Blogging Canadian Bioethics: Day 2

I realize that it may appear odd that I’m starting with the events of Day 2, but unfortunately I don’t have anything to post about Day 1 – I missed Maude Barlow’s plenary lecture on “Can Science Solve the Global Water Crisis?”, as I was locked up in my hotel room cramming everything there is to know about neuroimaging and genetics in preparation for my talk. In what follows I’ll describe a few of my highlights from Day 2 of CBS.

07:30: I arrived at the Hamilton Convention Centre and dragged my feet to the closest coffee dispenser. After filling my cup and grabbing some conference breakfast, I went and found the meeting of the Canadian Neuroethics Interest Group. After the short introductions (we are an ‘intimate’ group) there were some administrative matters to attend to, and a review of some of the major neuro-ethics projects that are going on, mainly in eastern Canada, such as the Neuroethics Net project. I took an opportunity to plug this blog, so perhaps we may see some additional contributors in the days to come.

09:00: It was time for the day’s plenary, a talk by Jerome C. Wakefield from NYU. As mentioned in my previous post, I was really looking forward to hearing Dr. Wakefield, particularly because his title was fairly captivating: The Loss of Sadness: Are we Misdiagnosing Normal Human Emotion as a Mental Disorder? Unfortunately I wasn’t so captivated by the talk. It wasn’t that Dr. Wakefield was not engaging – he is, in fact, an excellent speaker – it was that he did not, in my opinion, present anything new (he drew largely from his book). Based on the rhetorical slant of his title, it is fairly clear to what Wakefield’s perspective is on this matter, and he provided the typical ‘evidence’ to support his claims: the DSM-III revolution, anti-depressant prescriptions are on the rise. These were followed by the presentation of several advertisements for Prozac, Paxil, Effexor, etc throughout the years and how these ads were constructing or medicalising sadness, ‘normal’ anxiety and day-to-day stressors as life-style problems requiring medication. Giving this talk to an audience of bioethics folk, he was preaching to the choir. While an incredibly interesting topic, I was hoping to find something new. The one thing I did take from his talk, however, was the possible implications of a “spectrum-based” understanding of mental illness. One criticism of DSM-based diagnoses is that is constructs categorical ideas of illness and does not account for the wide-range of symptomatic experience by people who experience symptoms associated with particular diagnoses. However, as Wakefield pointed out, if clinicians suggest that an individual who is experiencing depressive symptoms fall along a spectrum, we risk further medicalising those points to which the individual falls, thus constructing the non-extreme ‘sadness’ end of the depression-spectrum as a medical problem.

10:30: Concurrent sessions. It was my turn to present and I was sandwiched between two excellent presenters with two very interesting topics. The first was P.H. Strachan from Hamilton who presented Exploring Uncharted Territory: Mapping the Ethical Terrain in Consent Narratives of Patients with Implantable Cardioverter Defibrillators. This presentation reported on a qualitative study exploring perspectives of individuals who have had a implantable cardioverter defibrillator (ICD) inserted. I’m not going to go into much detail on the presentations, but I wonder what the difference would be – if any – on comparing narritives of those who have had an ICD vs. those who had deep brain stimulation.  This was followed by my presentation which had the fairly un-sexy title, Navigating the Ethical Space of Imaging Genetics: Clinical Translation of Neuropsychiatric Research. Afterwards, Janice Graham presented her paper on Just Evidence in Assessing Risk in Emerging Health Care Products and argued for for more “openess” in the clinical trial process and increasing public access to the information.

12:00: Lunch. and more coffee.

13:30: TCPS Panel. I regrettably missed this. I think I was still slightly jet lagged and couldn’t keep my eyes open despite the over abundance of cognitive enhancers available (i.e., bad conference coffee). Perhaps I should have inquired amongst my colleagues for modafinil (bad neuro-ethics joke).

15:30: Concurrent sessions round 2. While there were tons of really interesting abstracts too see, I moderated a really interesting one as well – one on clinical ethics. Alister Browne from Vancouver discussed aggressive discharge planning, Rosanne Beuthin from Vancouver Island Health Authority on developing an island-wide clinical ethics program, and Sally Bean from Toronto discussed her proposal for a hybrid taxonomy clinical and organizational ethics.

All in all a great but long day. Since it was game 7 of the Stanley Cup finals, I was itching to find somewhere to watch the game. Naturally, the neuroethics folk from Montreal had the same idea. Good times!