Tackling Neuroethical Conundrums (Podcast)

As neurology and neurosurgery treatment options have expanded, neuroethical conundrums have proliferated. For example:

• Does the risk of cognitive change offset the potential benefit of neurosurgical resection for a patient with epilepsy?
• Is deep brain stimulation (and the requisite device programming) appropriate for a patient with significant psychiatric comorbidities?
• How do you ensure patient consent for an innovative or off-label treatment when a patient has cognitive limitations or dementia?

Clinical ethicist Lauren Sankary, JD, Associate Director of the Neuroethics Program at Cleveland Clinic, helps tackle issues like these every day alongside clinicians, patients and families. She explains more about her role in the newest episode of Cleveland Clinic’s Neuro Pathways podcast.

In the 17-minute audio interview, she talks about:

• Common ethical issues that arise in neurology and neurosurgery practices — and some unique issues she’s encountered in a tertiary care center
• Her consultation process and how she provides guidance in both inpatient and outpatient settings
• Her research on participants exiting clinical trials of investigational brain implants
• Tips for discussing ethical issues with patients and families

Click the player below to listen to the podcast now, or read on for a short edited excerpt. Check out more Neuro Pathways episodes at clevelandclinic.org/neuropodcast or wherever you get your podcasts.

Excerpt from the podcast

Sankary: Often we’re working with relatively imperfect information when we’re communicating in a healthcare setting. Sometimes it can take pressure off by acknowledging we don’t have perfect knowledge about what treatment might be best for any individual patient.

I also think it can be helpful for those of us who work in healthcare to think about some of the assumptions we bring to our practices. I’ve observed, just in interacting with patients, that I have biases myself. I want as much information as possible in order to make decisions. But I’ve met patients who have told me that getting a lot of information can be incredibly stressful for them, and it can be really helpful to get clear guidance from their clinicians. So that was an assumption that I brought to my work in healthcare that I learned to check.

Podcast host Alex Rae-Grant, MD: And, certainly, it seems as if different patients and families have different ways of thinking through decision making. It becomes quite personalized, doesn’t it?

Sankary: It does. And I think it can be incredibly helpful to directly ask patients, “How do you normally make important decisions in your life? Whom do you usually talk to when you’re thinking through difficult decisions or thinking about your health and treatments that might be right for you?” I’d encourage clinicians to ask that directly and ask patients how they’d like to receive information so that we can personalize care in that way.