W i n t e r E d i t i o n 2 0 1 5

M E D I C A L E T H I C S I N U TA 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

Welcome to new Division Faculty member, Brent Kious, MD, PhD!

Brent Kious joins us from the Department of Psychiatry at the

University of Utah, where he is a Clinical Instructor. He is a

practicing psychiatrist specializing in hospital-based adult

psychiatry and the outpatient management of Tourette Syndrome.

He is also engaged in clinical research in psychiatry, including

outcomes research for hospital-based psychiatry and clinical trials

in major depressive disorder and Tourette Syndrome. He

completed his M.D. at the David Geffen School of Medicine at

UCLA, his Ph.D in philosophy at the University of California, Los

Angeles, and residency in psychiatry at the University of Utah. His

philosophical research is focused on the philosophy of psychiatry, including the role

of values in psychiatric diagnoses, as well as on the ethics of consent. He hopes to

continue exploring these interests in conjunction with other members of the

Division.

The “Layers of Medicine,” course runs longitudinally over the first two years of the medical curriculum at the

University of Utah School of Medicine. Students in each cohort meet every other Friday in a large group, followed

by a small group facilitated by faculty from across the Health Sciences Campus. “Layers,” directed by Gretchen

Case, PhD and Karly Pippit, MD, covers a wide range of topics, including how sex and gender matter in medicine.

Guest speakers are an important part of the course, and one of this year’s most exciting guests was Jeanne

Nollman. Ms. Nollman is a past President and Board member for the largest intersex support group in the world,

AIS-DSD (Androgen Insensitivity Syndrome-Disorders of Sex Development). She has spent the last 10 years

educating doctors, lawyers, therapists, social workers, the criminal justice system, and college students on what

intersex is and how people with DSD are impacted physically and psychologically. Jeanne’s own journey of living

with Swyer Syndrome has been featured on TV shows, in an online magazine, and recently in an international video

campaign by the United Nations.

Ms. Nollman spoke to the University of Utah second-year medical students about her experience of learning in her

late teens that she is intersex. She spoke knowledgeably about the medical details of her diagnosis and candidly

about how being intersex has shaped her life experiences. Ms. Nollman also led discussions of intersex and other

sex and gender issues in medicine during a luncheon with medical students and at an Evening Ethics Discussion

sponsored by the DMEH. Students at the luncheon asked insightful and thought-provoking questions, showing

their great interest. Clinicians at Evening Ethics thanked Ms. Nollman for her positive impact. One piece of written

feedback pointed to her talk as instrumental in opening eyes to the “the lack of a standardized approach [to DSD

patients], limited knowledge about the many issues that strongly support a more nuanced and less emergency-

oriented approach, and limited data re: long-term follow-up of our own [DSD] patients.”

In thoughtful response to Ms. Nollman’s visit, these clinicians are planning in the

coming weeks to develop a more systematic approach and broader education for

themselves re: DSD with relevant clinical stakeholders (e.g., neonatology, genetics,

endocrine, pediatric urology, maternal-fetal medicine, social work, behavioral health)

to begin to address development of a more systematic and sensitive management

approach for infants and others with DSD.

Ms. Nollman’s visit was an exemplar of what a guest speaker, especially one with

such clear expertise in terms of both knowledge and lived experience, can bring to

our medical curriculum and to the wider community at the University of Utah. I N S I D E T H I S I S S U E :

Layers of Medicine

Brent Kious, MD, PhD

1

Mercy Killers

Writing Group

Biolaw Collaboration

Genetics Hot Topics

2

Evening Ethics 3

Physicians Literature

& Medicine

Speakerships

4

Calendar 5

Division Member

updates

6

Discussions of Intersex included in Medical Education in “Layers of Medicine” Course By: Gretchen Case, PhD

Mercy Killers Performance

Writing group for Residents and Fellows

Biolaw Collaboration

UCEER Hot Topics

This year, the DMEH is collaborating with the College of Law’s new Center for Law and

