The State News: What do you do here at MSU?
Leonard Fleck: Mostly I’m addressing issues related to health care ethics and health care policy in my teaching and research, (with) some social and political philosophy. There’s a lot of focus on issues of health care justice — how we allocate scarce resources, and how we do that fairly. I also do a fair amount of work related to emerging genetic technologies and some of the ethical and policy issues that are raised there.

TSN: So, like stem cells and cloning, that sort of thing?
LF: There’s some stuff I talk about there. But the larger issues have to do with what’s going on with personalized medicine and pharmacogenomics. So, for example, one of the issues we’ll be faced with is we have these extraordinarily expensive cancer drugs. … Is it worth it? Can we justify that when we have only limited resources — money — to meet virtually unlimited health care needs? … But what makes it even harder is that there’s a lot of research occurring now that shows that, for example, women with advanced breast cancer … have different genotypes that are more or less responsive to some of these extraordinarily expensive drugs. … And so the ethical and policy question we’re left with is would we, as a just and caring society, provide the drug at social expense to the women who would get a substantial gain — let’s say at least more than a year of extra life — from the drug, but deny it at social expense to those individuals who we would know ahead of time, on the basis of their genotype, would get much less than an extra year of life?

TSN: Is there anything in particular you think college students need to know about healthcare?
LF: From my point of view, the most important thing that college students and our society as a whole needs to think about is what kind of trade-offs we’re willing to make in order to meet what we collectively judge through a process of rational — non-shouting — democratic deliberation, what we judge to be our more important health care priorities and which ones are of lower importance. I would hope that students would begin the process of thinking about those issues, for their future possible selves — their future possible elderly selves. … So one of the questions would be: Should we do less in terms of very aggressive, very costly, life-sustaining care in the last six months, last year of life for elderly individuals in order to generate more resources to support more adequate long-term care programs? … But that’s a matter for democratic deliberation.