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, April 30, 2015

Most Prisoners Are Mentally Ill

By Olga Khazan
The Atlantic
Originally posted April 7, 2015

Here is an excerpt:

The numbers are even more stark when parsed by gender: 55 percent of male inmates in state prisons are mentally ill, but 73 percent of female inmates are. Meanwhile, the think-tank writes, "only one in three state prisoners and one in six jail inmates who suffer from mental-health problems report having received mental-health treatment since admission."

An increasingly popular program might help thin the ranks of these sick, untreated inmates. What are known as "mental-health courts" have sprung up in a number of states as an alternative to incarceration. A shoplifter who has, say, schizophrenia might be screened and found eligible for mental-health court, and then be sentenced to judicially supervised treatment. These types of courts have expanded rapidly since 2000, and there are now hundreds around the country.

The entire article is here.

Guatemalans deliberately infected with STDs sue Johns Hopkins

By Oliver Laughland
The Guardian
Originally posted April 2, 2015

Nearly 800 plaintiffs have launched a billion-dollar lawsuit against Johns Hopkins University over its alleged role in the deliberate infection of hundreds of vulnerable Guatemalans with sexually transmitted diseases, including syphilis and gonorrhea, during a medical experiment programme in the 1940s and 1950s.

The lawsuit, which also names the philanthropic Rockefeller Foundation, alleges that both institutions helped “design, support, encourage and finance” the experiments by employing scientists and physicians involved in the tests, which were designed to ascertain if penicillin could prevent the diseases.

The entire article is here.

Wednesday, April 29, 2015

Ways to Build Strong Ethical Cultures

By Keith Darcy
Risk and Compliance Journal

Here is an excerpt:

Not surprisingly, the group found strong support for the idea that culture needs top-down support and bottom-up buy-in. Senior managers need to be confident that in addition to following the letter of the law, the people they manage “get” the larger aim of a compliance and ethics initiative. That makes them more responsive to the necessary coaching and training. As for top leaders, one compliance panelist shared, “I view sales as a big part of my job. I have to sell senior management on why this is important—why they have to do this. I don’t expect them to know every rule, policy and procedure, but if they can more easily identify values, and make decisions based upon those values, we have a better chance to avoid a disaster.” Another executive added the importance of the tone at the top, “You have to show people the way. If it’s not important to senior leadership, it’s not important to the third level down.”

The entire article is here.

Aristotle on 'Flourishing'

How to live a good life? Aristotle’s answer was live virtuously: do what a virtuous person would do.

Learn more about Aristotle's Nichomachean Ethics explained how to flourish.

Narrated by Stephen Fry. Scripted by Nigel Warburton. Originally published 30 March 2015.

Tuesday, April 28, 2015

The Autism Paradox

Kathleen K. Miller
AMA Journal of Ethics. April 2015, Volume 17, Number 4: 297-298

Through the process of researching this issue, I became fascinated with recent research on neurodiversity as it applies to autism. To oversimplify vastly, neurodiversity is the idea that neurological differences (including autism) are the result of normal variation. In other words, we may be creating pathology where there is none. Should we consider autism a disease? Or is it a variation of normal? This question has been the source of heated debate, with many autism advocates arguing that autism should not be considered a disease or disorder.

As a pediatrician, this is a question I struggle with. I support autism advocacy and the rights of people with autism. I believe we need to adjust our mental framework and see people with autism as more than their diagnoses.

The entire article is here.

The Myth of the Normal Brain: Embracing Neurodiversity

By Thomas Armstrong
AMA Journal of Ethics. April 2015, Volume 17, Number 4: 348-352

Here is an excerpt:

Such strengths may suggest an evolutionary explanation for why these disorders are still in the gene pool. A growing number of scientists are suggesting that psychopathologies may have conferred specific evolutionary advantages in the past as well as in the present. The systemizing abilities of individuals with autism spectrum disorder might have been highly adaptive for the survival of prehistoric humans. As autism activist Temple Grandin, who herself has autism, surmised: “Some guy with high-functioning Asperger’s developed the first stone spear; it wasn’t developed by the social ones yakking around the campfire”.

Similarly, the three-dimensional thinking seen in some people with dyslexia may have been highly adaptive in preliterate cultures for designing tools, plotting out hunting routes, and constructing shelters, and would not have been regarded as a barrier to learning.

The entire article is here.

Monday, April 27, 2015

Science’s Big Scandal

Even legitimate publishers are faking peer review.

By Charles Seife
Originally published April 1, 2015

Here is an excerpt:

When something at the core of scientific publishing begins to rot, the smell of corruption quickly spreads to all areas of science. This is because the act of publishing a scientific finding is an essential part of the practice of science itself. You want a job? Tenure? A promotion? A juicy grant? You need to have a list of peer-reviewed publications, for publications are the coin of the scientific realm.

This coin has worth because of a long-standing social contract between scientists and publishers. Scientists hand over their work to a publication for free, and even sometimes pay a fee of several hundred to several thousand dollars for the privilege. What’s more, scientists often feel duty-bound to vet their colleagues’ work for little or no compensation when a publication asks them to. In return, the publications promise a thorough review process that establishes that a published article has some degree of scientific merit. Just like modern coinage, most of scholarly publications’ value resides in a stamp of approval from a trustworthy body.

The entire article is here.

Do You Google Your Shrink?

By Ana Fels
The New York Times - Opinionator
Originally published April 4, 2015

Here are two excerpts:

Patients’ access to huge amounts of information about therapists’ lives can’t help but change both members of the therapeutic dyad. It can have, for instance, a chilling effect on the therapist’s work outside the office. As a psychiatrist who occasionally writes and speaks, I now have to think about the impact of these activities on prospective patients. If I write a feminist article, will I end up with only female patients?


The blurring of boundaries between the personal and professional can get quite creepy. A patient told me, in greater detail than I wished to know, about her Match.com date with a psychoanalyst with whom I’ve had professional dealings. It was an encounter that almost certainly would not have occurred in the pre-Internet-dating era, and it will be hard ever to think of him in quite the same way.

