The 19th Annual American Society for Bioethics and Humanities (ASBH) Meeting was held October 19-22 in Kansas City, MO. Center faculty Laura Cabrera, Guobin Cheng, Marleen Eijkholt, Leonard Fleck, Devan Stahl, and Tom Tomlinson attended and presented at the conference. The post below includes abstracts for each presentation (abstracts have been edited for length).
Laura Cabrera, PhD
Assistant Professor, Center for Ethics and Humanities in the Life Sciences, Department of Translational Science & Molecular Medicine
Dr. Cabrera participated in a law, public health policy, and organizational ethics paper session, presenting “Centering the Re-Emergence of Psychiatric Neurosurgery: A Cross-National Comparison of Ethical and Societal Concerns in Media Coverage.”
Abstract: In light of the dark history of many surgical approaches to treat psychiatric disorders, understanding contemporary trends around the re-emergence of different methods to which patients and the public are exposed is essential to understanding their views and receptivity to them, both for healthcare and society. We conducted an in-depth content analysis of media articles reporting on all types of psychiatric neurosurgery between 1960 and 2015 with a focus on North America (Canada and the USA), Germany and Spain. After manually curating for duplicates and irrelevant returns, 167 Spanish articles, 160 German articles, and 217 articles from North America were analyzed inductively for content and coded for the phenomena of interest. Overall, the tone across articles was positive across interventions; articles retrieved from the German press were generally the most critical of the sample. Identity and privacy were among the few noted ethical and philosophical issues, and again found mostly in German articles. References to earlier forms of psychiatric neurosurgery were common across articles published after 2005. The findings suggest that while modern press reports about psychiatric neurosurgery tend to be positive and reference to historical antecedents are made in contemporary news, there is limited ethical and philosophical reflection. Future studies will further inform the influence of these trends on centering stakeholder values, perceptions of risk, and hope for benefits.
Marleen Eijkholt, JD, PhD
Assistant Professor, Center for Ethics and Humanities in the Life Sciences, Department of Obstetrics, Gynecology and Reproductive Biology
Dr. Eijkholt participated in a clinical ethics paper session, presenting “Tools for Trouble: Pain as a Clinical Ethical Torment.”
Abstract: Pain is a complex phenomenon that entails many clinical ethical challenges. Heterogeneity of providers and patients in the USA makes the context of pain treatment a hotbed for troubling practices. The current spotlight on the “opioid epidemic” reveals some of these challenges. For example, an increasing amount of requests relate to questions about the provider obligations in pain management, specifically for uninsured patients who are of an ethnic minority group. Restrictive guidelines reduce the epidemic to a biomedical pain treatment problem and do not address pain as a social construct, impacted by culture, environment and gender. While anthropological studies examine different ethnic factors contribute to management, perception and expression of pain, the clinical ethical literature is silent on these issues. I ask: What tools exist to address the socially constructed dimensions of pain in the clinic, and how should these be evaluated or developed?
Leonard Fleck, PhD
Professor, Center for Ethics and Humanities in the Life Sciences, Department of Philosophy
Dr. Fleck participated in a capacity, informed consent, and the quality adjusted life year paper session, presenting on “Precision QALYs: Precisely Unjust.”
Abstract: A recent essay by Heale (Journal of Medical Ethics, 2016) argues for the moral legitimacy (utility and equity) of individualized and personalized QALYs. He contends, for example, that it would be unfair to deny a patient access to $100,000 cancer drug that would give this patient three extra years of life simply because the average patient with that cancer would only gain four extra months of life. He assumes, arguendo, that some biomarker would allow us to identify such a patient before the fact (which is one objective of the precision medicine initiative), and concludes, from a cost-effectiveness perspective, that it would be unjust to deny this patient that drug. I believe this argument is flawed for several reasons. Other justice-relevant considerations, not just cost-effectiveness and utility, are ethically necessary for making many allocation decisions that are “just enough.” “Ragged edges” and clinical uncertainty undermine the practical applicability of his individualized QALYs methodology. Irrelevant personal utilities are given undeserved ethical weight (Heale gives a Jehovah’s Witness example with this consequence). Ethically irrelevant features of an individual are given ethical weight by Heale that results in their being denied access to care from which they would otherwise significantly benefit. To illustrate, a cancer drug whose cost is related to dose size would be cost-effective for a 70 kg person but cost-ineffective for a 90 kg person, though both individuals would otherwise benefit equally. To conclude, precision medicine requires complex considered judgments of health care justice.
Devan Stahl, PhD
Assistant Professor, Center for Ethics and Humanities in the Life Sciences, Department of Pediatrics and Human Development
Dr. Stahl led the Christian Theology and Bioethics Affinity Group, discussing the recent book The Finest Traditions of My Calling with the book’s author Abraham Nussbaum. Dr. Stahl was also on the Religion, Spirituality, and Bioethics Affinity Group panel. The group’s focus was religious and spiritual aspects of clinical ethics consultation.
Tom Tomlinson, PhD
Director, Center for Ethics and Humanities in the Life Sciences; Professor, Department of Philosophy
Guobin Cheng, PhD
Adjunct Associate Professor, Center for Ethics and Humanities in the Life Sciences; Associate Professor, Southeast University, China
Drs. Tomlinson and Cheng participated in a panel session, presenting on “Clinical Ethics in China and the United States: Worlds Apart?”
Abstract: China can seem like (half) a world away from the United States. Different political and legal systems, different health care and insurance systems, different culture and social values. The list goes on. So one would not be surprised if similar clinical situations raised very different ethical questions, or led to different ethical conclusions, for different ethical reasons. And indeed this can be true. But one can also find the same questions, the same conclusions, and appeals to the same reasons. It is often claimed that Chinese people place more value on the interests of the family and less on the interests or rights of the individual. Some cases will be designed to explore this hypothesis. Others will aim to surface whether quality of life plays different roles in decisions about continued treatment, and in what ways Chinese and American parents are obligated to protect their child’s best interest in decisions about medical treatment.