Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, philosophy and health care

Sunday, June 30, 2013

Biological psychiatry’s false paradigm—still no proof mental illness is a biological disease

By René J. Muller
Baltimore Sun
June 18, 2013

Days before the official May 22 publication date of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5), a number of psychiatrists who were closely associated with the project scrambled to do some preemptory damage control, mostly by lowering the expectations for what was to come.

Michael B. First, professor of psychiatry at Columbia, acknowledged on NPR that there was still no empirical method to confirm or rule out any mental illness. “We were hoping and imagining that research would advance at a pace that laboratory tests would have come out. And here we are 20 years later and we still unfortunately rely primarily on symptoms to make our diagnoses.” Speaking to The New York Times, Thomas R. Insel, director of the National Institutes of Mental Health, insisted that this failure had not been for lack of effort.

In the same Times article, David J. Kupfer, chairman of the DSM-5 Task Force, admitted “a failure of our neuroscience and biology to give us the level of diagnostic criteria, a level of sensitivity and specificity that we would be able to introduce into the diagnostic manual.” Drs. Kupfer, Insel and First agree that the new paradigm envisioned for psychiatry — the reason the new edition was undertaken — remains elusive.

The entire article is here.

The Problem with the Neuroscience Backlash

POSTED BY GARY MARCUS
The New Yorker Magazine
Originally published on June 19, 2013

Aristotle thought that the function of the brain was to cool the blood. That seems ludicrous now; through neuroscience, we know more about the brain and how it works than ever before. But, over the past several years, the field has given rise to pop neuroscience, which attempts to explain practically everything about human behavior and culture through the brain and its functions.

A backlash against pop neuroscience is now in full swing. The latest, and most cutting, critique yet is “Brainwashed: The Seductive Appeal of Mindless Neuroscience,” by Sally Satel and Scott Lilienfeld. The book, which slams dozens of inconclusive studies that have been spun into overblown and downright dubious fields, like neurolaw and neuromarketing, is a resounding call for skepticism of the most grandiose claims being made in the name of neuroscience. The authors describe it as “an exposé of mindless neuroscience: the oversimplification, interpretive license, and premature application of brain science in the legal, commercial, clinical, and philosophical domains.”

Unfortunately, the book is also prone to being misread. This is partly because it focusses largely on neuroscience’s current limitations rather than on its progress. Some, like David Brooks in the New York Times, are using books like “Brainwashed” as an excuse to toss out neuroscience altogether.

The entire article is here.

Saturday, June 29, 2013

Book raises alarms about alternative medicine

Liz Szabo
USA TODAY
Originally posted June 28, 2013

Doctors diagnosed her with acute pancreatitis, in which pancreatic enzymes begin digesting not just food, but the pancreas itself.

The most likely cause of the girl's condition: toxic side effects from more than 80 dietary supplements, which the girl's mother carried in a shopping bag, says Sarah Erush, clinical pharmacy manager at Children's Hospital of Philadelphia, where the girl was treated last summer.

The girl's mother had been treating her with the supplements and other therapies for four years to treat the girl's "chronic Lyme disease," a condition that, experts say, doesn't actually exist. While some Lyme infections cause pain and other lingering symptoms, the infections don't persist for years. And, according to the Infectious Disease Society of America, the infections don't require years of antibiotics or other risky therapies given by some alternative medicine practitioners.

Doctors were able to control the girl's illness with standard therapies, Erush says, and she was discharged from the hospital after two weeks.

Although the child's story was unforgettable, Erush says, it wasn't unusual. Parents now "routinely" bring children to her hospital with a variety of alternative remedies, hoping that nurses will administer them during a child's stay.

(cut)

Arthur Caplan, the director of medical ethics at NYU Langone Medical Center in New York, says alternative healers satisfy patients' needs for more personal attention.

"Medicine does a very poor job of addressing the emotional, spiritual and even psychological side of things," Caplan says. "When you are not good at doing important things, other people rush into that vacuum."

Yet people who put their faith in alternative healers and supplements may be putting themselves at risk, Caplan says.

The alternative therapy industry capitalizes on a number of common sentiments, Offit says, from a naïve belief in the safety of all things natural to distrust of government regulation.

The entire story is here.

For some, it matters who's donating an organ, blood

University of Michigan
Press Release - June 18, 2013

ANN ARBOR—Some people feel so "creeped out" that they would decline an organ or blood that came from a murderer or thief, according to a new University of Michigan study.

In addition, they express concern that their personality or behavior may change to become more like that of the donor, as a result of the donation.

Recipients prefer to get an organ or DNA transplant or blood transfusion from a donor whose personality or behavior matches theirs, said Meredith Meyer, the study's lead author and a research fellow in psychology. People think that people's behaviors and personalities are partly due to something hidden deep inside their blood or bodily organs, she said.

What surprised Meyer and colleagues were that the results from blood transfusions were just as strong as the results from heart transplants.

"Since blood transfusions are so common and relatively straightforward, we had expected people might think that they have very little effect," Meyer said.

"This suggests an interesting intuitive belief—that behaviors and personalities are inherent, unchanging aspects of who they are," said study co-author Susan Gelman, the Heinz Werner Collegiate Professor of Psychology.

The study's participants viewed a list of possible human donors and judged whether they wanted someone who shared similar traits, such as age, gender, sexual orientation and background. Possible donors also included two animals: a pig or a chimpanzee. For human donors described as having the same gender, the characteristics could be positive (e.g., high IQ, talented artist, kind person or philanthropist) or negative (e.g., low IQ, thief, gambler or murderer).

Respondents ranked how much they liked the idea of each being a donor, as well as assessed their beliefs that the transplant would cause the recipient's personality or behavior to become similar to the donor's. Questions also involved feeling "creeped out" or "contaminated" by the transplant.

The entire press release is here.

Friday, June 28, 2013

Kentucky same-sex case to be landmark

Murder case marks the first legal test in Ky. over whether same-sex partners can be forced to testify against each other.

Jason Riley
The (Louisville, Ky.) Courier-Journal
Originally published on June 16, 2013

Prosecutors say Geneva Case heard her spouse admit to killing a man two years ago and saw her clean blood out of the man's van and abandon it in Southern Indiana.

Now, they argue, Case must testify about those facts, even though Kentucky law exempts spouses from being compelled to testify against each other.

The reason, they say, is that Case and the defendant, Bobbie Joe Clary, entered into a same-sex civil union in Vermont in 2004 — and Kentucky does not t recognize same-sex civil unions or marriages.

"That ceremony is not a 'marriage' that is valid and recognized under Kentucky law," prosecutors said in a court motion, noting that marriage between members of the same sex is prohibited in Kentucky. "Geneva Case and the defendant cannot prove the existence of a marriage under Kentucky law."

But attorneys for Clary say they are legally married and denying them the same marital rights others have would be a violation of the Constitution.

The case has become the first legal test in the state over forcing same-sex partners to testify against each other — raising the broader issue of whether the state recognizes marriages or civil unions that are legal elsewhere. The case could have ramifications for issues such as divorces and division of property after death.

The entire story is here.

Supreme Court strikes down Defense of Marriage Act, paves way for gay marriage to resume in California

By Pete Williams and Erin McClam
NBC News
Originally posted June 26, 2013

In a pair of landmark decisions, the Supreme Court on Wednesday struck down the 1996 law blocking federal recognition of gay marriage, and it allowed gay marriage to resume in California by declining to decide a separate case.

The court invalidated the Defense of Marriage Act, which denied federal benefits to gay couples who are legally married in their states, including Social Security survivor benefits, immigration rights and family leave.

Justice Anthony Kennedy, writing for the majority in a 5-4 decision, said that the act wrote inequality into federal law and violated the Fifth Amendment’s protection of equal liberty.

“DOMA’s principal effect is to identify a subset of state-sanctioned marriages and make them unequal,” he wrote.

Edith Windsor, the 84-year-old woman who brought the case against DOMA, said that the ruling ensured that the federal government could no longer discriminate against the marriages of gays and lesbians.

“Children born today will grow up in a world without DOMA, and those same children who happen to be gay will be free to love and get married,” she said.

In the second case, the court said that it could not rule on a challenge to Proposition 8, a ban on gay marriage in California passed by voters there in 2008, because supporters of the ban lacked the legal standing to appeal a lower court’s decision against it.

The court did not rule on the constitutionality of gay marriage, but the effect of the decision will be to allow same-sex marriage to resume in California. That decision was also 5-4, written by Chief Justice John Roberts.

Lt. Gavin Newsom told NBC News that gay marriage would resume in California within 30 days. Gov. Jerry Brown said counties could begin issuing marriage licenses to gay couples as soon as one formality was taken care of: A federal appeals court had to lift a stay issued by a lower judge.

The entire story is here.

Exodus International Shuts Down: Apologizes to LGBT Community

By Jade Walker
The Huffington Post
Originally posted June 20, 2013

Exodus International, a large Christian ministry that claimed to offer a "cure" for homosexuality, plans to shut down.

In a press release posted on the ministry's website Wednesday night, the board of directors announced the decision to close after nearly four decades.

“We’re not negating the ways God used Exodus to positively affect thousands of people, but a new generation of Christians is looking for change -- and they want to be heard,” Exodus board member Tony Moore said.

