Patricia Rodney
AJN, American Journal of Nursing:
February 2017 - Volume 117 - Issue 2 - p S7–S10
doi: 10.1097/01.NAJ.0000512204.85973.04
Moral distress arises when nurses are unable to act according to their moral judgment. The concept is relatively recent, dating to American ethicist Andrew Jameton's 1984 landmark text on nursing ethics. Until that point, distress among clinicians had been understood primarily through psychological concepts such as stress and burnout, which, although relevant, were not sufficient. With the introduction of the concept of moral distress, Jameton added an ethical dimension to the study of distress.
Background
In the 33 years since Jameton's inaugural work, many nurses, inspired by the concept of moral distress, have continued to explore what happens when nurses are constrained from translating moral choice into moral action, and are consequently unable to uphold their sense of integrity and the values emphasized in the American Nurses Association's Code of Ethics for Nurses with Interpretive Statements. Moral distress might occur when, say, a nurse on a busy acute medical unit can't provide comfort and supportive care to a dying patient because of insufficient staffing.
The article is here.
Sunday, March 5, 2017
Saturday, March 4, 2017
JAMA Forum: Those Pesky Lines Around States
Larry Levitt
JAMA Forum Blog
Originally posted October 19, 2016
Here is an excerpt:
Allowing insurers to then sell plans across state lines would actually worsen access to coverage for people with preexisting conditions, since insurers would have a strong incentive to set up shop in states with minimal regulation, undermining the ability of other states to enact stricter rules.
Let’s say Delaware wanted to attract health insurance jobs to its state with industry-friendly regulations—for example, no required benefits (such as preventive services or maternity care) and no restrictions on medical underwriting (meaning people with preexisting conditions could be denied coverage). Insurers operating out of Delaware could offer cheaper health insurance by cherry-picking healthy enrollees from other states. If New York tried to require insurers to expand access to people with preexisting conditions or mandate specific benefits, its carriers would get stuck with disproportionately sick people.
Delaware is not a random example here. This is exactly what happened in the credit card industry after the Supreme Court ruled in 1978 that credit card companies could follow interest rate rules in the states where they operate, not the state where the cardholder lives. Two states—Delaware and South Dakota—moved quickly to deregulate interest rates, and banks followed suit by moving their credit card operations to those states. By 1997 Delaware had 43% of the nation’s credit card volume.
The blog post is here.
JAMA Forum Blog
Originally posted October 19, 2016
Here is an excerpt:
Allowing insurers to then sell plans across state lines would actually worsen access to coverage for people with preexisting conditions, since insurers would have a strong incentive to set up shop in states with minimal regulation, undermining the ability of other states to enact stricter rules.
Let’s say Delaware wanted to attract health insurance jobs to its state with industry-friendly regulations—for example, no required benefits (such as preventive services or maternity care) and no restrictions on medical underwriting (meaning people with preexisting conditions could be denied coverage). Insurers operating out of Delaware could offer cheaper health insurance by cherry-picking healthy enrollees from other states. If New York tried to require insurers to expand access to people with preexisting conditions or mandate specific benefits, its carriers would get stuck with disproportionately sick people.
Delaware is not a random example here. This is exactly what happened in the credit card industry after the Supreme Court ruled in 1978 that credit card companies could follow interest rate rules in the states where they operate, not the state where the cardholder lives. Two states—Delaware and South Dakota—moved quickly to deregulate interest rates, and banks followed suit by moving their credit card operations to those states. By 1997 Delaware had 43% of the nation’s credit card volume.
The blog post is here.
How ‘Intellectual Humility’ Can Make You a Better Person
Cindy Lamothe
The Science of Us
Originally posted February 3, 2017
There’s a well-known Indian parable about six blind men who argue at length about what an elephant feels like. Each has a different idea, and each holds fast to his own view. “It’s like a rope,” says the man who touched the tail. “Oh no, it’s more like the solid branch of a tree,” contends the one who touched the trunk. And so on and so forth, and round and round they go.
The moral of the story: We all have a tendency to overestimate how much we know — which, in turn, means that we often cling stubbornly to our beliefs while tuning out opinions different from our own. We generally believe we’re better or more correct than everyone else, or at least better than most people — a psychological quirk that’s as true for politics and religion as it is for things like fashion and lifestyles. And in a time when it seems like we’re all more convinced than ever of our own rightness, social scientists have begun to look more closely at an antidote: a concept called intellectual humility.
Unlike general humility — which is defined by traits like sincerity, honesty, and unselfishness — intellectual humility has to do with understanding the limits of one’s knowledge. It’s a state of openness to new ideas, a willingness to be receptive to new sources of evidence, and it comes with significant benefits: People with intellectual humility are both better learners and better able to engage in civil discourse. Google’s VP in charge of hiring, Laszlo Bock, has claimed it as one of the top qualities he looks for in a candidate: Without intellectual humility, he has said, “you are unable to learn.”