The entire article is here.

Sunday, April 26, 2015

The Empathic Civilisation

RSA Animate
Uploaded on May 6, 2010

Bestselling author, political adviser and social and ethical prophet Jeremy Rifkin investigates the evolution of empathy and the profound ways that it has shaped our development and our society. Taken from a lecture given by Jeremy Rifkin as part of the RSA's free public events programme.

Watch the full lecture here.

Saturday, April 25, 2015

On the Normative Significance of Experimental Moral Psychology

Victor Kumar and Richmond Campbell
Philosophical Psychology 
Vol. 25, Iss. 3, 2012, 311-330.

Experimental research in moral psychology can be used to generate debunking arguments in ethics. Specifically, research can indicate that we draw a moral distinction on the basis of a morally irrelevant difference. We develop this naturalistic approach by examining a recent debate between Joshua Greene and Selim Berker. We argue that Greene’s research, if accurate, undermines attempts to reconcile opposing judgments about trolley cases, but that his attempt to debunk deontology fails. We then draw some general lessons about the possibility of empirical debunking arguments in ethics.

The entire article is here.

Friday, April 24, 2015

When ‘Moneyball’ Meets Medicine

By Jeremy N. Smith
The New York Times
Originally published April 2, 2015

Here is an excerpt:

Now people everywhere can bring “Moneyball” to medicine. A few months after releasing their global numbers in The Lancet, the same scientists supplied the underlying figures for 187 nations. These statistics will be updated again later this year. At last report, in the United States, measured by DALYs, the third-largest health problem was low back pain. Fifth is major depressive disorders. Eleventh is neck pain. Thirteenth is anxiety disorders. None of these maladies kill anyone directly, so they don’t even show up on a list of leading killers. But they still cause huge amounts of pain and suffering, and cost our economy billions of dollars in lost productivity.

When will low back pain get the research funds and attention given to lung cancer, just below it in a DALY ranking? The toll from major depressive disorder, No. 5, is estimated to be 20 percent worse than that from stroke. Why don’t we promote early detection in the same way, on public billboards and ad campaigns? Health loss from anxiety disorders is estimated to be 80 percent higher than that from breast cancer. Do advocates for anxiety treatment even have their own colored ribbon?

The entire article is here.

Gender Differences in Responses to Moral Dilemmas

By Rebecca Riesdorf, Paul Conway, and Bertram Gawronski
Pers Soc Psychol Bull April 3, 2015


The principle of deontology states that the morality of an action depends on its consistency with moral norms; the principle of utilitarianism implies that the morality of an action depends on its consequences. Previous research suggests that deontological judgments are shaped by affective processes, whereas utilitarian judgments are guided by cognitive processes. The current research used process dissociation (PD) to independently assess deontological and utilitarian inclinations in women and men. A meta-analytic re-analysis of 40 studies with 6,100 participants indicated that men showed a stronger preference for utilitarian over deontological judgments than women when the two principles implied conflicting decisions (d = 0.52). PD further revealed that women exhibited stronger deontological inclinations than men (d = 0.57), while men exhibited only slightly stronger utilitarian inclinations than women (d = 0.10). The findings suggest that gender differences in moral dilemma judgments are due to differences in affective responses to harm rather than cognitive evaluations of outcomes.

The entire article is here.

Thursday, April 23, 2015

Gay Rights, Religious Freedom and the Moral Arc

By Michael Shermer
The Huffington Post
Originally published March 3, 2015

Here is an excerpt:

What is the cause of this moral progress? Most people associate it with religion, but in fact I believe that most of the moral development of the past several centuries has been the result of societies moving toward more secular forms of governance and politics, law and jurisprudence, moral reasoning and ethical analysis. Over time it has become less acceptable to argue that my beliefs, morals, and ways of life are better than yours simply because they are mine, or because they are traditional, or because my religion is better than your religion, or because my God is the One True God and yours is not.

It is no longer acceptable to simply assert your moral beliefs; you have to provide reasons for them, and those reasons had better be grounded in rational arguments and empirical evidence or else they will likely be ignored or rejected.

The entire article is here.

Moral foundations and political attitudes: The moderating role of political sophistication

By Patrizia Milesi
The International Journal of Psychology
Originally published February 26, 2015


Political attitudes can be associated with moral concerns. This research investigated whether people's level of political sophistication moderates this association. Based on the Moral Foundations Theory, this article examined whether political sophistication moderates the extent to which reliance on moral foundations, as categories of moral concerns, predicts judgements about policy positions. With this aim, two studies examined four policy positions shown by previous research to be best predicted by the endorsement of Sanctity, that is, the category of moral concerns focused on the preservation of physical and spiritual purity. The results showed that reliance on Sanctity predicted political sophisticates' judgements, as opposed to those of unsophisticates, on policy positions dealing with equal rights for same-sex and unmarried couples and with euthanasia. Political sophistication also interacted with Fairness endorsement, which includes moral concerns for equal treatment of everybody and reciprocity, in predicting judgements about equal rights for unmarried couples, and interacted with reliance on Authority, which includes moral concerns for obedience and respect for traditional authorities, in predicting opposition to stem cell research. Those findings suggest that, at least for these particular issues, endorsement of moral foundations can be associated with political attitudes more strongly among sophisticates than unsophisticates.

The entire article is here.

Wednesday, April 22, 2015

“Fury, us”: Anger as a basis for new group self-categories

Andrew G. Livingstone , Lee Shepherd , Russell Spears , Antony S. R. Manstead
Cognition & Emotion


We tested the hypothesis that shared emotions, notably anger, influence the formation of new self-categories. We first measured participants' (N = 89) emotional reactions to a proposal to make university assessment tougher before providing feedback about the reactions of eight other co-present individuals. This feedback always contained information about the other individuals' attitudes to the proposals (four opposed and four not opposed) and in the experimental condition emotion information (of those opposed, two were angry, two were sad). Participants self-categorised more with, and preferred to work with, angry rather than sad targets, but only when participants' own anger was high. These findings support the idea that emotions are a potent determinant of self-categorisation, even in the absence of existing, available self-categories.

