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

Friday, November 30, 2012

MaleSurvivor Conference Examines Sexual Abuse in Sports

By Eric V. Copage
The New York Times
Originally published November 18, 2012

Here are some excerpts:

A dour procession of stories about sexual misconduct by coaches toward their male charges has come to light in recent months. Jerry Sandusky, a former assistant football coach at Penn State, was sentenced in October to 30 to 60 years in prison on 45 counts of child molesting. Sugar Ray Leonard wrote in his autobiography last year that he was sexually molested by an Olympic boxing coach. The N.H.L. players Theo Fleury and Sheldon Kennedy were sexually abused as teenagers by their hockey coach Graham James.
The prevalence of sexual abuse among all boys 17 and under has been variously estimated to be as low as 5 percent and as high as 16 percent. For some of the millions of children who participate in sports nationwide, and their parents, sexual assault in a sports context has its own dynamic.
“Sports is a place where parents send their boys to learn skills, to learn how to be teammates and how to work together — to make boys stronger and healthier,” said Dr. Howard Fradkin, author of “Joining Forces,” a book about how men can heal from sexual abuse. “It’s the place where we send our boys to grow up. The betrayal that occurs when abuse occurs in sports is damaging because it destroys the whole intent of what they started out to do.”

Maine West High School Sued For Student Hazing, Sodomy 'Sanctioned By Coaches'

The Huffington Post
Originally published November 20, 2012

The family of a Illinois high school freshman is suing the Maine Township High School District 207, claiming that Maine West High School officials sanctioned hazing of the unnamed teen as part of a years-long ritual at the school.

The unidentified mother appeared at a news conference Monday wearing a baseball cap and sunglasses alongside attorney Antonio Romanucci.

"I thought my son would be safe at school," she said, according to WLS-TV. "You think when you drop off your son, it's a safe place to be. But I feel like the coaches should have kept him safe on the soccer field, and they didn't do that."

The mother adds that the acts -- and the school's failure to respond -- breaks Illinois state anti-bullying laws.

The lawsuit claims that the 14-year-old and at least two other boys were sexually assaulted during soccer practice in September -- during school hours and condoned by coaches. The complaint alleges that teammates shoved the three boys to the ground and beat them. The older players then held them down, pulled down their pants and underwear and sodomized them.

The entire story is here.

Thursday, November 29, 2012

The Role of Health Professionals in Detainee Interrogation

A teenager tortured at Guantanamo, and the stalled legislation to ensure clinicians "first, do no harm"

By Santiago Wills
The Atlantic
Originally published November 11, 2012

Here is one excerpt:

In the aftermath of the wars in Iraq and Afghanistan, ever since leaked reports and testimonies -- including that of alleged 9/11 mastermind Khalid Sheikh Mohammed, currently on trial in Guantanamo -- were published in 2004, the issue has attracted the attention of the media, health organizations, and political activists. Psychologists and doctors have clashed with their peers and with the Department of Defense over the role that health professionals should play in interrogations, given their oath to "do no harm." The Senate Judiciary Committee and numerous military investigations have confirmed that physicians and clinicians played a significant role during so-called enhanced interrogations, either through reverse engineering of the Survival, Evasion, Resistance, Escape (SERE) program, or through monitoring and assisting in CIA black sites and prisons like Bagram and Guantanamo.

Recently, that conflict reached politicians in Albany, New York. This year, State Senator Thomas Duane and Assembly Member Richard Gottfried sponsored a unique piece of legislation that establishes sanctions (including license removal) for state-licensed health professionals who participate in torture or improper treatment of prisoners.

"The bill presents an opportunity to fill a gap in state law on the regulation of health professionals that desperately needs to be filled," Leonard Rubenstein, the former president of Physicians for Human Rights -- an independent organization that fights human rights violations all around the world -- said in a public forum. "Almost everyone agrees that the idea that health professionals can participate in abuse of detainees and prisoners is indefensible. If that is the case, it is also indefensible to exclude such acts from state law on licensing and regulation of health professionals."

The entire story is here.

Wednesday, November 28, 2012

Physician Suicide Linked to Work Stress

By Crystal Phend, Senior Staff Writer
MedPage Today
Originally published November 14, 2012

Suicide among physicians appears to follow a different profile than in the general population, with a greater role played by job stress and mental health problems, a national analysis showed.

Problems with work were three times more likely to have contributed to a physician's suicide than a nonphysician's, Katherine J. Gold, MD, MSW, of the University of Michigan in Ann Arbor, and colleagues found.

Their analysis of the National Violent Death Reporting System also showed that known mental illness prior to suicide was 34% more common among physicians than nonphysicians.

"The results of this study paint a picture of the typical physician suicide victim that is substantially different from that of the nonphysician suicide victim in several important ways," the group wrote online in General Hospital Psychiatry.

The entire story is here.

The original article is here.

Here is the conclusion from the abstract:
Mental illness is an important comorbidity for physicians who complete a suicide but postmortem toxicology data shows low rates of medication treatment. Inadequate treatment and increased problems related to job stress may be potentially modifiable risk factors to reduce suicidal death among physicians.

Tuesday, November 27, 2012

L.A. Psych School Lied, Class Claims

Courthouse News Service
November 15, 2012

Students claim in a class action that the Los Angeles campus of the Chicago School of Professional Psychology recruited them by lying that it was accredited by the American Psychological Association.

Miranda Jo Truitt and three other named plaintiffs sued the Chicago School of Professional Psychology and its subsidiaries, including TCS Global, in Superior Court. They allege fraud, conspiracy, false advertising and consumer law violations.

