same time, attend closely to the unique particularities of the patient-doctor rela-

tionship: analyzing ethically and practically challenging scenarios and examining

issues of professionalism in medicine.”

Working with facilitators from a variety of medical and non-medical disciplines,

students will explore complex ideas such as health care delivery systems, global

views of health and health care, and sex and gender as they relate to health.

Medical ethics and humanities will make up some of the “layers” in these

complicated discussions. “Layers of Medicine” will make use of large and small

group settings and creative assignments. The interdisciplinary emphasis of the

course will encourage discussion that is rich and meaningful.

By: Teneille Brown, Linda Carr-Lee Faix, and Gretchen Case

I N S I D E T H I S I S S U E :

Innovative Changes in

Teaching

1&2

Distinguished Speakers 2

Evening Ethics 3

Genetics Hot Topics 3

Physicians Literature

& Medicine

4

Calendar 5

Division Member updates 5&6 Continued on page 2

A second innovative course, proposed as an elective for

second and fourth year medical students, will be offered in

the spring of 2015, co-taught by DMEH faculty, Leslie

Francis and Teneille Brown. This exciting new course

intended for clinicians is entitled, "Health Law for

Non-Lawyers." Teneille Brown writes: “Throughout our work

teaching medical students, we have been told there is a

need for a course that covers basic health law concepts in a way that is more

accessible to graduate students with no background in law. We will be using a very

readable book with excerpted cases, to learn some of the basic principles of health

law. The course will be an overview of topics such as medical negligence, informed

consent, reproductive rights, privacy, and public programs such as Medicaid and

Medicare. We will draw from traditional "landmark cases" as well as contemporary

cases in genetics and research ethics, and will work with the School of Medicine to

make sure this course is unique in its coverage. We welcome students from all

disciplines to enroll.” If you are interested in this course, please contact Teneille

Brown (Teneille.Brown@utah.edu ) or Linda Carr-Lee Faix (linda.carrlee@hsc.utah.edu)

From page 1

Innovative Changes in Teaching for Division of Medical Ethics and Humanities

at the School of Medicine

2014 David Green Memorial Lecture

Speaker Alex Kemper, MD. MPH, MS

with Jeffrey Botkin, MD., MPH.

What innovate courses will there

be for Dr. Zora in the class of

2034?

Distinguished Speakerships

2014 Max and Sara Cowan Memorial Speaker

Dan Brock, PhD

Watch his lecture here:

https://eq.utah.edu/u/items/b1ec55ee-6aad-

4335-a610-

ffd8c4fd7309/0/viewcontent?_sl.t=true

Special Guest Lecturer, Michael R. Rabow, MD, will be presenting a Palliative Care Grand Rounds and Community Event on

July 17, 2014, “Who Should Be Providing Palliative Care and Why?”, HSEB 1750, 7:45am-8:45am. For more information,

please see: http://uofupalliativecare.files.wordpress.com/2014/05/palliative-care-community-event-flyer3.pdf

Palliative Care Grand Rounds

"Safety in the Balance: The Role of Healthcare Professionals

in Weighing Patient Autonomy and Safety among Older Adults with

Decisional Impairment”

Wednesday, July 9, 2014 5:30pm-7:00pm

(note date change from previous announcements)

Research Administration Building Room #117

(1st floor conference room)

Light refreshments and CME are available

Impaired abilities among the elderly can raise concerns about self-neglect, the capacity to consent to or

refuse treatment, and the capacity to drive, manage money, or live alone. Almost every healthcare pro-

vider will encounter circumstances in which a person’s decision-making abilities raise ethical chal-

lenges. Providers often grapple with abstract rights and duties and their practical manifestations: the

need to balance an individual's safety against the actual harm that providers or courts may cause when

they take away an individual's rights to control his or her life. Is weighing these rights what is needed to

best address these cases? If so, how ought these differing rights be weighed and what ought—and ought

not—to be considered? How might providers, healthcare teams, and families work together to better

help the elderly when they appear to be failing? Tim Farrell, MD, geriatrician, and Maureen Henry,

JD, DMEH associate, will facilitate this discussion. We hope that you will join us with your insights,

concerns, and questions about this important topic.

Two background readings that can be found on our DMEH website will help prepare us for this

discussion: “Elder Self-Neglect—How Can a Physician Help?” by Alexander K. Smith, M.D., M.P.H.,

Bernard Lo, M.D. and Louise Aronson, M.D., New Engl. Jrnl. Med. 369; 26 (December 26, 2013)

and “Does This Patient Have Medical Decision-Making Capacity?” by Laura L. Sessums, JD, MD,

Hanna Zembrzuska, MD, Jeffrey L. Jackson, MD, MPH, JAMA 306;4 (July 27, 2011

Medical Ethics In Utah Page 3

Evening Ethics

September 16, 2014, RAB 117, 5:30-7:00 pm

Collaborative Evening Ethics with UCEER

(Utah Center for Excellence in Ethical, Legal and Social Implication Research) and DMEH,

with Jeff Botkin, MD, MPH and Nancy Rose, MD facilitating on

“Prenatal Whole-Genome Sequencing—Is the Quest to Know a Fetus’s Future Ethical?”

