Diagnostic Value in the Clinic
In this paper I argue that the results of an accurate diagnostic test can be clinically valuable even when they do not change what the clinician would or could do for the patient. This view of diagnostic value thus stands in contrast to the standard medical view, which states that, “test selection should be restricted to those diagnostic tests whose results could change the physician’s mind as to what should be done for a patient” (Sox et. al. 2007). While this criterion certainly applies in many cases, I argue that this view of diagnostic value knowledge is ultimately too narrow, and propose a more comprehensive view that takes into account both standardized diagnostic evidence and individual patient desires.
Mechanistic Reasoning and Informed Consent
A recent and prominent theme of discussion in the philosophy of medicine literature concerns the evidential role that mechanistic reasoning can (or should) play in medical decision-making. Many (most prominently supporters of the paradigm of Evidence Based Medicine (EBM)) have argued that this role is limited and should be considered secondary to research evidence derived from randomized controlled trials (RCTs) – which focus on whether or not a treatment or intervention works, and not (if it does) how. That is, RCTs don’t aim to establish causal claims in medicine, but instead focus on establishing treatment efficacy and safety. Similarly, there is much ongoing discussion in the biomedical ethics literature about the nature and extent of informed consent. It is generally agreed that for the minimum bar to be met for informed consent to be reached, a patient must understand the risk vs. benefit profile of the suggested treatment before s/he can decide to proceed with it. Thus a large portion of the bioethics literature on informed consent focuses on how best to relay this information to the patient. Here I will suggest an important role of mechanistic reasoning in the decision-making process that has been neglected in both the philosophy of medicine and biomedical ethics literatures: its importance in certain cases of informed consent. In some instances of informed consent, knowing how a treatment works is just as important as knowing whether it does. For example, I will argue that, for many women, the informed decision about whether or not to use hormonal birth control methods depends not just upon the treatment’s risk vs. benefit profile, but also upon the mechanism by which the treatment works. Thus cases such as these are importantly different from many others (such as the decision of whether or not to take a blood-pressure lowering medication) because the epistemic requirements for reaching informed consent are far broader.
A new generation in Myanmar: promoting health, justice, and education by working to eliminate child labor
The goal of this project is two-fold: the first aim is to understand some of the complex cultural, social and economic reasons for the continued acceptance of child labor in Myanmar. The second aim is to make recommendations for social and policy change, in light of these reasons, in order to promote health, justice and education for Myanmar’s youth. The project will take place over the next three semesters and will include an undergraduate research component, an on-site information-gathering trip, presentation at an international conference, and submission to a major biomedical ethics journal.