Also named as defendants are the California Graduate Institute and the school's national president Michelle Nealon-Woods and "lead faculty" member of the Los Angeles campus, David Sitzer.

The students claim the Chicago School of Professional Psychology, or TCS, was "ostensibly formed, organized and operated exclusively for exempt purposes under section 501(c)(3) of the Internal Revenue Code for the 'advancement of education and science,' but in fact is being operated by its management team for the benefit of private interests for financial profit and personal gain through a network of interrelated companies and entities owned and controlled by TCS.

The entire story is here.

Thanks to Ken Pope for this story.

Monday, November 26, 2012

What Brand Is Your Therapist?

by Lori Gottlieb
The New York Times
Originally published November 23, 2012

Here is an excerpt:

What nobody taught me in grad school was that psychotherapy, a practice that had sustained itself for more than a century, is losing its customers. If this came as a shock to me, the American Psychological Association tried to send out warnings in a 2010 paper titled, “Where Has all the Psychotherapy Gone?” According to the author, 30 percent fewer patients received psychological interventions in 2008 than they did 11 years earlier; since the 1990s, managed care has increasingly limited visits and reimbursements for talk therapy but not for drug treatment; and in 2005 alone, pharmaceutical companies spent $4.2 billion on direct-to-consumer advertising and $7.2 billion on promotion to physicians, nearly twice what they spent on research and development.

According to the A.P.A., therapists had to start paying attention to what the marketplace demanded or we risked our livelihoods. It wasn’t long before I learned that an entirely new specialized industry had cropped up: branding consultants for therapists.

I couldn’t imagine hiring a branding consultant to lure people to the couch. Psychotherapy is perhaps one of the few commercial businesses that doesn’t see itself as one, that views financial gain as unseemly when connected to the delicate work of emotional insight. Moreover, the field is predicated on strict concepts of authenticity, privacy and therapist-patient boundaries. Branding was the antithesis of what we did.

The entire article is here.

When the Patient Is ‘Noncompliant’

The New York Times
Originally published November 15, 2012

Here are some excerpts:

“Noncompliant” is doctor-shorthand for patients who don’t take their medications or follow medical recommendations. It’s one of those quasi-English-quasi-medical terms, loaded with implications and stereotypes.

As soon as a patient is described as noncompliant, it’s as though a black mark is branded on the chart. “This one’s trouble,” flashes into most doctors’ minds, even ones who don’t want to think that way about their patients. And like the child in school who is tagged early on as a troublemaker, the label can stick around forever.


“Improving adherence is a team sport,” Dr. Steiner adds. Input from nurses, care managers, social workers and pharmacists is critical.

The entire article is here.

Sunday, November 25, 2012

Move Over Economists: We Need a Council of Psychological Advisers

Much of governing involves predicting behavior or getting people to change it. Lawyers and economists need some help with both.

By Barry Schwartz
The Atlantic
Originally published

Though President Obama won reelection decisively, he won't have much time to celebrate. Many of the nation's problems -- stimulating employment, reducing the deficit, controlling health-care costs, and improving the quality of education -- are very serious, and some of them must be addressed with great urgency. And none of these problems can be addressed simply by waving a magic government wand. To a significant degree, they all involve understanding what motivates current practices -- of business-people, financiers, doctors, patients, teachers, students -- and what levers we may be able to use to change those practices.

Historically, when the need has arisen to change behavior, political leaders have turned to economists. That's one reason why presidents have a Council of Economic Advisers. When economists speak, presidents listen. And when economists have the president's ear, all their whispers are predicated on a set of assumptions about human behavior. Whether it's increasing GDP, reducing unemployment, sustaining Social Security, making sure people are financially prepared for retirement, or stabilizing the financial sector, economists commonly hold certain beliefs. They will for example argue that people are motivated by self-interest and are rational calculators of their interests, and that the most effective way to get people to change the way they behave is by creating the right material incentives.


There is also growing evidence, some of it provided by psychologists Carol Dweck and Angela Duckworth, that the focus on beefing up the cognitive components of education that has dominated reform for the last 30 years may be misplaced. More important may be efforts to cultivate motivation and character (Paul Tough's remarkable new book, How Children Succeed, provides a vivid summary of this work). The importance of character and motivation suggests that the drill-and-test model of education that has become so common may actually be not just ineffective, but counterproductive.

The entire story is here.

Saturday, November 24, 2012

The Half-Life Of Facts: Sam Arbesman at TEDxKC

Editorial note: The following video is about the half-life of facts.  Many lessons can be learned in this brief and fascinating presentation about our knowledge base related to psychology, ethics and ethical decision-making.

Friday, November 23, 2012

A Regular Checkup Is Good for the Mind as Well as the Body

By Ann Carrns
The New York Times
Originally published November 13, 2012

EVERYONE is familiar with the concept of a periodic medical checkup — some sort of scheduled doctor’s visit to check your blood pressure, weight and other physical benchmarks.

The notion of a regular mental health checkup is less established, perhaps because of the historical stigma about mental illness. But taking periodic stock of your emotional well-being can help identify warning signs of common ailments like depression or anxiety. Such illnesses are highly treatable, especially when they are identified in their early stages, before they get so severe that they precipitate some sort of personal — and perhaps financial — crisis.
“Absolutely, people should have a mental health checkup,” said Jeffrey Borenstein, editor in chief of Psychiatric News, published by the American Psychiatric Association. “It’s just as important as having a physical checkup.”
Over all, however, 15 percent of employers in the United States do not offer mental health coverage to employees, according to the Society for Human Resource Management. Such benefits may become more widely available in 2014, when many provisions of the Affordable Care Act take effect. Mental health benefits will be part of the “essential package” that must be offered by many insurance plans, including the new state-sponsored insurance exchanges.

