In 1981, under the auspices of the MacLean Center, Mark Siegler and Richard Epstein organized a yearlong interdisciplinary seminar series on Bad Outcomes after Medical Intervention. The success of that initial seminar program demonstrated that there was great interest at the University of Chicago in creating a sustainable interdisciplinary forum to discuss health-related subjects with colleagues from across campus. Since 1981, the MacLean Center has sponsored an annual lecture series that has examined the ethical aspects of one key health-related issue each year. Previous topics have included: Ethical Issues in Violence, Trauma, and Trauma Surgery, Organ Transplantation, Pediatric Ethics, End-of-Life Care, Global Health, Health Care Disparities, Medical Professionalism, Confidentiality, and Pharmaceutical Innovation and Regulation.
Please visit The MacLean Center YouTube Channel to view recordings of past lectures.
The theme for the 2018-2019 lecture series, co-sponsored by the MacLean Center for Clinical Medical Ethics and the Center for Health and the Social Sciences (directed by Dr. Mark Siegler and Dr. David Meltzer, respectively), is Improving Value in the U.S. Health Care System.
Patients, providers, and policymakers are all participants in health care decisions that involve tradeoffs of both costs and outcomes. Such tradeoffs frequently raise ethical dilemmas. Occasionally, the consequences of medical decisions are solely borne by patients. Far more often, policymakers and even providers are forced to make decisions in which the best interest of patients and other stakeholders are in conflict. Thoughtful approaches to decision-making in the health care delivery system are essential to defining and ultimately improving the quality, outcomes, and value of health care. This lecture series will examine these questions in the context of the current political climate and the uncertain future of the American health care system.
The theme for the 2017-18 lecture series, co-sponsored by the MacLean Center for Clinical Medical Ethics and the University of Chicago Trauma Center (Director: Dr. Selwyn Rogers Jr.), is the topic of Violence, Trauma and Trauma Surgery. These issues raise many ethical problems. For example, disparities in the prevalence of violence and in outcomes of trauma are based upon factors that include age, race, geography, insurance status, and socioeconomic status. Also, the emergency nature of interventions in the context of trauma complicates the informed consent process. Further, emergency care decisions must be made with no prior doctor-patient relationship, and often for patients who lack decisional capacity and have no available surrogate decision-makers.
Reducing intentional violence and preventing trauma will require both individual action and community engagement. Research is needed to reduce violence and trauma and to improve trauma care and patient outcomes.
As we plan our new trauma center at the University of Chicago, we have invited local and national experts and community leaders to discuss the ethical issues related to Violence, Trauma, and Trauma Surgery.
Reproductive ethics touches upon issues that frequently engage social, political, and popular discourse. This year's MacLean Center Interdisciplinary Lecture Series will explore controversies at the intersections of scientific advances, reproductive decision-making, and profound moral and legal considerations. While reproductive ethics encompasses a wide spectrum of topics, this series is organized around three overarching themes: obstetrical ethics, assisted reproduction, and family planning and abortion. This year's speakers reflect a diversity of backgrounds and perspectives, and include national experts in the fields of medicine, law, and the social sciences. This series aims to encourage thoughtful discussion through lectures and seminars that will at times complement and at other times challenge each other.
This year's series was planned by Dr. Julie Chor, Assistant Professor of Obstetrics and Gynecology and Assistant Director of the MacLean Center, and Dr. Mark Siegler, Director of the MacLean Center. They received valuable guidance from experts in the field, including Dr. Frank A. Chervenak, Chair of Obstetrics and Gynecology at Weill Cornell Medicine; Katie Watson, JD, Assistant Professor in Medical Education-Medical Humanities and Bioethics at Northwestern University; and Drs. Melissa Gilliam and Debra Stulberg, from the Departments of Obstetrics and Gynecology and Family Medicine at the University of Chicago.
This series is co-sponsored by the University of Chicago's Department of Gynecology (Dr. Ernst Lengyel, Chair) and the Bucksbaum Institute for Clinical Excellence.