The closure comes less than a day after Exodus released a statement apologizing to the lesbian, gay, bisexual and transgender community for years of undue judgment, by the organization and from the Christian Church as a whole.

“Exodus is an institution in the conservative Christian world, but we’ve ceased to be a living, breathing organism. For quite some time we’ve been imprisoned in a worldview that’s neither honoring toward our fellow human beings, nor biblical," said Alan Chambers, president of Exodus.

The entire story is here.

Thursday, June 27, 2013

Is Empathy Necessary for Morality?

By Jesse 
J.
 Prinz
Forthcoming in P. Goldie and A. Coplan (Eds.). Empathy: Philosophical and Psychological
Perspectives. Oxford University Press.)

1.
 Introduction 

It 
is
 widely
 believed
 that
 empathy
 is 
a
 good 
thing,
 from
 a
 moral 
point 
of
 view.
  It 
is
 something
 we
 should
 cultivate 
because
 it 
makes 
us
 better
 people.
 Perhaps 
that’s
 true.
  But
 it is
 also
 sometimes
 suggested 
that
 empathy 
is 
somehow
 necessary for
 morality.
  That
 is
 the 
hypothesis
 I
 want 
to
 interrogate
and 
challenge.
  Not
 only
 is
 there 
little 
evidence
 for
 the 
claim 
that
 empathy 
is 
necessary,
 there
 is
 also
reason
 to
 think
 empathy
 can 
interfere
 with
 the
 ends
 of
 morality.
  A
 capacity
 for
 empathy
 might
 make
 us
better
 people,
 but
 placing
 empathy
 at 
the
 center
 of
 our
 moral
 lives
 may
 be
 ill‐advised.
 That
 is
 not
 to
 say
that
 morality
 shouldn’t
 centrally
 involve
 emotions.
 I
 think
 emotions
 are
 essential
 for
 moral 
judgment
 and 
moral
 motivation
 (Prinz,
 2007).

  It’s 
just 
that
 empathetic
 emotions
 are
 not
 ideally
 suited
 for
 these
 jobs.

Before
 embarking
 on
 this
 campaign
 against
 empathy,
 I
 want
 to
 say
 a
 little
 more
 about
 the 
target
 of the 
attack.
 What
 is 
empathy?
 And
 what
 would 
it
 mean 
to say 
empathy 
is
 necessary
 for
 morality?
 With
respect 
to 
the 
first
 question,
 much
 has
 been 
written.
 Theories
 of
 empathy
 abound.
  Batson
 et
 al.
 (1995:
 1042)
 define
 empathy 
as,
 “as 
an other‐oriented
 emotional
 response
 congruent
 with
 the
 perceived
 welfare
 of
 another
 person.”
  This is
 not
 the
 definition
 I 
will
 be
 using.
  Batson’s
 construct
 might
 be
 better
characterized 
as
 “concern,”
 because
 of 
its
 focus
 on
 another
 person’s
 welfare.
  Indeed,
 in
 much
 of
 his
 research
 he
 talks
 about
 “empathetic
 concern.”
 Notice 
that
 this
 construct
 seems 
to
 be
 a 
combination
 of
two
 separable
 things.
 Being
 concerned
 for
 someone
 is
 worrying
 about
 their
 welfare,
 which
 is
 something
 one
 can
 do
 even 
if
 one 
doesn’t feel
what
 it
 would
 be
 like 
to
 be 
in
 their
 place.
  One
 can 
have
 concern 
for
 a
 plant,
 for
 example,
 and
 an
 insect,
 or
 even
 an
 artifact,
 like
 a 
beautiful 
building that
 has
 into
disrepair.
  Empathy,
 seems
 to
 connote
 a
 kind
 of
 feeling
 that
 has
 to 
be
 at
 last
 possible
 for the
 object
 of
empathy.
 If
 so,
 “empathetic 
concern” 
combines 
two 
different
 things—a
 find
 of
 feeling‐for
 an
 object
 and
 a
 feeling‐on‐behalf‐of
 an
 object.
  Much
 of
 the 
empirical
 literature,
 including
 the
 superb
 research 
that
 Batson
 has
 done,
 fails 
to 
isolate
 these 
components,
 and,
 as
 a
 result,
 some
 of 
the
 existing 
studies
 are
confounded.
  They
 purport 
to
 show 
the 
value
 of
 empathy, 
but
 may
 really
 show
 the
 value 
of
 concern.
 My
 focus 
below
 will
 be
 on
 empathy,
 and 
I
 leave 
it
 as
 an
 open 
possibility 
that
 concern 
is 
highly
 important, 
if
 not
 necessary, 
for
 morality.
  Indeed,
 concern
 often
 seems
 to
 involve
 an
 element
 kind 
of

moral
 anger,
 which
 I
 will 
argue
 is
 very 
important 
to
 morality.

The entire article is here.

Forget ethics training: Focus on empathy

Craig Dowden
Special to Financial Post
Originally published June 13, 2013

The sheer volume and diversity of recent scandals in the corporate world, various levels of government, and even the media, has been astounding. Even though initiatives to get tough on corporate malfeasance were introduced and promoted in the early 2000s, it seems the only lesson learned is how to shield bad deeds more effectively while keeping up the appearance of compliance.

The most recent National Business Ethics survey reinforces this notion. Using data from the 2011 report, 42% of respondents state their organizations have weak ethical cultures — a result comparable the highest level in the history of the survey.

Given the importance of ethics in underpinning effective organizational leadership, the question remains: how do we demonstrate and promote ethical behaviour?

Empathy and the moral compass

The Management Research Group (MRG) has been administering the “360 review” process to executives for almost 30 years, allowing it to build a database of 100,000 leaders’ assessments.

One of the great value-added features of the MRG 360 process is that it includes various outcome measures of leadership effectiveness. One of the performance indicators asks respondents to rate a leader on whether he or she “demonstrates ethical leadership.”

When MRG examined what was the strongest predictor of ethical leadership behaviour out of the 22 competencies in their model, the resounding answer was empathy. In other words, leaders who scored highest on empathy also exhibited the highest levels of ethical leadership.

The entire article is here.

The Baby in the Well: The Case Against Empathy

By Paul Bloom
The New Yorker
Originally published May 20, 2013

Here are some excerpts:

The word “empathy”—a rendering of the German Einfühlung, “feeling into”—is only a century old, but people have been interested for a long time in the moral implications of feeling our way into the lives of others. In “The Theory of Moral Sentiments” (1759), Adam Smith observed that sensory experience alone could not spur us toward sympathetic engagement with others: “Though our brother is upon the rack, as long as we ourselves are at our ease, our senses will never inform us of what he suffers.” For Smith, what made us moral beings was the imaginative capacity to “place ourselves in his situation . . . and become in some measure the same person with him, and thence form some idea of his sensations, and even feel something which, though weaker in degree, is not altogether unlike them.”

(cut)

Empathy research is thriving these days, as cognitive neuroscience undergoes what some call an “affective revolution.” There is increasing focus on the emotions, especially those involved in moral thought and action. We’ve learned, for instance, that some of the same neural systems that are active when we are in pain become engaged when we observe the suffering of others. Other researchers are exploring how empathy emerges in chimpanzee and other primates, how it flowers in young children, and the sort of circumstances that trigger it.

This interest isn’t just theoretical. If we can figure out how empathy works, we might be able to produce more of it. Some individuals staunch their empathy through the deliberate endorsement of political or religious ideologies that promote cruelty toward their adversaries, while others are deficient because of bad genes, abusive parenting, brutal experience, or the usual unhappy goulash of all of the above. At an extreme lie the one per cent or so of people who are clinically described as psychopaths. A standard checklist for the condition includes “callousness; lack of empathy”; many other distinguishing psychopathic traits, like lack of guilt and pathological lying, surely stem from this fundamental deficit. Some blame the empathy-deficient for much of the suffering in the world. In “The Science of Evil: On Empathy and the Origins of Cruelty” (Basic), Simon Baron-Cohen goes so far as to equate evil with “empathy erosion.”

(cut)

The key to engaging empathy is what has been called “the identifiable victim effect.” As the economist Thomas Schelling, writing forty-five years ago, mordantly observed, “Let a six-year-old girl with brown hair need thousands of dollars for an operation that will prolong her life until Christmas, and the post office will be swamped with nickels and dimes to save her. But let it be reported that without a sales tax the hospital facilities of Massachusetts will deteriorate and cause a barely perceptible increase in preventable deaths—not many will drop a tear or reach for their checkbooks.”

(cut)

On many issues, empathy can pull us in the wrong direction. The outrage that comes from adopting the perspective of a victim can drive an appetite for retribution. (Think of those statutes named for dead children: Megan’s Law, Jessica’s Law, Caylee’s Law.) But the appetite for retribution is typically indifferent to long-term consequences. In one study, conducted by Jonathan Baron and Ilana Ritov, people were asked how best to punish a company for producing a vaccine that caused the death of a child. Some were told that a higher fine would make the company work harder to manufacture a safer product; others were told that a higher fine would discourage the company from making the vaccine, and since there were no acceptable alternatives on the market the punishment would lead to more deaths. Most people didn’t care; they wanted the company fined heavily, whatever the consequence.

The entire article is here.