Military says it's focusing on suicide prevention

By Mike Urban
The Reading Eagle
Originally published November 12, 2012

Fewer of America's troops are heading into combat with the war in Iraq over and the war in Afghanistan nearing a close.

But the demand for mental health care among active duty personnel is increasing, in part because combat has left many in need of help, and because the military is doing more to treat its mentally ill troops, Department of Defense officials said.

Suicide prevention has become one of the military's most urgent concerns, and treatment of post-traumatic stress disorder within the military has come a long way in recent years, said Defense Department spokeswoman Cynthia O. Smith.

"We are committed to taking care of our people, and that includes doing everything possible to prevent suicides in the military," she said.

To reduce the long-standing military stigma surrounding mental health problems, the defense department urges commanders to support those in need of care, she said.

The entire story is here.

Army, Navy suicides at record high

By Gregg Zoroya
USA Today
Originally published on November 19, 2012

With six weeks left in the year, the Army and Navy are already reporting record numbers of suicides, with the Air Force and Marine Corps close to doing the same, making 2012 the worst year for military suicides since careful tracking began in 2001.

The deaths are now occurring at a rate faster than one per day. On Nov. 11, confirmed or suspected suicides among active-duty forces across the military reached 323, surpassing the Pentagon's previous high of 310 suicides set in 2009.

Of that total, the Army accounted for 168, surpassing its high last year of 165; 53 sailors took their own lives, one more than last year.

The Air Force and Marine Corps are only a few deaths from record numbers. Fifty-six airmen had committed suicide as of Nov. 11, short of the 60 in 2010. There have been 46 suicides among Marines, whose worst year was 2009 with 52.

The entire story is here.

Thursday, November 22, 2012

Emotions Come to Fore in Political Wins and Losses

By Richard Friedman
The New York Times 
Originally published November 12, 2012

Just one look at the dejection on the faces of Romney supporters or the jubilation of Obama supporters on election night should tell you that politics is first and foremost a very emotional affair.

Ann Romney was crying while her husband delivered his terse concession speech, not because a majority of Americans voted against his economic policy, but because of the personal — and highly public — rejection of Mitt Romney as their next president.

Nor were President Obama’s supporters ecstatic because his health care policy would not be overturned. Rather, both camps were in the grip of powerful emotions akin to the passion of spectators rooting for their team at a sporting event.


But political affiliation is not driven by ideas alone. Most people do not choose a political party by carefully analyzing its policies or even its track record for competence. Instead, some social scientists argue that people select their political party in early adulthood the way they choose their friends or social groups: They go for the party that has people who resemble themselves.

Once you’ve selected your party, you are likely to retrofit your beliefs and philosophy to align with it. In this sense, political parties are like tribes; membership in the tribe shapes your values and powerfully influences your allegiance to the group.

So strong is the social and emotional bond among members of a political tribe that they are likely to remain loyal to their party even when they give it low marks for performance. Yankees fans don’t jump ship when their team loses any more than Republicans switch parties when they lose an election.

The entire blog post is here.

Wednesday, November 21, 2012

25 Tips to Prevent Data Breaches

By Sharon D. Nelson & John W. Simek
The Wisconsin Lawyer
Volume 85, No. 11, November 2012

Another day, another data breach. Data breaches have proliferated with amazing speed. Here is the roundup of some of the largest victims in 2011 alone: Tricare, Nemours, Epsilon, WordPress, Sony, HB Gary, TripAdvisor, Citigroup, NASA, Lockheed Martin, and RSA Security. Some mighty big names on that list.

Don't be lulled into thinking that law firms (large and small) aren't suffering data breaches just because they don't have millions of clients affected. On Nov. 1, 2009, the FBI issued an advisory, warning law firms that they were specifically being targeted by hackers. Rob Lee, an information security specialist who investigates data breaches for the security company Mandiant, estimated that 10 percent of his time in 2010 was spent investigating law firm data breaches.


Top Practical Security Tips

1. Have a strong password – at least 12 characters. No matter how strong an eight-character password is, it can now be cracked in about two hours. A strong 12-character password takes roughly 17 years to crack. Much easier to hack someone else. Use a passphrase so you can remember the password: "Love ABATECHSHOW 2013!" is a perfect example.

2. Don't use the same password everywhere. If they crack you once, they've got you in other places, too.

3. Change your passwords regularly. This will foil anyone who has gotten your password.

The entire story is here.

Thanks to Ken Pope for this article.

Tuesday, November 20, 2012

Psychologist Kristina Nana Killam Duangpatra banned for six months for inappropriate relationship with prisoner

By Tony Keim
The Courier-Mail
Originally published November 5, 2012

A FEMALE psychologist who had a "personal and intimate relationship" with a Brisbane prisoner - including offering to have his child - has been banned for six months.

The Queensland Civil and Administrative Tribunal was told psychologist Kristina Nana Killam Duangpatra had an improper relationship with a prisoner over a two-year period.

QCAT acting Deputy President Kerrie O'Callaghan, in a just published eight-page decision, said Duagnpatra first met the prisoner, identified only as Mr Cougan, at Wacol's Wolston Correctional Centre when she began treating him on August 3, 2009.

The tribunal became involved after a disciplinary referral from the Psychology Board of Australia indicated Duangpatra was having an improper relationship with a former patient.

The entire story is here.

