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

Thursday, September 14, 2017

Over half of doctors have symptoms of burn-out: survey

Lynn Desjardins
Radio Canada International
Originally published August 28, 2017

A recent survey suggests that 54 per cent of Canadian doctors have symptoms of burn-out and it’s a problem that physicians themselves don’t like to talk about. This was a topic much discussed at the annual meeting of the Canadian Medical Association which represents more than 80,000 doctors.

‘Very frustrating and annoying’ interventions required

“First and foremost, it’s about the inability that physicians have sometimes to get what the patient actually needs in a timely way,” says Dr. Granger Avery, immediate past president of the Canadian Medical Association.

“So, that’s whether looking for a consultation, following up on an operation, whether it’s transferring a patient from one level of service to another, these things often require the doctor to make repeated phone calls, repeated interventions to get what should be a relatively simple piece of work done. So, that’s very frustrating and annoying for a physician who’s been brought up and trained and focused on helping people, not doing that administrative work.”

The article and the podcast are here.

Bioethics and multiculturalism: nuancing the discussion

Chris Durante
Journal of Medical Ethics 
Published Online First: 11 August 2017

Abstract

In his recent analysis of multiculturalism, Tom Beauchamp has argued that those who implement multicultural reasoning in their arguments against common morality theories, such as his own, have failed to understand that multiculturalism is neither a form of moral pluralism nor ethical relativism but is rather a universalistic moral theory in its own right. Beauchamp’s position is indeed on the right track in that multiculturalists do not consider themselves ethical relativists. Yet, Beauchamp tends to miss the mark when he argues that multiculturalism is in effect a school of thought that endorses a form of moral universalism that is akin to his own vision of a common morality. As a supporter of multiculturalism, I would like to discuss some aspects of Beauchamp’s comments on multiculturalism and clarify what a multicultural account of public bioethics might look like. Ultimately, multiculturalism is purported as a means of managing diversity in the public arena and should not be thought of as endorsing either a version of moral relativism or a universal morality. By simultaneously refraining from the promotion of a comprehensive common moral system while it attempts to avoid a collapse into relativism, multiculturalism can serve as the ethico-political framework in which diverse moralities can be managed and in which opportunities for ethical dialogue, debate and deliberation on the prospects of common bioethical norms are made possible.

The article is here.

Wednesday, September 13, 2017

Economics: Society Cannot Function Without Moral Bonds

Geoffrey Hodgson
Evonomics
Originally posted June 29, 2016

Here is an excerpt:

When mainstream economists began to question that individuals are entirely self-interested, their approach was to retain utility-maximization and preference functions, but to make them “other-regarding” so that some notion of altruism could be maintained. But such an individual is still self-serving, rather than being genuinely altruistic in a wider and more adequate sense. While “other regarding” he or she is still egotistically maximizing his or her own utility. As Deirdre McCloskey  put it, the economic agent is still Max U.

There is now an enormous body of empirical research confirming that humans have cooperative as well as self-interested dispositions. But many accounts conflate morality with altruism or cooperation. By contrast, Darwin established a distinctive and vital additional role for morality. Darwin’s argument counters the idea of unalloyed self-interest and the notion that morality can be reduced to a matter of utility or preference.

A widespread view among moral philosophers is that moral judgments cannot be treated as matters of mere preference or utility maximization. Morality means “doing the right thing.” It entails notions of justice that can over-ride our preferences or interests. Moral judgments are by their nature inescapable. They are buttressed by emotional feelings and reasoned argument. Morality differs fundamentally from matters of mere convenience, convention or conformism. Moral feelings are enhanced by learned cultural norms and rules. Morality is a group phenomenon involving deliberative, emotionally-driven and purportedly inescapable rules that apply to a community.

The article is here.

Peter Thiel sponsors offshore testing of herpes vaccine, sidestepping U.S. safety rules

Marisa Taylor
Kaiser News
Originally posted August 28, 2017

Here is an excerpt:

“What they’re doing is patently unethical,” said Jonathan Zenilman, chief of Johns Hopkins Bayview Medical Center’s Infectious Diseases Division. “There’s a reason why researchers rely on these protections. People can die.”

