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Evening Ethics Discussions 2022

(This series is approved for 1.5 hours of CME credit)

DETAILS:

NOVEMBER: The Problem of Alzheimer's Disease: How We Caused It, How We Can Solve It

with: Jason Karlawish, MD

In 2020, an estimated 5.8 million Americans had Alzheimer disease, and more than half a million died because of the disease and its devastating complications. 16 million caregivers are responsible for paying as much as half of the $226 billion annual costs of their care. As more people live beyond their seventies and eighties, the number of patients afflicted by Alzheimer disease will rise to an estimated 13.8 million by 2050.

In this Evening Ethics discussion, Jason Karlawish, MD will lead a discussion of evolving public views about Alzheimer disease and other causes of dementia.  Dr. Karlawish is Professor of Medicine, Medical Ethics and Health Policy, and Neurology at the University of Pennsylvania, and Co-Director of the Penn Memory Center, where he focuses on the care of persons with dementia.  The evening’s session will draw from his recent book, The Problem of Alzheimer’s: How Science, Culture, and Politics Turned a Rare Disease into a Crisis and What We Can Do About It (St. Martin’s Press, 2021), wherein he describes how public ideas about dementia have changed, leading to gradual recognition that Alzheimer disease and related conditions represent a public health crisis.  He will review the dramatic expansion in research about these conditions over the last several decades, recent breakthroughs that may eventually lead to meaningful treatment, and finally consider strategies for how patients and their families can, if adequate social supports are available, learn to live with dementia.  These topics raise important ethical questions regarding how physicians, healthcare systems, and societies should change their approach to caring for persons with dementia.

BACKGROUND READING:

 

This event is co-sponsored by the Center for Health Ethics, Arts, and Humanities (CHeEtAH) and the Spencer S. Eccles Health Sciences Library (EHSL)

OCTOBER: Encountering Chinese Medicine, Expanding Medical Ethics

with: Judith Farquhar, PhD

Our collaboration with the Utah Humanities Book Festival allows us to bring anthropologist Judith Farquhar to discuss Traditional Chinese Medicine (TCM). Her latest book, Way of Life: Things, Thought, and Action in Chinese Medicine, began as the Terry Lectures at Yale University, a lecture series exploring religion, science, and philosophy. As a longtime scholar of Chinese medicine and cultures, Farquhar will discuss, from a TCM perspective, what many Chinese doctors consider to be the root of medicine: humanism. “Let the body of the patient be your respected teacher,” advice from Zhang Taiyan, who wrote about modernizing Chinese medicine, may sound familiar to health care professionals and learners of all traditions.

During this Evening Ethics discussion, we will focus on ethical questions and issues raised by TCM for all medical practitioners and patients. For example: Can a system of medicine ever be comprehensive or complete? How does any diagnostic process manage uncertainty? Where do health, healthiness, and life-generating qi fit into experiences of illness and cure? What if knowledge is practice and healing is a mode of existence?

BACKGROUND READING:

 

This event is co-sponsored by the Center for Health Ethics, Arts, and Humanities (CHeEtAH) and the Utah Humanities Book Festival

SEPTEMBER: Chronic Illness as New Territory in the Kingdom of Illness

with: Meghan O'Rourke

In her new book, The Invisible Kingdom: Reimagining Chronic Illness, Meghan O’Rourke traces the history of Western definitions of illness to show how inherited ideas of cause, diagnosis, and treatment have contributed to what she calls a silent epidemic. Millions of Americans suffer from chronic conditions, including autoimmune diseases, post-treatment Lyme disease syndrome, and long COVID. Because these illnesses resist easy description or simple cures, patients are often unrecognized and undiagnosed. They also can be marginalized, particularly if they belong to underserved populations: BIPOC, LBGTQ+, the poor, and women.

