Overview

Overview

Cleveland Clinic's Neuroethics Program is housed in the Center for Bioethics, but constitutes a partnership between the Neurological Institute and the Center for Bioethics, with faculty from both areas. Paul J. Ford, PhD serves as Director and Lauren R. Sankary JD serves as Associate Director of the Neuroethics Program. 

Great need exists to address the emerging ethical challenges faced by patients, families, caretakers, researchers and clinicians related to brain-based diseases. This is particularly true given the increasing incidence of brain based diseases and the resulting world wide burden of suffering and disability. In the Neuroethics Program at Cleveland Clinic, we approach these ethical challenges in a practical manner starting from the problems that arise in the prevention, diagnosis and treatment of neurological conditions. We undertake research, education and clinical support through collaborations with clinicians, clinical researchers and bioethicists.

Opportunities 

  • If you are a resident or fellow considering Cleveland Clinic for a Neurology Residency or Fellowship and would like to continue your studies in Ethics, please contact Paul Ford, PhD at fordp@ccf.org.
  • If you would like to inquire about research opportunities within the Neuroethics Program, please contact Lauren Sankary at sankarl@ccf.org. 
Our Team

Our Team

Neuroethics Program Faculty

Paul Ford, PhD
Paul Ford, PhD
Staff
Lauren Sankary, JD
Lauren Sankary, JD
Neuroethics Staff
Cynthia Kubu, PhD
Cynthia Kubu, PhD
Staff
Clinical Neuroethics

Clinical Neuroethics

The Neuroethics Program faculty provides clinical ethics consultation services within Cleveland Clinic to patients, families, clinicians, and researchers. Further, we are actively involved on a national and international level regarding various neuroethics related work.

Other functions in Clinical NeuroEthics:

  • Consent monitor for clinical research.
  • Participation in specialized patient management conferences including conferences for Epilepsy Surgery and Deep Brain Stimulation highlighting patient selection and challenging patient care issues.
  • Frequently consulted on specific inpatient and outpatient neurosurgical issues: called on over twenty times per year to consult on specific inpatient/outpatient surgical issues.
Research

Research

Taught graduate neuroethics courses at Case Western Reserve University, Harvard University, and Columbia University, in addition to be a guest lecturer for various University courses across institutions.

  1. Sankary L, Zelinsky M, Ford PJ, et al. “Overcoming Barriers to Informed Consent in Neurological Research: Perspectives from a National Survey.” Research Ethics.
  1. Ford PJ, “Neuroethics, Neurodiversity, and Neurodisability.” 2022. Guidance for Healthcare Ethics Committees 2nd edition. Eds. Hester DM & Schonfeld T. Cambridge University Press. 175-182.
  1. Sun XR, Ford PJ, Schulder M. 2022. “History and Ethical Considerations in Functional Neurosurgery.” in Youmans & Winn Neurological Surgery, 8th edition. ed. Winn HR, Elsevier. 792-797.
  1. Feldman FL, Ford PJ, Sankary LR. 2022. “Neuroethics in the clinic: amplifying patient perspectives through enhanced decision-making frameworks” Thorny Issues in Clinical Ethics Consultation. Wasson K & Kuczewski MG, Springer.
  1. Tilahun BBS, Thompson NR, Bautista JF, Sankary LR, Stanton S, Punia V. Telepsychology May Improve Treatment Adherence in Patients with Psychogenic Nonepileptic Seizures. Telemedicine and e-Health. Published online December 28, 2021. doi:10.1089/tmj.2021.0463
  1. Mabel H, Bruno B, Jankowski J, Eves MM, Ford PJ. “Improving Real-World Innovation and Problem Solving in Clinical Ethics: Insights from the First Clinical Ethics Un-Conference” Journal of Clinical Ethics, 32(4). PMID: 34928861
  1. Sankary LR, Zelinsky M, Machado A, Rush T, White A, Ford PJ. "Exit from Brain Device Research: A Modified Ground Theory Study of Researcher Obligations and Participant Experiences" AJOB: Neuroscience. DOI: 10.1080/21507740.2021.1938293. PMID: 34255614.
  1. Blackstone E, Ford PJ, Sankary LR. Clarifying Definitions of Palliative Neurosurgery: A Neuroethics Perspective. World Neurosurgery. 2021. DOI: https://doi.org/10.1016/j.wneu.2021.08.148
  1. Ford PJ, Fox RJ, Mercer MB, Cofield SS. 2021. Patient Perceptions of FDA Approval: Gaps in education or variation in value? Neurol Clin Pract Jan 2021, DOI: 10.1212/CPJ.0000000000001034 . PMID: 34484926;
  1. Tilahun BBS, Thompson NR, Sankary LR, Laryea F, Trunick CM, Jehi LE. Outcomes in the treatment of psychogenic nonepileptic seizures (PNES) with CBTip: Response in seizure frequency, depression, anxiety, and quality of life. Epilepsy & Behavior. 2021;123:108277. doi: 10.1016/j.yebeh.2021.108277
  1. Shapiro D, Sankary LR, Ford PJ. Reconciling Supported Decision Making with Shared Decision Making in the Context of Potential Vulnerability, The American Journal of Bioethics, 2021, 21(11), 35-37, DOI: 10.1080/15265161.2021.1980139
  1. Merner AR, Frazier T, Ford PJ, Cooper S, Machado A, Lapin B, Vitek JL, Kubu CS. 2021. “Changes in patients' desired control of their deep brain stimulation and subjective global control over the course of deep brain stimulation,” Frontiers in Human Neuroscience, DOI: 10.3389/fnhum.2021.642195
  1. Sankary LR, Nallapan A, Hogue O, Machado A, Ford PJ. “Publication of Study Exit Procedures in Clinical Trials of Deep Brain Stimulation: A Focused Literature Review.” Frontiers in Human Neuroscience. doi: 10.3389/fnhum.2020.581090
  1. Shlobin NA, Rosenow JM, Ford PJ. 2020. “Using Functionality Rather Than Elective Nature to Characterize Surgeries in Neurosurgery.” American Journal of Bioethics. 29, 7: 196-198 https://doi.org/10.1080/15265161.2020.1777353
  1. Ramirez-Zamora A et al (including Sankary LR). Proceedings of the Seventh Annual Deep Brain Stimulation Think Tank: Advances in Neurophysiology, Adaptive DBS, Virtual Reality, Neuroethics and Technology. Front Hum Neurosci. 2020;14:54. PubMed PMID: 32292333; PubMed Central PMCID: PMC7134196.