Monday, November 19, 2012

EHRs Push Private Practice Docs Out of Business

Growing numbers seek employment, in part because government-mandated technology costs too much

By Ken Terry
Information Week
Originally published November 9, 2012

Sixty-one percent of independent physicians are seeking employment, and the majority of those doctors say that the government requirement for them to adopt and show meaningful use of an electronic health record (EHR) is one reason, a new Accenture report finds.

The paper, entitled "Clinical Transformation: New Business Models for a New Era in Healthcare," notes that the percentage of private practice physicians in the workforce dropped from 57% in 2000 to 39% in 2012. By the end of next year, Accenture forecasts, only 36% of physicians will be self-employed.

The biggest reason for doctors to seek employment, the Accenture survey shows, is the cost of doing business as an independent practitioner. Eighty-seven percent of respondents who were looking for a job cited that challenge, and 61% checked off "the prevalence of managed care." Government EHR requirements and maintaining/managing staff each were mentioned by 53% of doctors.

The entire story is here.

Sunday, November 18, 2012

Missouri, Kansas Reject State-Run Health Insurance Exchanges

By Alana Gordon
Kaiser Health News, in cooperation with NPR
Originally published November 19, 2012

Immediately after the presidential election, and more than a week ahead of the Nov. 16 deadline, Missouri Gov. Jay Nixon, a Democrat, announced he had made up his mind. The state would not be setting up its own health insurance exchange.

Next door in Kansas, Gov. Sam Brownback, a Republican, made a similar announcement. These governors' moves open the door for increased federal involvement in health care in both states.
President Barack Obama's health law has never had any easy time in this part of the country.

"Kansans feel Obamacare is an overreach by Washington and have rejected the state’s participation in this federal program," Brownback said in a statement.


Some health policy experts find the situation in Missouri ironic. "We have a state that is very much committed to state rights and state control," notes Thomas McAuliffe, with the Missouri Foundation for Health. "Yet we’re willing to just blindly cede all creation and administration of a health exchange or insurance state marketplace to the federal government." The foundation helped fund efforts to plan an exchange.

The entire story is here.

Backers of Mass. assisted suicide measure concede

Originally published NOVEMBER 07, 2012

Supporters of a ballot question legalizing physician-assisted suicide for the terminally ill in Massachusetts have conceded defeat, even though the vote is too close to call.

A spokesman for the Death With Dignity Act campaign said in a statement early Wednesday that ‘‘regrettably, we fell short.’’

The entire story is here.

Saturday, November 17, 2012

Washington Approves Same-Sex Marriage, Marking Shift in Nation’s Views

ABC News
Originally published November 7, 2012

On Thursday, opponents of the same-sex marriage referendum on the ballot in Washington state conceded the race, marking a full slate of victories for gay rights on Election Night. Same-sex marriage was legalized by popular vote for the first time in our nation’s history in not one, but all three states where it was on the ballot: Maine, Maryland and Washington. In Minnesota, a proposed ban on same-sex marriage that would have defined marriage as between one man and one woman in the state’s constitution was defeated.

Tuesday’s victories mark more than just a win for the gay rights movement; they represent a larger demographic shift in our country. In an election year where the president made history by publicly announcing his support for same-sex marriage — becoming the first sitting president to do so — the results in Maine, Maryland, Washington and Minnesota appear to be another sign of this increased acceptance.

The entire story is here.

In Maine and Maryland, Victories at the Ballot Box for Same-Sex Marriage

The New York Times
Originally published on November 7, 2012

Voters in Maine and Maryland approved same-sex marriage on an election night that jubilant gay rights advocates called a historic turning point, the first time that marriage for gay men and lesbians has been approved at the ballot box.

While six states and the District of Columbia have legalized same-sex marriage through court decisions or legislative decisions, voters had rejected it more than 30 times in a row.

Results for the other two states voting on same-sex marriage, Minnesota and Washington, were still coming in late Tuesday, but rights groups said that the victories in two states and possibly more were an important sign that public opinion was shifting in their direction.

The entire story is here.

Same-sex marriage upheld by Spain's highest court

By Iciar Reinlein and Sarah Morris
Originally published 6, 2012

Spain's highest court upheld the country's gay marriage law on Tuesday, rejecting an appeal lodged by the ruling People's Party seven years ago and confirming the legality of same-sex unions.

By the end of last year, more than 21,000 same-sex couples had tied the knot since Spain became the fourth country in the world to legalize gay marriage in July 2005.

Eight of the Constitutional Court's 11 judges voted in favor of the law, the court said in a statement, adding that the full ruling will be published in the next few days.

The entire story is here.

French government approves introduction of same-sex marriage

Draft law on gay marriage and adoption to go before parliament amid protests and concerns plans do not go far enough

by Angelique Chrisafis in Paris
The Guardian
Originally published November 7, 2012

Plans to introduce gay marriage and adoption rights have been approved by France amid growing protest from the French right and religious leaders.

François Hollande, the Socialist president, had made same-sex marriage and adoption a cornerstone of his election campaign, promising a law before mid-2013.

The draft legislation goes before parliament in January.

France would become the 12th country to legalise gay marriage – after others such as Canada, South Africa, Spain and Portugal. But with 60 million people it would be the biggest in terms of economic and diplomatic influence.

"This would be progress not just for the few, but for our whole society," Hollande told the cabinet meeting on Wednesday.

But the plans have proved more divisive than he and the left had hoped. Amid a conservative backlash, Catholic church protests and political squabbling, draft legislation has been slightly delayed and, some gay activists argue, watered down.

