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

Tuesday, January 3, 2012

The Contribution of Philosophy and Psychology in the Ethical Decision Making Process

Ethical D Making

This article can be found in the public domain here.

Geisinger no longer to hire job applicants who use tobacco products


CONTACT: Marcy Marshall: 570-271-8081
Dec. 28, 2011
FOR IMMEDIATE RELEASE

DANVILLE, Pa. – Starting Feb. 1, 2012, Geisinger will no longer hire job applicants who use tobacco products, including cigarettes, cigars, and chewing or smokeless tobacco.

“Geisinger is joining dozens of hospitals and medical organizations across the country that are encouraging healthier living, decreasing absenteeism and reducing health care costs by adopting strict policies that make smoking a reason to turn away job applicants,” said Richard Merkle, chief human resources officer, Geisinger Health System. “Non-nicotine hiring policies are legal in 20 states, including Pennsylvania.”

This policy also affects any applicants receiving offer letters as of Feb. 1. During the hiring process, all applicants – including those seeking full- and part-time positions, flex, volunteers, and students enrolled in Geisinger-based schools – will be tested for nicotine as part of the routine drug screening.

The test will include screening for cigarettes, smokeless tobacco, snuff, nicotine patches, nicotine gum and cigars. The test only detects active nicotine users, not those exposed to second-hand smoke.

“Applicants who test positive for nicotine use will be welcome to re-apply in six months provided they are nicotine free at that time,” Merkle said. “A listing of smoking cessation resources will be provided to any applicant who tests positive for nicotine.”

Current employees are not affected by this new policy, but are encouraged to take advantage of the tobacco cessation programs offered through Geisinger’s Employee Wellness program.

Geisinger currently has a no-tobacco-use policy that extends across all of its properties.

About Geisinger Health System

Geisinger is an integrated health services organization widely recognized for its innovative use of the electronic health record, and the development and implementation of innovative care models including ProvenHealth Navigator, an advanced medical home model, and ProvenCare program. The system serves more than 2.6 million residents throughout 44 counties in central and northeastern Pennsylvania.

Monday, January 2, 2012

Moral dilemma: Would you kill one person to save five?

Michigan State University News
Released December 1, 2011

C. D. Navarrete, PhD
EAST LANSING, Mich. — Imagine a runaway boxcar heading toward five people who can’t escape its path. Now imagine you had the power to reroute the boxcar onto different tracks with only one person along that route.

Would you do it?

That’s the moral dilemma posed by a team of Michigan State University researchers in a first-of-its-kind study published in the research journal Emotion. Research participants were put in a three dimensional setting and given the power to kill one person (in this case, a realistic digital character) to save five.

The results? About 90 percent of the participants pulled a switch to reroute the boxcar, suggesting people are willing to violate a moral rule if it means minimizing harm.

“What we found is that the rule of ‘Thou shalt not kill’ can be overcome by considerations of the greater good,” said Carlos David Navarrete, lead researcher on the project.

As an evolutionary psychologist, Navarrete explores big-picture topics such as morality – in other words, how do we come to our moral judgments and does our behavior follow suit?

His latest experiment offers a new twist on the “trolley problem,” a moral dilemma that philosophers have contemplated for decades. But this is the first time the dilemma has been posed as a behavioral experiment in a virtual environment, “with the sights, sounds and consequences of our actions thrown into stark relief,” the study says.

The research participants were presented with a 3-D simulated version of the classic dilemma though a head-mounted device. Sensors were attached to their fingertips to monitor emotional arousal.

In the virtual world, each participant was stationed at a railroad switch where two sets of tracks veered off. Up ahead and to their right, five people hiked along the tracks in a steep ravine that prevented escape. On the opposite side, a single person hiked along in the same setting.

As the boxcar approached over the horizon, the participants could either do nothing – letting the coal-filled boxcar go along its route and kill the five hikers – or pull a switch (in this case a joystick) and reroute it to the tracks occupied by the single hiker.

Of the 147 participants, 133 (or 90.5 percent) pulled the switch to divert the boxcar, resulting in the death of the one hiker. Fourteen participants allowed the boxcar to kill the five hikers (11 participants did not pull the switch, while three pulled the switch but then returned it to its original position).

The findings are consistent with past research that was not virtual-based, Navarrete said.

The study also found that participants who did not pull the switch were more emotionally aroused. The reasons for this are unknown, although it may be because people freeze up during highly anxious moments – akin to a solider failing to fire his weapon in battle, Navarrete said.

“I think humans have an aversion to harming others that needs to be overridden by something,” Navarrete said. “By rational thinking we can sometimes override it – by thinking about the people we will save, for example. But for some people, that increase in anxiety may be so overpowering that they don’t make the utilitarian choice, the choice for the greater good.”