The article is here.
The Science of Us
Originally posted February 3, 2017
There’s a well-known Indian parable about six blind men who argue at length about what an elephant feels like. Each has a different idea, and each holds fast to his own view. “It’s like a rope,” says the man who touched the tail. “Oh no, it’s more like the solid branch of a tree,” contends the one who touched the trunk. And so on and so forth, and round and round they go.
The moral of the story: We all have a tendency to overestimate how much we know — which, in turn, means that we often cling stubbornly to our beliefs while tuning out opinions different from our own. We generally believe we’re better or more correct than everyone else, or at least better than most people — a psychological quirk that’s as true for politics and religion as it is for things like fashion and lifestyles. And in a time when it seems like we’re all more convinced than ever of our own rightness, social scientists have begun to look more closely at an antidote: a concept called intellectual humility.
Unlike general humility — which is defined by traits like sincerity, honesty, and unselfishness — intellectual humility has to do with understanding the limits of one’s knowledge. It’s a state of openness to new ideas, a willingness to be receptive to new sources of evidence, and it comes with significant benefits: People with intellectual humility are both better learners and better able to engage in civil discourse. Google’s VP in charge of hiring, Laszlo Bock, has claimed it as one of the top qualities he looks for in a candidate: Without intellectual humility, he has said, “you are unable to learn.”
The article is here.
Friday, March 3, 2017
California Regulator Slams Health Insurers Over Faulty Doctor Lists
Chad Terhune
Kaiser Health News
Originally published February 13, 2017
California’s biggest health insurers reported inaccurate information to the state on which doctors are in their networks, offering conflicting lists that differed by several thousand physicians, according to a new state report.
Shelley Rouillard, director of the California Department of Managed Health Care, said 36 of 40 health insurers she reviewed — including industry giants like Aetna and UnitedHealthcare — could face fines for failing to submit accurate data or comply with state rules.
Rouillard said she told health plan executives in a meeting last week that such widespread errors made it impossible for regulators to tell whether patients have timely access to care in accordance with state law.
“I told the CEOs it looks to me like nobody cared. We will be holding their feet to the fire on this,” Rouillard said in an interview with California Healthline. “I am frustrated with the health plans because the data we got was unacceptable. It was a mess.”
The article is here.
Kaiser Health News
Originally published February 13, 2017
California’s biggest health insurers reported inaccurate information to the state on which doctors are in their networks, offering conflicting lists that differed by several thousand physicians, according to a new state report.
Shelley Rouillard, director of the California Department of Managed Health Care, said 36 of 40 health insurers she reviewed — including industry giants like Aetna and UnitedHealthcare — could face fines for failing to submit accurate data or comply with state rules.
Rouillard said she told health plan executives in a meeting last week that such widespread errors made it impossible for regulators to tell whether patients have timely access to care in accordance with state law.
“I told the CEOs it looks to me like nobody cared. We will be holding their feet to the fire on this,” Rouillard said in an interview with California Healthline. “I am frustrated with the health plans because the data we got was unacceptable. It was a mess.”
The article is here.
Doctors suffer from the same cognitive distortions as the rest of us
Michael Lewis
Nautilus
Originally posted February 9, 2017
Here are two excerpts:
What struck Redelmeier wasn’t the idea that people made mistakes. Of course people made mistakes! What was so compelling is that the mistakes were predictable and systematic. They seemed ingrained in human nature. One passage in particular stuck with him—about the role of the imagination in human error. “The risk involved in an adventurous expedition, for example, is evaluated by imagining contingencies with which the expedition is not equipped to cope,” the authors wrote. “If many such difficulties are vividly portrayed, the expedition can be made to appear exceedingly dangerous, although the ease with which disasters are imagined need not reflect their actual likelihood. Conversely, the risk involved in an undertaking may be grossly underestimated if some possible dangers are either difficult to conceive of, or simply do not come to mind.” This wasn’t just about how many words in the English language started with the letter K. This was about life and death.
(cut)
Toward the end of their article in Science, Daniel Kahneman and Amos Tversky had pointed out that, while statistically sophisticated people might avoid the simple mistakes made by less savvy people, even the most sophisticated minds were prone to error. As they put it, “their intuitive judgments are liable to similar fallacies in more intricate and less transparent problems.” That, the young Redelmeier realized, was a “fantastic rationale why brilliant physicians were not immune to these fallibilities.” Error wasn’t necessarily shameful; it was merely human. “They provided a language and a logic for articulating some of the pitfalls people encounter when they think. Now these mistakes could be communicated. It was the recognition of human error. Not its denial. Not its demonization. Just the understanding that they are part of human nature.”