G E N E T I C S H O T T O P I C S

From page 1

Save the date

Physicians Literature and Medicine Discussion Group Upcoming Physicians Literature and Medicine programs, 6:00-8:30pm

May 7, 2014 LDSH Pugh Boardroom Facilitated by Mark Matheson, D. Phil

Opened Ground: Selected Poems by Seamus Heaney

Poetry can represent a challenge, but we think you’ll find Heaney’s work very rewarding.

Heaney won the Nobel Prize for Literature in 1995. His speech on accepting it is printed

at the end of Opened Ground, and you might find it interesting and helpful as a reader of

his poems. Below are listed a few poems chosen by our facilitator, found in his volume

Opened Ground, that we will discuss at our session. Additional poems for discussion,

chosen by Mark Matheson, are listed on our DMEH website,

http://medicine.utah.edu/internalmedicine/medicalethics/activities/literature/2014.php

1. “Digging, “ p. 3. A poem about Heaney’s vocation as a writer and his relationship with his father and

the generations of men in his family, who tilled the soil as farmers.

2. “Follower,” p.10. Another poem about Heaney’s father and his legacy for the poet.

3. “Mid-Term Break,” p. 11. This is the one I mentioned at the end of our last discussion together.

Heaney’s younger brother Christopher was killed in an auto-pedestrian accident at the age of four.

4. “Wedding Day,” p. 65. The oddness of feelings on a day of great ritual and moment. Very, very far

from the emotional stereotypes perpetrated by the Bridal Industry.

5. “Mother of the Groom,” p.66. The progress of the generations.

6. “Exposure,” pp. 135-6. An Irish poet meditates on his role as an artist in the unfolding history of

violence and conflict in this homeland.

June 4, 2014 LDSH Pugh Boardroom Facilitated by Gretchen Case, PhD

June 18, 2014 UU Hospital Large Conference Room #W1220 Facilitated by Gretchen Case, PhD

Five Days at Memorial by Sheri Fink

Five Days at Memorial is a careful, in-depth look at the immediate aftermath of Hurricane

Katrina as it was experienced at Memorial Medical Center in New Orleans. After the

hospital flooded and lost power, help was excruciatingly slow in coming and staff had to

make decisions about who would be rescued first. Written by physician and journalist

Sheri Fink, who spent years unraveling the desperate scenarios that took place in a hospital

left to fend for itself.

July 2, 2014 LDSH Pugh Boardroom Facilitated by Gretchen Case, PhD

Post Mortem by Phillip Mackowiak

Post Mortem: Solving History’s Great Medical Mysteries doesn’t solve every medical

mystery, but does address the conditions of twelve important historical figures, from

Akhenaten to Joan of Arc to Booker T. Washington. Author Philip Mackowiak is both a

physician and historian of medicine, and draws on these dual specialties to give a detec-

tive’s attention to the lives and deaths of these famous people.

*Evening Ethics Discussion 5:30-7:00 pm RAB 117

"Safety in the Balance: The Role of Healthcare Professionals in Weighing Patient Autonomy and

Safety among Older Adults with Decisional Impairment” with Tim Farrell, MD & Maureen Henry, JD

*Genetics Hot Topics 5:30-7:00 pm RAB 117

“Prenatal Whole-Genome Sequencing—Is the Quest to Know a Fetus’s Future Ethical?”

with Jeffrey Botkin, M.D. and Nancy Rose, M.D.

Wed. July 9

(note date change)

Tue. Sept. 16

Resident Ethics Conferences 12:30-1:30 pm

Difficult Conversations: How to Convey Bad News

VAMC Tsagaris Conference room: Jim Tabery, PhD and Peter Yarbrough, MD

IMC: Jay Jacobson, M.D.

UUMC Cartwright Conference room: Jim Tabery, PhD and Sam Brown, MD

Personalized Medicine: Resident and Genetic Testing

IMC: Jay Jacobson, M.D.

UUMC Cartwright Conference room: Jeffrey Botkin, MD

July Resident Conference to be determined

Tue. May 20

Wed. May 22

Thurs. May 27

Wed. June 18

Thurs. June 19

*The Physicians Literature and Medicine Discussion Group 6:00 pm

Opened Ground: Selected Poems by Seamus Heaney, Facilitated by Mark Matheson, D. Phil

LDSH Pugh Boardroom

Five Days at Memorial by Sheri Fink , Facilitated by Gretchen Case, PhD

LDSH Pugh Boardroom

UU Hospital Large Conference Room #W1220

Post Mortem by Phillip Mackowiak, Facilitated by Gretchen Case, PhD

LDSH Pugh Boardroom

Wed. May 7

Wed. June 4

Wed. June 18

Wed. July 2

*These activities are approved for CME credit.