Biomedical Sciences to sponsor a Center fellow. The fellow is Annika Hoidal, a second year

law student at the College of Law who also has a graduate degree in social work. Her

responsibilities are to aid DMEH faculty with research needs, especially for legal or public

policy research. So far, she’s helped Leslie Francis with her article on the Americans with

Disabilities Act and accommodations within the health care work force, forthcoming in a

special issue of the St. Louis University Journal of Health Law & Policy devoted to the ADA

at 25 and health care workers. She’s also been working with Peggy Battin on her chapter on

male contraception for the Oxford Handbook on Reproductive Ethics. We hope this

collaboration will enhance research possibilities for the DMEH, as many issues in bioethics

and the humanities are linked inseparably to important legal questions.

The poetry of Ruth Stone provided insight into gerontology while the work of physician-writer

Oliver Sacks prompted reflection upon the dual professions of medicine and writing during

recent discussions of a new monthly writing group for residents and fellows.

Launched last August, the group meets in the evening in the Cartwright Conference room to

read the work of professionals writers, write in response to prompts, and to share members'

own writing. Leading the group is Susan Sample, Ph.D., M.F.A., program associate in the

Division of Medical Ethics and Humanities, and Writer-in-Residence at Huntsman Cancer

Institute, and Russ Johnson, M.D., M.Sc., PGY3 Internal Medicine/Pediatrics.

All residents and fellows are invited to join the group. The only requirement is an interest in writing creatively-

personal essays, creative nonfiction, fiction, poetry—and in sharing your work. No prior writing publication or

experience is necessary. Check the DMEH website for the next meeting in November. For more information,

contact Susan.Sample@hsc.utah.edu

Save the date for a Genetics Hot Topics Evening Ethics discussion with

Bob Cooke-Deegan, MD. Tuesday, Feb 23, 2016, 4:00pm-5:30pm!

(Watch for upcoming information on title and location.)

Bob Cooke-Degan

Eccles Auditorium at Huntsman Cancer Institute

November 6, 2015

Utah Presents in partnership with the DMEH

Blue collar Joe grapples with his red state ideals when he realizes the

measures he must take to care for his wife. A surprisingly tender love story about

an everyday American guy caught in a life and death struggle with the health care

system, Joe finds the bedrock of his life, marriage and

self-identity shifting under him.

Ticket information: https://itkt.choicecrm.net/templates/UTKH/?prod=UPSeason

Annika Hoidal

Tuesday, December 1, 2015

5:30-7:00pm, Research Administration Building, 1st floor large conference room

CME and Light Refreshments offered

“When a patient requests a white doctor”:

Where do we draw the line on allowing patient requests?

What should clinicians do when patients—or families of patients—request that a doctor of a particular race, ethnic

group, religion, gender, gender preference, or any “type,” provide -–or not provide—medical care for them? Clearly,

these situations reflect a clash of fundamental values. Do we grant these requests out of a respect for patient

choice, or do we reject them as medically irrelevant and offensive? KL Reynolds, JD Cowden, JP Brosco, and JD

Lantos discuss various ways to think about, analyze, and respond to these sorts of requests in “When a Family

Requests a White Doctor”. We ask that you read this article and bring your questions, concerns, experiences, and

thoughtful approaches on how to proceed in similar cases, to share at this Evening Ethics discussion.

Evening Ethics

Tuesday, November 3, 2015

5:30pm-7:00pm, Research Administration Building 1st floor large conference room

This Evening Ethics has been developed in collaboration with the Office of Health Equity and Inclusion

CME and Light Refreshments offered

Continuing the “Native Voices” Conversation in Utah: How can professionals trained in

Western medicine work with Native communities to improve the health

status of members?

The voices of contemporary American Indians featured this fall in a traveling exhibit at the Eccles Health Sciences

Library raise significant ethical issues for health-care professionals and students. As the exhibit title suggests--

"Native Voices: Native Peoples' Concepts of Health and Illness"—these issues are defined in the contexts of Native

People's cultural beliefs and values. So how can professionals trained in Western medicine work with Native

communities to improve the health status of members? What are the best ways to address health disparities that

encompass economic, racial, and historical concerns? And what has been learned so far in outreach programs

offered through various departments of the University of Utah health sciences center?

