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Wednesday, August 22, 2007

Pain Imaging

There is lots of litigation over the amount of pain people experience.  Yet, it's very difficult (both conceptually and technologically) to assess a person's pain and to compare it to the pain of others.  Nevertheless, such determinations are made everyday by judges, juries, administrative agencies, doctors, insurers, etc.  I have a soon-to-be published symposium article on the subject, entitled "Pain Detection and the Privacy of Subjective Experience."  In the piece, I discuss the possibility that advances in neuroimaging may someday improve our assessments about whether others are in pain and how much pain they are experiencing.  Here's a link to the abstract (scroll down to get the full text).  It's too late to make changes, but your feedback is quite welcome.

Posted by Adam Kolber on August 22, 2007 at 11:10 AM | Permalink


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Two possible lines of further inquiry sprung to mind after a look at this thought-provoking essay. Both involve historical antecedents:

1.) The development of the concept of brain death raised some similar issues, including questions about “Cartesian” dualism and about whether detectable biological events should be understood as death or as indicia of death. Yet, in the case of brain death, discussion of these issues was not so closely linked to concerns about personal subjectivity, privacy, and character inference. (The literature on brain death probably contains more references to concerns about social construction than to these concerns.) So, why the similarities to brain death? Because in both cases we’re thinking about the body as physical evidence about the person? If so, could you envision similar discussion about, say, evidence of intoxication? (Like pain, intoxication seems more understandable through common-sense intersubjectivity than death; also pain and intoxication are generally understood to occur on a continuum, whereas life/death is often regarded as binary.) Biological indicia of pain, death, and intoxication are typically introduced for different purposes: are these purposes driving the discourses?

2.) You attempt to distinguish normative from empirical questions. While this distinction can be analytically helpful, there’s also a connection between the two types of questions, because evolving technical capabilities may change what legal rules are workable and desirable. For example, according to Dan Kevles, the history of enforceable intellectual property rights in living organisms has reflected factors such as the (increasing) ability to characterize biological cultures or varieties and the (persistent) difficulty of developing varieties that will predictably breed “true to type.” These factors not only influence the feasibility of meeting the established requirements for a utility patent, such as disclosure; they may also be considerations that shape the scope of legislation such as the Plant Patent Act (limited to non-tuber, asexually reproducing plants). Similarly, my own reading suggests that the extension of the res ipsa loquitur doctrine to medical malpractice cases was roughly contemporaneous with the introduction of x-ray technology and widespread claims that medicine was becoming more scientific, although it’s a little harder to show how the pieces fit together. As neuroscience provides new insights into subjective experiences, many of the normative questions that arise may fit into one generalized framework: can existing rules that implicate privacy be applied to this new evidence directly and unproblematically, or is there a need to reformulate the rules to maintain fidelity to broad principles of privacy and autonomy?

Posted by: Jed Adam Gross | Aug 23, 2007 6:11:04 PM

Interesting! I've written before on empathy, narrative and pain (from a non-technological standpoint), and was curious about what neuroimaging would reveal about fibromyalgia, the ultimate "private" and "subjective" pain.

Posted by: JodyM | Aug 22, 2007 5:58:21 PM

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