The entire article is here.

Social media: A network boost

Monya Baker
Nature 518 ,263-265(2015)
Published online11 February 2015

Information scientist Cassidy Sugimoto was initially sceptical that Twitter was anything more than a self-promotional time-sink. But when she noticed that her graduate students were receiving conference and co-authoring invitations through connections made on Twitter, she decided to give the social-media platform a try. An exchange that began last year as short posts, or 'tweets', relating to conference sessions led to a new contact offering to help her negotiate access to an internal data set from a large scientific society. “Because we started the conversation on Twitter, it allowed me to move the conversation into the physical world,” says Sugimoto, who studies how ideas are disseminated among scientists at Indiana University in Bloomington. “It's allowed me to open up new communities for discussions and increase the interdisciplinarity of my research.”

The entire article is here.

Tuesday, April 21, 2015

Being There: Heidegger on Why Our Presence Matters

By Lawrence Berger
The New York Times - Opinionator
Originally published March 30, 2015

Here is an excerpt:

It can be argued that cognitive scientists tend to ignore the importance of what many consider to be essential features of human existence, preferring to see us as information processors rather than full-blooded human beings immersed in worlds of significance. In general, their intent is to explain human activity and life as we experience it on the basis of physical and physiological processes, the implicit assumption being that this is the domain of what is ultimately real. Since virtually everything that matters to us as human beings can be traced back to life as it is experienced, such thinking is bound to be unsettling.

The entire article is here.

Texas Bill Would Bar Pediatricians From Talking About Guns with Patients

By David Knowles
Bloomberg News
Originally posted March 26, 2015

Here is an excerpt:

“We, as physicians, ask all sorts of questions—about bike helmets and seat belts and swimming pool hazards, dangerous chemicals in the home, sexual behaviors, domestic violence. I could go on and on,” Gary Floyd, a Fort Worth pediatrician and board member of the Texas Medical Association, told the Texas Tribune.

The entire article is here.

Monday, April 20, 2015

Who Gets to Be a .Doctor?

By Carl Straumsheim
Inside Higher Ed
Originally posted March 26, 2015

Here is an excerpt:

“'Doctor' itself is a generic term and has a wide variety of uses,” Nevett said, using a “lawn doctor” as an example. “If we limited this top-level domain to just licensed medical practitioners, we would have a quirky situation where a Ph.D. in mathematics would not be permitted to get ‘mathematics.doctor,’ but your local pediatrician would.”

Ph.D. holders will at least have backup options if ICANN doesn’t reverse its decision. Google has been delegated .prof (meant for professionals), and a decision on who gets the rights to .phd is still pending.

The entire article is here.

Moral bioenhancement: a neuroscientific perspective

By Molly Crockett
J Med Ethics 2014;40:370-371

Here is an excerpt:

The science of moral bioenhancement is in its infancy. Laboratory studies of human morality usually employ highly simplified models aimed at measuring just one facet of a cognitive process that is relevant for morality. These studies have certainly deepened our understanding of the nature of moral behaviour, but it is important to avoid overstating the conclusions of any single study. De Grazia cites several purported examples of ‘non-traditional means of moral enhancement’, including one of my own studies. According to De Grazia, we showed that ‘selective serotonin reuptake inhibitors (can be used) as a means to being less inclined to assault people’. In fact, our findings are a bit more subtle and nuanced than implied in the target article, as is often the case in neuroscientific studies of complex human behaviour.

The entire article is here.

Sunday, April 19, 2015

Ethical Judgments of Counselors: Results From a Turkish Sample

By Rahsan Sivis-Cetinkaya
Ethics & Behavior


The present study examined the ethical judgements of Turkish counselors (N = 767) using a translation of the Gibson and Pope (1993) ethical judgements survey. Items predominantly judged as ethical and unethical, and group differences regarding gender, taking ethics as a course, professional affiliation, and level of academic degree, were investigated. Chi-square analysis, Fishers’s exact test, and Fisher–Freeman–Halton tests were used in statistical analysis. Results revealed that participants predominantly judged breach of confidentiality in cases of child abuse and potential harm toward oneself or others as ethical. Items concerning sexual dual relationships were predominantly perceived as unethical, and male participants were more likely to judge items regarding sexual and nonsexual dual relationships as ethical. Implications for future research and practice are discussed.

The entire article is here.

Saturday, April 18, 2015

Stigmatized Schizophrenia Gets a Rebrand

By Elizabeth Picciuto
The Daily Beast
Originally published March 26, 2015

Here are two excerpts:

The word “schizophrenia” was coined in the early 20th century, deriving from the Greek word for “split mind.” The term conveyed the idea that people with schizophrenia experienced a splitting of their personality—that they no longer had unified identities.

Considering all the words for mental illness, both those used by medical doctors and those that are cruel slurs used by the general public, it is striking how many of them have connotations of being broken or disorganized: deranged, crazy (which means cracked— itself a derogatory term), unglued, having a screw loose, unhinged, off the wall.


“The first lesson from the Japanese experience is that a change is possible and that the change may be beneficial for mental health users and their careers, for professionals and researchers alike,” said Lasalvia. “An early effect of renaming schizophrenia, as proven by the Japanese findings, would increase the percentage of patients informed about their diagnosis, prognosis, and available interventions. A name change would facilitate help seeking and service uptake by patients, and would be most beneficial for the provision of psychosocial interventions, since better informed patients generally display a more positive attitude towards care and a more active involvement in their own care programs.”

The entire article is here.

Friday, April 17, 2015

We all feel disgust but why do some of us turn it on ourselves?

