08:30 am
A Façade of Futility
Dr. Cressida Auckland | London School of Economics | United Kingdom
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Author:
Dr. Cressida Auckland | London School of Economics | United Kingdom
Since the courts first relied on the concept of “futility” in Bland, it has been widely invoked as a justification for the withholding or withdrawal of life-sustaining treatment. In this paper, I argue that the way that futility is currently conceptualised in the case law, defined by reference to whether the treatment is “ineffective” or the patient will receive any “benefit” from it, is deeply problematic. Deciding whether or not a person derives a benefit from life-sustaining treatment, particularly in circumstances where they are seriously disabled or brain damaged, inevitably involves value judgements about their perceived quality of life. By conflating these with questions about the efficacy of treatments under the broad umbrella of “futility”, these value judgements are being obscured, hidden behind statistics on therapeutic success. This is not only a problem with the current law: in fact, defining futility in a way which is both value-neutral and broadly applicable is, I argue, impossible.
While some value judgements may be unavoidable in cases such as these, it is crucially important that where a judge decides that a person’s quality of life is sufficiently low that it ought not to be prolonged by further treatment, this assessment is made honestly and openly, and is capable of scrutiny and challenge. The language of futility militates against this. Given this, any legal significance attributed to futility as a justification for the withholding or withdrawing of treatment ought to be abandoned.
08:45 am
‘No One Is Listening’: Epistemicide in Clinical Encounters
Dr. Georgina Campelia | University of Washington School of Medicine | United States
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Authors:
Dr. Georgina Campelia | University of Washington School of Medicine | United States
Dr. Timothy Brown | University of Washington School of Medicine
Dr. Nancy Jecker | University of Washington School of Medicine
Introduction: Since its inception, contemporary bioethics has centered impartial ethical principles, drawn mostly from utilitarianism and Kantian ethics, without situating these principles in historical context of oppression and social structures that generate and reproduce health inequities. The field of bioethics must incorporate critical analyses of oppression into normative frameworks in order to address ongoing legacies of injustice and violence in medical practice. This paper centers a normative framework of epistemic justice that attends to social and historical contexts, and responds to health inequities by providing tools for counteracting violence and oppression in healthcare.
Methods: This paper employs methods from moral epistemology to address unjust clinical practices. Section I addresses a phenomenon Gayatri Spivak calls ‘epistemic violence’, which can manifest in clinical settings when unequal power relations are used to produce credibility excesses and deficits. When this happens, important knowledge is dismissed or goes entirely unrecognized—with adverse effects on patient care and clinician-patient relationships. Section II takes up the worst form of epistemic violence: epistemicide. Epistemicide, a term coined by Boaventura de Sousa Santos, arises in healthcare when credibility deficits supplant the knowledge and values of patients and their communities with the knowledge and values of medical professionals. Section III introduces two paradigm cases of resistance that show ways of responding to both epistemic violence and epistemicide and the challenges associated with each.
Outcome/ Conclusion: We argue that counteracting and preventing epistemic violence in clinical settings is possible —but it requires a transformative response, which Miranda Fricker calls “epistemic justice.”
09:00 am
Society, Trust, and Medicine's Responsibility
Prof. Rosamond Rhodes | Icahn School of Medicine at Mount Sinai | United States
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Prof. Rosamond Rhodes | Icahn School of Medicine at Mount Sinai | United States
Introduction
Numerous authors discuss trust in ethics. For example, Annette Baier wrote about “warranted trust,” and Onora O’Neill discussed the importance of trust and trustworthiness in professions. Taking a different tack, I focus on the creation of professions as a product of political philosophy. From that perspective, I offer an account of how society’s trust defines medicine’s responsibilities.
Method
Philosophy and bioethics often rely on thought experiments. In that tradition, I describe a hypothetical account of how society authorizes medical professionals’ distinctive powers, privileges, and immunities. By describing the profession as having an “at will” contract that can be revised or cancelled at the discretion of society, I explain medicine’s extraordinary license and its responsibilities.