Featured at our discussion will be three professionals with expertise in health disparities. Ana Maria Lopez, MD,

MPH, is associate vice president health equity and inclusion for University of Utah Health System. An oncologist, Dr.

Lopez also directs Cancer Health Equity at Huntsman Cancer Institute (HCI). Phyllis Pettit Nassi, M.S.W.,

Manager Special Populations at HCI, oversees Native American outreach. She is enrolled in the Otoe/Missouri Tribe

and is a member of the Cherokee Nation. Michael Lei, manager of Global Outreach for the Moran Eye

Center, oversees the delivery of ophthalmology care on Utah's reservations and has sixteen years' experience

working with the Navajo Nation.

To begin our discussion, we'll consider how tribal consultation serves as an ethical model for engagement with

Native populations. The process is guided by respect for autonomy, truthfulness, fairness, justice, and

beneficence. We will look at how the University might respond to Governor Herbert's 2014 order for state

agencies to establish tribal consultation policies.

Two articles are suggested background reading:

"Addressing disparities in the health of American Indian and Alaska Native People: The importance of improved pub-

lic health data"

“Toward Genuine Tribal Consultation in the 21st Century”

David Green Memorial Speakership: Jeffrey P. Brosco MD, PhD

Thursday, April 14, 2016, Pediatric Grand Rounds, 8am:

“Justice and Child Health: The Obligations of Pediatric Clinicians.”

Wednesday, April 13, 2016, Evening Ethics Discussion, 5:30pm-7:00pm:

The ethical implications of next-generation genome sequencing on

clinical practice and public policy.

Max and Sara Cowan Memorial Speakership: Wylie Burke, MD, PhD

Wednesday, March 23, 5:30-7pm Evening Ethics

Thursday, March 24, 7:45-9am Internal Medicine Grand Rounds

Thursday, March 24, noon-1pm, Cowan Public Lecture

(at Eccles Genetics Auditorium)

Physicians Literature and Medicine Discussion Group

November 4, 2015

LDSH Pugh Boardroom 6:00-8:30p, Facilitated by Aden Ross, PhD

The Rosie Project by Graeme Simsion

The Rosie Project, by Graeme Simsion, is a lighthearted novel about a serious subject. Don Tillman,

a genetics professor, leads a life of tightly structured routine and excessive regimentation, dividing his

endeavors into “Problems” and “Projects,” including cooking, sleeping and eating. His rigid

constraints serve him well enough until he decides that he needs a wife—the Wife Problem, which we

recognize is a subdivision of the People Problem. To solve the wife issue, he characteristically

develops a questionnaire to filter out unsuitable candidates. Enter Rosie Jarman, the most unsuitable

candidate imaginable—irrational, vegetarian and late.

Because of Don’s literal-mindedness, insensitivity to social cues and revulsion at being touched, his

behavior certainly falls within the spectrum of autism disorders; but it also makes him a lovable and

unwittingly comic narrator. Whether or not Don has Asperger’s Syndrome is less relevant than

recognizing in him traits we all recognize in our family members, our friends and, possibly, in

ourselves.

December 2, 2015

LDSH Pugh Boardroom 6:00-8:30p, Facilitated by Rachel Borup, PhD

The Children Act by Ian McEwan

In Ian McEwan’s novel, The Children Act, well-respected British High Court Judge, Fiona Maye,

has made a career of bringing “reasonableness to hopeless situations.” In her toughest case yet,

she must decide whether Adam Henry, a Jehovah’s Witness with leukemia, will be compelled to

forsake his religion and undergo lifesaving blood transfusions. Making the decision more difficult

is the fact that Adam is almost 18, the age at which he would be able to make his own decision

under English law. In considering her decision, Fiona confronts several conflicting ideals: the

protection of children, the sanctity of life, parental authority, patient autonomy, and religious

freedom. Not a writer of simple polemics, McEwan further complicates matters by putting Fiona’s

marriage in jeopardy and infusing her own personal vulnerabilities into the story.