Recent advances in the neurosciences have raised a host of important ethical issues, some of which are of such magnitude as to have given rise to a new field, dubbed “Neuroethics.” This year’s MacLean Center Interdisciplinary Faculty Seminar will cover many of these issues in depth, drawing upon the expertise of an international and impressively interdisciplinary group of scholars from the neurosciences, philosophy, psychology, history, law, and medicine. The workshop will cover a broad range of topics, including the neuroscience of moral decision-making, philosophical/legal questions of agency and free will, and the ethics of doing neuroscientific research with cognitively impaired subjects. Many seminars will address controversies in the application of neuroscientific findings, such as the forensic use of neuroscience (e.g., the use of functional MRI data in legal cases), cognitive enhancement, moral enhancement, and the privacy/confidentiality of neuroscientific data.
This seminar was planned by Dr. Mark Siegler, Director of the MacLean Center, Dr. Daniel Sulmasy, Associate Director of the MacLean Center, John Mansell, the Albert D. Lasker Professor in Neurobiology and Director of the Grossman Institute for Neuroscience, and Peggy Mason, Professor of Neuroscience, with the assistance of a committee of University of Chicago faculty from psychology, philosophy, history, law, and neurology. The 34th year of the MacLean Center seminar series was among the most lively and interdisciplinary yet!
In the past 50 years, medicine has developed new and unprecedented technologies like breathing machines and dialysis that can prevent or delay death. These technologies have changed how people die, where people die, and physicians’ responsibilities to dying patients. During these 50 years, physicians and society have gradually learned how to best apply these life-saving technologies and how to stop them. In the vast majority of cases in which death is anticipated, patients, families and physicians reach prudent and “negotiated” decisions on when to stop aggressive care.
Yet questions remain. Advance directives have not been the panacea they were hoped to be and deciding for patients who are unable to speak for themselves remains painfully difficult for families and practitioners. Newer technologies such as implanted cardiac defibrillators, left ventricular assist devices, extracorporeal membrane oxygenation continue to raise new questions. Euthanasia and physician assisted suicide remain contentious subjects. Even questions that were thought settled, such as brain death and palliative sedation, have generated new controversies. Further, the cost of caring for patients at the end of life continues to consume a large percentage of the health budget, raising questions about the optimal and just use of health care resources.
In these seminars, local and national experts addressed these and other controversial ethical issues in care at the end of life. While much has happened in the past 50 years, the age-old issues of suffering, death, caring, and the limits of medicine have found new expressions that require new answers. This year’s interdisciplinary seminar series was organized by Mark Siegler, the Director of the MacLean Center for Clinical Ethics and Daniel Sulmasy, Associate Director of the MacLean Center. These discussions aim to help shape debate about these critically important questions at the University of Chicago and across the wider society.
In 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law. It was the greatest modification of the American health care system since the Johnson presidency nearly a half-century before. The ACA was designed to increase access to care for millions of uninsured Americans, decrease costs for patients and purchasers of health care, and improve the quality of care to patients. The ACA has many parts, some that affect individuals, others that affect employers, and some that require responses from state governments, such as the proposed expansion of Medicaid and the creation of health insurance exchanges. Health care reform of this magnitude will change the way medicine is practiced and will create not only social and political challenges, but important ethical dilemmas as well.
Crucial questions will be debated as the ACA is implemented. How will the ACA affect Chicago, the state of Illinois, and the nation? What effect will the ACA have on the poor, the disabled, immigrants, children, racial and ethnic minorities, and persons with mental illness? How will academic medical centers, organized medicine, and large employers respond to the ACA? What effect will the ACA have on the doctor-patient relationship and the role of physicians as leaders in the health care system? How did health reform evolve and what are the current politics? Will health reform save money? What changes might we expect in physician payment and the organization of care? Are we better off with the ACA?
This interdisciplinary seminar series was organized by Mark Siegler, the Director of the MacLean Center, and Marshall Chin, Associate Director of the MacLean Center and Director of the Robert Wood Johnson Foundation Finding Answers: Disparities Research for Change National Program Office. The series brings together leading national, state, and local experts to provide insights into the evolution of health reform and the ACA. These weekly seminar discussions contributed to a deeper understanding at The University of Chicago and nationally about the vital role that health reform will play in shaping the future of American health care.