The Western Michigan University Ethics Center hosted the conference “Bioethics: Preparing for the Unknown” on March 17-18, 2016 in Kalamazoo, MI. The conference included presentations from Center faculty members Laura Cabrera, Leonard Fleck, and Devan Stahl.
Drs. Cabrera and Stahl participated in the panel “The Future of Psychiatric Deep Brain Stimulation: Dealing with the Unknown” along with WMU Assistant Professor Dr. Tyler Gibb. Dr. Cabrera states: “The use of deep brain stimulation (DBS) for psychiatric disorders raises ethical debate for a number of reasons: the same intervention can be of great benefit for some but not for others, patients are desperate to find some relieve from their disease thus they might underestimate the risks and unknowns around the intervention; and it is not clear how can we ensure that conflicts of interest do not blur the ethical judgment of clinicians involved in these procedures. Thus we must remain aware that the new frontiers of psychosurgery are not free from similar abuses as those from the past, and that there are many unknowns surrounding psychiatric DBS and its current practice.”
“The panel was well received, and we enjoyed a lively conversation about our thesis,” said Dr. Stahl. “Overall, the conference presented a variety of topics about the future of medicine and health care and the speakers presented dynamic ideas in an intimate setting.”
Dr. Fleck presented the paper “Just Caring: Parsimonious Care in Certain Uncertain Circumstances” as part of the Medical Decision Making session. Dr. Fleck discussed how uncertainty should be addressed in the economic and political context of having to do health care rationing, and in the ethical context of having to do that rationing justly. He offered several common examples, such as $100,000 precision cancer drugs, $40,000 implantable cardiac defibrillators, PCSK9s for lowering “bad” cholesterol, access to ICU beds—all of which represent uncertain benefit at very great cost. Dr. Fleck states: “Access to health care resources is about access to a limited common good. This is what makes such access a matter of justice rather than a matter of informed consent wherein a patient weighs from their point of view the risks and benefits (and related uncertainty) they are willing to trade off. Matters of justice require social decisions. Patients do not have a presumptive just claim to a $100,000 cancer drug if there is only a small chance that drug would yield an extra six months of life. What level of certainty would generate such a just claim? There is no objectively correct answer to that question. It needs to be resolved, I will argue, through a process of rational democratic deliberation, the results of which will be just and legitimate for all in the relevant clinical circumstances.”
The conference was part of the 30th anniversary of the WMU Center for the Study of Ethics in Society. Attendees and speakers included medical doctors from a variety of specialties, clinical ethics consultants, lawyers, and philosophers from Michigan and throughout the United States and other countries.