The entire story is here.

Friday, November 16, 2012

The only religion that my patients see me practice is medicine

By Jennifer Gunter
KevinMD.com - Social Media's Leading Physician Voice
Originally published November 1, 2012

When I was the director of undergraduate medical education for OB/GYN at a Midwestern university (a state school), it came to my attention that a medical student was refusing to have anything to do with contraception as it was against her religion.

So I spoke with her. I explained that over the course of her career she would undoubtedly see people from all walks of life with a myriad of religious and or personal practices. I explained that medical care is not about fulfilling any personal need beyond the need to help.

I gave the example of a doctor who is a Jehovah’s Witness. Refusing to order a blood transfusion would be both unethical and malpractice.

I had an OB/GYN who practiced the same religion discuss how he felt that he could prescribe contraception and still honor his Church.

None of this mattered. In her eyes prescribing contraception was an affront to her religion.

“What if you don’t council a patient about condoms and she gets HIV?” I asked.

No answer.

“Do you think it’s ethical for a woman to take time out of her day to come for a well-woman exam and not leave with the contraception that she wants and needs?”


The entire blog post is here.

Thanks to Ed Zuckerman for this information.

Thursday, November 15, 2012

Anthropologists Approve Ethics Code

By Scott Jaschik
Inside Higher Ed
Originally published November 7, 2012

After five years of study, the American Anthropological Association has adopted a new code of ethics. In a vote of members, 93 percent approved of the statement, which shifts away from a legal-type list of specific prohibitions (a characteristic of past codes) and stresses general principles.

As a discipline, anthropology has at times been divided over ethics, with many in the field feeling shame over early work in the field that was used to promote imperialism and with more recent debate over whether it is appropriate for anthropologists to work with the U.S. military. But debate over the new code (as is reflected in the overwhelming vote to approve it) was not as intense as discussions in recent years over very specific questions, such as whether anthropologists should work to help American efforts in Afghanistan and Iraq.

The entire story is here.

A Firing Upheld

By Colleen Flaherty
Inside Higher Ed
Originally published November 14, 2012

Indiana's highest court on Tuesday upheld the University of Evansville's decision to fire a tenured professor accused of violating its sexual harassment policy.

John Haegert, a professor at the private university since  1979, was fired in 2004 following an incident involving a female tenured professor. Margaret McMullan, then chair of the English department, was speaking with a prospective student and her parents in August 2004 when Haegert entered the department lounge and began to stroke the professor on her face and neck, calling her "Sweetie," according to court documents.

McMullan, who testified she was "embarrassed and humiliated" by Haegert's actions, filed a formal complaint against her colleague -- and that complaint led to his termination, following extensive internal review. Court documents reveal several female students had launched similar but informal complaints against Haegert since 2002.

The entire story is here.

Wednesday, November 14, 2012

Colo. man plotted to kill children, president

By 9News
Originally published November 14, 2012

9Wants to Know has learned a Colorado man is in federal custody after plotting to kill President Barack Obama and kill children on Halloween night in Westminster.

Sources tell 9Wants to Know Mitchell Kusick's plan involved stealing a family member's shotgun and using it to shoot children on Halloween and assassinate the president in Colorado.

Officials do not know when he wanted to kill the president.

The restraining order filed in Jefferson county court says Kusick "stole a shotgun from his aunt's house, hid the weapon, attempted to purchase ammunition for the gun" and then told his therapist about his plan.

The entire story is here.

HCEC Pearls and Pitfalls: Suggested Do’s and Don’t’s for Healthcare Ethics Consultants

Joseph A. Carrese and the Members of the
American Society for Bioethics and Humanities
Clinical Ethics Consultation Affairs Standing Committee

1. Don't assume that the question you are asked to address is a matter of ethics, or that it is the primary issue or the only issue. Do take the time to clarify for yourself (and your team) the following: What are the relevant concerns, and are they a matter of ethics?

Those requesting an ethics consultation recognize that a problem exists. However, they may not be able to accurately determine whether the problem is truly a matter of ethics or not, and even if they can, they may not be able to correctly articulate the precise nature of the ethical concerns (that is, the values about which there is uncertainty or conflict). Further, requesters may not appreciate that, in addition to the question(s) they have raised, other important ethical concerns may be involved. One important task for HCECs, then, is to determine if the request is appropriate for ethics consultation and, if so, to clarify the ethical concern(s). 1 If the request does not involve an ethics question (that is, what should be done in the face of uncertainty or conflict about values), it should be referred to other resources in the healthcare system that are better equipped to handle such requests. For example, if the requester is seeking a legal opinion, he or she should be referred to legal counsel. Similar to making a diagnosis in clinical medicine, where precision in diagnosis leads to appropriate intervention, clearly and accurately identifying and describing the ethical concerns in an ethics consultation will more likely lead to a correct and helpful analysis and appropriate recommendations. Another parallel to clinical medicine is that, as the case unfolds over time, new issues may emerge. An initial set of questions, even when addressed and resolved, may lead to awareness of new ethical issues as the case evolves. The consultant should be attentive and open to this possibility and revisit the ethics question(s) in the consultation, as needed.

The other 11 suggestions are here.

Thanks to Ken Pope for this article.

Tuesday, November 13, 2012

How celebrity child sex scandal has rocked the BBC

By Simon Hooper
Special to CNN
Originally published October 22, 2012

In life he was one of Britain's best loved children's television personalities, an icon of the pop music world, flamboyant friend of the famous, renowned for his eccentricities and honored for his tireless charity work.

