Diane O’Leary talks ‘Why Bioethics Should be Concerned with Medically Unexplained Symptoms”

The KIE hosted Diane O’Leary, PhD, last week, who gave a talk on the topic of “Why Bioethics Should be Concerned with Medically Unexplained Symptoms.” O’Leary’s research focuses on medically unexplained symptoms (MUS) and psychogenic symptoms (symptoms O’Leary describes as “all in your head”) and the challenges these present to the medical and patient communities. Material for the presentation was drawn from a target article forthcoming in the American Journal of Bioethics, and O’Leary developed this article as a Visiting Researcher with the KIE in 2016-2017.

In the presentation, O’Leary pointed out that policy documents and review systems such as “Up to Date” state that roughly 50 percent of outpatients’ symptoms are medically unexplained.  Symptoms of this kind pose significant challenges with respect to informed consent, autonomy, and truth telling, and O’Leary suggested these challenges are tied to the original presumption that patients with “female hysteria” lacked the capacity to make autonomous medical decisions, a presumption that originated with Sigmund Freud.

O’Leary’s work also suggests that there is a lack of attention in research and practice to the possibility of error in diagnosing unexplained symptoms as psychogenic – that is, caused by psychosocial distress rather than biological pathology.  She stated that the source of this problem is philosophical confusion about what dualism and “mind-body integration” mean in the context of medical practice. To address this confusion she suggests that medical education should include basic philosophical tools for sound reasoning about mind and body. 

This year O’Leary is a Visiting Scholar in Neuroethics at Pellegrino Center for Clinical Bioethics.  She is the former director of the Coalition for Diagnostic Rights, and Associate Adjunct Professor in Philosophy at University of Maryland University College. O’Leary has presented on related topics at the International Congress on Women’s Health Issues, to the UN Special Rapporteur on Health and Human Rights, and in the House of Lords to the Countess of Mar’s coalition of “chronic fatigue syndrome” organizations.

We tweeted the event live. View the thread, here.