Department of Bioethics and Decision Sciences

Although department researchers also pursue more traditional research in their respective fields of bioethics and decision sciences, the department uniquely brings them together to collaboratively investigate questions at their intersection, especially in the domains of health, science and innovation. 

Researchers in the department use a wide range of quantitative and qualitative methods, and enjoy access to over 25 years of electronic health record and claims data, and over 300,000 consented participants in the MyCode Community Health Initiative biobank. 

They investigate questions such as:

• When and why do people exhibit aversion to, or appreciation of, the use of “algorithms” and other AI tools in decision-making?
• How do people incorporate beliefs, misbeliefs, and concerns about data privacy into their decisions about healthcare and research?
• How do people (mis)understand genetic information, and how is this information best presented?
• Does the disclosure to adolescents of genetic variants associated with adult-onset disease place them at risk of psychological harm?
• When and why do people prefer to implement untested practices and policies instead of subjecting them to A/B testing, and how can we intervene to reduce this bias to advance a learning health system? 
• How does moral distress affect the quality of clinical decisions? How does moral distress affect the functioning of healthcare teams?
• Do clinicians neglect important information when interpreting diagnostic test results, and if so, how can the incidence of such biases be reduced?
• Are laypeople and clinicians rational when making decisions about rationing healthcare?
• When and why are some people hesitant to be vaccinated and how can that be addressed?
• What kinds of “nudges” are acceptable to stakeholders, when and why?

Departmental research has been funded by several divisions of the National Institutes of Health (NIH), including: 

• National Institute on Aging (NIA)
• The National Human Genome Research Institute (NHGRI), 
• The National Cancer Institute (NCI)
• The National Center for Advancing Translational Sciences (NCATS)
• The Office of the Director; the U.S. Food and Drug Administration (FDA)
• The National Science Foundation (NSF)
• The Patient-Centered Outcomes Research Institute (PCORI)
• The National Bureau of Economic Research (NBER) 
• Roybal Center for Behavior Change in Health
• The Russell Sage Foundation (RSF)
• The JPB Foundation
• The Robert Wood Johnson Foundation (RWJF)
• Open Philanthropy
• Riksbankens Jubileumsfond, a Swedish foundation dedicated to supporting the humanities and social sciences. 

Department members have published their research in leading peer-reviewed journals in several fields, including: 

• The New England Journal of Medicine, Science, Nature
• Proceedings of the National Academy of Sciences (PNAS)
• Health Affairs
• Nature Medicine
• Nature Genetics
• Nature Computational Science
• American Journal of Bioethics (AJOB)
• Hastings Center Report
• Journal of Law, Medicine & Ethics
• JAMA Network Open
• Circulation
• Genetics in Medicine
• Clinical Trials
• Perspectives on Psychological Science
• Trends in Cognitive Sciences
• Advances in Methods and Practices in Psychological Science (AMPPS)
• The Behavioral Economics Guide
• Edited volumes from Routledge, Cambridge University Press, MIT Press, and other publishers. 

Members have also translated their research for the public, writing for popular media outlets such as The New York Times, The Wall Street Journal, The Washington Post, Los Angeles Times, Slate, the Chronicle of Higher Education and Wired.

Department members present their work at national and international conferences, including: 

• The American Society for Bioethics and Humanities (ASBH)
• The American Society of Human Genetics (ASHG), 
• ELSI Congress, 
• Public Responsibility in Medicine and Research (PRIM&R)
• The International Conference on Computational Social Science (IC2S2)
• The Conference on Digital Experimentation @ MIT (CODE)
• The ASLME Health Law Professors Conference
• The Penn Medicine Nudges in Health Care Symposium
• The Penn Behavioral Science & Health Symposium;
• As well as numerous invited talks at institutions in the U.S., Canada, Europe and Australia. 

Finally, members of the department have served on several boards and commissions, including the President’s Council on Bioethics, the Healthcare Ethics Consultant Certification (HEC-C) Commission, an American Psychology Association blue ribbon commission, National Academies study committees, task forces of the American Society for Bioethics and Humanities, NIH and NSF review panels, multiple IRBs and journal editorial or advisory boards.