C A L E N D A R O F A C T I V I T I E S A N D P R O G R A M S

CME Statements

Accreditation: The University of Utah School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. AMA Credit: The University of Utah School of Medicine designates these live activities for a maximum of 1.5AMA PRA Category

1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. NONDISCRIMINATION AND DISABILITY ACCOMMODATION STATEMENT: The University of Utah does not exclude, deny benefits to or otherwise discriminate against any person on the basis of race, color, national origin, sex, disability, age, veteran’s status, religion, gender identity/expression, genetic information, or sexual orientation in admiss ion to or participation in its programs and activities. Reasonable accommodations will be provided to qualified individuals with disabilities upon request, with reasonable notice. Requests for accommodations or inquiries or complaints about University nondiscrimination and disability/access policies may be directed to the Director, OEO/AA, Title IX/Section 504/ADA Coordinator, 201 S President’s Circle, RM 135, Salt Lake City, UT 84112, 801-581-8365 (Voice/TTY), 801-585-5746 (Fax).

Jim Tabery was interviewed by KSL Radio on a piece entitled "Medical Conspiracy Theories"

regarding a recently published article about American's beliefs in medical conspiracy theories.

Susan Sample’s poem, "Indigo," was published in the Spring 2014 issue of The Intima: A Journal of

Narrative Medicine. www.theintima.org/poetry4.html. Susan was invited to write a commentary on

several poems; "Resiliency through Images of Nature" that will appear on the journal's upcoming

blog, Crossroads. Susan also was accepted to the Kienle Symposium on Medical Humanities at Penn

State Hershey Medical Center from May 25-30.

Teneille Brown been working on an ongoing project on the reimbursement incentives for terminal cancer treatment, and

will be presenting this work at the American Society for Medicine, Law and Ethics in San Francisco in June. She just

finished a symposium piece responding to a manuscript on Minds, Brains and the Law, and last month, presented ethical

cases in sentencing to a group of district court judges in Utah.

D I V I S I O N M E M B E R S O N T H E R O A D A N D I N P R I N T

DIVISION OF MEDICAL ETHICS

AND HUMANITIES

75 South 2000 East #108

Salt Lake City, Utah 84112

DIVISION OF MEDICAL ETHICS AND HUMANITIES

Division Faculty: Margaret P. Battin, M.F.A., Ph.D. Jeffrey R. Botkin, MD, M.P.H. Samuel M. Brown, MD, M.S. Teneille R. Brown, JD Gretchen A. Case, Ph.D. Leslie P. Francis, Ph.D., J.D. Erin Rothwell, Ph.D Jacob Stegenga, Ph.D James Tabery, Ph.D. Jay Jacobson, M.D. (Emeritus)

Program Associates: Howard Mann, MD Mark Matheson, D. Phil. Susan Sample, M.F.A.

Division Associates: Rebecca Anderson, RN Philip L. Baese, M.D Maureen Henry, JD Thomas Schenkenberg, PhD

Academic Program Manager: Linda Carr-Lee Faix, M.A., Ph.C

Executive Assistant: Heather Sudbury

Phone: (801) 581-7170 or (801) 587-5884 Fax: (801) 585-9588

Leslie Francis was elected vice-president of the Pacific Division of

the American Philosophical Association at the recent APA meeting

in San Diego. This is the highest academic honor the Pacific

Division has to bestow. She will serve a year as vice-president

beginning July 1, 2014, and then assume the Presidency of the

Pacific Division July 1, 2015.

Leslie Francis also attended the annual tenBroek disability law symposium at the

National Federation for the Blind; she served on the planning committee for the

symposium and was part of a tribute to the work and memory of Adrienne Asch.

Maureen Henry, PhD candidate in nursing affiliated with the Hartford Center of

Geriatric Nursing Excellence in the College of Nursing, was awarded the 2014

Elizabeth Fuhriman Gardner Prize for the Outstanding Woman Student in the Health

Sciences during the May 2, 2014 College of Nursing Convocation.

Peggy Battin presented "Lessons from Brooke," at the Center for Practical Bioethics,

Kansas City, MO, April 24, 2014, and will give the plenary talk on Sept. 1, 2014, at

the Association of Spinal Cord Injury Professionals, St. Louis, MO.

This summer, Jacob Stegenga will present “Hollow Hunt for Harms” at the

University of Aarhus (Denmark) and at Bielefeld University (Germany). He will also

present “Measuring Effectiveness” at the Prediction in Epidemiology and Healthcare

workshop in London (U.K.), and “Measuring the Quality of Evidence in Medical

Research” at the Evidence in Science and Epistemology Workshop in Helsinki

(Finland).

D I V I S I O N M E M B E R S O N T H E R O A D A N D I N P R I N T