The Ethical Consequences of Medical Objectivity, 2021, Sevareid (Masters thesis)

There is some discussion of ME/CFS and medically unexplained symptoms in this including mention of papers by Keith Geraghty and Diane O'Leary.

https://scholarshare.temple.edu/bit...temple_0225M_14400.pdf?sequence=1&isAllowed=y

ABSTRACT

Objectivity is a valued principle in western allopathic medicine, and for good reason: it has been very effective in saving lives and improving quality of life since the nineteenth century. In recent years, however, there have been many visible accounts in social and mass media describing the consequences of disbelief by physicians, particularly from women and people from marginalized communities. This paper uses an urban bioethics perspective to examine how overreliance on the principle of objectivity can lead to violations of bioethical principles that it should be in balance with.

First, media and personal accounts of physician disbelief and misdiagnosis of patients are discussed. This is followed by a brief discussion of the historical roots of objectivity in medicine, an examination of the particular difficulty western medicine seems to have with medically-unexplained symptoms, and a closer look at specific diseases that encounter stigma in the clinical setting. From there, specific bioethical principles are analyzed. Nomaleficence is violated when clinicians traumatize their patients through disbelief of symptoms that cannot be confirmed through confirmatory testing and when they prematurely assume a psychogenic cause of symptoms simply because the cause cannot be found with a physical examination, laboratory test, or imaging study. Solidarity, autonomy, and agency are violated through the denial of the patient’s expertise in their own experience and the disempowerment of the patient in the doctor-patient relationship. Distributive and social justice are violated when the efficiency demanded of a medical system built upon reliance on objective findings disadvantages patients with difficult-to-diagnose conditions along with women and marginalized groups. Potential solutions to the unethical overreliance on objectivity include changes to medical education and culture to be more allowing of fallibility and humility, as well as better integration of mental and behavioral health into the primary care setting, so patients’ medical and psychosocial needs may be treated more holistically. Structural changes to the healthcare system allowing better physician reimbursement for clinical counseling will also mitigate dependency on objective findings for diagnosis and treatment.

 

But that would be exactly what perpetuates the difficulty medicine has with medically unexplained symptoms.

The difficulty medicine has with medically unexplained symptoms is precisely that they're convinced that the solution lies somewhere in the domain of mental and behavioural health and that patients lack insight and need to be convinced of these ideas. It sets patients and doctors up for conflict and fails to produce any reliablly positive results.

 

What might behavioural health be, I wonder?

Nul points, I am afraid.

 

I, for one, would love objectivity in medical care. There is so little of it, it's in fact the very problem with us: complete lack of objectivity (and common sense to boot).

This genre of creative writing where people suggest the problem as the solution to the problem is seriously amazing, to state that integrating more behavioral crap, the very problem here and fully rooted in lack of objectivity, is the solution to obsessive integration of behavioral crap is galactic brain "fight fire with fire" genius. You know what will put down that fire? More fire, of course. Yes, very objective.

 

Why better integration of the speciality of mental & behavioural health over any other speciality such as endocrinology or gynaecology, for example.

Primary care is primary care and (from the UK perspective) supposedly serves as a triage for those who need input from a specialist.

Admittedly, the lines blur from time to time as more responsibility is either placed on the speciality or pushed back onto primary care as fashion within the medical system dictates.

Lots of people face unacceptable long delays or even denial of referral to endocrinology or gynaecology & the patient suffers unnecessarily as the GP faffs about. I have suffered from delays in referrals to bith specialities in my life that caused needless grief.

To go on about being holistic etc, yet then demand that psych services are given a special place in primary care above and beyond other specialities is not holistic. It smacks of pushing an agenda.

 

An objective look at someone with ME would see that they are very sick so something is going wrong in their body - they have a disease even if the cause is not known.

There is nothing weird about ME. All the confusion has been caused by meddling by the BPS and their ideas. Many diseases have strange combinations of symptoms; if you look at them you realise that they could easily have been classed as MUS if the BPS had noticed them.

 

@Mithriel

Yes, and some diseases have in the past been classified as MUS by the BPS Movement: MS, asthma, stomach ulcers, to name a few.

It is possible that providing an integrated holistic approach to people with MUS, will just eventually shuttle them over to the BPS bailiwick, like they are now. Nothing will have changed.