National Talks

  1. “Alzheimer’s Disease Research Participant Perspectives on the Return of Individual Research Results.” Sankary, LR. (Poster Presentation). Alzheimer’s Association International Conference. August 3, 2022.
  1. “Ethical Considerations of Loss of Benefit in a Crossover Clinical Trial Design.” Poster. P. Ford, L. Johnson, M. Morell. 8th Annual BRAIN Initiative Meeting, June 21-22, 2022.
  1. “Evolution of an Ethics Rounding Tool: Neuro-Stepdown Unit & Nursing Moral Distress” Ford PJ. Propelling Clinical Ethics Forward: A Working Unconference, Atlanta, GA, April 28, 2022.
  1. “Mental Health First Aid: Grassroots Trust Building for Racial Justice,” Ford PJ. Propelling Clinical Ethics Forward: A Working Unconference, Atlanta, GA, April 28, 2022.
  1. “Ethics Consultation in Brain Diseases: Straddling Role Boundaries as an Ethicist,” Ford PJ. The David F. Kelly Bioethics Lecture, Duquesne University, March 31, 2022.
  1. “The Accelerated Approval of Aduhelm: Implications for Public Trust.” Sankary, LR. (Oral Presentation). Arizona Bioethics Network. January 26, 2022.
  1. “Perceptions of Vulnerability and Moral Distress in Neurological Care.” Sankary, LR. (Grand Rounds Presentation) Marcel and Josephine Patterson Memorial Lecture in the Medical Humanities, University of Texas Medical Branch, Virtual, October 21, 2021.
  1. “Navigating Bioethical Issues in PD: Addressing Barriers to Adherence, DBS & End of Life Issues.” Sankary, LR. (Panel Presentation). 2021 Parkinson Foundation Virtual Centers of Excellence Leadership Conference (CLC), November 18, 2021.
  1. “Challenging Ethics Consultations: Listening to those with fluctuating capacity,” Ford PJ. Healthcare Ethics Grand Rounds, National Veterans Affairs Center for Ethics in Healthcare, November 16, 2021. (virtual with 670 participants)
  1. “Ethical Challenges in Neurology,” Sankary, LR. 22nd Annual Innovations in Neuroscience Conference, Cleveland Clinic, Cleveland, OH, May 14, 2021.
  1. “Dealing with Uncertainty: Neurosurgery, Compromised Capacity, and Ethics,” Ford PJ. Hospital Grand Rounds, Virginia Mason Medical Center, Seattle, WA, July 30, 2021. (virtual)
  1. “Surgical Decision-Making: How Do We Balance Paternalism, Shared Decision-Making and Free Will,” Ford PJ. Panelist in CME program, Navigating the Mind-Field: Practical Applications of Bioethics when the Patient’s Capacity is Compromised, Seattle, WA, July 30, 2021. (virtual)
  1. “Least Restrictive?: Adolescent Eating Disorder and ICU,” Ford PJ. Visiting Faculty Commentator, Harvard Clinical Ethics Consortium, March 5, 2021. (virtual)
  1. “Has the Time Come to Eliminate Controls that Involve Burr Holes in Sham Neurosurgical Research?” Debate between Ford PJ. & M. Kelly, MD, Cambridge-ICM Brain and Spine Institute Neuroethics Network Symposium, February 3, 2021. (virtual)
  1. “Ethics and control for neurological patients: Expressions of values in innovative practices,” Ford PJ. Neurology Grand Rounds (Virtual because of COVID 19 pandemic), University of Arkansas Medical Center, April 17, 2020.
  1. Podcast Interview, “E16 Bioethics and Bioelectronic Medicines an Emerging Area of Intertwined Significance,” Sankary LR and Ford PJ. SKARPS: Stories of scientific brilliance, Recorded 2020: Last viewed 12/15/2020: https://www.skrapsofbrilliance.com/podcast/episode/48e17f0f/e16-bioethics-and-bioelectronic-medicines-an-emerging-area-of-intertwined-significance
  1. “Bioethical Considerations in Today’s Neurology and Neurosurgery Practice,” Sankary LR. April 8, 2020, Neuro Pathways Podcast. https://podcasts.apple.com/us/podcast/bioethical-considerations-in-todays-neurology-neurosurgery/id1467738002?i=1000470876017
  1. I AM HUMAN Documentary | Cleveland Premiere & Panel Discussion, Ford PJ. Panelist,Hanna Theatre, Cleveland, OH, January 30, 2020 (Panel recording at: https://www.youtube.com/watch?v=Q1hUbdDVJjo also see: https://www.eventbrite.com/e/i-am-human-documentary-cleveland-premiere-panel-discussion-tickets-82611580461# )

