Listen, explain, involve, and evaluate: why respecting autonomy benefits suicidal patients

Samuel J. Knapp (2024)

Ethics & Behavior, 34:1, 18-27

DOI: 10.1080/10508422.2022.2152338

Abstract

Out of a concern for keeping suicidal patients alive, some psychotherapists may use hard persuasion or coercion to keep them in treatment. However, more recent evidence-supported interventions have made respect for patient autonomy a cornerstone, showing that the effective interventions that promote the wellbeing of suicidal patients also prioritize respect for patient autonomy. This article details how psychotherapists can incorporate respect for patient autonomy in the effective treatment of suicidal patients by listening to them, explaining treatments to them, involving them in decisions, and inviting evaluations from them on the process and progress of their treatment. It also describes how processes that respect patient autonomy can supplement interventions that directly address some of the drivers of suicide.

Public Impact Statement

Treatments for suicidal patients have improved in recent years, in part, because they emphasize promoting patient autonomy. This article explains why respecting patient autonomy is important in the treatment of suicidal patients and how psychotherapists can integrate respect for patient autonomy in their treatments.

My lengthy summary, because the article is paywalled here.

Dr. Knapp's article discusses the importance of respecting patient autonomy in the treatment of suicidal patients within the framework of principle-based ethics. It highlights the ethical principles of beneficence, nonmaleficence, justice, respecting patient autonomy, and professional-patient relationships. The article emphasizes the challenges psychotherapists face in balancing the promotion of patient well-being with the need to respect autonomy, especially when dealing with suicidal patients.

Fear and stress in treating suicidal patients may lead psychotherapists to prioritize more restrictive interventions, potentially disregarding the importance of patient autonomy. The article argues that actions minimizing respect for patient autonomy may reflect a paternalistic attitude, which is implementing interventions without patient consent for the sake of well-being.

The problems associated with paternalistic interventions are discussed, emphasizing the importance of patients' internal motivation to change. The article advocates for autonomy-focused interventions, such as cognitive behavior therapy and dialectical behavior therapy, which have been shown to reduce suicide risk and improve outcomes. It suggests that involving patients in treatment decisions, listening to their experiences, and validating their feelings contribute to more effective interventions.

The article provides recommendations on how psychotherapists can respect patient autonomy, including listening carefully to patients, explaining treatment processes, involving patients in decisions, and inviting them to evaluate their progress. The ongoing nature of the informed consent process is stressed, along with the benefits of incorporating patient feedback into treatment. The article concludes by acknowledging the need for a balance between beneficence and respect for patient autonomy, particularly in cases of imminent danger, where temporary prioritization of beneficence may be necessary.

In summary, the article underscores the significance of respecting patient autonomy in the treatment of suicidal patients and provides practical guidance for psychotherapists to achieve this while promoting patient well-being.

Experimental Regulations for AI: Sandboxes for Morals and Mores

Ranchordas, Sofia

Morals and Machines (vol.1, 2021)

Available at SSRN: 

https://ssrn.com/abstract=3839744

Abstract

Recent EU legislative and policy initiatives aim to offer flexible, innovation-friendly, and future-proof regulatory frameworks. Key examples are the EU Coordinated Plan on AI and the recently published EU AI Regulation Proposal which refer to the importance of experimenting with regulatory sandboxes so as to balance innovation in AI against its potential risks. Originally developed in the Fintech sector, regulatory sandboxes create a testbed for a selected number of innovative projects, by waiving otherwise applicable rules, guiding compliance, or customizing enforcement. Despite the burgeoning literature on regulatory sandboxes and the regulation of AI, the legal, methodological, and ethical challenges of regulatory sandboxes have remained understudied. This exploratory article delves into the some of the benefits and intricacies of employing experimental legal instruments in the context of the regulation of AI. This article’s contribution is twofold: first, it contextualizes the adoption of regulatory sandboxes in the broader discussion on experimental approaches to regulation; second, it offers a reflection on the steps ahead for the design and implementation of AI regulatory sandboxes.