By Jane Simpson and Phillip Powell
The Conversation
Originally posted March 27, 2015

Here is an excerpt:

Self-disgust differs from other negative feelings that people have about themselves in a number of ways. While self-disgust is likely to happen alongside other self-directed issues such as shame, unique features include feelings of revulsion, for example when looking in the mirror, contamination and magical rather than reasoned thinking. These, taken with other characteristics, such as its particular cognitive-affective content, suggest an emotional experience that is different to shame (related to hierarchical submission and diminished social rank).

Disgust is not about just “not liking” aspects of yourself – the depth of the emotion can mean you can’t even look at yourself without being overwhelmed with revulsion. The feeling that you are disgusting also means that you are potentially toxic to others – so people can become isolated as they do not wish to “infect” and “contaminate” others with their own perceived “disgustingness”.

The entire post is here.

Editor's Note: This article pertains to psychotherapy with trauma, personality disorders, and eating disorders.

Instilling empathy among doctors pays off for patient care

By Sandra G. Boodman via Kaiser Health News
CNN website
Originally posted March 26, 2015

Here is an excerpt:

Clinical empathy was once dismissively known as "good bedside manner" and traditionally regarded as far less important than technical acumen. But a spate of studies in the past decade has found that it is no mere frill. Increasingly, empathy is considered essential to establishing trust, the foundation of a good doctor-patient relationship.

Studies have linked empathy to greater patient satisfaction, better outcomes, decreased physician burnout and a lower risk of malpractice suits and errors. Beginning this year, the Medical College Admission Test will contain questions involving human behavior and psychology, a recognition that being a good doctor "requires an understanding of people," not just science, according to the American Association of Medical Colleges. Patient satisfaction scores are now being used to calculate Medicare reimbursement under the Affordable Care Act. And more than 70 percent of hospitals and health networks are using patient satisfaction scores in physician compensation decisions.

The entire article is here.

Thursday, April 16, 2015

Thinking about how we think about morality

By Jennifer Cole Wright
Originally published March 22, 2015

Morality is a funny thing. On the one hand, it stands as a normative boundary – a barrier between us and the evils that threaten our lives and humanity. It protects us from the darkness, both outside and within ourselves. It structures and guides our conception of what it is to be good (decent, honorable, honest, compassionate) and to live well.

On the other hand, morality breeds intolerance. After all, if something is morally wrong to do, then we ought not to tolerate its being done. Living morally requires denying the darkness. It requires cultivating virtue and living in alignment with our moral values and principles. Anything that threatens this – divergent ideas, values, practices, or people – must therefore be ignored or challenged; or worse, sanctioned, punished, destroyed.

The entire blog post is here.

Stigma Around Physician-Assisted Dying Lingers

By Clyde Haberman
The New York Times
Originally posted on March 22, 2015

Here is an excerpt:

Arguments, pro and con, have not changed much over the years. Assisted dying was and is anathema to many religious leaders, notably in the Roman Catholic Church. For the American Medical Association, it remains “fundamentally incompatible with the physician’s role as healer.”

Some opponents express slippery-slope concerns: that certain patients might feel they owe it to their overburdened families to call it quits. That the poor and the uninsured, disproportionately, will have their lives cut short. That medication might be prescribed for the mentally incompetent. That doctors might move too readily to bring an end to those in the throes of depression. “We should address what would give them purpose, not give them a handful of pills,” Dr. Ezekiel Emanuel, a prominent oncologist and medical ethicist, told Retro Report.

The entire article is here.

Wednesday, April 15, 2015

The disremembered

Dementia undermines all of our philosophical assumptions about the coherence of the self. But that might be a good thing

By Charles Leadbeater
Originally published March 26, 2015

Here are two excerpts:

The memory-based account of identity is powerful, deeply rooted and dangerously partial. It will direct us to potential memory cures – a mixture of implants and drugs – that will almost certainly disappoint as much as they excite. Memory is not created in a little box in the brain, but by diffuse and dispersed circuits of neurons firing in concert. Someone with dementia would need more than an implant: they would need their brain refreshed and rewired. And still the nagging question would remain: are they the same person?


The notion of an embedded identity takes us into much more fertile territory when it comes to considering meaningful care for dementia sufferers. It implies that the main challenge is to work imaginatively and empathetically to find common ground, creating conversational topics and cues that help make connections with people, despite their failing memory. As the British psychologist Oliver James explains in Contented Dementia (2008), this requires more skill and persistence than most conversations demand, precisely because its pre-suppositions cannot be taken for granted. My 85-year-old mother-in-law, for example, cannot always remember that she has a preserving pan, but that does not stop her enjoying making (and, even more, talking about making) marmalade.

The entire article is here.

Measuring the Return on Character

Harvard Business Review
April 2015

Here is an excerpt:

Character is a subjective trait that might seem to defy quantification. To measure it, KRW cofounder Fred Kiel and his colleagues began by sifting through the anthropologist Donald Brown’s classic inventory of about 500 behaviors and characteristics that are recognized and displayed in all human societies. Drawing on that list, they identified four moral principles—integrity, responsibility, forgiveness, and compassion—as universal. Then they sent anonymous surveys to employees at 84 U.S. companies and nonprofits, asking, among other things, how consistently their CEOs and management teams embodied the four principles. They also interviewed many of the executives and analyzed the organizations’ financial results. When financial data was unavailable, leaders’ results were excluded.

The entire article is here.

Tuesday, April 14, 2015

Hannah Arendt: thinking versus evil

By Jon Nixon
The Times of Higher Education
Originally posted February 26, 2015

Here are two excerpts:

That is why the notion of “thinking” played such an important part in Arendt’s analysis of totalitarianism, from her 1951 The Origins of Totalitarianism to her highly controversial coverage of the Adolf Eichmann trial, the latter culminating in her 1963 book Eichmann in Jerusalem. In this, she famously employed the phrase “the banality of evil” to describe what she saw as Eichmann’s unquestioning adherence to the norms of the Nazi regime. In concluding from the occasional lies and inconsistencies in his courtroom testimony that Eichmann was a liar, the prosecution had missed the moral and legal challenge of the case: “Their case rested on the assumption that the defendant, like all ‘normal persons’, must have been aware of the criminal nature of his acts” – but, she added, Eichmann was normal only in so far as he was “no exception within the Nazi regime”. The prosecution had, according to Arendt’s analysis, failed to grasp the moral and political significance of Eichmann’s “abnormality”: namely, his adherence to the norms of the regime he had served and therefore his lack of awareness of the criminal nature of his acts.