O’Rourke, editor of the literary quarterly The Yale Review and a lecturer at Yale University, draws on her own medical experiences as well as a decade of interviews with doctors, patients, researchers, and public health experts. Her writing has appeared in The Atlantic Monthly, The New Yorker, and The New York Times. Her first nonfiction book, The Long Goodbye (2008), examines grief as a taboo subject in contemporary America. She has also published three volumes of poetry.

BACKGROUND READING:

 

This event is co-sponsored by the Center for Health Ethics, Arts, and Humanities (CHeEtAH) and the Utah Humanities Book Festival

AUGUST: Prevention, Progress, and Persistent Disparities: Ethical Dilemmas and Child Mortality

with 2022 HEALTH HUMANITIES SPEAKER: Perri Klass, MD

Perri Klass, MD, our 4th Annual Health Humanities Lecturer, is a prolific physician-author who writes medical journalism, creative nonfiction, and fiction. During her visit, she will discuss her latest book, The Best Medicine: How Science and Medicine Gave Children a Future, in which she shows how the decline in infant and child mortality has transformed parenting and society as well as medical practice. Dr. Klass weaves stories of pioneering women physicians, public health advocates, and scientists with poignant accounts of historical parents, such as Abraham and Mary Lincoln, who suffered the deaths of their children.

A professor of pediatrics and journalism at New York University, Dr. Klass contributes weekly columns on childhood to The New York Times and has published medical journalism in Harpers, The Atlantic, The Washington Post, The Wall Street Journal, The New Yorker, and The New England Journal of Medicine.

Her own experiences as a medical trainee—at Harvard Medical School and Children’s Hospital, Boston—inspired two early books: A Not Entirely Benign Procedure: Four Years as a Medical Student (1987), and Baby Doctor: A Pediatrician’s Training (1992); each was reissued as a classic in 2010. When her son Orlando applied to medical school, she wrote Treatment Kind and Fair: Letters to a Young Physician (2007), which was gifted to U of U students at their White Coat Ceremony.

Questions to consider as you read the background chapter and article below:

  • What lessons can we learn from Klass’s historical account of how public health, science, and medicine worked together to transform child mortality that can be applied today to better deal with the pandemic?
  • Klass cites racial inequalities in child and maternity mortality, epidemic gun violence, pollution, and environmental toxins as current threats to children’s safety. What roles should medicine and public health take in combating these?

BACKGROUND READINGS:

 

This event is co-sponsored by the CHeEtAH (Center for Health Ethics, Arts, and Humanities) and the University of Utah's Edna Anderson-Taylor Communication Institute

JULY: The Implications of the Supreme Court’s Abortion Decision

with Leslie P. Francis, PhD, JD 

The leak of a draft majority opinion for the Supreme Court in Dobbs written by Justice Alito and overruling Roe v. Wade brought shock waves both for what it said and for what the leak may have revealed about current thinking at the Court. The draft opinion, however, was just that: a first draft. By the time of this Evening Ethics Discussion, we expect that the Court’s final decision will have been issued. We will know whether the Court has decided to abrogate the viability line, overruling only Casey, or whether the Court has also overruled Roe, holding that there is no fundamental right to reproductive choice. Whichever way the Court goes, the decision will leave open legal and ethical issues for providers.

In this Evening Ethics, we will focus on the ethical issues for providers raised by the Dobbs decision, however it comes out.  For example: How will contraceptive care be affected?  Miscarriage care? Fertility care? What issues will arise with respect to medication abortion or counseling patients about the availability of abortion across the border in Nevada? Will new problems of privacy emerge for patients and providers?

JUNE: The Story Matters: Listening to patients is the foundation of diagnosing terminal anorexia nervosa

with Jennifer L. Gaudiani, MD, CEDS-S, FAED

At the core of all healing professions is the art of listening to a patient's narrative as a responsive and connected partner. This has often been lost in the demands of the 8-minute visit and the safer, clearer, more objective data obtained through the wonders of modern measurement, and yet the patient's story as they choose to reveal it always gives us the very best and most relevant information. Dr. Jennifer Gaudiani is an internist who specializes in eating disorders (and former English major) who recently wrote the first paper addressing the topic of terminal anorexia nervosa directly, after having had the privilege of caring for three patients who died of their eating disorder.

