 | Diane O'Leary Visiting Scholar in Neuroethics - Georgetown University PCCB |
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01.03.2018-30.04.2018
Ethical and Philosophical Parameters for Management of Medically Unexplained Symptoms
There are three parts to this project. Part I involves papers that articulate the four central areas of ethical concern with management of medically unexplained symptoms: (1) “The silent problem of obstructed access to biomedical care with mistaken psychogenic diagnosis”, is currently under revision for resubmission to Hastings Center Report following comments from reviewers, and (2) “Deliberate misrepresentation of psychogenic diagnosis: Addressing a formidable threat to ethical medical practice”, is currently under review as a target article for American Journal of Bioethics. These papers are based on two presentations I gave at Hastings Center for Bioethics in February of 2016. Before the end of the current academic term I will submit (3) “The women who cry illness” to the Journal of Medicine, Law and Ethics as an expansion of their 2001 article, “The girl who cried pain”. This paper is based on a presentation I gave at the International Congress on Women’s Health in 2016 about the demonstrable disparity between women’s actual rate of biomedical need and the rate at which physicians must diagnose women’s symptoms as psychogenic given the two basic principles for psychogenic diagnosis in medical education. During summer of 2017 I will complete, (4) “Outlining ethical parameters for management of chronic fatigue syndrome and other contentious conditions”, based on an abstract accepted for poster presentation at the 2016 International CFS/ME conference. (I was unable to attend due to lack of funding).
Part II of the project explores the metaphysical side of this area of medical practice, and it will be completed during fall of 2017. (I am in the process of applying to pursue this part of the project at the Rotman Institute of Philosophy, where the overlap between philosophy and bioethics is very fruitful.) (1) “The Elephant in the room: how dualism about psychogenic symptoms continues to harm the practice of medicine” is underway at this time, as is (2) “What do we mean, metaphysically, by ‘psychogenic symptoms’?” This paper lays out four distinct ways that researchers and providers understand the relation of brain states and mind states in psychogenic symptoms, based on an abstract accepted for poster presentation at the 2016 International Neuroethics Society Conference (unable to attend due to lack of funding). Finally (3) In “How patient care is routinely compromised by metaphysical ambiguity in psychogenic diagnosis: The case of Chloe Atkins”, I apply those four distinctions to a specific case of psychogenic diagnosis from philosopher Chloe Atkins’ book, My Imaginary Illness.
During the period of my stay at Brocher, I would focus on Part III of the project, which will introduce the construct of “bodily distress syndrome” to professionals in bioethics, (a) clarifying the immensely important role it will play in everyday medical practice across the globe if it is, in fact, adopted by the World Health Organization to replace somatoform disorders in the upcoming edition of the ICD, and (b) exploring the ways in which the construct challenges current standards for ethical clinical practice. Also during the peiod of my stay at Brocher, I will outline the final papers of the project, which articulate for bioethicists, readers in psychogenic medicine, and readers in general medicine, an ethically informed, philosophical viable alternative for management of unexplained symptoms (an approach very broadly outlined in my “Deliberate Misrepresentation of Psychogenic Diagnosis”, currently under review at AJOB).
I work on mind-body issues as they arise in medicine. At this time I am exploring ethical management of medically unexplained symptoms, trying to pin down ethical and philosophical parameters for diagnosis of "causes in the mind". While at Brocher I am developing a paper that evaluates proposals to replace "somatoform disorders" in ICD-11 from a philosophical and ethical perspective.
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