A 2-D example of the virtual environment used in this study is available at www.cdnresearch.net/vr

Sunday, January 1, 2012

Inviting Patients to Read Their Doctors' Notes


Patients and Doctors Look Ahead
Patient and Physician Surveys
Original Research: Improving Patient Care
Annals of Internal Medicine

By Jan Walker, RN, MBA; Suzanne G. Leveille, PhD, RN; Long Ngo, PhD; Elisabeth Vodicka, BA; Jonathan D. Darer, MD, MPH; Shireesha Dhanireddy, MD; Joann G. Elmore, MD, MPH; Henry J. Feldman, MD; Marc J. Lichtenfeld, PhD; Natalia Oster, MPH; James D. Ralston, MD, MPH; Stephen E. Ross, MD; and Tom Delbanco, MD

Abstract

Background: Little is known about what primary care physicians (PCPs) and patients would expect if patients were invited to read their doctors' office notes.

Objective: To explore attitudes toward potential benefits or harms if PCPs offered patients ready access to visit notes.

Design: The PCPs and patients completed surveys before joining a voluntary program that provided electronic links to doctors' notes.

Setting: Primary care practices in 3 U.S. states.

Participants: Participating and nonparticipating PCPs and adult patients at primary care practices in Massachusetts, Pennsylvania, and Washington.

Measurements: Doctors' and patients' attitudes toward and expectations of open visit notes, their ideas about the potential benefits and risks, and demographic characteristics.

Results: 110 of 114 participating PCPs (96%), 63 of 140 nonparticipating PCPs (45%), and 37 856 of 90 203 patients (42%) completed surveys. Overall, 69% to 81% of participating PCPs across the 3 sites and 92% to 97% of patients thought open visit notes were a good idea, compared with 16% to 33% of nonparticipating PCPs. Similarly, participating PCPs and patients generally agreed with statements about potential benefits of open visit notes, whereas nonparticipating PCPs were less likely to agree. Among participating PCPs, 74% to 92% anticipated improved communication and patient education, in contrast to 45% to 67% of nonparticipating PCPs. More than one half of participating PCPs (50% to 58%) and most nonparticipating PCPs (88% to 92%) expected that open visit notes would result in greater worry among patients; far fewer patients concurred (12% to 16%). Thirty-six percent to 50% of participating PCPs and 83% to 84% of nonparticipating PCPs anticipated more patient questions between visits. Few PCPs (0% to 33%) anticipated increased risk for lawsuits. Patient enthusiasm extended across age, education, and health status, and 22% anticipated sharing visit notes with others, including other doctors.

Limitations: Access to electronic patient portals is not widespread, and participation was limited to patients using such portals. Response rates were higher among participating PCPs than nonparticipating PCPs; many participating PCPs had small patient panels.

Conclusion: Among PCPs, opinions about open visit notes varied widely in terms of predicting the effect on their practices and benefits for patients. In contrast, patients expressed considerable enthusiasm and few fears, anticipating both improved understanding and more involvement in care. Sharing visit notes has broad implications for quality of care, privacy, and shared accountability.

Primary Funding Source: The Robert Wood Johnson Foundation's Pioneer Portfolio, Drane Family Fund, and Koplow Charitable Foundation.

The entire story is here.

Thanks to Ken Pope for this story.

Saturday, December 31, 2011

Anti-Gay Student's Suit Rejected

By Scott Jaschik
Inside Higer Ed

A federal appeals court has upheld the right of Augusta State University to enforce standards of its counseling graduate program -- even when a religious student objects to requirements to treat gay people in a nondiscriminatory manner.

While the ruling may be appealed, it represents a strong victory for advocates of counseling standards that require that students be trained to treat a range of clients in supportive, nonjudgmental ways. The student who sued Augusta State, and already lost in a lower court, maintained that her First Amendment rights were violated when the university required her to complete a "remediation plan" over her willingness to treat gay people.

She had stated her intent to recommend "conversion therapy" to gay clients and to tell them that they could choose to be straight. (A wide consensus among psychology and sexuality experts holds that people don't select their sexual orientation and that encouraging people to change their orientation can be seriously harmful to them.)

The student, Jennifer Keeton, argues that her religiously motivated beliefs are being challenged by Augusta State's policies -- and that a public university may not do so. Keeton was expelled when she declined to participate in the remediation plan, and she asked a federal district court and the appeals court to order her reinstatement in the program.

A three-judge panel of the U.S. Court of Appeals for the 11th Circuit found that Augusta State had legitimate, nondiscriminatory reasons to enforce its rules. The counseling program's accreditation depended in part on adhering to a code of conduct, and faculty members believed it was their responsibility to train students to work with a wide range of clients, the court found. The decision placed the counseling department's actions at Augusta State in the broader context of faculty members training professionals who must pay attention to the ethics of various fields.

"Just as a medical school would be permitted to bar a student who refused to administer blood transfusions for religious reasons from participating in clinical rotations, so ASU may prohibit Keeton from participating in its clinical practicum if she refuses to administer the treatment it has deemed appropriate," says the decision.

"Every profession has its own ethical codes and dictates. When someone voluntarily chooses to enter a profession, he or she must comply with its rules and ethical requirements. Lawyers must present legal arguments on behalf of their clients, notwithstanding their personal views.... So too, counselors must refrain from imposing their moral and religious views on their clients."

Read more here.