Examples of our work (bold indicates Geisinger author):

• Michelle N. Meyer, Patrick R. Heck, Geoffrey S. Holtzman, Stephen M. Anderson, William Cai, Duncan J. Watts, Christopher F. Chabris, Objecting to experiments that compare two unobjectionable policies or treatments, PNAS (2019)
• Patrick R. Heck, Christopher F. Chabris, Duncan J. Watts, Michelle N. Meyer, Objecting to experiments even while approving of the policies or treatments they compare, PNAS (2020)
• Patrick Turley,* Michelle N. Meyer,* Nancy Wang, David Cesarini, Evelynn Hammonds, Alicia R. Martin, Benjamin M. Neale, Heidi L. Rehm, Louise Wilkins-Haug, Daniel J. Benjamin, Steven Hyman, David Laibson, Peter M. Visscher, Special Report, Problems with using polygenic scores to select embryos, New England Journal of Medicine (2021)
• Christopher F. Chabris and Daniel J. Simons, The Invisible Gorilla: How Our Intuitions Deceive Us (New York: Crown, 2010)
• Michelle N. Meyer, Practical tips for ethical data sharing, Advances in Methods and Practices in Psychological Science (2018)
• Katherine L. Milkman . . . Christopher F. Chabris . . . Amir Goren . . . Michelle N. Meyer . . . Maheen Shermohammed . . . Angela L. Duckworth, A megastudy of text-based nudges encouraging patients to get vaccinated at an upcoming doctor’s appointment, PNAS (2021)
• Michelle N. Meyer, Tami Gjorgjieva, Daniel Rosica, Trends in health care worker intentions to receive a COVID-19 vaccine and reasons for hesitancy, JAMA Network Open (2021)
• Tessy A. Thomas, Laurence B. McCullough, A philosophical taxonomy of ethically significant moral distress, Journal of Medicine and Philosophy(2014)
• Cynda H. Rushton, Tessy A. Thomas, Inga M. Antonsdottir, Katie E. Nelson, Danielle Boyce, Anna Vioral, Deborah Swavely, Cathaleen D. Ley, Ginger C. Hanson, Moral injury and moral resilience in health care workers during COVID-19 pandemic, Journal of Palliative Medicine(2021)
• Henri C. Santos, Michelle N. Meyer, Christopher F. Chabris, Reports of the death of expertise may be exaggerated: Limits on knowledge resistance in health and medicine. In J. Stromback, Å. Wikforss, H. Oscarsson, T. Lindholm, & K. Glüer (Eds.). Knowledge Resistance in High-Choice Information Environments (London: Routledge, 2022)
• Amy L. McGuire, Mark P. Aulisio, F. Daniel Davis, Cheryl Erwin, Thomas D. Harter, Reshma Jagsi, Robert Klitzman, Robert Macauley, Eric Racine, Susan M. Wolf, Matthew Wynia, Paul Root Wolpe, Ethical challenges arising in the COVID-19 pandemic: An overview from the Association of Bioethics Program Directors (ABPD) task force, American Journal of Bioethics (2020)
• F. Daniel Davis, Pellegrino and the Learning Health Care System: A Speculative Exploration. Forthcoming in Pellegrino: Essays in Memoriam (in press, Catholic University of America Press)
• Sam Zhang, Patrick R. Heck, Michelle N. Meyer, Christopher F. Chabris, Daniel G. Goldstein, Jake M. Hofman, An illusion of predictability in scientific results: Even experts confuse inferential uncertainty and outcome variability, PNAS (in press)

The department is part of the Geisinger College of Health Sciences, which includes (in addition to its Research Institute) the Geisinger Commonwealth School of Medicine, the Geisinger School of Nursing and the Geisinger School of Graduate Education (which includes master’s programs in Biomedical Sciences and Genetic Counseling and graduate certificates in Pharmacy Systems Science and Healthcare Leadership). 

Department faculty are members of Geisinger’s Academy of Educators and participate in graduate and continuing education in (primarily clinical) ethics and the decision sciences. This includes producing an annual spring bioethics symposium for medical residents and fellows and developing and delivering program-specific educational content in several of Geisinger’s numerous medical and nurse fellowship and residency programs. 

The department also develops ethics quality advisories (EQAs) — brief, targeted, widely-distributed communiques about such special topics as advance directives, surrogate decision makers and healthcare decision making with intellectually disabled patients. In addition, the department develops strategic educational initiatives on these and other topics for delivery to clinicians.  