The risks are real. Experimental trials with live viruses could lead to infection if not handled properly or produce side effects in those already infected. Genital herpes is caused by two viruses that can trigger outbreaks of painful sores. Many patients have no symptoms, though a small number suffer greatly. The virus is primarily spread through sexual contact, but also can be released through skin.

The push behind the vaccine is as much political as medical. President Trump has vowed to speed up the FDA’s approval of some medicines. FDA Commissioner Scott Gottlieb, who had deep financial ties to the pharmaceutical industry, slammed the FDA before his confirmation for over-prioritizing consumer protection to the detriment of medical innovations.

“This is a test case,” said Bartley Madden, a retired Credit Suisse banker and policy adviser to the conservative Heartland Institute, who is another investor in the vaccine. “The FDA is standing in the way, and Americans are going to hear about this and demand action.”

American researchers are increasingly going offshore to developing countries to conduct clinical trials, citing rising domestic costs. But in order to approve the drug for the U.S. market, the FDA requires that clinical trials involving human participants be reviewed and approved by an IRB or an international equivalent. The IRB can reject research based on safety concerns.

The article is here.

Tuesday, September 12, 2017

The consent dilemma

Elyn Saks
Politico - The Agenda
Originally published August 9, 2017

Patient consent is an important principle in medicine, but when it comes to mental illness, things get complicated. Other diseases don’t affect a patient’s cognition the way a mental illness can. When the organ with the disease is a patient’s brain, how can it be trusted to make decisions?

That’s one reason that, historically, psychiatric patients were given very little authority to make decisions about their own care. Mental illness and incompetence were considered the same thing. People could be hospitalized and treated against their will if they were considered mentally ill and “in need of treatment.” The presumption was that people with mental illness—essentially by definition—lacked the ability to appreciate their own need for treatment.

In the 1970s, the situation began to change. First, the U.S. Supreme Court ruled that a patient could be hospitalized against his will only if he were dangerous to himself or others, or “gravely disabled,” a decision that led to the de-institutionalization of most mental health care. Second, anti-psychotic medications came into wide use, effectively handing patients the power—on a daily basis—to decide whether to consent to treatment or not, simply by deciding whether or not to take their pills.

The article is here.

Personal values in human life

Lilach Sagiv, Sonia Roccas, Jan Cieciuch & Shalom H. Schwartz
Nature Human Behaviour (2017)
doi:10.1038/s41562-017-0185-3

Abstract

The construct of values is central to many fields in the social sciences and humanities. The last two decades have seen a growing body of psychological research that investigates the content, structure and consequences of personal values in many cultures. Taking a cross-cultural perspective we review, organize and integrate research on personal values, and point to some of the main findings that this research has yielded. Personal values are subjective in nature, and reflect what people think and state about themselves. Consequently, both researchers and laymen sometimes question the usefulness of personal values in influencing action. Yet, self-reported values predict a large variety of attitudes, preferences and overt behaviours. Individuals act in ways that allow them to express their important values and attain the goals underlying them. Thus, understanding personal values means understanding human behaviour.

Monday, September 11, 2017

Do’s and Don’ts for Media Reporting on Suicide

David Susman
The Mental Health and Wellness Blog
Originally published June 15, 2017

Here is an excerpt:

I was reminded recently of the excellent resources which provide guidelines for the responsible reporting and discussion of suicide in the media. In the guideline document, “Recommendations for Reporting on Suicide,” several useful and concrete guidelines are offered for how to talk about suicide in the media. Most of the material in this article comes from this source. Let’s first review and summarize the list of do’s and don’ts.

1) Don’t use big or sensationalistic headlines with specific details about the method of suicide. Do inform without sensationalizing the suicide and without providing details in the headline.

2) Don’t include photos or videos of the location or method of death, grieving family or friends, funerals. Do use a school or work photo; include suicide hotline numbers or local crisis contacts.

