Health: objective, subjective or other?
In this presentation, I examine how we define and perceive health. Is it an objective, observed phenomenon? Is it a subjective, experienced phenomenon? Or some combination of the two, captured by Health-Related Quality of Life (HRQL) measures? Here I argue that health is not objective or subjective or a combination, but the capacity for meaningful action.
Originally delivered at University of Washington Philosophy of Science Colloquium on January 13, 2017.
Is respecting patient autonomy enough or must we promote patient autonomy as well?
In this presentation, I examine the duty to respect patient autonomy through the requirement for informed consent. I argue that this is inadequate for outpatients with chronic disease. In these patients, we must also promote patient autonomy, understood broadly as the capacity to do and be things of value, for this is the core of the health that is the goal of care.
Originally delivered at University of Washington Bioethics Grand Rounds April 7, 2015, and at Harborview Medical Center Ethics Forum on February 8, 2017.
Advancing from the activated patient to the autonomous patient in chronic illness care
In this presentation, I examine the “activated patient,” which is one of the foundations for Wagner’s Chronic Care Model. I argue that this concept is not an adequate description of the role of the patient in chronic illness care. We need to advance to the autonomous patient who defines and pursues her own vital goals if we are to achieve sustained improvements in health behavior.
Originally delivered at the Group Health Research Institute Seminar February 14, 2017.
Patient Agency: a focus for integrated care
In this presentation, I argue that patient agency is an essential goal for mental health care integrated into the primary care management of chronic disease. This model of integrated care was developed by my colleagues Wayne Katon and Jurgen Unutzer. It is now widely disseminated throughout primary care systems nationwide. But it can be implemented in many different ways, with different goals. This presentation uses the example of a patient with diabetes to argue that integrated mental health care should focus on the enhancement of patient agency.
Originally delivered at Harborview Medical Center Psychiatry Friday Noon Conference July 14, 2017.
Ethics of Pain Care: what duties do we have to patients with chronic pain?
In this presentation, I ask: what duties do we have to patients with chronic pain? I examine the case of Daniel, a 48-year-old man with chronic back, neck and head pain after a motor vehicle accident 8 years previously. I argue that our foremost duty to patients with chronic pain is not to reduce their pain intensity but to improve their health. Titrating opioid doses to a pain level may reduce pain and at the same time make it harder for a patient to live his or her life.
Originally delivered at Virginia Mason Medical Center CME Chronic Pain at the Crossroads November 10, 2017.
Between suffering and survival: understanding the dynamic links among physical pain, social pain and addiction
In the presentation, I argue that human physical survival depends on social survival, so our brains have evolved to make both physical and social injury painful. Our endogenous opioid system modulates both forms of pain to promote both forms of survival.
Originally delivered at American Academy of Psychodynamic Psychiatry and Psychoanalysis AAPDPP in New York City.
Pain and Opioids: damage and danger, mechanism and meaning
In this presentation, I argue that pain exists more to protect than to inform, so survival implications affect pain processing. The salience and valence of pain are continually adjusted to promote survival. For humans, physical survival depends on social survival, so our brains have evolved to make both physical and social injury painful, with our endogenous opioid system modulating both forms of pain to promote both forms of survival.
Originally delivered at BC Pain Research Network Conference, Pain, Affect and Opioids, University of British Columbia, Vancouver BC, Canada.
Understanding Opioid Dependence: a significant harm of long-term opioid therapy
In this presentation, I argue that prescription opioid policy is often framed as a balance of the right to pain relief vs the risk of addiction. But our brains have evolved to make both physical and social injury painful, with our endogenous opioid system modulating both forms of pain to promote both forms of survival. Long-term exogenous opioid medications disrupt this system and thereby impair human social and emotional function.
Originally delivered as the Second Annual Covington Lecture at Cleveland Clinic, Cleveland, OH.