Finally, researchers in the department contribute to education by mentoring junior faculty, postdoctoral fellows, predoctoral fellows, and undergraduate and medical student interns interested in research, by guest lecturing in undergraduate and graduate classes across the country, and by serving as faculty at continuing professional education conferences.

Members of the department staff two advice and consultation services in clinical and research ethics, respectively, and oversee a network of hospital ethics committees.

Clinical Ethics Advice and Consultation Service (CEACS): The CEACS is staffed by department members who are certified healthcare ethics consultants. It is available 24 hours a day, seven days a week, free of charge, to any Geisinger patient, patient family member or loved one, or healthcare team member at all system locations in both in- and out-patient settings. 

Ethics consultants help navigate the ethical challenges of uncertainty and conflict inherent in clinical decision-making and care. Employees with access to TigerConnect may request a consult by contacting the ethicist on call, who will respond as soon as possible. Patients, their family members or friends, or surrogate decision makers (along with staff without access to TigerConnect) may request a consult by calling 570-214-2400.

Research Ethics Advice and Consultation Service (REACS): The REACS is staffed by department members with expertise in the responsible conduct of research. It is available, free of charge, to investigators and other research team members as well as to IRB members and staff. REACS provides members of the research community with timely consultation on ethical issues in the design and conduct of research (including but not limited to research involving human participants), quality improvement, and innovation.

Hospital ethics committees: Members of the department participate in and oversee Geisinger’s five hospital ethics committees. Each committee is engaged in policy development, review, and revision; quality oversight of clinical ethics advice and consultation; and clinical ethics education.

Members of the department are responsible for the development, review and (as appropriate) revision of several system policies and guidelines, and they participate in the development and revision of many more. These policies and guidelines span the range of bioethics subfields (e.g., clinical ethics, research ethics, public health ethics, the ethical, legal and social implications (ELSI) of emerging technologies) and include the following topics: 

• Surrogate decision-making
• Assessing decisional capacity
• Shared decision-making
• Advanced care planning/advance directives
• Unrepresented patients
• Crisis standards of care 
• Allocation of scarce resources 
• Employee vaccine mandate exemptions
• Trial prioritization
• Appropriate use, disclosure and sharing of data 
• Appropriate use of MyCode Community Health Initiative data and engagement of participants
• Appropriate use of health AI
• Integrative medicine
• Program evaluation

Members of the department lead or participate in a range of initiatives aimed at improving the safety and quality of care for Geisinger’s patients – and of the environment for both patients and employees. 

MyCareChoices: Department faculty serve on the steering committee for this broad-based initiative to improve the quality of decision making and care for patients grappling with serious advanced illness by (1) increasing the uptake of advance care planning and (2) enhancing the communication skills of clinicians for person-centered, shared decision making. Department faculty are also among the core faculty for Shared Decision Making in Serious Illness, the communication skills-focused component of MyCareChoices.

Patient safety: Department faculty serve on the steering committee for Communication and Optimal Response (CANDOR), the AHRQ-developed framework and process for improving organizational responses to adverse events and errors that Geisinger adopted in 2018. In collaboration with the Healthcare Communication Program, department faculty lead the education and training for senior clinicians and clinical leaders in the “ethical, effective disclosure of events and errors” workshop, a key programmatic element of CANDOR.

Patient/Surrogate misconduct: Department faculty co-lead this system-wide initiative to develop more effective responses to the challenges of misconduct on the part of patients and their loved ones or surrogates. Faculty were instrumental in developing the system’s patient and visitor misconduct policy, as well as guidelines to inform the behavior and responses of frontline clinicians who are confronted with misconduct. 

Organizational culture — professionalism, psychological safety and just culture: Department faculty collaborated with faculty from the Center for Professionalism and Well-Being to develop a toolkit of resources for improving aspects of the system’s organizational culture, including workshops on: giving and receiving effective feedback; resolving and transforming conflict; and fostering psychological safety. Faculty also collaborate with residency and fellowship program directors to develop and offer education and trainings designed to advance professionalism on the part of learners. Finally, bioethics faculty are integrally involved in the ongoing development of standards of professionalism for focused implementation in the learning environment.