In Arendt’s view, Eichmann’s “banality” left him no less culpable – and rendered the death sentence no less justifiable – but it shifted the basis of the argument against him: if he was a monster, then his monstrosity arose from an all too human propensity towards thoughtlessness. If Heidegger had represented the unworldliness of “pure thought”, then Eichmann represented the unworldliness of “thoughtlessness”. Neither connected with the plurality of the world as Arendt understood it. A world devoid of thinking, willing and judging would, she argued, be a world inhabited by automatons such as Eichmann who lacked freedom of will and any capacity for independent judgement.

The entire article is here.

The Ethics of Physicians’ Web Searches for Patients’ Information

Nicholas Genes and Jacob Appel
The Journal of Clinical Ethics
Volume 26, Number 1, Spring 2015

When physicians search the web for personal information about their patients, others have argued that this undermines  patients’ trust, and the physician-patient relationship in general. We add that this practice also places other relationships at risk, and could jeopardize a physician’s career.

Yet there are also reports of web searches that have unambiguously helped in the care of patients, suggesting circumstances in which a routine search of the web could be beneficial. We advance the notion that, just as nonverbal cues and unsolicited information can be useful in clinical decision making, so too can online information from patients. As electronic records grow more voluminous and span more types of data, searching these resources will become a clinical skill, to be used judiciously and with care—just as evaluating the literature is, today.

But to proscribe web searches of patients’ information altogether is as nonsensical as disregarding findings from physical exams—instead, what’s needed are guidelines for when to look and how to evaluate what’s uncovered, online.

The entire article is here.

Monday, April 13, 2015

Steps to Strengthen Ethics in Organizations: Research Findings, Ethics Placebos, and What Works

By Ken Pope
Journal of Trauma & Dissociation
Volume 16, Issue 2, 2015


Research shows that many organizations overlook needs and opportunities to strengthen ethics. Barriers can make it hard to see the need for stronger ethics and even harder to take effective action. These barriers include the organization’s misleading use of language, misuse of an ethics code, culture of silence, strategies of justification, institutional betrayal, and ethical fallacies. Ethics placebos tend to take the place of steps to see, solve, and prevent problems. This article reviews relevant research and specific steps that create change.

The entire article is here.

Antipsychotics, Other Psychotropics, and the Risk of Death in Patients With Dementia

Maust DT, Kim H, Seyfried LS, et al.
Antipsychotics, Other Psychotropics, and the Risk of Death in Patients With Dementia: Number Needed to Harm.
JAMA Psychiatry. Published online March 18, 2015.


Antipsychotic medications are associated with increased mortality in older adults with dementia, yet their absolute effect on risk relative to no treatment or an alternative psychotropic is unclear.


To determine the absolute mortality risk increase and number needed to harm (NNH) (ie, number of patients who receive treatment that would be associated with 1 death) of antipsychotic, valproic acid and its derivatives, and antidepressant use in patients with dementia relative to either no treatment or antidepressant treatment.


Conclusions and Relevance

The absolute effect of antipsychotics on mortality in elderly patients with dementia may be higher than previously reported and increases with dose.

The research article is here.

Sunday, April 12, 2015

Human, All Too Human: 3-Part Documentary Profiles Nietzsche, Heidegger & Sartre

From Open Culture
Originally published in April 8, 2014

Certainly three of the most radical thinkers of the last 150 years, Nietzsche, Heidegger, and Sartre were also three of the most controversial, and at times politically toxic, for their perceived links to totalitarian regimes. In Nietzsche’s case, the connection to Nazism was wholly spurious, concocted after his death by his anti-Semitic sister. Nevertheless, Nietzsche’s philosophy is far from sympathetic to equality, his politics, such as they are, highly undemocratic. The case of Heidegger is much more disturbing—a member of the Nazi party, the author of Being and Time notoriously held fascist views, made all the more clear by the recent publication of his infamous “black notebooks.” And Sartre, author of Being and Nothingness, has long been accused of supporting Stalinism—a charge that may be oversimplified, but is not without some merit.

The three 50 minute videos are here.

Saturday, April 11, 2015

Amid a Sea of False Findings, the NIH Tries Reform; Science needs to get its house in order, says Francis Collins, director of the NIH

By Paul Voosen
Chronicle of Higher Education
Originally published March 16, 2015

How do you change an entire scientific culture?

It may sound grandiose, but that is the loaded question now facing the National Institutes of Health, the federal agency that oversees and finances U.S. biomedical research.

While the public remains relatively unaware of the problem, it is now a truism in the scientific establishment that many preclinical biomedical studies, when subjected to additional scrutiny, turn out to be false.

Many researchers believe that if scientists set out to reproduce preclinical work published over the past decade, a majority would fail.


The NIH, if it was at first reluctant to consider the problem, is now taking it seriously. Just over a year ago, the agency's director, Francis S. Collins, and his chief deputy, Lawrence A. Tabak, announced actions the agency would take to improve the research it finances.

Science needs to get its house in order, Dr. Collins said in a recent interview with The Chronicle.

The entire article is here.

Telepsychology, Telehealth, & Internet-Based Therapy

From Ken Pope's site

I gathered the following resources to help therapists, counselors, and other clinicians to keep abreast of the rapidly evolving professional guidelines, research, treatments, innovations, and practices in the areas of telepsychology, telehealth, internet-based therapy.

I've divided the resources into 3 sections:

1) Links to 24 sets of professional guidelines that focus on telepsychology, online counseling, internet-based therapy, etc.

