PACE Bioethics 2012

One of the things that made last week absolutely frantic was that the annual PACE ethics conference, It ran during the last half of the week. Any time I didn't have a meeting, I tried to be in the conference. Here's a quick rundown of some of the highlights that I saw.

On Wednesday morning, I introduced one of the keynote speakers, Robin Fuchs-Young. Robin has visited our campus before many times, including once as an REU speaker. She spoke about the evolution of ethical regulations in research, mostly in the United States. One of the recurring themes in her talk was how recent many regulations and policies were. After the talk, she told me that preparing for this presentation that helped her realize that, "We're not doing a very good job of introducing our students to these issues."

This was immediately followed by a panel I was on, titled, "Would you trust a robot surgeon?" This panel was meant to be about fears of new medical technology generally, although it got a bit more focused on the robotic surgery than I initially expected. There was some interesting discussion of the psychology of who adopts new technologies in any endeavor, not just medicine.

I was on the panel because I was saw some parallels between whether people trust medical technology and science denialism. Indeed, one person at the audience started talking about how the use of any new technology should be made by patients weighing the pros and cons. I pointed out that this was a very academic way of looking at things, and people often don't make decisions based purely on information. I noted that arguably the most successful medical technology in history, the only one that has permanently rid the planet of two diseases, is widely distrusted, even by reasonably highly educated people.

In the afternoon, I watched a panel titled, "Ethical Complications of Perpetual Competition." What blew me away was that what seemed to me to be the most obvious potential complication to competing all the way from K-12 to residency - the temptation to cheat - was never mentioned. One of the things that did come out was that there are some big changes planned for medical education. There's some discussion about creating something like a "Medical humanities" major, so that the medical schools do not just have biology and chemistry majors.

I spent late afternoon and early evening chatting with fellow blogger Janet Stemwedel, a.k.a. Doc Freeride. And the rumors are all true: she's just an amazingly cool person.

It's a fascinating experience to meet someone face to face who you're followed online for years. The online persona captures a lot, but not everything. Her blog doesn't always convey her quirky sense of humour, which is abundantly evident face to face. But anyone who says you can't build real dialogue through online interactions is wrong.

We sat and listened to the evening keynote, by local physician Carlos Cardenas. Cardenas's argument was his criterion for judging health policy: anything that interferes in any way with the relationship with the doctor and a patient is bad. While I appreciated that he was trying to emphasize trust and human connections, his point of view undervalued that any physician is a member of a professional community.

On Thursday, I couldn't miss Janet Stemwedel's keynote. Janet gave a great talk about how many biomedical students think that they can avoid worrying about ethical issues by working with materials in a dish. But using Rebecca Skloot's The Immortal Life of Henrietta Lacks as a guide, she showed that you don't get a pass on ethical dilemmas just because you're working with tissues and cell lines.

A couple of things stood out to me. One was that the ethics got sticky because the list of relevant stakeholders kept expanding, in an unpredictable way. Nobody knew much about DNA when the HeLa cell line was started; it was only much later that genetic technologies brought Henrietta's family back as stakeholders. The other point that Janet made, echoing Robin's from the day before, was how much ethical policies around research are crisis driven. It's fairly common for policies to be created after problems have occurred, rather than being written in anticipation of problems.

The last panel I saw, in the afternoon, concerned violence, particularly against women and vulnerable groups, as a health care problem. More so than the other panels I had watched, this one focused more on local issues and problems. For instance, the local availability of nurses trained to do examinations for sexual assault, and that there is no medical examiner's office in the region.

One undercurrent that I sensed several times though the conference - and maybe I'm reading between the lines too much - was suspicion of government. After the technology panel I sat on, a local nurse got up and was talking local health care, rather enthusiastically. At some point, she talked about what made "us" great was "our freedoms." I think she may have even snuck in a mention of either the founding fathers, the American constitution, or both.

During the competition panel, one phsyician talked about government being in competition wit physicians. In his evening keynote, Cardenas said:

(N)ot one insurance plan ever cured a patient, much less held their hand, and no set of laws written by policy makers in Washington or Austin ever truly saved a life(.)

This was a rather surprising claim to me. I can think of plenty of laws that have saved huge numbers of lives. Seat belt legislation. Safety regulations. Restaurant health inspections.

I suspect I raised my eyebrows, too, when someone in the audience at Cardenas's keynote complained that physicians weren't listened to in policy discussions. I'm almost certain my eyebrows crawled up my forehead when this individual said that if they were allowed to, physicians could solve all the problems in about five minutes.

I'm hoping that was meant to be funny. But I'm not sure it was.

I understand frustration with legislators. I've often said I've been surprised by how much Texas lawmakers want to dabble with universities, for instance. But I don't think I would ever say that we professors could solve it all during a coffee break if people would just listen to us.

I kept sort of waiting for someone to jump up and say, "Ron Paul 2012!"

Janet Stemwedel has blogged about her thoughts here. The university's summary is here.