CUNY philosophers Phoebe Friesen (PhD Candidate), Rosamond Rhodes (faculty), Georgina Campelia and Carolyn Neuhaus (alumni) and are on the program for the 2017 American Society for Bioethics & Humanities Conference, Oct. 19th-22nd in Kansas City, MO.
The sessions in which these speakers appear are listed below, along with the abstracts for their panels/talks.
Friday, October 19th
Centering Housestaff Ethics Education
1:30pm – 2:30pm
Our healthcare system has recently grown to include five additional hospitals. This rapid growth demanded that we expand our housestaff bioethics education efforts and target it to meet trainee needs. Our housestaff come from medical schools across the country and around the world. Given that there is little uniformity or consistency in bioethics training, last fall we developed a seven-question pilot needs assessment survey built around the kinds of ethical issues that housestaff were most likely to encounter during Graduate Medical Education. Our aim was to center our educational efforts by identifying situations that housestaff did not feel sufficiently prepared to handle.We received fewer responses than we had hoped, and the responses came from trainees in many different programs at different stages in their training. Nevertheless, the pilot study showed that our approach was effective in identifying issues for which housestaff would welcome more education. For example, the survey revealed that our housestaff considered themselves to be adequately prepared to handle matters involving privacy and confidentiality, but they were desirous of training on treating over objection, assessing decisional capacity, delivering serious news, responding to errors, and having end-of-life discussions. Based on that preliminary experience, in June 2017 we will conduct a survey of all of our incoming housestaff and all chief residents. Data from those surveys will provide us with an understanding of where to focus our educational efforts so that we may help our trainees understand their roles and responsibilities and provide guidance for navigating their responses.
Saturday, October 21st
Conscientious Refusal to Provide Specific Healthcare Services
10:45am – 12:15pm
The role of personal conscience in the practice of medicine is at the very center of medical practice, and the topic raises heated controversies within bioethics and the humanities. Recently, a group of bioethicists at a workshop sponsored by the Brocher Foundation in Geneva issued a consensus statement on the topic of conscientious objection. Their recommendations limit the right of healthcare providers to refuse to provide services based on conscientious objection. At the same time, the American Medical Association’s Code of Medical Ethics 1.1.7 maintains that the organization recognizes a right to conscientious objection and the right for physicians and nurses to invoke conscientious objection and refuse to provide services is legally protected in 48 states. This panel will air the significant debate over whether individual healthcare providers or institutions may legitimately invoke conscientious objection to refuse specific medical services for religious or other moral reasons. Abortion, physician-assisted suicide/physician aid-in-dying, contraceptive prescriptions, and gender confirmation/reassignment surgery are central examples that raise issues of conscientious objection. Seeking a resolution to the profound disagreements that are at the heart of this issue is consistent with our field’s long tradition of examining the core commitments of clinical medicine. The subject also fits well with the annual ASBH meeting theme of centering bioethics. This panel will include four scholars who are actively involved in this debate. Two will argue in opposition to a right of conscientious refusal, and two will argue in favor of recognizing such a right for individuals and institutions.
Philosophy / History Paper Session 3
4:30pm – 5:30pm
“Sloppy Science” in Preclinical Research: Implications for the Welfare of Research Participants and Compassionate Use Programs
It’s no secret that preclinical research studies involving animals overwhelmingly fail to predict an investigational drug’s safety and efficacy in humans. A growing literature attributes this failure to ‘sloppy science’: limited reproducibility, lack of random allocation or blinded outcome assessment, biases, etc. This presents a moral problem insofar as poor quality animal studies harm human research subjects. Core protections for research subjects assume that the results of animal studies upon which first-in-human studies are justified are valid and reproducible. IRBs and research subjects cannot be safe in that assumption.
Increased utilization of compassionate use programs, which provide patients access to unapproved investigational drugs outside of an IRB-approved clinical trial, exacerbates this moral problem. ‘Right to Try’ laws allow patients to obtain investigational drugs with no IRB or FDA oversight. The possibility of harm to vulnerable people – people who are extremely sick and near death – is high. We might expect the number of people exposed to this harm to rise as more people avail themselves of the ‘right to try.’
Improving the quality of preclinical studies involving animals will not remove all risks to people who receive an investigational drug through compassionate use. Still, scientific practices in preclinical studies could be much improved to provide a more accurate risk-benefit ration and informed consent process. As compassionate use expands, our moral obligation to protect the most vulnerable patients entails that there ought to be more stringent oversight of the scientific integrity and design of experiments involving animals.
Sunday, October 22nd
Research Ethics Paper Session 7
8:00am – 9:00am
Is More Knowledge Always Better? The Ethics of Predictive Analytics in Health Care
This presentation examines ethical issues related to predictive analytics in health care. As patient autonomy is given more and more weight in health care settings, the assumption that more patient knowledge is always better increasingly plays a role in bioethical analyses. This assumption is challenged through the examination of two case studies that involve the use of predictive analytics to facilitate early diagnoses, one involving detection of pancreatic cancer through the analysis of user web searches, and another which relies on classification algorithms of speech features in order to predict the likelihood that a given individual will develop psychosis. Because pancreatic cancer has such low rates of survival, this case points the importance of weighing the possibility of benefits from early detection against the possibility of harm to an individual through the delivery of unsolicited serious news. The second case raises distinct worries related to autonomy; as increasing evidence suggests that psychosis may operate within a network of symptoms, this suggests that knowledge of one’s risk may actually have a negative impact on experiences of psychosis, through an increase in symptoms of anxiety and/or depression. Taken together, these cases suggest that more knowledge is not always better, and at times, can lead to unintended harms. In a concluding discussion, it is suggested that the growing field of predictive analytics in health care could benefit from looking to bioethical analyses of incidental findings.
In this presentation, after outlining the flaws of the NIH’s approach, I briefly describe what a comprehensive review of the ethics of primate research would entail. I outline theoretical alternatives to harm-benefit analysis that should be part of the ethical debate about primates, and also describe which harms need to be taken into account. Moreover, I review research on the cognitive and effective capacities of primates that would need to be considered in a thorough review, with a particular emphasis on understanding primate behavior in natural settings.
Clinical Ethics Paper Session 17
11:00am – 12:00pm
Responding to Moral Distress: Reason for More Empathy, Not Less
The relatively recent emergence of ‘empathy’ in philosophy, psychology, neuroscience, and healthcare research, has come with skepticism on all fronts, but particularly in healthcare. Here, the preeminence of objectivity and evidence-based medicine obligates distance rather than attachment and cognition rather than affect. Even when one admits that empathy has an important place in patient care, it is quickly assured that a clinician’s empathy must be balanced with distance and guided by more objective principles (e.g. respect for autonomy, beneficence). Empathy comes at a cost, after all, it is burdensome to clinicians to try but fail to make empathic connections with patients who refuse to engage in dialogue and even to succeed when empathic success means feeling with a patient’s suffering. These interactions are said to lead to moral-emotional distress and burnout. So, the typical response goes, empathy must be avoided or, at least, balanced with clinical distance. However, we argue here that there is an alternative response, one that is sensitive to the fundamental epistemic and moral value of empathy in healthcare. Compassion fatigue and clinician burnout, may be better served by: (1) changing structural components of clinician-patient interactions (time, education, etc.) so as to better enable empathy in the first place, and (2) creating robust systems of empathy to support and alleviate clinicians when empathy is burdensome (e.g. debriefing, group counseling, education, etc.).