Ethox Seminar - Neuroethics of lumbar punctures (aka ‘spinal taps’) for psychiatric indications

Abstract

A rare subset of people with new-onset severe psychiatric symptoms have neuro-inflammatory processes, which are most apparent in cerebrospinal fluid (CSF), the fluid that bathes the brain and spinal cord. People recover best when the inflammation is promptly detected and treated with strong immunosuppressive medications, but the medical procedure needed to collect CSF, a lumbar puncture (LP), aka spinal tap, is not a conventional tool in psychiatric practice and many psychiatrists may never have performed one. Some experts have argued that LP should become part of routine diagnostic workup, but others disagree, saying that the neuro-inflammatory processes are too rare to merit screening with an invasive procedure; rather, LP should be reserved only for cases that are highest risk.  Both positions are underspecified, however, and it is unclear how each translates from a given probability of neuro-inflammation to their recommendations. When should LP be offered, and who should decide? If we assume that the answers to these questions, prima facie, should be the same whether a person’s symptoms are psychiatric or not, we might be able to make progress by examining benchmark cases in neurology and pediatrics where LP is routine. Following this principle of psychiatric healthcare parity, we might identify psychiatric indications that meet/fail to meet those benchmarks, thus that would/would not be candidates for routine LP. We might then examine morally relevant differences to these cases that could appropriately modify the prima facie judgments, including health disparities and prioritarian principles of distributive justice.

Registration

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