Wednesday, June 26, 2013

Committee supervises ethics of human testing

By Madison Pauly
The Dartmouth
Published on Monday, February 25, 2013

From new cardiology studies to students that go overseas and want to interview people, the Committee for the Protection of Human Subjects answers ethical questions about human research at Dartmouth. The committee is an interdisciplinary group of experts and community members who analyze the risk posed to participants by Dartmouth-affiliated researchers’ studies.

As Dartmouth’s incarnation of a federally-mandated institutional review board, the committee analyzes proposals for research on human subjects from Dartmouth-Hitchcock Medical Center and the Veterans Affairs Medical Center in White River Junction, as well as the College’s graduate and undergraduate departments.

While all studies involving human participants are subject to review by the committee, those that receive funding from sources other than the government must pay a review fee to the committee office.

A division of the Provost’s Office, the committee is financed in part by federal funds allocated to Dartmouth for research. Accordingly, its review process follows federal policies to ensure “respect for persons, beneficence and justice,” according to a Department of Health and Human Services report.

Major areas of ethical concern include the research’s medical relevance, involvement of vulnerable populations, its informed consent process and use of deception, said assistant provost for research Liz Bankert, a member of the committee.

The current federal regulations were last revised in 1991 and often fail to give adequate ethical guidance on modern research questions, said Bankert, who also serves on a national research ethics advisory committee.

The entire story is here.

End-of-Life Care Improves But Costs Increase, Study Finds

by E.J. Mitchell
The Medicare News Group
Originally published July 12, 2013

Improvements in end-of-life care have occurred rapidly for Medicare patients but costs have increased, according to a new Dartmouth Institute brief that was released today. The study revealed that beneficiaries in their last six months of life spent fewer days in the hospital and that more patients received hospice services in 2010 compared to 2007.

However, Medicare spending for chronically ill patients at the end of life increased more than 15 percent during that time period, while the consumer price index rose only 5.3 percent.

The data from the brief, which is through the Dartmouth Atlas Project, also found that in 2010 compared to 2007:
  • patients were less likely to die in the hospital;
  • patients were as likely to spend time in intensive care units (ICUs) during the last six months of life;
  • the variations in end-of-life care at some academic medical centers quickly changed;
  • patients spent more days in hospice care; and
  • patients were more likely to see more than 10 physicians during the last 6 months of life.
  • The Dartmouth Atlas brief found that across hospitals improvement was variable, with some experiencing rapid change while others showed little improvement.

Tuesday, June 25, 2013

What happens to whistleblowers?

By David Nather
Politico
Originally published June 13, 2013

Edward Snowden might want to talk to a slew of recent national security leakers who learned a lesson the hard way: whistleblowing comes at a price.

Thomas Tamm, the DOJ attorney who told the New York Times about the National Security Agency’s surveillance program in 2004, struggled to stay employed for the five years he was under federal investigation.

And he was one of the lucky ones. Thomas Drake, a former National Security Agency official who helped expose a wasteful NSA surveillance program without privacy protections, is working in an Apple store.

And Matt Diaz, the Navy lawyer who secretly sent a list of Guantanamo Bay prisoners to a New York civil rights firm, was disbarred and now does non-legal work for the Bronx public defender’s office.

Snowden is still on the run, but he is expected to be extradited to the United States, eventually, and most likely charged with a crime.

If Snowden’s life turns out like other national security whistleblowers, his life will never be the same — leaving him to grapple with huge legal bills, poor job prospects, and a notoriety that will never really go away.

The entire story is here.

Guantanamo Bay: A Medical Ethics–free Zone?

George J. Annas, J.D., M.P.H., Sondra S. Crosby, M.D., and Leonard H. Glantz, J.D.
June 12, 2013
DOI: 10.1056/NEJMp1306065

American physicians have not widely criticized medical policies at the Guantanamo Bay detainment camp that violate medical ethics. We believe they should. Actions violating medical ethics, taken on behalf of the government, devalue medical ethics for all physicians. The ongoing hunger strike at Guantanamo by as many as 100 of the 166 remaining prisoners presents a stark challenge to the U.S. Department of Defense (DOD) to resist the temptation to use military physicians to “break” the strike through force-feeding.

President Barack Obama has publicly commented on the hunger strike twice. On April 26, he said, “I don't want these individuals [on hunger strike] to die.” In a May 23 speech on terrorism, the President said, “Look at our current situation, where we are force-feeding detainees who are . . . on a hunger strike. . . . Is this who we are? . . . Is that the America we want to leave our children? Our sense of justice is stronger than that.” How should physicians respond? That force-feeding of mentally competent hunger strikers violates basic medical ethics principles is not in serious dispute. Similarly, the Constitution Project's bipartisan Task Force on Detainee Treatment concluded in April that “forced feeding of detainees [at Guantanamo] is a form of abuse that must end” and urged the government to “adopt standards of care, policies, and procedures regarding detainees engaged in hunger strikes that are in keeping with established medical professional ethical and care standards.” Nevertheless, the DOD has sent about 40 additional medical personnel to help force-feed the hunger strikers.

The ethics standard regarding physician involvement in hunger strikes was probably best articulated by the World Medical Association (WMA) in its Declaration of Malta on Hunger Strikers. Created after World War II, the WMA comprises medical societies from almost 100 countries. Despite its checkered history, its process, transparency, and composition give it credibility regarding international medical ethics, and its statement on hunger strikers is widely considered authoritative.

The entire article is here.

Thanks to Gary Schoener for this lead.

Monday, June 24, 2013

In Bed with our Clients: Should Psychotherapists Play Matchmaker or is this Plain Old Erotic Transference?

By Keely Kolmes, PsyD.
http://drkkolmes.com

Last January, there was an opinion piece in the New York Times, written by Richard Friedman on whether therapists should play Cupid for clients, basically performing as a matchmaker, setting them up on dates. The article focused primarily on the fantasies that some clinicians have about wanting to do this and the potential issues that could come up regarding transference. It did not speak directly to erotic transference, but I think this is a key component of such a question.

Following the article, HuffPost Live did a segment on which I was one of four guests interviewed about our points of view on the issue. As expected, the show included diverse opinions and even had the one clinician, Terah Harrison, who has expanded her practice to include matching services.

Another clinician, Dr. Lazarus, argued passionately that we are "uniquely well positioned" to make such matchmaking recommendations to our clients. Jeff Sumber agreed it was unethical but he admitted to having such strong fantasies about fixing up his clients that he'd deliberately scheduled people in hopes they might meet. (I imagine his clients are now wondering as they arrive for therapy if the person leaving is someone he has chosen for them?)

Guess which role I played on this segment? Yes, I was the conservative fuddy-duddy talking ethics, dual relationships, and risk management.

The entire story is here.


Five Ethical Mistakes To Avoid with Clients on the Internet

This is a brief overview of common mistakes to avoid with online psychotherapy.  If nothing else, this short video should help a psychologist contemplating providing online psychotherapy services.





From the Australian Counseling Association.

Sunday, June 23, 2013

Could intranasal oxytocin be used to enhance relationships?

Research imperatives, clinical policy, and ethical considerations

By O. A. Wudarczyk, B. D. Earp, A. J. Guastella & J. Savulescu

Abstract

Purpose of review. 
Well-functioning romantic relationships are important for long-term health and well-being, but they are often difficult to sustain. This difficulty arises (in part) because of an underlying tension between our psychobiological natures, culture/environment, and modern love and relationship goals. One possible solution to this predicament is to intervene at the level of psychobiology, enhancing partners’ interpersonal connection through neurochemical modulation. This article focuses on a single, promising biobehavioral sub-system for such intervention: the attachment system, based largely upon the expression of the neuropeptide oxytocin. Could the exogenous administration of oxytocin—under the right conditions—be used to facilitate relational or marital well-being?

Recent findings.
If so, it would require considerable forethought. Recent research complicates the popular image of oxytocin as a universal social enhancer or ‘love hormone’ and shows that it may exert a variety of different effects, at different dosages, on different people, under different circumstances. Accordingly, we discuss what is known about oxytocin, including its“good” and “bad” effects on human behavior and on higher-order functional processes.

Summary.
Building upon animal-model, human preclinical, and clinical findings, we outline a proposal for the use of oxytocin in the therapeutic neuroenhancement of contemporary romantic relationships. Highlighting key targets for future research along the way, we then conclude by discussing some of the clinical and ethical considerations that would pertain to the implementation of this knowledge in applied settings.

Key Points

* Intranasal oxytocin may hold promise for the therapeutic neuroenhancement of modern relationships. Oxytocin has “good” and “bad” effects, however, that may be different for different individuals and couples depending upon a range of personal, interpersonal, and contextual factors.

* Large-scale clinical trials with adequate sample sizes, and that include both males and females, are needed to fill in a range of “gaps” in existing knowledge. Chronic administrations and ecologically valid study designs should be top research priorities.

* The imminent prospect of neurochemical modulation of interpersonal relationships should inspire the development of general ethical guidelines for the responsible use of such technology. These guidelines should emphasize autonomy, consent, and personal and interpersonal well-being.

* As is the case with any new area of biomedical research, practical, moral, and clinical-policy considerations must be addressed in tandem with any progress made on scientific and theoretical fronts.