(cut)

In conclusion, AI regulatory sandboxes are not the answer to more innovation in AI. They are part of the path to a more forward-looking approach to the interaction between law and technology. This new approach will most certainly be welcomed with reluctance in years to come as it disrupts existing dogmas pertaining to the way in which we conceive the principle of legal certainty and the reactive—rather than anticipatory—nature of law. However, traditional law and regulation were designed with human agents and enigmas in mind. Many of the problems generated by AI (discrimination, power asymmetries, and manipulation) are still human but their scale and potential for harms (and benefits) have long ceased to be. It is thus time to rethink our fundamental approach to regulation and refocus on the new regulatory subject before us.

Deliver Us From A.I.? This Priest-Led Network Aims to Shepherd Silicon Valley Tech Ethics

Rebecca Heilweil
Fortune.com
Originally posted 24 Nov 19

Here is an excerpt:

When asked about engaging leaders in atheist- and liberal-leaning Silicon Valley, Salobir says that, even if they’re not religious, many do seek meaning in their work. “They dedicate all their time, all their money, all their energy to build a startup—it has to be meaningful," he says. "If it’s not, what is the point of waking up every morning and working so much?"

It's the kind of work that has Salobir finding inspiration in John the Baptist. “He’s the one who connects," he says. "He’s the one who puts people in touch.” 

There are other Vatican-affiliated groups interested in the impact of emerging technologies, Green says. He points to pontifical academies that have—or will—host conferences on topics including robotics and artificial intelligence. This past September, the Pontifical Council for Culture and the Dicastery for Promoting Integral Human Development came together to host a conference on the common good in the digital age that featured Silicon Valley leaders like Reid Hoffman and representatives from Facebook and Mozilla.

But Green says Optic is somewhat unique in its focus on establishing a reciprocal relationship with the technology industry. “It’s not just that the Church is going to get good information here, but [that] the technologists are going to feel like they’re also being benefitted," he says.

They’re getting the opportunity to think about technology in a way that they haven’t been thinking about it before, Green adds. “It’s a mutually beneficial relationship.”

The info is here.

The Ethics of Treating Loved Ones

Christopher Cheney
www.medpagetoday.com
Originally posted May 19, 2019

When treating family members, friends, colleague, or themselves, ER physicians face ethical, professional, patient welfare, and liability concerns, a recent research article found.

Similar to situations arising in the treatment of VIP patients, ER physicians treating loved ones or close associates may vary their customary medical care from the standard treatment and inadvertently produce harm rather than benefit.

"Despite being common, this practice raises ethical concerns and concern for the welfare of both the patient and the physician," the authors of the recent article wrote in the American Journal of Emergency Medicine.

There are several liability concerns for clinicians, the lead author explained.


"Doctors would be held to the same standard of care as for other patients, and if care is violated and leads to damages, they could be liable. Intuitively, family and friends might be less likely to sue but that is not true of subordinates. In addition, as we state in the paper, for most ED physicians, practice outside of the home institution is not a covered event by the malpractice insurer," said Joel Geiderman, MD, professor and co-chairman of emergency medicine, Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles.

The info is here.

A philosopher who studies life changes says our biggest decisions can never be rational

Olivia Goldhill
Quartz.com
Originally published August 13, 2017

At some point, everyone reaches a crossroads in life: Do you decide to take that job and move to a new country, or stay put? Should you become a parent, or continue your life unencumbered by the needs of children?

Instinctively, we try to make these decisions by projecting ourselves into the future, trying to imagine which choice will make us happier. Perhaps we seek counsel or weigh up evidence. We might write out a pro/con list. What we are doing, ultimately, is trying to figure out whether or not we will be better off working for a new boss and living in Morocco, say, or raising three beautiful children.

This is fundamentally impossible, though, says philosopher L.A. Paul at the University of North Carolina at Chapel Hill, a pioneer in the philosophical study of transformative experiences. Certain life choices are so significant that they change who we are. Before undertaking those choices, we are unable to evaluate them from the perspective and values of our future, changed selves. In other words, your present self cannot know whether your future self will enjoy being a parent or not.

The article is here.