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

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

Monday, November 7, 2011

Nonrational processes in ethical decision making

By Rogerson, Mark D.; Gottlieb, Michael C.; Handelsman, Mitchell M.; Knapp, Samuel; Younggren, Jeffrey

American Psychologist, Vol 66(7), Oct 2011, 614-623.

Abstract
Most current ethical decision-making models provide a logical and reasoned process for making ethical judgments, but these models are empirically unproven and rely upon assumptions of rational, conscious, and quasilegal reasoning. Such models predominate despite the fact that many nonrational factors influence ethical thought and behavior, including context, perceptions, relationships, emotions, and heuristics. For example, a large body of behavioral research has demonstrated the importance of automatic intuitive and affective processes in decision-making and judgment. These processes profoundly affect human behavior and lead to systematic biases and departures from normative theories of rationality. Their influence represents an important but largely unrecognized component of ethical decision making. We selectively review this work; provide various illustrations; and make recommendations for scientists, trainers, and practitioners to aid them in integrating the understanding of nonrational processes with ethical decision-making.


Ethics Non Rational

Sandusky arrested, AG charges against 2 top Penn St. officials

By Myles Snyder and Megan Healey
WHTM News

Jerry Sandusky
Penn State's legendary assistant football coach, Jerry Sandusky, was arrested Saturday on child sex abuse charges, as state prosecutors announced charges against two top university officials who apparently knew of at least one incident on the campus and did nothing about it.

Attorney General Linda Kelly said Timothy Curley, Penn State's director of athletics, and Gary Schultz, the university's senior vice president for finance and business, are charged with perjury and failure to report suspected child abuse. Schultz's position includes oversight of the university's police department.

"This is a case about a sexual predator who used his position within the university and community to repeatedly prey on young boys," Kelly said in a news release Saturday. "It is also a case about high-ranking university officials who allegedly failed to report the sexual assault of a young boy after the information was brought to their attention, and later made false statements to a grand jury that was investigating a series of assaults on young boys."

Kelly said the attorney general's office and state police began the investigation when a young boy reported that Sandusky had sexually abused him while the boy was a house guest at Sandusky's home near State College.

According to evidence presented to an investigating grand jury, the boy was 11 or 12 years old when he first met Sandusky at a camp for The Second Mile program, a charity for at-risk children founded by Sandusky.

Sandusky used expensive gifts to keep in touch with the boy - including trips to professional and college sporting events, golf clubs, a computer, clothing and money - and used the overnight visits at his home to perform sex acts on the boy, according to the grand jury.

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"The failure of top university officials to act on reports of Sandusky's alleged sexual misconduct, even after it was reported to them in graphic detail by an eyewitness, allowed a predator to walk free for years - continuing to target new victims," Kelly said.

"Equally disturbing is the lack of action and apparent lack of concern among those same officials, and others who received information about this case, who either avoided asking difficult questions or chose to look the other way."

Kelly said that despite the false testimony and "uncooperative atmosphere" by some Penn State University and Second Mile officials, the grand jury eventually identified a total of eight young men who were targets of sexual advances or assaults by Sandusky, starting in 1994 and continuing through 2009, after meeting him through Second Mile activities.

The grand jury findings can be found here.

The entire story can be read here.

The two Penn State Administrators are now stepping down, after an emergency meeting by Penn State's Board of Trustees.  The story can be found here.

Sunday, November 6, 2011

Psychiatrist Acquitted Quickly due to Insufficient Evidence

Judge Smith
In a very rapid process, United States District Judge Rebecca Beach Smith acquitted Dr. Richard Kaye of charges due to "insufficiency of the evidence".  While the details provided in the article below appear intriguing, the facts of the case will not be heard.

The very short judgment by Judge Smith can be found here.

Thanks to Ken Pope for this information.

Psychiatrist faces federal charges in HIPAA case

By Tim McGlone
The Virginian-Pilot

A psychiatrist faces trial in federal court on charges of illegally disclosing medical information of a Virginia state trooper who had been in his care after being held hostage and raped over three nights.

Prosecutors said this could be the first prosecution nationwide of a physician for violating the Health Insurance Portability and Accountability Act, known as HIPAA, which went into effect in 2003. The act prohibits disclosure of health records unless the patient gives consent.

Dr. Kaye
Jury selection and testimony began Tuesday in U.S. District Court, where Dr. Richard Alan Kaye, the former medical director of psychiatry at Sentara Obici Hospital in Suffolk, faces three counts of wrongfully disclosing an individual's health information.
Kaye was working at Obici in 2007 when the female trooper came to him for treatment. Kaye diagnosed her with post-traumatic stress disorder stemming from the attack in her home several months earlier.

But the trooper wasn't happy with the way Kaye was treating her and left after 16 days. She filed a complaint with the hospital and, according to federal prosecutors, he lost his job as a result. The Virginian-Pilot does not disclose the identity of rape victims.