The article is here.
Nautilus
Originally posted February 9, 2017
Here are two excerpts:
What struck Redelmeier wasn’t the idea that people made mistakes. Of course people made mistakes! What was so compelling is that the mistakes were predictable and systematic. They seemed ingrained in human nature. One passage in particular stuck with him—about the role of the imagination in human error. “The risk involved in an adventurous expedition, for example, is evaluated by imagining contingencies with which the expedition is not equipped to cope,” the authors wrote. “If many such difficulties are vividly portrayed, the expedition can be made to appear exceedingly dangerous, although the ease with which disasters are imagined need not reflect their actual likelihood. Conversely, the risk involved in an undertaking may be grossly underestimated if some possible dangers are either difficult to conceive of, or simply do not come to mind.” This wasn’t just about how many words in the English language started with the letter K. This was about life and death.
(cut)
Toward the end of their article in Science, Daniel Kahneman and Amos Tversky had pointed out that, while statistically sophisticated people might avoid the simple mistakes made by less savvy people, even the most sophisticated minds were prone to error. As they put it, “their intuitive judgments are liable to similar fallacies in more intricate and less transparent problems.” That, the young Redelmeier realized, was a “fantastic rationale why brilliant physicians were not immune to these fallibilities.” Error wasn’t necessarily shameful; it was merely human. “They provided a language and a logic for articulating some of the pitfalls people encounter when they think. Now these mistakes could be communicated. It was the recognition of human error. Not its denial. Not its demonization. Just the understanding that they are part of human nature.”
The article is here.
Thursday, March 2, 2017
Jail cells await mentally ill in Rapid City
Mike Anderson
Rapid City Journal
Originally published February 7, 2017
Mentally ill people in Rapid City who have committed no crimes will probably end up in jail because of a major policy change recently announced by Rapid City Regional Hospital.
The hospital is no longer taking in certain types of mentally ill patients and will instead contact the Pennington County Sheriff’s Office to take them into custody.
The move has prompted criticism from local law enforcement officials, who say the decision was made suddenly and without their input.
“In my view, this is the biggest step backward our community has experienced in terms of health care for mental health patients,” said Rapid City police Chief Karl Jegeris. “And though it’s legally permissible by statute to put someone in an incarceration setting, it doesn’t mean that it’s the right thing to do.”
This is the second major policy change to come out of Regional in recent days that places limits on the type of mental health care the hospital will provide.
The article is here.
Rapid City Journal
Originally published February 7, 2017
Mentally ill people in Rapid City who have committed no crimes will probably end up in jail because of a major policy change recently announced by Rapid City Regional Hospital.
The hospital is no longer taking in certain types of mentally ill patients and will instead contact the Pennington County Sheriff’s Office to take them into custody.
The move has prompted criticism from local law enforcement officials, who say the decision was made suddenly and without their input.
“In my view, this is the biggest step backward our community has experienced in terms of health care for mental health patients,” said Rapid City police Chief Karl Jegeris. “And though it’s legally permissible by statute to put someone in an incarceration setting, it doesn’t mean that it’s the right thing to do.”
This is the second major policy change to come out of Regional in recent days that places limits on the type of mental health care the hospital will provide.
The article is here.
Pornography and the Philosophy of Fiction
John Danaher
Philosophical Disquisitions
Originally published February 9, 2017
Here are two excerpts:
Pornography is now ubiquitous. If you have an internet connection, you have access to a virtually inexhaustible supply of the stuff. Debates rage over whether this is a good or bad thing. There are long-standing research programmes in psychology and philosophy that focus on the ethical and social consequences of exposure to pornography. These debates often raise important questions about human sexuality, gender equality, sexual aggression and violence. They also often touch upon (esoteric) aspects of the philosophy of speech acts and freedom of expression. Noticeably neglected in the debate is any discussion of the fictional nature of pornography and how it affects its social reception.
That, at any rate, is the claim made by Shen-yi Liao and Sara Protasi in their article ‘The Fictional Character of Pornography’. In it, they draw upon a number of ideas in the philosophy of aesthetics in an effort to refine the arguments made by participants in the pornography debate.
(cut)
The more important part of the definition concerns the prompting of imagination. Liao and Protasi have a longish argument in their paper as to why sexual desire (as an appetite) involves imagination and hence why pornographic representations often prompt imaginings. That argument is interesting, but I’m going to skip over the details here. The important point is that in satisfying our sexual appetites we often engage the imagination (imagining certain roles or actions). Indeed, the sexual appetite might be unique among appetites as being the one that can be satisfied purely through the imagination. Furthermore, the typical user of pornography will often engage their imaginations when using it. They will imagine themselves being involved (directly or indirectly) in the represented sexual acts.
