AJOB Neuroscience.

Values at the Crossroads of Neurology, Psychiatry, and Psychology

Clinical neuroethics often engages a paradigm of medicine that has a significant discomfort with ambiguities. Uncertainty in both medical diagnosis and treatment constitutes the reality of many disease processes in which patients, families, and health care providers make health care decisions that deeply affect their lives. In particular, conditions whose neurological symptoms challenge our distinctions between the physical and mental bring a special type of uncertainty into focus with an array of moral implications. For instance, a patient may present with stroke-like symptoms or convulsions that appear to be epilepsy, but for which “stress” is the most likely cause. At another time, a young patient arrives at a health care facility with a psychosis evaluated by psychiatry that in the end is caused by a rare tumor. The uncertainty about the causal factors contributing to these symptoms challenges the patient’s sense of self and the patient’s social roles in a system that is accustomed to operating within a “traditional” framework of neurological disease. The neurologist may believe the patient is served best by the psychologist; the psychologist may believe it is the psychiatrist; and the psychiatrist may believe it is the neurologist. Patients find themselves passed around among specialties or are unable to find a specialist willing to evaluate them. At times, clinicians resort to providing a label for the patient’s condition, such as a “touch of multiple sclerosis,” even when the patient does not have the disease, and subsequently provide a placebo as the solution (Boissy and Ford 2012). For a variety of pragmatic reasons, stakeholders desire labels for sets of symptoms in order to move forward with their lives and perhaps to have treatment reimbursed. Given the stigmatization of mental health diagnosis, a label entailing an identifiable organic/biological correlate may be preferred. However, there are important ethical considerations that may not at first be obvious in trying to manage these types of conditions. A better understanding of ambiguities and value assumptions can allow us to shape our health care in better ways to serve all stakeholders. […]

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Volume 4, Issue 3
July 2013