The entire story can be read here.

Saturday, November 5, 2011

Weight Loss Surgery Benefits Entire Family

By Anahad O'Connor
The New York Times - Health

Having gastric bypass surgery has a ripple effect that causes family members to lose weight, eat better and exercise more, a new study shows.

The research found that spouses, relatives and even the children of patients who underwent the procedure dropped significant amounts of weight, doubled their activity levels and had other improvements that were still evident a year after the surgery. The findings suggest that doctors who perform gastric bypass operations may want to look at the procedure as a way to bring about change in entire families in need of help with their weight and exercise habits, said Dr. John Morton, the director of bariatric surgery at the Stanford School of Medicine and an author of the study, which appeared in The Archives of Surgery.

“If you have a committed and involved family,” he said, “you’re going to have better outcomes for the patient, and also by the same token, the family members can have a collateral benefit.”

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“Obesity is a family disease,” he said, “and we do need to treat everyone involved and start thinking about bariatric surgery as a platform for change.”

The entire story can be read here.

Many Don't Believe Their Obesity is Unhealthy

By Jenifer Goodwin
Health Daily Reporter
MedicineNet.com

Many overweight and obese patients seen in hospital emergency departments don't believe their weight poses a risk to their health, and many say doctors have never told them otherwise, a new study finds.

Researchers asked 450 randomly selected patients who were seen in the emergency department at Shands at the University of Florida two questions: Do you believe your present weight is damaging to your health, and has a doctor or other health professional ever told you that you are overweight?

Of those who reported that their weight was unhealthy, only 19% said they'd ever discussed it with a health care provider. And only 30% of those who reported being told by their health care provider that their weight was unhealthy agreed with that opinion, according to the study.

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Ryan recommends that patients leave the ER with referrals to dieticians and other weight-loss specialists, and that primary care doctors make sure to take the time to broach the issue with patients.

Gans agreed. Though emergency room physicians are pressed for time, when patients are sick and worried about their health may be an opportune moment to encourage changes.

"Unfortunately nothing happens until a patient becomes fearful," Gans said. "I see that all too often. I'll ask them, 'Do you need to wait until you have diabetes until you start to lose weight? Do you need to suffer a heart attack? And some people will actually say 'Yes.'"

The whole story can be read here.

Friday, November 4, 2011

A Girl Not Named Sybil

By Debbie Nathan
The New York Times
Published October 14, 2011

Undated photo of
Shirley Mason
“What about Mama?” the psychiatrist asks her patient. “What’s Mama been doing to you, dear? . . . I know she gave you the enemas. And I know she filled your bladder up with cold water, and I know she used the flashlight on you, and I know she stuck the washcloth in your mouth, cotton in your nose so you couldn’t breathe. . . . What else did she do to you? It’s all right to talk about it now. . . . ”

“My mommy,” the patient says.

“Yes.”

“My mommy said that I was a bad little girl, and . . . she slapped me . . . with her knuckles. . . .”

“Mommy isn’t going to ever hurt you again,” the psychiatrist says at the close of the session. “Do you want to know something, Sweetie? I’m stronger than Mother.”

The transcript of this conversation is stored at John Jay College of Criminal Justice, in New York City, among the papers of Flora Schreiber, author of “Sybil,” the blockbuster book about a woman with 16 personalities. “Sybil” was published in 1973; within four years it had sold more than six million copies in the United States and hundreds of thousands abroad. A television adaptation broadcast in 1976 was seen by a fifth of all Americans. But Sybil’s story was not just gripping reading; it was instrumental in creating a new psychiatric diagnosis: multiple-personality disorder, or M.P.D., known today as dissociative-identity disorder.

Schreiber collaborated on the book with Dr. Cornelia Wilbur, the psychiatrist who asks, “What about Mama?” — and with Wilbur’s patient, whose name Schreiber changed to Sybil Dorsett. Schreiber worked from records of Sybil’s therapy, including thousands of pages of patient diaries and transcripts of tape-recorded therapy sessions. Before she died in the late 1980s, Schreiber stipulated that the material be archived at a library. For a decade after Schreiber’s death, Sybil’s identity remained unknown. To protect her privacy, librarians sealed her records. In 1998, two researchers discovered that her real name was Shirley Mason. In trying to track her down, they learned that she was dead, and the librarians at John Jay decided to unseal the Schreiber papers.

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One May afternoon in 1958, Mason walked into Wilbur’s office carrying a typed letter that ran to four pages. It began with Mason admitting that she was “none of the things I have pretended to be.

“I am not going to tell you there isn’t anything wrong,” the letter continued. “But it is not what I have led you to believe. . . . I do not have any multiple personalities. . . . I do not even have a ‘double.’ . . . I am all of them. I have been essentially lying.”