The blog post is here.
Philosophical Disquisitions
Originally published February 9, 2017
Here are two excerpts:
Pornography is now ubiquitous. If you have an internet connection, you have access to a virtually inexhaustible supply of the stuff. Debates rage over whether this is a good or bad thing. There are long-standing research programmes in psychology and philosophy that focus on the ethical and social consequences of exposure to pornography. These debates often raise important questions about human sexuality, gender equality, sexual aggression and violence. They also often touch upon (esoteric) aspects of the philosophy of speech acts and freedom of expression. Noticeably neglected in the debate is any discussion of the fictional nature of pornography and how it affects its social reception.
That, at any rate, is the claim made by Shen-yi Liao and Sara Protasi in their article ‘The Fictional Character of Pornography’. In it, they draw upon a number of ideas in the philosophy of aesthetics in an effort to refine the arguments made by participants in the pornography debate.
(cut)
The more important part of the definition concerns the prompting of imagination. Liao and Protasi have a longish argument in their paper as to why sexual desire (as an appetite) involves imagination and hence why pornographic representations often prompt imaginings. That argument is interesting, but I’m going to skip over the details here. The important point is that in satisfying our sexual appetites we often engage the imagination (imagining certain roles or actions). Indeed, the sexual appetite might be unique among appetites as being the one that can be satisfied purely through the imagination. Furthermore, the typical user of pornography will often engage their imaginations when using it. They will imagine themselves being involved (directly or indirectly) in the represented sexual acts.
The blog post is here.
Wednesday, March 1, 2017
Clinicians’ Expectations of the Benefits and Harms of Treatments, Screening, and Tests
Tammy C. Hoffmann & Chris Del Mar
JAMA Intern Med.
Published online January 9, 2017.
doi:10.1001/jamainternmed.2016.8254
Question
Do clinicians have accurate expectations of the benefits and harms of treatments, tests, and screening tests?
Findings
In this systematic review of 48 studies (13 011 clinicians), most participants correctly estimated 13% of the 69 harm expectation outcomes and 11% of the 28 benefit expectations. The majority of participants overestimated benefit for 32% of outcomes, underestimated benefit for 9%, underestimated harm for 34%, and overestimated harm for 5% of outcomes.
Meaning
Clinicians rarely had accurate expectations of benefits or harms, with inaccuracies in both directions, but more often underestimated harms and overestimated benefits.
The research is here.
JAMA Intern Med.
Published online January 9, 2017.
doi:10.1001/jamainternmed.2016.8254
Question
Do clinicians have accurate expectations of the benefits and harms of treatments, tests, and screening tests?
Findings
In this systematic review of 48 studies (13 011 clinicians), most participants correctly estimated 13% of the 69 harm expectation outcomes and 11% of the 28 benefit expectations. The majority of participants overestimated benefit for 32% of outcomes, underestimated benefit for 9%, underestimated harm for 34%, and overestimated harm for 5% of outcomes.
Meaning
Clinicians rarely had accurate expectations of benefits or harms, with inaccuracies in both directions, but more often underestimated harms and overestimated benefits.
The research is here.
Should healthcare professionals sometimes allow harm? The case of self-injury
Patrick J Sullivan
Journal of Medical Ethics
Published Online First: 09 February 2017.
doi: 10.1136/medethics-2015-103146
Abstract
This paper considers the ethical justification for the use of harm minimisation approaches with individuals who self-injure. While the general issues concerning harm minimisation have been widely debated, there has been only limited consideration of the ethical issues raised by allowing people to continue injuring themselves as part of an agreed therapeutic programme. I will argue that harm minimisation should be supported on the basis that it results in an overall reduction in harm when compared with more traditional ways of dealing with self-injurious behaviour. It will be argued that this is an example of a situation where healthcare professionals sometimes have a moral obligation to allow harm to come to their patients.
The article is here.
Journal of Medical Ethics
Published Online First: 09 February 2017.
doi: 10.1136/medethics-2015-103146
Abstract
This paper considers the ethical justification for the use of harm minimisation approaches with individuals who self-injure. While the general issues concerning harm minimisation have been widely debated, there has been only limited consideration of the ethical issues raised by allowing people to continue injuring themselves as part of an agreed therapeutic programme. I will argue that harm minimisation should be supported on the basis that it results in an overall reduction in harm when compared with more traditional ways of dealing with self-injurious behaviour. It will be argued that this is an example of a situation where healthcare professionals sometimes have a moral obligation to allow harm to come to their patients.
The article is here.
Subscribe to:
Posts (Atom)