Saturday, June 22, 2013

The Value of Role Reversal

Guest Post by Rebecca Dresser, Washington
BMJ Group Blogs
Originally posted on June 20, 2013

"Not so long ago, medical researchers had a habit of using themselves as guinea pigs.  Many scientists saw self-experimentation as the most ethical way to try out their ideas.  By going first, researchers could test their hypotheses and see how novel interventions affected human beings.

Today we rely on a more systematic process to decide when to begin human testing, with experts and ethicists evaluating when a trial is justified.  But a modified version of self-experimentation still makes sense.

People who conduct human research, as well as those serving on research ethics boards, can learn a lot from volunteering for studies.  Just as doctors learn from personal experience as patients, scientists and ethicists learn from personal experience as subjects.

Looking at study requirements and the consent process from the subject’s point of view can be quite educational.  I discovered this myself when I was given the option of enrolling in a cancer treatment trial.  I had never before realized that enrolling in a trial can delay the start of treatment, because of the extra appointments and procedures research enrollment can require.  Nor had I realized that because cancer trials take years to finish, subjects in those trials may lose an opportunity to receive new drugs that emerge during that time.  I’ve spent three decades writing about research ethics and serving on research review boards, but I learned new things once I had to decide whether to become a subject myself.

No one should be forced to participate in research, of course.  But I encourage research professionals to consider becoming subjects themselves (not necessarily in their own trials, but in studies conducted by others).  This modern version of self-experimentation might give researchers and ethicists a better sense of what people need to know before enrolling in a study.  It might also give scientists and review committees a deeper understanding of the risks, inconveniences, and benefits that subjects experience in research."

Rebecca’s paper “Personal Knowledge and Study Participation” is now available online first here.

The Limits of Moral Argument: Tamler Sommer presents at TEDx

Tamler Sommers is an Assistant Professor of Philosophy at the University of Houston and holds a joint appointment with the Honors College. His research and teaching are in the areas of ethics, political philosophy, and the philosophy of law, specializing in issues relating to free will, moral responsibility, punishment, and revenge.

Uploaded on December 17, 2011





The link to this video will be kept in the Audio and Video Resource page of this site.

Friday, June 21, 2013

Your Smartphone Might Hold Key To Your Medical Records

By Elizabeth Stawicki
Minnesota Public Radio
JUN 17, 2013

It's one of those unhappy holiday surprises -- a visiting family member gets sick. That happened to Dr. Farzad Mostashari last Thanksgiving.

"My dad comes downstairs and he has acute pain in his eye where he had cataract surgery. And I said, 'What's the matter, what's the story?'" recalled Mostashari, who lives in Bethesda, Md. "And he said, 'Well, I think they put the wrong lens in my eye, I'd gone back to the doctor and...'" His father didn't remember exactly what had happened at his last doctor's appointment and the office was closed anyway.

How could a local doctor in Maryland access his dad's medical record in Boston? Through Medicare Blue Button, a computer program that allows patients to download their medical history into a simple text file on their smartphones and personal computers. Then third-party applications that you download help organize this information.

Mostashari certainly knew how to handle his dad's problem. After all, he's the coordinator for health information technology at the U.S. Department of Health and Human Services, and it's his passion and profession to promote electronic health records.

And, he had signed his dad up for Blue Button, which downloads three years of a patient's medical history, as well as the Humetrix iBlueButton, a smartphone app that translates and displays the information in a simple-to-understand way. The file includes names, phone numbers and addresses of physicians as well as diagnoses, lab tests, imaging studies, and medications.

So when Mostashari took his father to a local doctor, his dad was able to hand over his iPhone and say, "Here's my history."

The entire story is here.

Here is a link to Medicare's Blue Button program.

Grime and Punishment: How disgust influences moral, social, and legal judgments

By Yoel Inbar and David Pizarro
The Jury Expert
Originally published March 2009 (but still relevant)

Here is an excerpt:

We experience a wide range of emotions every day: a bad mood because we skipped breakfast, anger because we got cut off in traffic, and even nostalgia from receiving an old picture of high school friends over email. To be sure, the insight that emotions influence judgment existed long before psychologists were able to confirm it experimentally. Yet a great deal of psychological research in the last few decades demonstrates that emotions just like those described above can subtly alter a wide range of judgments, including judgments that are completely unrelated to the original source of the emotion. In his Rhetoric, Aristotle exhorted his pupils to learn how emotions might influence human judgment so that they might best utilize these emotions to persuade their audience (Aristotle, 350 B.C.E./1991). But the explosion of research on the topic has allowed us to document exactly how these emotions influence judgment, as well as what kinds of judgments are particularly prone to their influence. For instance, we know that anger over the traffic incident on your way to work may lead to an increased reliance on racial stereotypes moments later when interviewing a job candidate (anger seems to encourage the use of cognitive “shortcuts” such as stereotypes; DeSteno, Dasgupta, Bartlett, & Cajdric, 2004). Mild sadness, on the other hand, would have an opposite effect—because it tends to make people more careful, analytic thinkers, it would actually lead to less reliance on stereotypes when evaluating a candidate.

Not surprisingly, legal scholars have taken a keen interest in understanding exactly how emotions influence the kinds of judgments that are central to the legal process, such as judgments of blame and responsibility (Feigenson, 2008). Here we examine disgust, an emotion that has received little attention historically—at least relative to emotions such as fear, anger, or sympathy—but about which much more has become known in the past few years. On its face, disgust may seem less relevant to legal judgments than emotions such as sympathy or anger. Unlike those emotions, its influence on courtroom proceedings is not intuitively obvious. Nonetheless, it has become increasingly evident that disgust plays an important role in a much wider set of social and moral judgments than was once believed. This article sheds light on what disgust is, how it influences judgments, and why legal scholars, judges, and attorneys should pay attention to it.

The entire volume is here.

Thursday, June 20, 2013

Very Bad Wizards: Trolleys, Utilitarianism, and Psychopaths

Tamler Sommers
Very Bad Wizards Podcast

A philosopher and a psychologist ponder the nature of human morality

Published on October 20, 2012

Notes

Tamler contemplates ending it all because he can't get 'Call Me Maybe' out of his head, and Dave doesn't try to talk him out of it. This is followed by a discussion about drones, psychopaths, Canadians, Elle Fanning, horrible moral dilemmas, and the biggest rivalry in Ethics: utilitarians vs. Kantians.

Episode 6 page: Trolleys, Utilitarianism and Psychopaths

The podcast is here. 

Editorial notes: Very Bad Wizards is a series of podcasts that combine psychological and philosophical perspectives on a variety of topics.   In terms of informed consent, the language is rough and the humor is..........let's just say bawdy, crude and coarse.   Truly, the podcast is not for the faint of heart.

If you like this podcast, there are a variety of Very Bad Wizards podcasts.  While their brand of humor is part of the content, the episodes that I have found as potentially good teaching tools are found in the Audio and Video resource page of this site.

And, I have Tamler's picture on this page to help boost his self-esteem.  Apparently, he feels badly that his TEDx talk has less views that Dave Pizarro's TEDx talk.  Both of their TEDx  talks are also on the Audio and Video resource page.

Wednesday, June 19, 2013

Out of the ER

By Jessica Zigmond
Modern Healthcare
Originally published on May 26, 2013

Borderline personality disorder. Schizophrenia. Psychotic tendencies. Suicidal behaviors. Typically found in the caseload of an inpatient psychiatric facility, these conditions have become prevalent in another area of the U.S. healthcare system: the acute-care hospital emergency department.

In 2006, an Institute of Medicine report concluded hospital emergency rooms are overwhelmed, citing increases in lengths of stay for patients seeking care, crowding of existing ER space and boarding of patients who need an inpatient bed as the reasons.

And a recent study published online in the Annals of Emergency Medicine shows that psychiatric patients spent more than 11 hours in the ER, on average, when they sought care. According to the recent findings, the need for hospitalization, use of restraints and completing diagnostic imaging led to more time after a patient was assessed, while the presence of alcohol on toxicology screening caused delays earlier in ER stay.

“Basically, the ER has gone from an emergency room to a place where all of society's problems show up,” says Dr. Nicholas Vasquez, an emergency services physician at St. Joseph's Hospital and Medical Center in Phoenix, who did not speak on behalf of the hospital. “And one of those is mental health issues.”

A noisy, chaotic place isn't the appropriate setting for patients who require stability and quiet, says Vasquez, past president of the Arizona College of Emergency Physicians. As he explains, the 60-bed emergency department where he works expands and contracts throughout the day and includes an average of three to four psychiatric patients daily.

The entire story is reprinted here.

How Money Affects Morality

By Eduardo Porter
The New York Times - Business
Originally published June 13, 2013

From Judas Iscariot, who betrayed Jesus for 30 pieces of silver, to Bernard L. Madoff to the standard member of Congress fighting tirelessly to further the interests of campaign donors, human history is full of examples of money’s ability to weaken even the firmest ethical backbone.

Money sows mistrust. It ends friendships. Experiments have found that it encourages us to lie and cheat. As Karl Marx, the scourge of capitalism, noted, ‘‘Money then appears as the enemy of man and social bonds that pretend to self-subsistence.’’

Yet though we clearly understand money’s power to debase character, we have less certain a grasp on what it is about money that corrupts us so. Is it simply greed? Does the appetite for the more comfortable life that money can buy push us over the line?