The 2016 Schedule of Readings will be posted on our website in December 2015.

http://medicine.utah.edu/internalmedicine/medicalethics/

Save the Dates for upcoming Speakerships!

Jeffrey Brosco MD, PhD

Wylie Burke, MD, PhD

Mercy Killers Performance 7:00 pm Huntsman Cancer Institute 6th Floor Auditorium

Thurs. Nov. 6

Resident Ethics Conferences 12:30-1:15 pm

Informed Consent

UUMC Cartwright Conference room: Gretchen Case, PhD & Leslie Francis, JD, PhD

IMC: Jay Jacobson, MD

VAMC Tsagaris Conference room: Gretchen Case, PhD

Leaving Against Medical Advice (role play)

UUMC Cartwright Conference room: Gretchen Case, PhD

IMC: Jay Jacobson, MD

VAMC Tsagaris Conference room: Gretchen Case, PhD

Impaired Physicians

IMC: Jay Jacobson, MD

UUMC Cartwright Conference room: Leslie Franci, JD, PhD

VAMC Tsagaris Conference room: Brent Kious, MD, PhD

Thurs. Nov .12

Thurs. Nov. 18

Wed. Nov. 19

Thurs. Dec. 10

Thurs. Dec. 17

Wed. Dec. 16

Wed. Jan. 20

Tues. Jan. 26

Thurs. Jan. 28

*The Physicians Literature and Medicine Discussion Group 6:00-8:30 pm

The Rosie Project by Graeme Simsion, Facilitated by Aden Ross, PhD

LDSH Pugh Boardroom

The Children Act by Ian McEwan, Facilitated by Rachel Borup, PhD

LDSH Pugh Boardroom

Wed. Nov. 4

Wed. Dec. 2

*Evening Ethics Discussions

“Continuing the “Native Voices” Conversation in Utah: How can professionals trained in Western

medicine work with Native communities to improve the health status of members?

5:30-7:30 pm RAB 117

“When a patient requests a white doctor”: Where do we draw the line on allowing patient requests?

5:30-7:30 pm RAB 117

Tues. Nov. 3

Tues. Dec. 1

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 (ACCME) to provide continuing medical educa-

tion 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 orienta-

tion in admission 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 accommoda-

tions 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). 1.5 CME for Evening Ethics and Literature & Medicine.

Division of Medical Ethics & Humanities Retreat

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. Brent Kious, MD, Ph.D Erin Rothwell, 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, Ph.D Philip L. Baese, M.D Maureen Henry, JD Thomas Schenkenberg, Ph.D

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

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

Sam Brown was interviewed by Good4Utah regarding the ICU at IMC

working to help patients and families during trying times

Brent Kious presented "Physician-Assisted Suicide: Legal Changes in Utah

and Their Implications for Mental Health Practice" at the Critical Issues

Facing Children and Adolescents conference on October 8, 2015. He was also

recently appointed Chair of the Utah Psychiatric Association Ethics Committee.

Peggy Battin is speaking to the American Society for Pharmacy Law, meeting in Miami,

Nov. 14; giving Clinical Ethics Grand Rounds at University of North Carolina, Chapter Hill,

January 7, 2016; and has an entry on "Responding to Requests for Physician-Assisted

Dying," co-authored with Timothy Quill MD, now online in UpToDate, a reference service for

physicians.

Peggy Battin’s October 5th book and digital archive event at the Marriot Library, The Ethics

of Suicide: Historical Sources, is rebroadcast here.

An article commenting on Peggy Battin’s book, by Rick Anderson, Associate Dean for

Collections and Scholarly Communications at the Marriott Library, and the president-elect

of the Society for Scholarly Publishing, can be found here.