3) Don’t describe suicide as “an epidemic,” “skyrocketing,” or other exaggerated terms. Do use accurate words such as “higher rates” or “rising.”

4) Don’t describe a suicide as “without warning” or “inexplicable.” Do convey that people exhibit warning signs of suicide and include a list of common warning signs and ways to intervene when someone is suicidal (see section below).

5) Don’t say “she left a suicide note saying…” Do say “a note from the deceased was found.”

6) Don’t investigate and report on suicide as though it is a crime. Do report on suicide as a public health issue.

7) Don’t quote police or first responders about the causes of suicide. Do seek advice and information from suicide prevention experts.

8) Don’t refer to suicide as “successful,” “unsuccessful,” or a “failed attempt.” Avoid the use of “committed suicide,” which is an antiquated reference to when suicidal acts or attempts were punished as crimes. Do say “died by suicide,” “completed” or “killed him/herself.”

The article is here.

Nonvoluntary Psychiatric Treatment Is Distinct From Involuntary Psychiatric Treatment

Dominic A. Sisti
JAMA. Published online August 24, 2017

Some of the most ethically challenging cases in mental health care involve providing treatment to individuals who refuse that treatment. Sometimes when persons with mental illness become unsafe to themselves or others, they must be taken, despite their outward and often vigorous refusal, to an emergency department or psychiatric hospital to receive treatment, such as stabilizing psychotropic medication. On occasion, to provide medical care over objection, a patient must be physically restrained.

The modifier “involuntary” is generally used to describe these cases. For example, it is said that a patient has been involuntarily hospitalized or is receiving involuntary medication ostensibly because the patient did not consent and was forced or strongly coerced into treatment. Importantly, a person may be involuntarily hospitalized but retain the right to refuse treatment. “Involuntary” is also used to describe instances when an individual is committed to outpatient treatment by a court. The fact that a person is being treated involuntarily raises numerous challenges; it raises concerns about protecting individual liberty, respect for patient autonomy, and the specter of past abuses of patients in psychiatric institutions.

Although it has become both a clinical colloquialism and legal touchstone, the concept of involuntary treatment is used imprecisely to describe all instances in which a patient has refused the treatment he or she subsequently receives. In some cases, a patient outwardly refuses treatment but may have previously expressed a desire to be treated in crisis or, according to a reasonable evaluator, he or she would have agreed to accept stabilizing treatment, such as antipsychotic medication. A similar scenario occurs in the treatment of individuals who experience a first episode of psychosis and who outwardly refuse treatment. With no prior experience of what it is like to have psychosis, these patients are unable to develop informed preferences about treatment in advance of their first crisis. In these cases, some believe it is reasonable to provide treatment despite the opposition of the patient, although this could be debated.

The article is here.

Sunday, September 10, 2017

Google has created a tool that tests for clinical depression

Katherine Ellen Foley
Quartz
Originally posted August 24, 2017

People often delay seeking treatment for mental health conditions like depression. The longer they wait to see their doctors, the worse the condition becomes, making it harder to treat in the future.

In an effort to encourage more patients to seek treatment sooner, Google announced Aug. 23 that it has teamed up with National Alliance on Mental Illness (NAMI), an advocacy group, to create a simple tool for users to assess if they may be depressed. Now, when people in the US search for “clinical depression” on their phones, the typical “knowledge panel”—a container that displays company-vetted information on Google’s search results page—will come with an option to take a quiz that can assess the severity of symptoms. (Google says the quiz results will not be seen by anyone but the quiz-taker.)

Google’s quiz isn’t new. It’s a reskinned version of the 18-year-old PQH-9 (pdf), used by physicians to help diagnose patients with mental illnesses like depression and anxiety. It asks about general interest in activities, eating and sleeping habits, and overall mood. Alone, the PQH-9 won’t give a definitive diagnosis. Doctors use it in conjunction with physical exams to rule out other causes for patients’ symptoms, like a thyroid problem. Google says its incorporation of the PQH-9 test in its search results is not meant as a final diagnosis, but as a tool to inspire people to have conversations with their healthcare providers if they were hesitant before.

The article is here.