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Leonard Fleck - Michigan State University. East Lansing, MI, US

Leonard Fleck Leonard Fleck

Professor of Philosophy | Michigan State University


Leonard Fleck is an expert in health care justice, health care rationing, as well as ethical issues related to genetic technologies.




Leonard Fleck Publication



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Obstacles to Health Care Reform The Big Questions: U.S. Health Care



Leonard Fleck is a medical ethicist and philosopher. He is an expert in health care justice, health care rationing and policy, stem cell research, as well as ethical issues related to emerging genetic technologies.

Fleck served as a member of the Clinton Administration’s Health Care Reform Task Force in 1993 and as a state ethicist for Michigan regarding access to health care.

Industry Expertise (1)


Areas of Expertise (1)

Health care policy including changes being made by the Trump administration

Accomplishments (1)

Distinguished Faculty Award (professional)

College of Human Medicine

News (2)

Michigan State looks to change rules for firing tenured professors

Lansing State Journal  online


In April, Michigan State University's acting general counsel, Kristine Zayko, came to the University Committee on Faculty Tenure with two proposed changes to the policy on firing tenured professors.

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Leonard Fleck: Using a Medical Ethicsope

360 Perspective  online


As you embark on the adventure of discovery and growth that is a liberal arts education in the College of Arts & Letters here at Michigan State University, I invite you to consider for a moment what we might learn from a peculiar tree you will encounter on campus.

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Journal Articles (3)

Just caring: Do we need philosophical foundations? Ethics, Medicine and Public Health

L.M. Fleck PhD


The “Just Caring” problem asks: What does it mean to be a “just” and “caring” society when we have only limited resources (money) to meet virtually unlimited health care needs (linked to novel emerging medical technologies)? The practical implication of the “Just Caring” problem is that the need for health care rationing is inescapable. That means that some health care needs will not be met, even though those needs have moral weight, because meeting such needs is presumptively a matter of justice. How then can such rationing decisions be made justly or fairly? And who should have responsibility for making such decisions? Should such decision-making be the responsibility of legislative bodies, or administrators of health care institutions, or associations of physicians, or private insurers (in the United States), or employers (in the United States)? What should be the role of philosophers in addressing the problem of just health care rationing? After all, philosophers are supposed to be the experts when it comes to theories of justice.

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How Should Therapeutic Decisions about Expensive Drugs Be Made in Imperfect Environments? AMA Journal of Ethics

LM Fleck, M Danis


Clinicians must inevitably make therapeutic decisions under nonideal conditions. They practice in circumstances that involve incomplete evidence. They deliver care in health care systems that are complex and poorly coordinated. Each of the patients that they take care of is unique while research offers evidence regarding relatively homogeneous populations of patients. Under these circumstances, many parties—medical scientists, reviewing agencies, insurers, and accountable care organizations—can and should contribute to optimizing the development, approval, funding, and prescription of therapies—particularly expensive and marginally beneficial therapies. In aggregate, they should aspire to achieve a pattern of fair, cost-effective therapeutic decisions to ensure a sustainable health care system. Here we offer some suggestions regarding decisions that physicians might pursue to facilitate fair and cost-effective patient care.

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Choosing Wisely: Is Parsimonious Care Just Rationing? Cambridge Quarterly of Healthcare Ethics

Leonard M. Fleck


The American College of Physicians in its ethics manual endorsed the idea that physicians ought to improve their ability to provide care to their patients more parsimoniously. This elicited a critical backlash; critics essentially claimed that what was being endorsed was a renamed form of rationing. In a recent article, Tilburt and Cassel argued that parsimonious care and rationing are ethically distinct practices. In this essay I critically assess that claim. I argue that in practice there is considerable overlap between what they term parsimonious care and what they define as rationing. The same is true of the Choosing Wisely campaign endorsed by the American Board of Internal Medicine. In both cases, if the goal is to control healthcare costs by reducing the use of marginally beneficial care that is not cost effective, then a public conversation about the justness of specific choices is essential.

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