2) Citations for 51 recent (i.e., published in 2013-2015) articles

3) State Psychology Board Telepsychology Laws, Regulations, Policies, & Opinions--This third section was generously compiled by psychologist Kenneth R. Drude, and I am indebted to him for his kind offer to post it here.

The resource page is here.

I will link it in the Guides and Guidelines section of this site.

Friday, April 10, 2015

Ethics of Money in Medicine

By Danielle Ofri
Physician, Writer, Editor

Here is an excerpt:

But this is just one example of unethical allocation of money in medicine. Much ado was rightly made last year when Medicare data showed a few doctors with unsavory and maybe illegal billing practices.  But for all the complaints about doctors’ salaries driving up healthcare costs, hardly anyone made a peep when that same data revealed that it is the salaries of the administrators and executives that are tipping the scales.

Nor did anyone so much as hiccup when it was reported that $455 million dollars was spent on TV ads since the Affordable Care Act was enacted, more than 90% of which was devoted to trying to destroy the ACA. We are so jaded about CEO salaries and the money swamp of politics that we hardly are hardly bothered when we see these statistics.

When I read about the $400 million was spent on TV ads to prevent uninsured Americans from getting health insurance, I was frankly disgusted. If people with deep pockets are really interested in improving our healthcare system there are far better ways to use that money. That handsome sum could have put several thousand nurses in clinics or schools. It could have sponsored medical school for 2000 students from underserved communities.  Heck, it could have purchase 6 million albuterol inhalers and handed them out. But no, the money was squandered on TV advertisements.

The entire article is here.

Informed Consent Procedures with Cognitively Impaired Patients: A Review of Ethics and Best Practices

By L. M. Field and J. D. Calvert
Psychiatry Clin Neurosci. 2015 Mar 10
doi: 10.1111/pcn.12289



The objectives of this paper are to discuss ethical issues of informed consent in cognitively impaired patients and review considerations for capacity determination. We will also discuss how to evaluate capacity, determine competence, and obtain informed consent when a patient is deemed incompetent. This review emphasizes how to carry out informed consent procedures when capacity is questionable and discusses measures supported for use when determining cognitively impaired patients' ability to consent.


Information was gathered from medical and psychological codes of ethics, peer-reviewed journals, published guidelines from healthcare organizations (e.g., American Medical Association), and scholarly books. Google Scholar and PsycINFO were searched for articles related to "informed consent" and "cognitive impairment" published in English between 1975 and 2014. Relevant sources referenced in retrieved publications were subsequently searched and reviewed.


We selected 43 sources generated by our search. Sources were included in our review if they presented information related to at least one of our focus areas. These areas included: review of informed consent ethics and procedures, review of cognitive impairment evaluations, recommendations for measuring cognitive capacity, and alternative forms of informed consent.


Patients' cognitive impairments can hinder the ability of patients to understand treatment options. Evaluating the capacity of patients with cognitive impairment to understand treatment options is vital for valid informed consent and should be guided by best practices. Thus, proper identification of patients with questionable capacity, capacity evaluation, and determination of competence, as well as reliance upon appropriate alternative consent procedures, are paramount.

The article is here.

Thursday, April 9, 2015

Controversy Continues at University of Oregon Counseling Center

By Richard Read
The Oregonian
Originally published April 8, 2015

Here is an excerpt:

Bronet assured students in a March 20 memo that UO's counseling center would keep records confidential barring extraordinary circumstances. She urged them to use university mental-health services without fear.

Meanwhile, The Oregonian/OregonLive has learned, the head of the University Counseling and Testing Center significantly weakened confidentiality safeguards in a policy statement she wrote with UO's legal department.

Director Shelly Kerr wrote in an internal April 3 email obtained by the news organization that she worked with university attorneys to draft the new confidentiality policy. "I want to be sure that the information on our web and printed materials are as clear and accurate as possible," she wrote.

But the new policy, already in effect, contradicts promises Bronet made and greatly expands the number of exceptions that could be cited as justification to break confidentiality.

The entire article is here.

Ethical Framework for the Use of Technology in Mental Health

Online Therapy Institute

Here is an excerpt from their resource page:

A competent practitioner working online will always adhere at least the following minimum standards and practices in order to be considered to be working in an ethical manner.

Practitioners have a sufficient understanding of technology.

Technology basics are required for practitioners who choose to deliver therapeutic services via technology. Practitioners will possess a basic understanding of technology as the technology relates to delivery of services

  • Encryption: Practitioners understand how to access encrypted services to store records and deliver communication. Records storage can be hosted on a secure server with a third-party, stored on the practitioner’s hard drive utilizing encrypted folders or stored on an external drive that is safely stored.
  • Backup Systems: Records and data that are stored on the practitioner’s hard drive are backed up either to an external drive or remotely via the Internet.
  • Password Protection: Practitioners take further steps to ensure confidentiality of therapeutic communication and other materials by password protecting the computer, drives and stored files or communication websites.
  • Firewalls: Practitioners utilize firewall protection externally or through web-based programs.
  • Virus Protection: Practitioners protect work computers from viruses that can be received from or transmitted to others, including clients.
  • Hardware: Practitioners understand the basic running platform of the work computer and know whether or not a client’s hardware/platform is compatible with any communication programs the practitioner uses.
  • Software: Practitioners know how to download and operate software and assist clients with the same when necessary to the delivery of services.
  • Third-party services: Practitioners utilize third-party services that offer an address and phone number so that contact is possible via means other than email. This offers a modicum of trust in the third-party utilized for such services as backup, storage, virus protection and communication.

Wednesday, April 8, 2015

Online Ethics for Professionals

By The Social Network Show
Originally published March 16, 2015

Part of the Show Recap

The Social Network Show welcomes Dr. John Gavazzi to the March 16, 2015 episode.