Outcomes
I argue that professions’ fundamental duty is to Seek trust and be deserving of it. That core duty instructs professionals to focus attention on how society regards professional behavior. Every permission that professionals wield is contingent on society trusting its employment in a trustworthy manner for trustworthy goals. Earning society’s trust for new permissions (e.g., “brain death,” living donor organ transplantation, assisted reproduction) requires professionals to persuade society to grant new powers. Whereas scientific advance and technological developments play a role in expanding professional permissions, the expansion is dependent on gaining society’s trust every step of the way.
Conclusion
Medicine’s codes and oaths publicly declare the profession’s commitment to society and make medicine’s responsibilities transparently clear. Defining professional duties and setting professional standards allows society to trust that medicine’s responsibilities are upheld.
09:15 am
Responsibilization in light of medical innovation: Revisiting the ‘ought implies can’ dictum
Dr. Seppe Segers | Bioethics Institute Ghent & Metamedica (Ghent University) | Belgium
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Dr. Seppe Segers | Bioethics Institute Ghent & Metamedica (Ghent University) | Belgium
Introduction
It is a dominant dictum in ethics that ‘ought’ implies ‘can’: if an agent morally ought to do an action, the agent must be capable of performing that action. Yet, with current technological developments (e.g.) in direct-to-consumer genomics, big data analytics and wearable technologies, there may be reasons to reorient this ethical principle, both from the perspective of physicians and that of patients.
Methods
Conceptual analysis, normative analysis.
Outcome
As an effect of prevention and prediction oriented technological innovation, an increased focus on assumedly controllable lifestyle risks may be anticipated. For patients, this may entail a reinforced behavior-based individual responsibilization. Holding on to the ‘ought implies can’ dictum, such responsibilization seems to require that individuals can actually control what is framed as ‘lifestyle risks’. In addition: the idea that patients can obtain more health information through personalized health tools, need not entail that individuals are capable of making good healthcare decisions. For physicians, the ‘ought implies can’ principle is linked to questions about missed diagnosis and risks of liability: can healthcare professionals be held morally responsible if the steady flow of patients’ self-tracking data suggests clues to a missed diagnosis? What can be reasonably expected from healthcare professionals in terms of alertness and monitoring?
Conclusion
As medical and clinical ethics are deeply invested in the interaction between technology, ethical principles and moral value, it is timely to engage with the ethical theoretical question about the potential impact of technological innovation on the established principle that ought implies can.
09:30 am
“Being well informed” as the basis for “good care”: Moving towards standards for counseling for dementia prediction and early diagnosis in Germany
Dr. Zümrüt Alpinar Sencan | University Medical Center Goettingen | Germany
Julia Perry | University Medical Center Goettingen | Germany
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Authors:
Dr. Zümrüt Alpinar Sencan | University Medical Center Goettingen | Germany
Julia Perry | University Medical Center Goettingen | Germany
Introduction: Biomarkers may soon make the detection of Alzheimer’s disease (AD) possible in preclinical stages. However, their clinical use raises unresolved ethical, social, and practical issues, especially regarding counseled individuals’ informed decision-making about potential diagnostics. While popular and scientific interest in prediction and early diagnosis is increasing, there is a lack of person-oriented, high-quality, and low-threshold information and counseling services for the context of dementia risk prediction. Further, health care professionals are insufficiently trained for counseling this target group.
Methods: This analysis brings together two research projects focusing on ethical issues of prediction and early diagnosis of dementia. For the sustainable provision of counseling services and training of professionals in Germany, we explore experts’ views and affected people’s demands.
Outcome: Our analysis points to a high need for counseling and information on available diagnostics, treatment options, and support in care. The experts’ perspectives highlight the importance of multi-professional, two-staged (pre- and post-) counseling for the affected individual and family members as well as standards for communication. This supports the affected people’s demands for support in understanding what diagnostic tests can actually provide and accurate information about potential treatment approaches. Comprehensive counseling will support autonomous and responsible decision-making. For establishing ethical standards, interactive exchange between professionals and affected persons and on inter-professional levels becomes highly necessary.
Conclusion: Counseling services are currently neither sufficiently available nor standardized. This analysis incorporates affected people’s needs into a counseling system focusing on the provision of “good care” by ensuring counseled individuals to be “well informed”.