But in death, Jimmy Savile now stands accused of being a pedophile who used his status and celebrity to prey on young girls throughout decades in the public spotlight, his gravestone already removed amid an outpouring of public revulsion. Prime Minister David Cameron has even suggested the removal of Savile's knighthood might be considered in light of the allegations.

As presenter of "Jim'll Fix It," the BBC's flagship Saturday teatime kids' show from the mid-70s until the mid-90s, Savile cultivated an image as the nation's kindly uncle who could make children's dreams come true with a twirl of his trademark cigar.

Yet an ITV documentary -- "Exposure: The Other Side of Jimmy Savile" -- broadcast in early October portrayed the late star as a nightmarish figure whose sexual predilection for teenagers was known about, laughed off or suspected by many within the entertainment industry but never openly challenged.

The entire story is here.

School Psychologist Pleads No Contest To Taking Photo Of Woman's Pubic Area

By David Owens
The Hartford Courant
Originally published November 1, 2012

In November 2011, as many people suffered through the power outages that followed the October snowstorm, David Pino of Keen Court opened his home to a friend who had no electricity.

The 36-year-old woman, a longtime friend of Pino and his wife, was going to stay the night. Before going to bed, the group had several drinks.

The guest was going to sleep on a day bed in a home office, but Pino suggested that she sleep in the master bedroom with Pino's wife. He said he would sleep on the day bed.

Early the next morning, the woman later told police, something went wrong.

The entire story is here.

Monday, November 12, 2012

U.S. Suicide Rate Jumped During Recession as Unemployment Rose

By Phil Serafino
Bloomberg News
Originally posted November 4, 2012

The suicide rate in the U.S. increased during the recession, a sign that rising joblessness took a toll on Americans’ mental health, researchers said.

About 1,580 additional suicides occurred annually in the U.S. from 2008 to 2010 than would have been expected based on statistical trends before the recession, according to a letter published today in the Lancet journal by researchers from the U.K., Hong Kong and the U.S. They looked at suicide mortality statistics from the U.S. Centers for Disease Control and Prevention for 1999 through 2010, according to the letter.

The findings add to evidence from other countries that the recession and debt crisis have harmed mental health. Previous studies found that Greece and Spain, two of the countries hit hardest by the economic duress, showed increases in illnesses including depression.

The entire story is here.

Sunday, November 11, 2012

Psychologists helping psychologists

Determining your responsibilities when you believe a colleague may have behaved unethically.

By Rebecca A. Clay
The Monitor on Psychology
October 2012, Vol 43, No. 9
Print version: page 36

If you saw another psychologist do something that appeared unethical, would you know how to respond?

Many psychologists don't, says Beth Kaplan Westbrook, PsyD, co-chair of APA's Advisory Committee on Colleague Assistance (ACCA) and a private practitioner in Portland, Ore. They may be unsure about laws in their state and how those laws interact with APA's Ethics Code. They may lack the information they need. Or they may be nervous about the liability issues that could arise, either from reporting a colleague or failing to do so.

ACCA is working to make sure psychologists are clear about how to react when a colleague needs help. In addition to creating a series of online resources, the group is urging state, provincial and territorial psychological associations (SPTAs) to create colleague assistance programs that can stop problems before they become crises.

"Health professionals aren't immune from the same problems that affect the general public," says Westbrook, citing as examples substance abuse and mental health disorders. "ACCA's main purpose is not only to help people get the treatment they need, but also to focus on prevention—to have programs in place so that psychologists can seek help or refer colleagues as problems arise."

The entire story is here.

Saturday, November 10, 2012

Caregiving as moral experience

By Arthur Kleinman
The Lancet
Volume 380, Issue 9853, Pages 1550 - 1551
3 November 2012

Everyone who has been in love or built a family knows that there are things, essential things, that money can't buy. Patients with serious illness and their network of caregivers know this too, because those things that really matter to us are threatened and must be defended. And many clinicians, reflecting on what is at stake in health care not only for patients but for themselves, know the same thing: the market has an important role in health-care financing and health systems reform, but it should not reach into those quintessentials of caregiving that speak to what is most deeply human in medicine and in living. This is the moral limit of an economic paradigm. Or at least it should be.

But we live in a truly confused age. The market model seems to have infiltrated so thoroughly into human lives and medicine that in certain circles—policy making and analysis, hospital and clinic administration, and even clinical work—economic rationality with its imperative of containing costs and maximising efficiency has come to mute the moral, emotional, religious, and aesthetic expressions of patients and caregivers. Most take it for granted and accept its implications. Models from economic psychology, behavioural economics, and business studies, based on the narrowest calculations of what a “rational” person would choose as most cost-effective, are now routinely applied to clinical decision making and the organisation of care.


The great failure of contemporary medicine to promote caregiving as an existential practice and moral vision that resists reduction to the market model or the clarion call of efficiency has diminished professionals, patients, and family caregivers alike. It has enabled a noisy and ubiquitous market to all but silence different motives, ideals, hopes, and behaviours that must be expressed, because they are as much who we are as economic rationality.

The entire piece is here.


Friday, November 9, 2012

DSM-5 Field Trials Discredit the American Psychiatric Association

By Allen Frances, M.D.
The Huffington Post
Originally posted October 31, 2012

The $3 million DSM-5 Field Trials have been a pure disaster from start to finish. First, there was the poor choice of design. The study restricted itself to reliability -- the measurement of diagnostic agreement among different raters. Unaccountably, it failed to address two much more crucial questions -- DSM-5's potential impact on who would be diagnosed and on how much its dramatic lowering of diagnostic thresholds would increase the rates of mental disorder in the general population. There was no possible excuse for not asking these simple-to-answer and vitally important questions. We have a right to know how much DSM-5 will contribute to the already rampant diagnostic inflation in psychiatry, especially since this risks even greater overuse of psychotropic drugs.