The entire article is here.

Tuesday, June 18, 2013

Chief of Army message regarding unacceptable behaviour

Published on Jun 12, 2013

Message from the Chief of Army, Lieutenant General David Morrison, AO, to the Australian Army following the announcement on Thursday, 13 June 2013 of civilian police and Defence investigations into allegations of unacceptable behaviour by Army members.





This video was made in response to news reports to the following:
Australian news outlets reported last week that at least 17 soldiers circulated video of themselves having sex with women. The videos were shared without the women's knowledge. Some of the material was distributed over military computer networks, and those under investigation include a lieutenant colonel and a major, Morrison told reporters on Thursday.
The following quote is from a CNN story found here.

Editorial notes: This video is an interesting and thought-provoking way to share unequivocal moral and ethical standards to the military community under his leadership.  Also interesting is the number of comments and the wide variety of responses to this video.

Additionally, compare and contrast this response to the United States military's response to the increased reports of sexual assault in our military community.  The responses are not the same.


Large Hospital Breach Caused by Inside Inappropriate Access

Health Data Management
Originally published May 31, 2013

Bon Secours Mary Immaculate Hospital in Suffolk, Va., is notifying about 5,000 patients after discovering a significant amount of inappropriate access to patients’ electronic health records from two employees inside the facility.

“During an April 2013 audit of a patient’s medical record, the health system identified suspicious access that prompted an investigation,” according to a notice the hospital issued. “The investigation revealed that two members of the patient care team accessed patients’ medical records in a manner that was inconsistent with their job functions and hospital procedures, and inconsistent with the training they received regarding appropriate access of patient medical records.”

The entire story is here.

Monday, June 17, 2013

Treatment of Mental Illness Lowers Arrest Rates, Saves Money

Science Daily
Originally published June 10, 2013

Research from North Carolina State University, the Research Triangle Institute (RTI) and the University of South Florida shows that outpatient treatment of mental illness significantly reduces arrest rates for people with mental health problems and saves taxpayers money.

"This study shows that providing mental health care is not only in the best interest of people with mental illness, but in the best interests of society," says Dr. Sarah Desmarais, an assistant professor of psychology at NC State and co-author of a paper describing the research.

The researchers wanted to determine the extent to which treating mental illness can keep people with mental health problems out of trouble with the law. It is well established that people with mental health problems, such as schizophrenia or bipolar disorder, make up a disproportionate percentage of defendants, inmates and others who come into contact with the criminal justice system.

The entire story is here.

Families of Violent Patients: 'We're Locked Out' of Care

By Gary Fields
The Wall Street Journal
Originally published on June 7, 2013

Suzanne Lankford for seven years has tried and failed to get long-term mental-health care for her son. When she hears news of a gun rampage or other violence, she gets chills.

"Whenever I see the parents saying they tried to get help, I think, 'That could be me,' " she says.

Ms. Lankford has watched her son, Joshua Rockwell, today 28 years old, barricade himself inside a room to ward off imaginary assassins. He once knocked her out with a blow to the head. She called the police on him after recognizing him in a mall security video of an armed robbery. Charges are pending.

He was later charged with attacking and harassing a nurse and law-enforcement officer. That trial has been delayed several times.

After Ms. Lankford's punch to the head, she asked her son's doctors about his treatment. She received a standard answer: Privacy laws prevent his doctors from talking to her without his permission, because he is an adult. His lawyer declined to comment citing the pending charges. Mr. Rockwell, who is in custody, declined to comment through his mother under the advice of his attorney.

When America began dismantling its government-run mental institutions a half-century ago, the U.S. started creating privacy protections and made it tougher to forcibly hospitalize people. The goal was to allow the mentally ill to live something close to a regular life.

Today, after a series of high-profile shooting rampages, many with links to mental illness, the U.S. is re-examining this approach. Some of the loudest voices for overhaul are from the families of the mentally ill—a first line of defense.

"We have been asking for information on Josh's medications, on his treatment plan…so that we can help him meet those obligations, but we're locked out," Ms. Lankford says. "I don't know how this story ends."

The entire story is here.

Sunday, June 16, 2013

Why do identical twins end up having such different lives?

Their genes are exactly the same, so why don't identical siblings' lives follow more similar patterns? The scientist behind a pioneering 21-year study believes he has the answer

By Robin McKie
The Guardian/The Observer
Originally published June 1, 2013

Here is one excerpt:

"We now began to look not at the similarities between identical twins but the differences. It was a shift in perception really. Our work shows that the heritability of your age at death is only about 25%. Similarly, there is only a 30% chance that if one identical twin gets heart disease the other one will as well, while the figure for rheumatoid arthritis is only about 15%."

It is a baffling observation: individuals with identical genes and often very similar conditions of upbringing but who experience very different life outcomes. What could be the cause? The answer, says Spector, came to him in a Damascene moment four years ago. The causes of these differences were due to changes in the human epigenome, he realised.

"Essentially, epigenetics is the mechanism by which environmental changes alter the behaviour of our genes," he says. "This involves a process known as methylation, which occurs when a chemical known as methyl, which floats around the inside of our cells, attaches itself to our DNA. When it does so, it can inhibit or turn down the activity of a gene and block it from making a particular version of a protein in our bodies." Crucially, all sorts of life events can affect DNA methylation levels in our bodies: diet, illnesses, ageing, chemicals in the environment, smoking, drugs and medicines.

Thus epigenetic changes produce variation in disease patterns. And recent experiments carried out by Spector and his colleagues, in which they have looked at methylation levels in pairs of identical twins, back the theory. "We have studied identical twins who have different tolerances to pain and shown that they have different states of methylation. We have also produced similar results for depression, diabetes and breast cancer. In each case, we have found genes that are switched on in one twin and switched off in the other twin. This often determines whether or not they are likely to get a disease."

Epigenetic changes are not just simple environmental changes, however. They influence a person's genes and can have an effect that can last for two or three generations in extreme cases. For example, studies of the children and grandchildren of pregnant women who endured starvation in the second world war and in China in the 50s have revealed they tended to be smaller and more prone to diabetes and psychosis. These trends are put down to epigenetic changes.

The entire article is here.

Thanks to Ed Zuckerman for this article.  The article may change the way that a psychologist thinks about twin study research indicating biological bases of psychopathology.

Saturday, June 15, 2013

'Moral Mondays' are here to stay

By William J. Barber
The Guardian
Originally published June 10, 2013

Here is one excerpt:

It is not surprising, then, that a couple of months ago, when we called for moral witnesses based on Gandhi and Dr King's brilliant examples of nonviolent direct action, we had 17 ministers and other leaders answer the call and participate in the first inaugural "Moral Monday".

We were pleased, but not shocked, when 29 additional North Carolinians came the second Monday; 49 the third, 59 the fourth, and 151 last Monday, 3 June. Each week, the number of supporters multiplies; from about 300 the first week to more than 4,000 on 3 June.

The appeal for each Moral Monday has been the same: urging legislators to govern for the good of the whole, rather than for the wealthy. We didn't come to this decision lightly. In fact, we made several attempts to meet with the far-right legislative leadership. Governor Pat McCrory invited us to his house for a 20-minute chat. We said we wanted to work with him to be sure he governed for the good of the whole, as the US constitution requires him to do. But it was clear he was marching to the beat of a different drummer.

Since then, we have tried repeatedly to meet with legislative leaders. No luck. Once they refused to meet and refused to stop their destructive campaign, we had no choice but to commit our constitutional responsibility to instruct our legislators by engaging in nonviolent civil disobedience.

The entire story is here.

UNC-Chapel Hill drops honor court case against student

By Phil Gast
CNN
Originally posted June 7, 2013

The University of North Carolina at Chapel Hill has dropped honor-court proceedings against a student who said the school retaliated against her for a sexual assault allegation.

In an e-mail to faculty and students on Thursday, Chancellor Holden Thorp said an outside review indicated no evidence of retaliation against Landen Gambill, who accused her ex-boyfriend of rape.

Gambill is one of several students who sparked a Department of Education investigation into how the university handles sex assault cases.

Thorp said a section of the honor code pertaining to "disruptive or intimidating behavior" would be suspended pending further review.

"This action is not a challenge to the important role of students in our Honor System, but is intended to protect the free speech rights of our students," the chancellor said in his e-mail. Thorp said the "important issue" will receive further discussion.

Gambill's attorney, Henry Clay Turner, had written a letter to Thorp, saying his client believed the university was retaliating against her because it let the student-run honor court charge her with intimidating her former boyfriend.

Gambill did not file a sexual assault report with police, and her former boyfriend -- who has not been identified publicly -- denied her accusation, according to his attorney.

The entire story is here.


Friday, June 14, 2013

How Danish Work Design Creates Productivity and Life Quality

Copenhagen Balance
By Camilla Kring, Vivi Bach Pedersen, and Andres Raastrup Kristensen

The future can be found in Denmark. In this report we show how some of the most successful companies in Denmark developed their business through an innovative, results-oriented focus on balancing employees’ work and private lives.

Denmark has a unique position in the world when it comes to balancing work and private life.