If you are a healthcare professional or a professional in any other field, one thing you have to pay attention to is your online reputation. Something to remember, there is no difference in your professional and your personal online presence and patients, clients and customers can find you.

Dr. Gavazzi, a clinical psychologist and named Ethics Educator of the Year by the Pennsylvania Psychological Association in 2013, talks about the issues to consider when building an online presence. In this episode you will hear about what ethical issues to consider; the importance of setting boundaries; what is included in informed consent; the limitations of technology; what constitutes a violation of privacy; and what are the advantages of being online for professionals.

(I was also named Ethics Educator of the Year by the American Psychological Association in 2014.)

The podcast is here.

Tuesday, April 7, 2015

Premera Blue Cross Breach May Have Exposed 11 Million Customers' Medical And Financial Data

By Kate Vinton
Originally published March 17, 2015

Medical and financial data belonging to as many as 11 million Premera Blue Cross customers may have been exposed in a breach discovered on the same day as the Anthem breach, the health insurance company announced Tuesday.

Premera discovered the breach on January 29, 2015. Working with both Mandiant and the FBI to investigate the attack, the company discovered that the initial attack occurred on May 5, 2014. Premera Blue Cross and Premera Blue Cross Blue Shield of Alaska were both impacted, in addition to affiliate brands Vivacity and Connexion Insurance Solutions. Additionally, other Blue Cross Blue Shield customers in Washington and Alaska may have been affected by the breach.

The entire article is here.

Healthcare Accounted For Almost Half Of 2014 Client Breaches

By Christine Kern
Health IT Outcomes
Originally published March 12, 2015

A Kroll study has found the healthcare industry accounted for 49 percent of the company’s “client events” during 2014, followed by business services (retail, insurance, and financial services) at 26 percent, and higher education at 11 percent. The study further found malicious intent breach events increased while those caused by human error declined.

Monday, April 6, 2015

Evolutionary Moral Realism

By John Collier and Michael Stingl
Biological Theory
March 2013, Volume 7, Issue 3, pp 218-226


Evolutionary moral realism is the view that there are moral values with roots in evolution that are both specifically moral and exist independently of human belief systems. In beginning to sketch the outlines of such a view, we examine moral goods like fairness and empathetic caring as valuable and real aspects of the environments of species that are intelligent and social, or at least developing along an evolutionary trajectory that could lead to a level of intelligence that would enable individual members of the species to recognize and respond to such things as the moral goods they in fact are. We suggest that what is most morally interesting and important from a biological perspective is the existence and development of such trajectories, rather than the position of one particular species, such as our own, on one particular trajectory.

The entire article is here.

How (Un)ethical Are You?

Mahzarin R. Banaji, Max H. Bazerman, & Dolly Chugh
Harvard Business Review
Originally published in 2003

Here is an excerpt:

Bias That Emerges from Unconscious Beliefs

Most fair-minded people strive to judge others according to their merits, but our research shows how often people instead judge according to unconscious stereotypes and attitudes, or “implicit prejudice.” What makes implicit prejudice so common and persistent is that it is rooted in the fundamental mechanics of thought. Early on, we learn to associate things that commonly go together and expect them to inevitably coexist: thunder and rain, for instance, or gray hair and old age. This skill—to perceive and learn from associations—often serves us well.

But, of course, our associations only reflect approximations of the truth; they are rarely applicable to every encounter. Rain doesn’t always accompany thunder, and the young can also go gray. Nonetheless, because we automatically make such associations to help us organize our world, we grow to trust them, and they can blind us to those instances in which the associations are not accurate—when they don’t align with our expectations.

Because implicit prejudice arises from the ordinary and unconscious tendency to make associations, it is distinct from conscious forms of prejudice, such as overt racism or sexism. This distinction explains why people who are free from conscious prejudice may still harbor biases and act accordingly.

The entire article is here.

Sunday, April 5, 2015

Compliance with Results Reporting at ClinicalTrials.gov

By Monique L. Anderson and others
N Engl J Med 2015; 372:1031-1039
March 12, 2015
DOI: 10.1056/NEJMsa1409364

Here are two excerpts:

The human experimentation that is conducted in clinical trials creates ethical obligations to make research findings publicly available. However, there are numerous historical examples of potentially harmful data being withheld from public scrutiny and selective publication of trial results. In 2000, Congress authorized the creation of the ClinicalTrials.gov registry to provide information about and access to clinical trials for persons with serious medical conditions. In 2007, Section 801 of the Food and Drug Administration Amendments Act (FDAAA) expanded this mandate by requiring sponsors of applicable clinical trials to register and report basic summary results at ClinicalTrials.gov. Such trials generally include all non–phase 1 interventional trials of drugs, medical devices, or biologics that were initiated after September 27, 2007, or before that date but that were still ongoing as of December 26, 2007, have at least one U.S. research site, or are conducted under an investigational-new-drug application or an investigational-device exemption. The FDAAA also mandates that trial results be reported by the sponsor within 1 year after the completion of data collection for the prespecified primary outcome (primary completion date) or within 1 year after the date of early termination, unless legally acceptable reasons for the delay are evident.


In conclusion, despite ethical mandates, statutory obligations, and considerable societal pressure, most trials that were funded by the NIH or other government or academic institutions and were subject to FDAAA provisions have yet to report results at ClinicalTrials.gov, whereas the medical-products industry has been more responsive to the legal mandate of the FDAAA. However, industry, the NIH, and other government and academic institutions all performed poorly with respect to ethical obligations for transparency.

The entire article is here.

Saturday, April 4, 2015

Teaching doctors how to engage more and lecture less

By Sandra G. Boodman
The Washington Post
Originally posted March 9, 2015

Here is an excerpt:

“Doctors are explainaholics,” Tulsky said. “Our answer to distress is more information, that if a patient just understood it better, they would come around.” In reality, bombarding a patient with information does little to alleviate the underlying worry.