The entire story is here.

Thursday, November 8, 2012

Suit filed against Capitola psychologist for allegedly sexually abusing a child patient

By Jessica M. Pasko
The Santa Cruz Sentinel
Originally published October 23, 2012

A civil lawsuit has been filed against a Capitola psychologist who is facing criminal charges of sexual abuse against a child.

Dr. John William Visher was arrested last month at his La Selva Beach home after Capitola police investigated allegations that he committed lewd acts against an 8-year-old girl. The girl had been his patient and detectives believe the incidents occurred at Visher's former Bay Avenue office in 2009.

Last week, the girl's family filed a personal injury suit against Visher in the civil divisions of Santa Cruz County Court. It charges him with sexual harassment, professional negligence and intentional infliction of emotional distress, and seeks unspecified damages.

Visher pleaded not guilty on Oct. 9 to five felony charges that include lewd acts upon a child, sending obscene material and possession of material depicting a minor engaging in sexual conduct. He is due back in court Nov. 14.

The entire story is here.

Wednesday, November 7, 2012

Students Rate Mental Health Services

By Allie Grasgreen
Inside Higher Ed
Originally published October 30, 2012

More than 62 percent of students who withdrew from college with mental health problems did so for that reason, a new national survey shows.

The survey, released today by the National Alliance on Mental Illness, aims to gauge, based on student perceptions, whether colleges are meeting students' mental health needs and how they can better support those students' academic experience. The results are mixed.

From August to November 2011, the NAMI surveyed 765 people diagnosed with a mental health condition who are currently enrolled in college (68 percent were) or were enrolled within the past five years. The vast majority -- 71 percent -- attended public or private four-year colleges, while 19 percent attended community colleges (the others were online, trade or technical and specialty colleges). Eighty-two percent of respondents were white and the same percentage were female (women are much more likely than men to seek counseling on campus), and more than 60 percent were between the ages of 18 and 27 (with 37 percent in the traditional college ages of 18-22). Nearly eight in 10 identified as straight.

Consistent with other national surveys, depression is one of the most common problems for students, with 27 percent reporting it as their primary diagnosis.

Read more here.

Tuesday, November 6, 2012

China passes mental health law to curb unnecessary hospitalizations

CBS News
Originally posted October 26, 2012

China's legislature on Friday passed a long-awaited mental health law that aims to prevent people from being involuntarily held and unnecessarily treated in psychiatric facilities - abuses that have been used against government critics and triggered public outrage.

The law standardizes mental health care services, requiring general hospitals to set up special outpatient clinics or provide counseling, and calls for the training of more doctors.

Debated for years, the law attempts to address an imbalance in Chinese society -- a lack of mental health care services for a population that has grown more prosperous but also more aware of modern-day stresses and the need for treatment. Psychiatrists who helped draft and improve the legislation welcomed its passage.

The entire story is here.

Suicide by Choice? Not So Fast

By Ben Mattlin
The New York Times - Opinion Pages
Originally published October 31, 2012

NEXT week, voters in Massachusetts will decide whether to adopt an assisted-suicide law. As a good pro-choice liberal, I ought to support the effort. But as a lifelong disabled person, I cannot.

There are solid arguments in favor. No one will be coerced into taking a poison pill, supporters insist. The “right to die” will apply only to those with six months to live or less. Doctors will take into account the possibility of depression. There is no slippery slope.

Fair enough, but I remain skeptical. There’s been scant evidence of abuse so far in Oregon, Washington and Montana, the three states where physician-assisted death is already legal, but abuse — whether spousal, child or elder — is notoriously underreported, and evidence is difficult to come by. What’s more, Massachusetts registered nearly 20,000 cases of elder abuse in 2010 alone.

The entire article is here.

Monday, November 5, 2012

Vignette 19: A Missing Patient

A psychologist has been working individually with a 17-year-old male for issues related to depression and family dynamics. The psychologist and the young man have been engaged in psychotherapy for the past 2 years. The patient has trust issues with his parents, especially his father.

Ten minutes prior the scheduled appointment, the patient's mother calls the psychologist on the phone. The mother explains that the child has run away and the mother has reported the child missing to the police. The mother further reports that the patient's cousin has been driving the patient around town. She wants the psychologist to phone the police immediately when the patient arrives in order to arrest the cousin for unlawfully detaining the minor child or kidnapping and recover her minor child.

After the phone call, the psychologist checks the waiting room and sees the patient there.  He is talking with a young man, most likely his cousin.

What obligations does the psychologist have to the parent?

What obligations does the psychologist have to the patient?

What is the psychologist to do?

What are some likely emotional reactions would you have in this situation?

Sunday, November 4, 2012

HHS IG pledges focus on Medicare billing abuse involving electronic records

Inclusion in IG work plan for 2013 follows Center's 'Cracking the Codes' series

By Fred Schulte
The Center for Public Integrity
Originally published October 24, 2012

Federal officials will focus on possible Medicare overbilling by doctors and hospitals that use electronic medical records, a top government fraud investigator said  Wednesday, in announcing investigative priorities for the coming year.

“Electronic medical records can improve quality of care and efficiency and help us uncover cases of fraud and abuse. At the same time, we must guard against the use of electronic records to cover up crime,” said Daniel Levinson, the Department of Health and Human Services inspector general, in a video presentation.