  • Denmark has one of the highest participation rates for women in the workforce. (75% of women are in the workforce).
  • Among all EU countries, Danish employees have the highest degree of influence over their work. (85% of employees indicate that they have an influence on their work situation).
  • Danish employees have some of the world’s most flexible work conditions. (43% of employees can regulate their work hours to meet their private needs).
  • Danish employees have some of the best maternity/paternity leaves in the world (combined one year leave per child).

The Danish model is known as ‘flexicurity’. In this model, it is easy for organizations to hire and lay off employees, while government subsidies assure a safety net if people cannot find jobs. Denmark is also known for a variety of public initiatives that make it easier to have children. For example, the state subsidizes parental leave for a year after childbirth. After the leave, parents can go back to work, while the children are cared for in subsidized nurseries and preschools. 92% of Danish children in the age group 3-5 years are in preschool. Thus, having a family can be combined with holding down a job.

(cut)

Introduction

In this report we discuss how six leading Danish companies innovate with work-life balance as an integrated part of their strategy. We provide you with a variety of concrete ideas and inspiration that work with Balance. These case examples demonstrate unique versions of the concept, and show how to implement such initiatives in order to simultaneously improve employee well-being and productivity. The report describes not only the current and new innovative best practices in the field, but also points to the new directions in which work-life balance is most likely to progress.

Balance is about Business

All the companies described in this report have worked with balance between work and private life for many years. In this process they have left the traditional understanding of Balance behind. This was an understanding built on the sharp dichotomy of the industrial era, during which work and private life were seen as conflicting entities in two distinct spheres that were to be balanced as if on a scale.

The entire work-life balance report is here.

Morality and ethics - the 'next big thing' for IT suppliers

By Brian Glick
Computer Weekly Editor's Blog
Originally published on June 10, 2013

Here is an excerpt:

But with that greater influence, comes greater responsibility. It is inevitable there would be a backlash, and that backlash is well and truly underway.

IT was at the heart of the global boom in financial services. Today it stands accused of enabling the behaviours of bankers that crippled Western economies.

Facebook and social media have transformed personal communications, enabled new communities and improved information sharing for all. But at what cost for privacy of our personal information.

Google and Amazon have made it easy to find information, to buy quickly and cheaply, opening up new knowledge and commercial opportunities. And they are pilloried as arrogant tax avoiders.

But the biggest example of the dark side of technology so far is dominating front pages and web pages alike around the world - the US National Security Agency (NSA) monitoring of electronic communications, and the allegations of complicity on the part of the global internet giants that provide that data.

Look at all the great things the web allows us to do - and look at how easy that makes it to create a surveillance society. As someone said recently, if you could give George Orwell one Tweet from beyond the grave, he would write: "I told you so #Prism".

This backlash is an inevitable stage in the progress of technology and the digital revolution, but of course it presents challenges on a scale that the world has never before had to comprehend.

The entire blog post is here.

Thursday, June 13, 2013

How Not to Be Alone

By Jonathan Safran Foer
The New York Times - Opinion
Originally published June 8, 2013

Here is an excerpt:

Psychologists who study empathy and compassion are finding that unlike our almost instantaneous responses to physical pain, it takes time for the brain to comprehend the psychological and moral dimensions of a situation. The more distracted we become, and the more emphasis we place on speed at the expense of depth, the less likely and able we are to care.

Everyone wants his parent’s, or friend’s, or partner’s undivided attention — even if many of us, especially children, are getting used to far less. Simone Weil wrote, “Attention is the rarest and purest form of generosity.” By this definition, our relationships to the world, and to one another, and to ourselves, are becoming increasingly miserly.

Most of our communication technologies began as diminished substitutes for an impossible activity. We couldn’t always see one another face to face, so the telephone made it possible to keep in touch at a distance. One is not always home, so the answering machine made a kind of interaction possible without the person being near his phone. Online communication originated as a substitute for telephonic communication, which was considered, for whatever reasons, too burdensome or inconvenient. And then texting, which facilitated yet faster, and more mobile, messaging. These inventions were not created to be improvements upon face-to-face communication, but a declension of acceptable, if diminished, substitutes for it.

But then a funny thing happened: we began to prefer the diminished substitutes. It’s easier to make a phone call than to schlep to see someone in person. Leaving a message on someone’s machine is easier than having a phone conversation — you can say what you need to say without a response; hard news is easier to leave; it’s easier to check in without becoming entangled. So we began calling when we knew no one would pick up.

The entire story is here.

Suspect in Colorado Killings Enters Insanity Plea

By Jack Healy
The New York Times
Originally posted on June 4, 2013

James E. Holmes, the former neuroscience student charged with killing 12 people inside a Colorado movie theater last July, changed his plea on Tuesday to not guilty by reason of insanity.

It was an expected shift in Mr. Holmes’s defense, formalized during a court hearing in this Denver suburb. As the judge read a lengthy document describing the legal consequences and psychiatric examinations that would follow the plea, Mr. Holmes, shackled and dressed in a red jail uniform, appeared to follow along on a copy, gazing down as one of his lawyers flipped the pages.

The entire story is here.

Wednesday, June 12, 2013

An Ethical Prohibition that Isn’t — And Never Really Was

By Robert E. Erard, Ph.D.
The National Psychologist
March 11, 2013

A decade after the 2002 APA Ethics Code and the HIPAA Privacy Rule should have settled the matter many psychologists continue to believe fervently that they have some special ethical duty to resist all formal requests for their raw test data, even when these requests are accompanied by releases from the test taker and even by subpoenas or court orders.

When asked for their test data, some psychologists claim paternalistically that nobody could ever understand what these mysterious numbers mean without being a licensed psychologist. They seem to ignore the fact that we ourselves have an ethical duty (Ethical Standard 9.10; APA, 2002) to provide test feedback (i.e., explaining those numbers), not to mention that most test publishers routinely sell test forms and computerized test interpretations to psychiatrists, social workers, counselors and others.

Other psychologists contend that either test copyrights or licensing agreements with test publishers prevent them from complying with these requests. They overlook the fact that the Fair Use Doctrine under the Copyright Act of 1976 (2011), the legal rights of test takers to their health care information and discovery rules governing the bases for experts’ opinions in forensic matters have consistently trumped these arguments when they have been put to the test (e.g., see Carpenter v. Yamaha, 2006).

The entire story is here.

A Simple Way to Reduce Suicides

By Ezekiel J. Emanuel
The New York Times - Opinionator
Originally published June 2, 2013

EVERY year about a million Americans attempt suicide. More than 38,000 succeed. In addition, each year there are around 33,000 unintentional deaths by poisonings. Taken together, that’s more than twice the number of people who die annually in car accidents.

The tragedy is that while motor vehicle deaths have been dropping, suicides and poisonings from medications have been steadily rising since 1999. About half of suicides are committed with firearms, and nearly 20 percent by poisoning. A good way to kill yourself is by overdosing on Tylenol or other pills. About 90 percent of the deaths from unintentional poisonings occur because of drugs, and not because of things like household cleaners or bleach.

There is a simple way to make medication less accessible for those who would deliberately or accidentally overdose — and that is packaging.

We need to make it harder to buy pills in bottles of 50 or 100 that can be easily dumped out and swallowed. We should not be selling big bottles of Tylenol and other drugs that are typically implicated in overdoses, like prescription painkillers and Valium-type drugs, called benzodiazepines. Pills should be packaged in blister packs of 16 or 25.

The entire opinion piece is here.

Tuesday, June 11, 2013

Pediatricians warned children of military personnel face mental health risks

By Ryan Jaslow
CBS News
Originally posted May 27, 2012

Children of military personnel may be at an increased risk for social, emotional and behavioral problems, according to a new report from the American Academy of Pediatrics.

Published May 27, Memorial Day, in the academy's journal Pediatrics, the new clinical report aims to raise awareness among pediatricians for the mental health needs for military children.

Authored by Dr. Ben S. Siegel and Dr. Beth Ellen Davis, who serve as members on the Committee On Psychosocial Aspects of Child and Family Health and Section on Uniformed Services, the report points out about 60 percent of U.S. service members have families while about 2.3 million military members have been deployed since the start of the wars in Afghanistan and Iraq about a decade ago.

The entire article is here.

Prominent Hilton Head psychologist’s license revoked; Sex with patient alleged

By Alice Stice
The State (South Carolina News Site)
Originally published May 31, 2013

A prominent Hilton Head Island psychologist has had his license permanently revoked for having a sexual relationship with a patient that included intimate encounters in his office, according to an order from the S.C. Board of Examiners in Psychology.

Dr. Howard Rankin, a psychologist, neuropsychologist and author who has been featured in the national media, admitted the relationship to an investigator from the S.C. Department of Labor, Licensing & Regulation and is barred from practice after an April disciplinary hearing before the board, records show.

Rankin has been featured as an expert on addiction, weight loss and other fields in The Wall Street Journal and Los Angeles Times, and has appeared as a guest on CNN and ABC’s “The View” and “20/20.”

He declined to comment for this article.

According to the board’s order, a female patient diagnosed with borderline personality disorder and post-traumatic stress disorder began seeing Rankin for therapy in 2005. The patient, referred to only by her initials in the order, had attempted suicide on several occasions and had been hospitalized for psychiatric treatment more than once, the order says.

The entire story is here.

