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The protocol is malleable (the majority of miners need to agree on changes) and can be migrated to use sub-Satoshi units if necessary.

So bitcoin miners as a whole become a de-facto central bank based on majority adoption?

That's actually a very interesting possibility.

Yes the "central bank" in bitcoin is essentially a diffuse network of trust established via a large network of people.

And we know for a fact that it's not possible to manipulate large networks of people in an organized manner...

Certainly it's easier to do that than to manipulate a small group of mostly hidden individuals with severe conflicts of interest.

How is consensus reached? Who has the 'final say' to merge in the patches necessary to make such a fundamental change?

You know, open source. I can decide not to take the new version or I can even fork it. The majority decides, democracy like.

Wouldn't a fork lead to decreased value for everyone...?

Correct.

It's happening right now where the majority of the world's ISPs and companies are switching over to IPv6 (as a comparison).