The “Empathetics” program teaches doctors “how to show up, not what to say,” said Riess. “We do a lot of training in emotional recognition and self-monitoring.” That includes learning to identify seven universal facial expressions — using research pioneered by psychologist Paul Ekman — and to take stock of one’s own emotional responses to patients or situations.

The entire article is here.

Friday, April 3, 2015

Ethical Implications of Patients and Families Secretly Recording Conversations With Physicians

By Michelle Rodriguez, Jason Morrow, and Ali Seifi
Published online March 12, 2015. doi:10.1001/jama.2015.2424

Here are two excerpts:

Recording conversations could be beneficial for patients. Patients do not always understand or recall all the information provided during visits to physicians.  Recordings could potentially improve accuracy, adherence, and personal engagement by providing opportunities to review conversations at other times, from the comfort of home, and in conjunction with other family members or caregivers.


Not all possible uses of these recorded conversations are beneficial to patients and physicians. Patients or family members who disagree with the advice of their physicians or who are upset with their physicians for whatever reason can easily take comments from these recordings out of context and, with a few keystrokes, disseminate them via social media. Patients can conceivably record conversations with the specific intent of establishing the grounds for a lawsuit or gathering material with which to manipulate a physician.

The entire article is here.

Ethical Breakdowns

Max H. Bazerman and Ann E. Tenbrunsel
Harvard Business Review
Originally published in April 2011

Here is an excerpt:

Motivated Blindness

It’s well documented that people see what they want to see and easily miss contradictory information when it’s in their interest to remain ignorant—a psychological phenomenon known as motivated blindness. This bias applies dramatically with respect to unethical behavior. At Ford the senior-most executives involved in the decision to rush the flawed Pinto into production not only seemed unable to clearly see the ethical dimensions of their own decision but failed to recognize the unethical behavior of the subordinates who implemented it.

Let’s return to the 2008 financial collapse, in which motivated blindness contributed to some bad decision making. The “independent” credit rating agencies that famously gave AAA ratings to collateralized mortgage securities of demonstrably low quality helped build a house of cards that ultimately came crashing down, driving a wave of foreclosures that pushed thousands of people out of their homes. Why did the agencies vouch for those risky securities?

Part of the answer lies in powerful conflicts of interest that helped blind them to their own unethical behavior and that of the companies they rated. The agencies’ purpose is to provide stakeholders with an objective determination of the creditworthiness of financial institutions and the debt instruments they sell.

Thursday, April 2, 2015

Unraveling the Church Ban on Gay Sex

By Gary Gutting
The New York Times
Originally published March 12, 2015

Here is an excerpt:

The primary arguments derive from what is known as the “natural-law tradition” of ethical thought, which begins with Plato and Aristotle, continues through Thomas Aquinas and other medieval and modern philosophers, and still flourishes today in the work of thinkers like John Finnis and Robert George. This tradition sees morality as a matter of the moral laws that follow from what fundamentally makes us human: our human nature. This is what the archbishop was referring to when he said that homosexual acts are contrary to natural law. This has long been a major basis for the church’s claim that homosexual acts are immoral — indeed “gravely sinful.”

The problem is that, rightly developed, natural-law thinking seems to support rather than reject the morality of homosexual behavior. 

The entire article is here.

What Can Be Done about Pseudoskepticism?

By Michael Shermer
Scientific American
Originally published February 17, 2015

Here is an excerpt:

Climate change is the latest arena for pseudoskepticism, and the front group du jour is ClimateDepot.com, financed in part by Chevron and Exxon and headed by a colorful character named Marc Morano, who told Kenner: “I'm not a scientist, but I do play one on TV occasionally … hell, more than occasionally.” Morano's motto to challenge climate science, about which he admits he has no scientific training, is “keep it short, keep it simple, keep it funny.” That includes ridiculing climate scientists such as James E. Hansen of Columbia University. “You can't be afraid of the absolute hand-to-hand combat metaphorically. And you've got to name names, and you've got to go after individuals,” he says, adding with a wry smile, “I think that's what I enjoy the most.”

The entire article is here.

Wednesday, April 1, 2015

Guidelines for Best Practices in Electronic Communications

Ontario Psychological Association
February 2015


Preamble Technology has been changing communication between psychological service providers and patients, referral sources, other healthcare providers and third-party payers. Members may be aware of websites, applications, and email communication tools that can be used to improve the delivery of patient care. Many of us use email extensively because it is fast, reliable, and convenient. These same characteristics, however, bring legal and liability risks, including a higher potential for privacy breaches.

As regulated health professionals, we have an obligation to maintain the confidentiality of our patients' personal health information (PHI) and to comply with privacy regulations (see Appendix A). Members need to consider how to communicate with and about patients while still protecting patient privacy. While email is fast and convenient, it also is often the least secure and the least private way to communicate.

 We are aware that many larger healthcare and academic settings now have policies stating that email should not be used to transmit any PHI. We are also aware that general guidelines for use of email suggest that it is not a secure form of communication for any personal information. Most guidelines for general email use suggest that information that is sensitive, confidential, potentially embarrassing, proprietary, personal, or classified should never be sent through email.

While members practicing within healthcare and academic settings may be familiar with their institution’s policies, those in community-based practice may not be as familiar with regulations and expectations regarding electronic communication. To clarify the responsibilities of members, the Ontario Psychological Association’s Communication and Member Services Committee is providing the following Guidelines for Best Practices in Electronic Communications.

The entire helpful guide is here.

Homeopathy not effective for treating any condition, Australian report finds

Report by top medical research body says ‘people who choose homeopathy may put their health at risk if they reject or delay treatments’

By Melissa Davey
The Guardian
Originally published March 11, 2015

Homeopathy is not effective for treating any health condition, Australia’s top body for medical research has concluded, after undertaking an extensive review of existing studies.

Homeopaths believe that illness-causing substances can, in minute doses, treat people who are unwell.

By diluting these substances in water or alcohol, homeopaths claim the resulting mixture retains a “memory” of the original substance that triggers a healing response in the body.

The entire article is here.