Monday, June 10, 2013

Human Subjects Research Landscape Project – Analysis Dataset

The Presidential Commission for the Study of Bioethics

In order to respond to President Obama’s November 24, 2010 charge “to determine if Federal regulations and international standards adequately guard the health and well-being of participants in scientific studies supported by the Federal Government,” the Commission recognized that a critical first step would be to define and understand the landscape of “scientific studies supported by the Federal Government.” Finding no comprehensive publicly available source for this information, the Commission asked the 18 federal departments and agencies that have adopted the Common Rule—and therefore were likely to support scientific studies with human subjects—to provide basic project-level data for department/agency-supported human subjects research in Fiscal Year 2006 to Fiscal Year 2010.

These data, which include study title, number and location of sites, number of subjects, and funding information, were compiled into the Commission’s Research Project Database, and analyzed as part of its Human Subjects Research Landscape Project.

Posted here is the Commission’s analysis dataset, which incorporates minimal data cleaning as detailed in “Appendix II: Human Subjects Research Landscape Project Methods.”  Also posted is a data dictionary that defines the dataset’s fields. The data are available in two formats: Microsoft Access and .CSV.  The Access file contains the same information as the three .CSV files.

As detailed in the Methods, department/agency-reported information in the dataset was not independently audited or verified.  Moreover, the dataset is static; no additional data will be added to it.

For further information, and to read the Human Subjects Research Landscape Project Methods, please see “Appendix I: Human Subjects Research Landscape Project: Scope and Volume of Federally Supported Human Subjects Research” and “Appendix II: Human Subjects Research Landscape Project Methods.”

The entire study is here.

SUPPORT Update: OHRP’s Compliance Actions on Hold

By John B. Lantos
The Hastings Center Bioethics Forum
Originally posted June 5, 2013

In a thoughtful, nuanced letter to the University of Alabama (the home of the Principal Investigator of the SUPPORT study), the Office for Human Research Protection announced that it has “put on hold all compliance actions against UAB relating to the SUPPORT case.”  Further, OHRP promises not to initiate compliance actions “in studies involving similar designs” until it clarifies the guidelines for such studies. In doing so, it acknowledges “widespread misunderstanding about the risks that are required to be disclosed in obtaining informed consent for certain types of studies.”  (Previous posts on the SUPPORT controversy are here, here, here, and here.)

OHRP promises that the process of drafting new guidelines will be “as open as possible, with input from all interested parties.”  To achieve this, it will “engage in the usual notice and comment process with regard to draft guidance” and “will also conduct an open public meeting on this topic.” This is a welcome development.

The letter also suggests the positions that OHRP will take in these discussions. It focuses on three main points.

First, the letter acknowledges that these discussions will focus on situations where the standard of care includes known and widespread practice variation with no reliable evidence on which practices are associated with which risks or benefits. “When the SUPPORT study was initiated,” it states, “there was no clear recent evidence indicating that different oxygenation levels with the then-current standard of care (85%- 95%) would produce differences in neurological damage or survival.”

The entire blog post is here.

Sunday, June 9, 2013

Studying Childhood Morality via Social Groups and Cognition

Rhodes, M. (in press). Naive theories of social groups. Child Development.

Here are some excerpts from this paper regarding the importance of studying moral development.

Yet, despite preschoolers’ general commitment to fairness, the possibility that children view people as having special moral obligations to their own group members cannot be entirely ruled out. This possibility is consistent with several theoretical accounts of morality proposed by social and cultural psychologists (Cohen, Montoya, & Insko, 2006; Dovidio, 1984; Haidt & Joseph, 2007; Haidt & Kesebir, 2010; Levine, Cassidy, Brazier, & Reicher, 2002; Levine & Thompson, 2004), and there is recent developmental data that appear consistent with this possibility (Castelli, De Amicis, & Sherman, 2007; Rhodes & Brickman, 2011). Thus, this remains an important area for future work.

(cut)

Whereas the majority of research in this area has examined how children appeal to individual mental states to make these predictions, there has recently been increasing emphasis on understanding how children make these predictions by reference to social causes that extend beyond the individual, including social categories, norms, and morality (Hirschfeld, 1996; Olson & Dweck, 2008; Wellman & Miller, 2008). This emphasis—on considering children’s naı¨ve sociology along with their naive psychology—is particularly important given that preschool-age children often weight the causal features  specified by naive sociology (e.g., categories, norms) more heavily than individual mental states (e.g., traits, desires) to predict individual action (Berndt & Heller, 1986; Biernat, 1991; Diesendruck & haLevi, 2006; Kalish, 2002; Kalish & Shiverick, 2004; Lawson & Kalish, 2006; Rhodes & Gelman, 2008; Taylor, 1996).

The entire paper is here.

Blurring the lines of ethics when doctors use social media

By Wes Fisher
Dr.KevinMD Blog
Originally posted on May 28, 2013

The position paper from the American College of Physicians and the Federation of State Medical Boards, is a humbling reminder of the challenges that today’s physicians face when entering the online space.

Their recommendations for online medical professionalism, written by ethics committees for the two organizations, “provides recommendations about the influence of social media on the patient–physician relationship, the role of these media in public perception of physician behaviors, and strategies for physician–physician communication that preserve confidentiality while best using these technologies” — no small amount of territory to summarize.

But given the tenure of their document, I should probably hang up this blog right now.  After all, why risk being vulnerable in the online world?  While well-meaning on one hand, we should appreciate that physicians have officially been put on notice on how to behave online.

To be fair, I agree with most of what they say.   All the things about patient confidentiality are appropriate.  All the things about respect for persons, better still.

But to me, the part of the document that wanders off into the “influence of social media on the patient-physician relationship” and the influence of social media on the “public perception of physician behaviors,” is more difficult to gauge in its benefit or detriment to the public discourse.

The entire article is here.

Saturday, June 8, 2013

Needed: New approaches to defuse 'suicide contagion' among teens

How should we talk about suicide? Mental health experts have some ideas

By Andre Mayer
CBC News 
Posted: May 23, 2013

Experts on adolescent behaviour say the apparent susceptibility of Canadian teens to the idea of suicide shows the need to change public discussion about this sensitive topic.

Among the suggestions being put forward are finding new ways to refer to the act, to put it in a more appropriate context and training crisis-intervention teams to be more aware of how young people can respond to a suicide in their midst.

A study published May 21 in the Canadian Medical Association Journal reported that teens who knew of schoolmates who took their own lives were more likely to consider it or attempt it themselves — a phenomenon the authors call "suicide contagion."

The entire article is here.

Ethics Without Borders

By Cynthia Schoeman
The Ethics Monitor

For organisations that strive to be ethical, there are two important criteria for earning and maintaining an ethical status: the continual, consistent application of their values to all their stakeholders and their on-going adherence to all applicable laws and regulations. If a company’s commitment to their values or their compliance with regulations is intermittent or applied selectively, it erodes their ethical standing. The constancy of ethical behaviour reflects the practice of “ethics without borders”.

Borderless ethics necessitates that the organisation has a very inclusive ethical boundary, whereby ethics is exercised beyond self-interest and includes all stakeholders affected by the company’s operations. By contrast, an exclusive ethical boundary, which implies that ethics is exercised only for the organisation’s own benefit and relative to a select few stakeholders (typically shareholders), totally contradicts an approach of ethics without borders. While the exclusion of other stakeholders does not necessarily mean that the company is behaving unethically, it does highlight the fact that the company prioritises their own goals and needs above others’ or that they don’t give equal priority to their various stakeholders – such as communities who are impacted by the company’s operations. Added to that, organisations are rarely obliged - for example, by law - to include all stakeholder groups formally within their ethical boundary. So, although such companies may not be technically behaving unethically or illegally, their limited application of ethics means that they would rarely be regarded as an ethical organisation.

There is a further challenge to following an approach of ethics without borders. This emanates from the recurring discourse in workplace ethics that ethics differs for different people, cultures, countries and situations. This view needs to be addressed not only because it appears to invalidate the possibility for ethics without borders, but also because it undermines the pursuit of common and shared organisational ethics. The globalised nature of the world of work particularly makes for a multitude of differences in the workplace. Yet, ironically, globalisation makes the practice of ethics without borders all the more valuable, not least for the clarity it offers all affected parties and the fairness it embodies by operating in terms of the same ethics globally.

The entire story is here.

Editor's Note: This article has direct connections to individual psychologists in private practice, businesses in general, state psychological associations, and the American Psychological Association.

Friday, June 7, 2013

Vignette 26: A Political Donation

Dr. Fair performs child custody evaluations.  She is well known in both the legal and psychological communities.  Recently, Dr. Fair received solicitations for contributions from a candidate for judge in her county, Deloris True.  She has worked with Attorney True on numerous occasions and believes that she would be a real asset as a judge in her community.  She clearly wants this individual to be elected as a judge.

However, if Attorney True is elected as judge, Dr. Fair will likely appear before her in court as an expert witness. Will contributing to the campaign of the judicial candidate be contraindicated because it could lead to a perception of bias in future court cases?  Is the contribution warranted because Dr. Fair believes that Attorney True is highly qualified for that position?

In her state, political contributions over $50 are in the public domain and anyone could see that Dr. Fair made the contribution.  Dr. Fair would like to show her financial support by contributing more than $50.  (Dr. Fair has already ruled out giving 10 checks for $49.95.).  Concerned about ethics and reputation, Dr. Fair contacts you for a consult.