Grants

  1. “Optimizing Decision Support for Alzheimer's Disease Research,” Alzheimer’s Association Research Grant (AARG-22-974462) Roles: PI: Lauren Sankary, JD., Co-I Paul Ford, PhD. 09/2022-06/2025.
  1. “COVID-19 Related Barriers to Informed Consent in Aging and Cognitively Vulnerable Patients” National Institute on Aging (NIA) (3P30AG062428-02S2). Roles: Co-I: Lauren Sankary, JD. 09/2020-present.
  1. “Summit and Consortium for Mental Health First Aid,” Cleveland Clinic Caregiver Catalyst Grant, Role: Awardee/organize, 07/01/22-06/30/23.
  1. “Mental health First Aid: A CCF/Glenville Collaboration,” Cleveland Partnership Award, Cleveland Clinic Community Health & Partnerships, ($17,250) Role: Program Partner and Grant writer, Awardee: Khnemu Foundation. 05/10/22-05/09/23.
  1. “Neurologist-in-Training Clinical Ethics Elective” The American Academy of Neurology, American Neurological Association, and the Child Neurology Society, Mentor: Paul Ford, PhD. Awardee: S. Tavella-Burka. 01/07/22-30/06/23.
  1. “Shor Study: The Effects of Integrative Behavioral and Wellness-Based Interventions for Patients with Epilepsy,” Philanthropy donor Charles Shor, Co-investigator: Paul Ford,; 01/01/21 – Present.
  1. “Cleveland Clinic Brain Study,” Cleveland Clinic Funded, Co-investigator: Lauren Sankary, JD , Paul Ford, PhD; 01/01/21 – Present.
  1. “Ethics of Choice of Invasive versus Non-invasive Neurosurgery: Different Stakeholders’ Perspectives, NIMH NIH Surgical Decision-making, and Impact on Patient Sense of Control.” Mechanism: RF1,PI: Cynthia Kubu, PhD. Co-I: Lauren Sankary, JD , Paul Ford, PhD 7/20/2020-7/19/2024.
  1. "Ethical Safeguards for Exit and Withdrawal from Implanted Neurotechnology Research” National Institute of Neurological Disorders and Stroke (1F32MH115419). PI: Lauren Sankary, JD, 09/2017-01/2020
  1. “Electrical Stimulation of the Dentate Nucleus for Upper Extremity Hemiparesis Due to Ischemic Stroke (EDEN)” National Institute of Neurological Disorders and Stroke(UH3NS100543-01). Consent Monitor: Lauren Sankary, JD , Paul Ford, PhD. 09/2016 – 06/2022.
News

News

The mission of the Neuroethics Program is to conduct cutting-edge neuroethics research, both scholarly and empirical, provide the highest level of training in clinical neuroethics and develop and promulgate best ethical practices in the diagnosis and treatment of neurological diseases that include provision of ethics services to patients, families, and care providers.

Current Grant News

"A Study of Benefit and Risk in People with MS," National Multiple Sclerosis Society Grant. Role: Co-investigator (directing qualitative portion), PI: Robert Fox, MD. August 2015 – Present.

"Assessing Access, Change, Concerns, and Consequences of People with MS Regarding Four Types of Personal Insurances," National Multiple Sclerosis Society Grant. Role: Co-investigator (directing qualitative portion), PI: Deborah Miller, PhD, August 2015 – Present.

"Understanding the worlds and spiritual laws that guide prenatal genetic technologies as a pathway to enhance life," Enhancing Life Project – funded by John Templeton Foundation through University of Chicago and Ruhr-University Bochum (Germany). Role: Co-investigator, PI: Ruth Farrell, MD. July 2015- Present.

Past Hosted Conference

Emerging Ethical and Legal Challenges in Chronic Neurological Conditions October 8-9, 2014 as Part of the Epilepsy Symposium