The video posted on the agency’s website on Wednesday summarized the inspector general’s “work plan,” for 2013, a listing of Medicare and Medicaid fraud fighting efforts the agency plans to emphasize.

The entire article is here.

Saturday, November 3, 2012

Is Lab Safety An Ethical Issue?

By Jane Robbins
Inside Higher Ed
Originally published October 24, 2012

This week’s post is in response to an issue raised via the confidential post box.  The questioner wondered, as one of two principle questions, whether laboratory safety fell into the category of an ethical issue.

The short answer is yes. Safety is, in fact, often referred to, in organizational terms, as a “terminal value”; most airlines, for example, would say that safety is their primary terminal value: something closely tied to their mission-critical goal of getting people and cargo entrusted to them from point A to point B. Such terminal values translate into rules of conduct that become a matter of duty in practical, everyday terms:  for airlines, all the safety checks to the plane, pilots’ autonomy in the cockpit to abort, the security procedures, the flight attendant demonstrations and cross-checks, and so on. Without safety and a record of safety, there would be no business, no ability to fulfill the mission. So operationally it is sometimes said that such procedures are instrumental to supporting the terminal value -- indeed, to the very raison d’être of an organization.

In supporting mission in a particular way, safety, in theory and practice, is normative at its core. Lab safety, like airline safety, can be thought of in the stakeholder terms that airline safety procedures reflect. Beyond excellence at, say, flying or a conducting a particular type of research, there is recognition that the very act or process of flying or running a lab affects others.  So here we see how much relational context (internal to external); rights and obligations; and consequences enter into thinking about what is an ethical issue or not. Each lab might analyze their stakeholders differently, but at a minimum they likely include funders; scientists, technicians, students, administrators, custodians, and other lab workers; and the potential users of the lab’s outputs, such as patients, industrial firms, or consumers.

The entire blog post is here.

Mistrial in Political Bias Case

By Scott Jaschik
Inside Higher Ed
Originally published October 25, 2012

A federal judge on Wednesday declared a mistrial on one charge in a suit by a professor who charged she was passed over for a law school faculty position at the University of Iowa because of her conservative politics and activism, while the jurors rejected another charge.

The judge acted after jurors twice declared that they were deadlocked. The first time they did so, the judge urged them to try to reach a verdict.

Initial press reports indicated that the jury deadlocked on the entire case, but The Iowa City Press-Citizen reported that -- after some confusion on this point -- the judge clarified that the jurors had rejected a claim of First Amendment violations but had deadlocked on the question of whether equal protection rights had been violated.

While informal allegations of political bias against conservatives in higher education are widespread, lawsuits of this nature are rare.

The entire story is here.

Unlicensed psychologist also faces offender registration charge

By Nathan Woodside
The State Journal-Register
Originally published October 22, 2012

A man recently disciplined by the state of Illinois for unlicensed practice of clinical psychology is a former priest who also faces a criminal charge of failure to register as a sex offender.

Francis A. Benham, 74, was released from a Maryland jail in early 2006 after being convicted of sex crimes against children while serving as a priest there in the 1970s.

The entire story is here.

Thanks to Ken Pope for this story.

Friday, November 2, 2012

Can Gay and Lesbian Parents Promote Healthy Development in High-Risk Children Adopted From Foster Care?

Justin A. Lavner, Jill Waterman, Letitia Anne Peplau

American Journal of Orthopsychiatry
Volume 82, Issue 4, pages 465–472, October 2012

Adoption is known to promote cognitive and emotional development in children from foster care, but policy debates remain regarding whether children adopted by gay and lesbian parents can achieve these positive outcomes. This study compared the cognitive development and behavior problems at 2, 12, and 24 months postplacement of 82 high-risk children adopted from foster care in heterosexual and gay or lesbian households. On average, children in both household types showed significant gains in cognitive development and maintained similar levels of behavior problems over time, despite gay and lesbian parents raising children with higher levels of biological and environmental risks prior to adoptive placement. Results demonstrated that high-risk children show similar patterns of development over time in heterosexual and gay and lesbian adoptive households.

The entire article is here.

Thursday, November 1, 2012

The Use of Checklists in Research

By Kaitlin Gallagher
Inside HigherEd
Originally published October 21, 2012

We may not like to admit it, but many of us can describe a time when we’ve made a mistake during the progress of a study. These mistakes can range from mixing up wires or forgetting to turn on an amplifier to forgetting to collect an essential piece of information that either requires additional processing time or prevents you from analyzing a certain variable altogether. Increased computing power and technological advancements have also made it easier than ever to collect data. We can collect five measures simultaneously in one study and hundreds of trials in no time at all. But where does this leave us now? We must set up all of this equipment and make sure it works together, monitor it as well as our participant or specimen, and somehow sift through all the data post hoc. Even with a detailed lab notebook, its no wonder problems can arise. Even just writing this makes me feel…exposed, as if I’m the only one who struggles with this. It seems so simple, how can I not get it perfect every time? I always thought that I just had to work harder to not miss small steps, but maybe I just needed a different, yet structured, perspective on how to manage such a high volume of complex information.

My interest in general checklists above and beyond the detailed lab notebook began after reading The Checklist Manifesto by Atul Gawande, a surgeon and Harvard Professor (he also is the author of a New Yorker column on the same subject). The purpose of this book is to describe how a basic checklist can help us perform complex tasks consistently, correctly, and safely. Much of the book is told from the point of view of eliminating errors during surgery, but Gawande also draws on stories on how checklists have benefited those in construction, aviation, and investing.

The entire story is here.