Before coming to New York, she wrote, she never pretended to have multiple personalities. As for her tales about “fugue” trips to Philadelphia, they were lies, too. Mason knew she had a problem. She “very, very, very much” wanted Wilbur’s help. To identify her real trouble and deal with it honestly, Mason wrote, she and Wilbur needed to stop demonizing her mother. It was true that she had been anxious and overly protective. But the “extreme things” — the rapes with the flashlights and bottles — were as fictional as the soap operas that she and her mother listened to on the radio. Her descriptions of gothic tortures “just sort of rolled out from somewhere, and once I had started and found you were interested, I continued. . . . Under pentothal,” Mason added, “I am much more original.”

Mason was the most important patient in Wilbur’s professional career. She was preserving the tape-recorded narcosynthesis interviews she was doing with Mason and preparing to speak about the case at professional meetings. Wilbur told her patient that the recantation was “a major defensive maneuver,” merely the ego’s attempt to trick itself into thinking it didn’t need therapy. But Mason did need it, badly, Wilbur insisted. She was denying that she’d been tortured by her mother; this showed she really had been tortured.

Mason went home and composed a new letter. “One Friday,” she wrote Wilbur, “ ‘someone’ stalked into your office, imitated me [and] had a paper written about how she had now become well and was confessing . . . that it had all been put on. Well, you knew better.”

Wilbur instructed her secretary to schedule five sessions a week with Mason. She started the pentothal again.

Mason developed more and more personalities, ending up with a total of 16. Her “memories” of Mattie’s torture — of being sexually assaulted by her mother with kitchen implements; of seeing Mattie Mason conducting orgies in the woods with teenage girls; of being buried alive in a grain silo in her father’s workshop — were flowing.

Mason’s roommate, horrified by the treatment Mason was receiving, urged Mason to terminate her sessions with Wilbur. Instead, Mason left the apartment they shared on the West Side and found a tiny place on East 78th Street where she could live alone, just a few blocks from Wilbur’s home and office on Park Avenue. Wilbur paid the deposit on the new apartment and showered Mason with gifts: old rugs and drapes from her office, a fur-trimmed winter coat — even a cat.

The entire article can be found here.

Thursday, November 3, 2011

Psychologist gets jail time for sex with patient


By Bruce Vielmetti
The Journal Sentinel

An Oak Creek psychologist convicted of starting a sexual relationship with a longtime patient in 2005 was sentenced Thursday to a year in jail.

Dr. Adamczak
Jeffrey Adamczak, 48, faced up to 7 1/2 years for sexual exploitation by a therapist.

But Milwaukee County Assistant District Attorney Jacob Manian said the state wasn't seeking prison, just accountability.

"This case has always been about protecting patients," Manian told Circuit Judge Rebecca Dallet.

Adamczak made a public apology to his wife for the affair and the public spectacle. He said it never should have happened and he'd never forgive himself.

"I'm truly paying the price for infidelity," he said.

Dallet corrected Adamczak, saying she wasn't sentencing him for having an affair, but for abusing the trust patients put in their psychotherapists.

"You took advantage of that relationship, used it and turned it around into a sexual relationship," she said. "That's the serious part."

The whole story can be found here.

Stories related to Dr. Adamczak can be found here.

Wednesday, November 2, 2011

Pediatric Emergency Department Visits for Psychiatric Care on the Rise

American Academy of Pediatrics
News Release
Published: October 14, 2011

BOSTON – Pediatric patients, primarily those who are underinsured (either without insurance or receiving Medicaid), are increasingly receiving psychiatric care in hospital emergency departments (EDs), according to an abstract presented Friday, Oct. 14, at the American Academy of Pediatrics (AAP) National Conference and Exhibition in Boston.

Researchers reviewed ED data, including patient age, sex, race, ethnicity, insurance status, and type of care received, from the National Hospital Ambulatory Medical Care Survey, between 1999 through 2007. The study, “Disproportionately Increasing Psychiatric Visits to the Pediatric Emergency Department Among the Underinsured,” found that over eight years, 279 million pediatric patients were seen in U.S. EDs, of which 2.8 percent were for psychiatric visits. The prevalence of psychiatric visits among pediatric patients increased from 2.4 percent in 1999 to 3 percent in 2007. The underinsured group initially accounted for 46 percent of pediatric ED visits in 1999, growing to 54 percent in 2007.

The results of this study are important for several reasons. First, the data show that, as anticipated, psychiatric visits by children to emergency departments continue to increase in number and as a percentage of all patients being seen in emergency departments, said lead study author Zachary Pittsenbarger, MD. “A second, and more novel finding, is that one group in particular is increasing beyond any other socio-demographic group, and that is the publicly insured.” he said.

“It has been found previously that the publicly insured have fewer treatment options and longer wait times for psychiatric disorders when not hospitalized,” Dr. Pittsenbarger said. “This new finding argues that limited outpatient mental health resources force those patients to seek the care they need in the emergency department.”

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The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well being of infants, children, adolescents and young adults. For more information, visit www.aap.org.