In this CHeEtAH discussion group, she will give more background on this complex topic as a means of continuing to advocate for this rare and underserved population of patients; frame the issue as fundamentally relating to questions of mental health stigma and decision making, body autonomy and the right to choose one's destiny; and keep coming back to the precious gift of the patient's story.

BACKGROUND READING:

MAY: Elegies as Creative, Ethical Expressions of End-of-Life Planning

with Kimberly Johnson, PhD, MFA

With COVID, we have had to confront our denial of death, prevalent for decades in American culture including health care.  Too often, death is regarded as the failure of medicine, if not the fault of individual providers entrusted with the lives of patients.  “It’s natural and perhaps instinctive to want to look away from mortality, to deny its existence,” writes Sunita Puri, MD, a palliative medicine physician and author of That Good Night:  Life and Medicine in the Eleventh Hour.  Instead, she calls us to “examine, rather than bury the loss and grief around us, even if—especially if—it is not our own.”

Perhaps that is why we see the revival of the elegy. This poetic form, dating to ancient Greece, not only mourns the death of a person but creates space for our grief during the pandemic. It “performs an essential caretaking, both intimate and public, of our dead,” claim David Sherman and Karen Elizabeth Bishop in a recent Washington Post article.  

To write about death, though, is to write about life. That’s what we do when we fill out the Utah Advance Health Care Directive:  we write the name of another who will speak for us when we cannot.  It is a difficult task, asking us to think deeply about our life and inevitable death.

A Utah couple has done just this with eloquence, wisdom, and love. Jay Hopler, a finalist for the National Book Award in Poetry and recipient of numerous national and international awards, is a patient at Huntsman Cancer Institute.  In 2017 when he received a terminal diagnosis, he gave himself a 24-month deadline to complete a new book of poems. His wife, Kimberly Johnson, a renowned poet and Renaissance scholar at BYU, as well as a recent Tanner Humanities Fellow at the U, independently began work on a collection of elegies, Fatal. 

As we listen to Johnson read selections from their new books and hear from a panel of experts in palliative care, philosophy, and advance directives, including Anna Beck, MD and Peggy Battin, MFA, PhD, we’ll discuss:

  • How essential is inquiry into the meaning of one’s life before completing an advance directive and/or living will?
  • Should the topics of death, mortality, grief, and loss be addressed more directly in the education of health-care professionals?
  • Is the pandemic enabling us to envision new and significant roles for art in the practice of health care that may improve the lives of patients and professionals alike?

BACKGROUND READINGS:

MARCH: Healthcare Stories

Our healthcare-themed storytelling event returns, featuring stories from the age of COVID, told by healthcare workers and community members whose lives were impacted by this once-in-a-lifetime pandemic.

This event requires tickets

 

This is a UtahPresents event that is co-sponsored with the CHeEtAH (Center for Health Ethics, Arts, and Humanities) and the University of Utah Health’s Resiliency Center

JANUARY: Vaccine Hesitancy: Role of Moral Values, Political Beliefs, and Conspiracy Theories

with 2022 DAVID GREEN MEMORIAL SPEAKER: Alyssa Burgart, MD, MA, FAAP

Vaccine hesitancy can encompass a rich tapestry of beliefs, with individual patients and their families influenced by a variety of forces. Understanding the underlying causes of hesitancy can help clinicians identify barriers to vaccination in ways that preserve the patient/clinician relationship and strengthen trust. We will explore the roles of moral values, belief in conspiracy theories, and political beliefs in sharing vaccine acceptance/hesitancy/refusal. Participants may bring their experiences with vaccine hesitancy, and we can explore the ethical dimensions of these important, public health conversations.

Three articles selected to spark conversation:

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