Medical situations can instantly change. This can be for the better or for the worse:  A patient who consistently refused to eat, now suddenly decides to eat. A patient who is delirious or manic threatens a staff member at 11:50, but subsequently seems rational and reasonable when we arrive in his room 15 minutes later. A stroke patient who does not communicate or respond, and who is likely to develop into a permanent vegetative state (PVS), perks up, talks and leaves. A patient, who is on the mend, develops a fever, requires a rapid response and dies. 

The ethical issues, similarly, change instantly in these situations. It requires me, as a new clinical ethics, to constantly redefine my perspectives. Where we plan to discuss placement of a feeding tube, the patient’s mood alteration resolves issues around placement and resolves the ethical questions. Where we address concerns around a safe discharge, we find out that the patient’s mood changes at 12 o' clock, and awareness of this time frame allows for a safe discharge. Where have family meetings to discuss quality of life in a PVS, this discussion is no longer necessary as the patient can be discharged.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

As a new clinical ethicist in training, I’m allowed to take some looks in the metaphorical kitchen of the hospital where things really happen: seeing research and treatment in practice. This is an amazing experience, as I always thought of myself in the court room (my primary degree is in law) and I had never pictured myself in an operating room. Thanks to all the compassionate and generous physicians in this hospital, who allow me to peek in their kitchen (as long as I don’t function as the ethics police), I get an understanding of the difference between the ivory tower of academic (bio) medical ethics and the real ethical issues of the work floor.  

Not too long ago I observed a WADA test in the epilepsy department. The WADA test is used to establish where language and memory are located in the brain; in which hemisphere do these capacities ‘reside’. (When we think simplistically and typically, a right-handed individual has memory and language on the left side of the brain, but there are a lot of exceptions and mixed brains). During the WADA test, doctors try to mimic a stroke of the brain; while the patient is awake, one hemisphere is temporarily sedated (around 2 minutes) and a series of tests are done to see how the patient memorizes and describes objects, based on the functioning of only 1 side of the brain. Subsequently, the other hemisphere is sedated and a similar test is performed. These tests are done, for example, to assess what would happen if a particular part of the brain is surgically removed; i.e. the area that contains the origin of the epileptic episodes.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

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Dr. Adina Roskies is Associate Professor in the Department of Philosophy at Dartmouth College. Her areas of specialization are Philosophy of Science, Philosophy of Cognitive Science, and Philosophy of Mind.

Dr. Roskies was Project Fellow on the MacArthur Project in Law and Neuroscience from 2007 through 2010. Her recent publications include Neuroscientific challenges to free will and responsibility, published in Trends in Cognitive Sciences; “Neuroethics beyond genethics”, published in EMBO Reports; and Neuroimaging and inferential distance, published in Neuroethics.

In our 5-3-2011 BIOETHICS TODAY conversation, Dr. Roskies discusses

• Free will and determinism
• Compatibilism and incompatibilism
• Neuroscience–the brain as a mechanism
• Can the brain cause behavior?
• Neuroscience, determinism, and moral responsibility
• Neuroscience and the law

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.