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<h2>Leonard Fleck</h2>
<p>Most people don’t want to think about health issues when they aren’t facing an illness, but Leonard Fleck, Professor of Philosophy and Medical Ethics at MSU, disagrees. Fleck believes that in a democratic society decisions about resource allocation in health care should be achieved through deliberative discussion. Citizens should participate in these forums when they are healthy and thus impartial. “We have to make rationing decisions for our future selves, unless we are willing to spend unlimited sums on ourselves and others to meet future health needs,” Fleck argues, and his three decades of experience indicate that this is not an easy goal.</p>
<p>Whether it is the high health care costs or the newest breakthrough in medicine, everybody has an opinion about current medical issues, which can lead to conflict. Fleck, however, has shown how strong opinions (respectfully presented) only begin the conversation. In 2004 he led a deliberative discussion at MSU about the inclusion of Herceptin in health insurance coverage. On average, treatment with Herceptin prolongs the lives of HER2 type breast cancer patients for 5.5 months. Treatment for an individual costs $70,000 and it is just one of the new and expensive cancer drugs considered for health insurance coverage.</p>
<p>Participants in the conversation had the opportunity to express their views through an audience response system. The results were then used to start a conversation about what morally relevant factors ought to shape our health care priorities and rationing strategies. The key to successful deliberative conversations, Fleck explains, is the internally conflicted audience that realizes the ethical dilemma behind the issue and becomes ready to make rationing judgments. Improving medical technology provides brand-new treatments, yet participants in such discussions must decide whether the benefits are worth the costs. Fleck welcomes the opportunity to challenge the claim that we have a moral obligation “to save all lives and life-years that medical technology permits,” because that would lead to “a gross distortion in our society’s health care priorities that would not be just, compassionate, or prudent.”</p>
<p>Fleck has given hundreds of talks and led deliberative discussions throughout the U.S. that have led to concrete positive results such as development of a hospice program or policies aimed at protecting the privacy of genetic information. He feels fortunate to have gained substantial financial support for his work, including $2,000,000 from ELSI (Ethical, Legal, and Social Implications of the Human Genome Project) to support community dialogues for several years on a range of issues related to genetics, ethics, public policy and reproductive decision making. This was a joint project with the University of Michigan.</p>
<p>His latest project is another good example of the role of public dialogue in the policy making process. This is the Michigan blood spots project which received $20,000 from MSU. The project will organize a deliberative jury to hear testimony from scientists about the benefits and risks of storing newborns’ blood spots indefinitely for use in a broad range of possible medical research projects. These are uses that parents of these infants could not have consented to when they allowed that blood to be drawn many years ago. The results of the jury’s deliberative conversations will then be presented to Michigan legislators to achieve what Fleck believes will be “reasonable public policy that fairly balances conflicting social values, i.e., protect genetic privacy vs. advance medical research.”</p>
<p>Fleck and others have organized discussions on blood spots, costly cancer medications and “last chance therapies” in other states as well, and his ultimate goal is for these conversations to reach the national level as part of an effort to achieve national health reform. As a member of the 1993 White House Task Force on Health Reform as well as the Governor’s Task Force on Access to Health Care in Michigan, Fleck sees the final challenge of a national deliberative discussion on health issues as educating the public: “To have such conversations be productive people need to be comfortable with each other; people need to understand the concept of mutual respect in speaking to each other. Beyond that, if we would to provide a decent health insurance for the 47 million Americans now without health insurance, we must be willing to sacrifice some extremely costly but marginally beneficial health care for our future selves. This is what is necessary if we are to have a “just” and “caring” society so far as access to health care is concerned.”</p>
<p><em>Leonard Fleck’s newest book, </em>Just Caring: The Ethical Challenge of Health Care Rationing and Rational Democratic Deliberation <em>will appear in fall, 2008.</em></p>
<p> </p>
Leonard Fleck
Most people don’t want to think about health issues when they aren’t facing an illness, but Leonard Fleck, Professor of Philosophy and Medical Ethics at MSU, disagrees. Fleck believes that in a democratic society decisions about resource allocation in health care should be achieved through deliberative discussion. Citizens should participate in these forums when they are healthy and thus impartial. “We have to make rationing decisions for our future selves, unless we are willing to spend unlimited sums on ourselves and others to meet future health needs,” Fleck argues, and his three decades of experience indicate that this is not an easy goal.
Whether it is the high health care costs or the newest breakthrough in medicine, everybody has an opinion about current medical issues, which can lead to conflict. Fleck, however, has shown how strong opinions (respectfully presented) only begin the conversation. In 2004 he led a deliberative discussion at MSU about the inclusion of Herceptin in health insurance coverage. On average, treatment with Herceptin prolongs the lives of HER2 type breast cancer patients for 5.5 months. Treatment for an individual costs $70,000 and it is just one of the new and expensive cancer drugs considered for health insurance coverage.
Participants in the conversation had the opportunity to express their views through an audience response system. The results were then used to start a conversation about what morally relevant factors ought to shape our health care priorities and rationing strategies. The key to successful deliberative conversations, Fleck explains, is the internally conflicted audience that realizes the ethical dilemma behind the issue and becomes ready to make rationing judgments. Improving medical technology provides brand-new treatments, yet participants in such discussions must decide whether the benefits are worth the costs. Fleck welcomes the opportunity to challenge the claim that we have a moral obligation “to save all lives and life-years that medical technology permits,” because that would lead to “a gross distortion in our society’s health care priorities that would not be just, compassionate, or prudent.”
Fleck has given hundreds of talks and led deliberative discussions throughout the U.S. that have led to concrete positive results such as development of a hospice program or policies aimed at protecting the privacy of genetic information. He feels fortunate to have gained substantial financial support for his work, including $2,000,000 from ELSI (Ethical, Legal, and Social Implications of the Human Genome Project) to support community dialogues for several years on a range of issues related to genetics, ethics, public policy and reproductive decision making. This was a joint project with the University of Michigan.
His latest project is another good example of the role of public dialogue in the policy making process. This is the Michigan blood spots project which received $20,000 from MSU. The project will organize a deliberative jury to hear testimony from scientists about the benefits and risks of storing newborns’ blood spots indefinitely for use in a broad range of possible medical research projects. These are uses that parents of these infants could not have consented to when they allowed that blood to be drawn many years ago. The results of the jury’s deliberative conversations will then be presented to Michigan legislators to achieve what Fleck believes will be “reasonable public policy that fairly balances conflicting social values, i.e., protect genetic privacy vs. advance medical research.”
Fleck and others have organized discussions on blood spots, costly cancer medications and “last chance therapies” in other states as well, and his ultimate goal is for these conversations to reach the national level as part of an effort to achieve national health reform. As a member of the 1993 White House Task Force on Health Reform as well as the Governor’s Task Force on Access to Health Care in Michigan, Fleck sees the final challenge of a national deliberative discussion on health issues as educating the public: “To have such conversations be productive people need to be comfortable with each other; people need to understand the concept of mutual respect in speaking to each other. Beyond that, if we would to provide a decent health insurance for the 47 million Americans now without health insurance, we must be willing to sacrifice some extremely costly but marginally beneficial health care for our future selves. This is what is necessary if we are to have a “just” and “caring” society so far as access to health care is concerned.”
Leonard Fleck’s newest book, Just Caring: The Ethical Challenge of Health Care Rationing and Rational Democratic Deliberation will appear in fall, 2008.