Thanks to Ken Pope for this article.

Friday, December 30, 2011

Supreme Court hears case involving medical record disclosure


An HIV-positive pilot claims the government is liable for releasing his medical history during a joint-agency investigation.

By Alicia Gallegos, amednews staff. 
Originally posted Dec. 26, 2011.

The U.S. Supreme Court has heard oral arguments in a case centering on whether the government is liable for disclosing to another agency the medical history of an HIV-positive patient.

The Social Security Administration admits that it violated federal law when it shared a pilot's medical records with the Federal Aviation Administration. But government attorneys say the federal Privacy Act allows recovery for economic damages only, not for emotional distress.

The case emphasizes the importance of adhering to national privacy laws, such as the Health Insurance Portability and Accountability Act, said Alexander Wohl, a law professor at the Washington College of Law and a contributor to the Supreme Court's blog.

"It reinforces the impact of those laws. Doctors have their own legal standards," but they still need to be careful not to violate their patients' privacy, he said.

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Case at a glance

Is the government liable for noneconomic damages for disclosing a person's medical records to another agency?

A federal court said no. The court ruled that the government violated the Privacy Act but is not responsible for noneconomic damages. The 9th U.S. Circuit Court of Appeals disagreed. It ruled that when a federal agency intentionally or willfully fails to uphold its record-keeping obligations under the law, Congress intended that the plaintiff be entitled to recover both pecuniary and nonpecuniary damages. The case is before the U.S. Supreme Court, which heard arguments Nov. 30.

Impact: Attorneys for the plaintiff say a ruling for the government would significantly limit recoveries for people whose privacy is violated by government agencies. In addition, whistle-blowers, including doctors, who report instances of fraud and abuse would face greater disincentives to expose misconduct. A ruling for the plaintiff would lead to more lawsuits against the government for overly broad claims related to the Privacy Act, government attorneys say. A decision is expected in 2012.


The entire story can be read here.

Digital Data on Patients Raises Risk of Breaches

By Nicole Perlroth
Published 12/18/11
The New York Times: Technology

One afternoon last spring, Micky Tripathi received a panicked call from an employee. Someone had broken into his car and stolen his briefcase and company laptop along with it.

So began a nightmare that cost Mr. Tripathi’s small nonprofit health consultancy nearly $300,000 in legal, private investigation, credit monitoring and media consultancy fees. Not to mention 600 hours dealing with the fallout and the intangible cost of repairing the reputational damage that followed.

Mr. Tripathi’s nonprofit, the Massachusetts eHealth Collaborative in Waltham, Mass., works with doctors and hospitals to help digitize their patient records. His employee’s stolen laptop contained unencrypted records for some 13,687 patients — each record containing some combination of a patient’s name, Social Security number, birth date, contact information and insurance information — an identity theft gold mine.

His experience was hardly uncommon. As part of the 2009 stimulus bill, the federal government provides incentive payments to doctors and hospitals to adopt electronic health records. Some 57 percent of office-based physicians now use electronic health records, a 12 percent jump from last year, according to the Centers for Disease Control.

An unintended consequence is that as patient records have been digitized, health data breaches have surged. The number of reported breaches is up 32 percent this year from last year, according to the Ponemon Institute, a security research group. Those breaches cost the industry an estimated $6.5 billion last year. In almost half the cases, a lost or stolen phone or personal computer was responsible.

The entire story can be read here.

Thursday, December 29, 2011

LV teacher gets state prison for sex with student

By MCT Information Services
The Pocono Record
Originally published December 20, 2011

A former Allen High School teacher wept in anguish Tuesday as a Lehigh County judge shocked the woman and her supporters by sending her to state prison for having sex with a 17-year-old student on prom weekend.

Ms. Marvelli
Gabrielle Suzanne Marvelli, 39, of Quakertown looked stunned as Judge Maria L. Dantos sentenced her to nine months to five years in state prison. About 15 friends and family members cried and shook their heads as Marvelli, who had been free on bail, was led off to prison. Marvelli wept loudly.

"You violated everything that a teacher is supposed to be," Dantos told Marvelli moments before issuing the sentence.

Marvelli had been seeking probation. Instead she got the maximum sentence under the law.

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The student, a senior who Marvelli had previously taught, was a week shy of his 18th birthday and Marvelli was on the staff at Allen when the tryst occurred.

The entire story is here.

Former Utah teacher gets prison for sex with student

By Roxana Orellana
The Salt Lake Tribune
Originally published December 16, 2011

Former drama teacher Jeremy Flygare delivered a tearful apology for having a sexual relationship with a 17-year-old student. But the girl’s mother called Flygare’s statements just another performance from an actor who has manipulated others and lied.
Jeremy Flygare
"Your honor, please send him to prison. He has no fear for the law. Has no respect for kids," the victim’s mother said in court. "This is going to be on our family for life, not for like a year."
On Friday, Judge Thomas Kay sentenced Flygare to prison for up to 15 years.
Flygare, 33, was charged in 2nd District Court with three counts of first-degree felony rape, which is punishable by up to life in prison.
The story is here.