What are the potential ethical issues involved in the situation?

What are the competing ethical principles?

What are your suggestions for Dr. Fair?

Thursday, June 6, 2013

Gag Orders on Sexuality

By Allie Grasgreen
Inside Higher Ed
Originally posted on May 23, 2013

When Brittney Griner, Baylor University’s star basketball player and one of the most celebrated athletes in the history of the sport, came out publicly as gay last month, she was rather nonchalant about it. She didn’t write a Sports Illustrated cover story – à la professional basketball player Jason Collins, a few weeks later – she just sort of mentioned it in media interviews. Griner is “someone who’s always been open,” she said, with family, friends and teammates.

But, as Griner revealed a few weeks later, she wasn’t allowed to be open as much as she might have liked. That’s because Baylor head coach Kim Mulkey told her and her teammates not to talk publicly about their sexuality.

“It was a recruiting thing,” Griner told ESPN. “The coaches thought that if it seemed like they condoned it, people wouldn’t let their kids come play for Baylor.”

Griner's account followed on the heels of speculation that her coming out signaled a new age at Baylor – a private Christian university whose nondiscrimination policy does not cover sexual orientation and whose student handbook entry for “sexual misconduct” includes as examples of inappropriate actions "homosexual behavior" and participation in “advocacy groups which promote understanding of sexuality that are contrary to biblical teaching.”

City Seeking to Diversify Foster System

By Mara Gay
The Wall Street Journal
Originally posted on June 2, 2013

New York City is launching a campaign to recruit gay and lesbian foster parents, part of a major push to expand the kinds of families who consider fostering and to find more welcoming homes for children who identify as lesbian, gay, bisexual, transgender or queer.

The public ad campaign, set to roll out this week, features images of an interracial gay couple spending time with a young child. "Be the reason she has hope," one of the ads reads. In another, a black woman is pictured alone with a white teenage boy. "Be the reason it gets better," the message says.

How many of the nearly 13,000 children in New York City's foster-care system identify as LGBTQ is unclear because the city does not keep such data. But, citing anecdotal evidence, researchers, child advocates and city officials insist that the children are disproportionately represented in the foster care system and say the need to find them supportive homes is great.

"When we decided to do this campaign we knew that LGBTQ young people are disproportionately represented in our foster care population, especially among our teens," said Ronald Richter, commissioner of the Administration for Children's Services, the city's child welfare agency.

Mr. Richter, citing a study the city commissioned last year, said the data show that adults who identify as LGBTQ are more likely to want to foster a child who may also identify that way.

The entire story is here.

Wednesday, June 5, 2013

Empathy Plays a Key Role in Moral Judgments

Science Daily
Originally published May 22, 2013

Is it permissible to harm one to save many? Those who tend to say "yes" when faced with this classic dilemma are likely to be deficient in a specific kind of empathy, according to a report published in the scientific journal PLOS ONE.

Philosophers and psychologists have long argued about whether there is one "right" answer to such moral questions, be it utilitarian ethics, which advocates saving as many as possible, even if it requires personally harming an individual, or non-utilitarian principles, which mandate strict adherence to rules like "don't kill" that are rooted in the value of human life and dignity.

In their new report, co-authors Liane Young, an assistant professor of psychology at Boston College, and Ezequiel Gleichgerrcht of the Institute of Cognitive Neurology and Favaloro University in Argentina, address two key questions related to moral decision-making: First, what specific aspect of emotional responding is relevant for these judgments? Second, is this aspect of emotional responding selectively reduced in utilitarian respondents or enhanced in non-utilitarians?

The entire story is here.

The entire article is here.

Abstract

Is it permissible to harm one to save many? Classic moral dilemmas are often defined by the conflict between a putatively rational response to maximize aggregate welfare (i.e., the utilitarian judgment) and an emotional aversion to harm (i.e., the non-utilitarian judgment). Here, we address two questions. First, what specific aspect of emotional responding is relevant for these judgments? Second, is this aspect of emotional responding selectively reduced in utilitarians or enhanced in non-utilitarians? The results reveal a key relationship between moral judgment and empathic concern in particular (i.e., feelings of warmth and compassion in response to someone in distress). Utilitarian participants showed significantly reduced empathic concern on an independent empathy measure. These findings therefore reveal diminished empathic concern in utilitarian moral judges.

Citation: Gleichgerrcht E, Young L (2013) Low Levels of Empathic Concern Predict Utilitarian Moral Judgment. PLoS ONE 8(4): e60418. doi:10.1371/journal.pone.0060418

Silencing the Whistle-Blowers

By EYAL PRESS
The New York Times - OpEd
Published: May 27, 2013

LAST week Pfc. Bradley Manning returned to court for his final pretrial hearing in the WikiLeaks case, an appearance that has renewed debate about how to balance the imperatives of national security against the rights of whistle-blowers.

But while Private Manning’s ordeal has received exhaustive news coverage, it may ultimately have a less profound bearing on this tension than a barely noticed memo quietly released by the Obama administration earlier this year.

Issued on Jan. 25, the memo instructs the director of national intelligence and the Office of Personnel Management to establish standards that would give federal agencies the power to fire employees, without appeal, deemed ineligible to hold “noncritical sensitive” jobs. It means giving them immense power to bypass civil service law, which is the foundation for all whistle-blower rights.

The administration claims that the order will simply enable these agencies to determine which jobs qualify as “sensitive.” But the proposed rules are exceptionally vague, defining such jobs as any that could have “a material adverse impact” on national security — including police, customs and immigration positions.

If the new rules are put in place, national security could soon be invoked to deny civil servants like Franz Gayl the right to defend themselves when subjected to retaliation. Back in 2010, Mr. Gayl was accused of engaging in a pattern of “intentional misconduct” and suspended from his job. A Marine Corps adviser who had been deployed to Iraq in 2006, Mr. Gayl claimed he was being punished for publicly disclosing that Pentagon bureaucrats had ignored battlefield requests for mine-resistant armored vehicles, at a time when roadside bombs were killing and maiming soldiers.

The entire story is here.

Tuesday, June 4, 2013

Scholars call for new ethical guidelines to direct research on social networking

By Jennifer Sereno
University of Wisconsin-Madison News
Originally published January 2013

The unique data collection capabilities of social networking and online gaming websites require new ethical guidance from federal regulators concerning online research involving adolescent subjects, an ethics scholar from the Morgridge Institute for Research and a computer and learning sciences expert from Tufts University argue in the journal Science.

Increasingly, academics are designing and implementing research interventions on social network sites such as Facebook to learn how these interventions may affect user behavior, knowledge, attitudes and psychological health. Online games are being used as research interventions. However, the ability to mine user data (including information about Facebook "friends"), sensitive personal information and behavior raises concerns that deserve closer ethical scrutiny, say Pilar Ossorio and R. Benjamin Shapiro.

Ossorio is a bioethics scholar-in-residence at the Morgridge Institute, a private, nonprofit biomedical research institute on the University of Wisconsin-Madison campus. She also holds joint appointments as a professor of law and bioethics at the University of Wisconsin Law School and the School of Medicine and Public Health. Shapiro is an assistant professor in computer science and education at Tufts, where he is a member of the Center for Engineering Education and Outreach. He previously held appointments in educational research at Morgridge and the Wisconsin Institute for Discovery.

"Given the unprecedented ability of online research using social network sites to identify sensitive personal information concerning the research subject and the subject's online acquaintances, researchers need clarification concerning applicable ethical and regulatory standards," Ossorio says. "Regulators need greater insights into the possible benefits and harms of online social network research, and researchers need to better understand the relevant ethical and regulatory universe so they can design technical strategies for minimizing harm and complying with legal requirements."

For instance, Ossorio says, researchers may be able to design game features that detect player distress and respond by modifying the game environment, and marry those features to data collection technologies that maximally protect users' privacy while still offering useful data to researchers.

Consent for online research is tricky, particularly when it involves minors. Under Shapiro and Ossorio's analysis, current law does not require that researchers obtain parental permission to conduct studies of adolescents on social networking sites. Parental permission is required for younger children, while adolescents and adults provide their own consent. Of course, parents can prohibit their adolescents from any online activity, including research participation, regardless of legal limits on researchers. Parents have the same amount of control over their adolescents' online research participation as they do over any other online activity in which their teens engage.

"Researchers should use the online environment to deliver innovative, informative consent processes that help participants understand the dimensions of the research and the accompanying data collection," Shapiro says. "This is especially important given the general public's ignorance about the ability to collect massive amounts of personal data over the Internet."

If traditional approaches to consent are of limited value for protecting online subjects, Ossorio says, then researchers and regulators should emphasize other aspects of research ethics, such as using all reasonable approaches to minimize research risks. Also, researchers should seek innovative methods for generating transparency around the research enterprise.

Writing in the Policy Forum section of the Jan. 11 edition of Science, Shapiro and Ossorio conclude by emphasizing that the richness of online information should not become the sole domain of commercial marketing interests but should be used to advance understanding of human behavior and inspire positive social outcomes. Elucidating ethical and legal guidelines for design research on social media will create new opportunities for researchers to understand and improve society.

The news release is here.