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
Showing posts with label Abandonment. Show all posts
Showing posts with label Abandonment. Show all posts

Monday, July 10, 2023

Santa Monica’s Headspace Health laid off dozens of therapists. Their patients don’t know where they went

Jaimie Ding
The Los Angeles Times
Originally posted 7 July 23

When Headspace Health laid off 33 of its therapists June 29, patients were told their providers had left the platform.

What they didn’t know was their therapists had lost their jobs. And they suddenly had no way to contact them.

Several therapists who were let go from Headspace, the Santa Monica meditation app and remote mental health care company, have raised alarm over their treatment and that of their patients after the companywide layoff of 181 total employees, which amounts to 15% of the workforce.

After the layoffs were announced in the morning without warning, these therapists said they immediately lost access to their patient care systems. Appointments, they said, were canceled without explanation, potentially causing irreparable harm to their patients and forcing them to violate the ethical guidelines of their profession.

One former therapist, who specializes in working with the LGBTQ+ community, said one of his clients had just come out in a session the day before he lost his job. The therapist requested anonymity because he was still awaiting severance from Headspace and feared retribution.

“I’m the first person they’ve ever talked to about it,” he said. “They’re never going back to therapy. They just had the first person she talked to about it abandon them.”

He didn’t know he had been laid off until 10 minutes after his first appointment was supposed to start and he had been unable to log into the system.


Some thoughts and analysis from me.  There are clear ethical and legal concerns here.

Abandoning patients: Headspace Health did not provide patients with any notice or information about where their therapists had gone. This is a violation of the ethical principle of fidelity, which requires healthcare providers to act in the best interests of their patients. It also leaves patients feeling abandoned and without a source of care.

Potential for harm to patients: The sudden loss of a therapist can be disruptive and stressful for patients, especially those who are in the middle of treatment. This could lead to relapses, increased anxiety, or other negative consequences. In more extreme, but realistic cases, it could even lead to suicide.

In addition to the ethical and legal problems outlined above, the article also raises questions about the quality of care that patients can expect from Headspace Health. If the company is willing to abruptly lay off therapists without providing any notice or information to patients, it raises concerns about how they value the well-being of their patients. It also raises questions about the company's commitment to providing quality care.  Headspace may believe itself to be a tech company, but it is a healthcare company subject to many rules, regulations, and standards.

Wednesday, November 16, 2022

‘What if Yale finds out?’

William Wan
The Washington Post
Originally posted November 11, 2022

Suicidal students are pressured to withdraw from Yale, then have to apply to get back into the university

Here are two excerpt:

‘Getting rid of me’

Five years before the pandemic derailed so many college students’ lives, a 20-year-old math major named Luchang Wang posted this message on Facebook:

“Dear Yale, I loved being here. I only wish I could’ve had some time. I needed time to work things out and to wait for new medication to kick in, but I couldn’t do it in school, and I couldn’t bear the thought of having to leave for a full year, or of leaving and never being readmitted. Love, Luchang.”

Wang had withdrawn from Yale once before and feared that under Yale’s policies, a second readmission could be denied.
Instead, she flew to San Francisco, and, according to authorities, climbed over the railing at the Golden Gate Bridge and jumped to her death.

Her 2015 suicide sparked demands for change at Yale. Administrators convened a committee to evaluate readmission policies, but critics said the reforms they adopted were minor.

They renamed the process “reinstatement” instead of “readmission,” eliminated a $50 reapplication fee and gave students a few more days at the beginning of each semester to take a leave of absence without having to reapply.

Students who withdrew still needed to write an essay, secure letters of recommendation, interview with Yale officials and prove their academic worth by taking two courses at another four-year university. Those who left for mental health reasons also had to demonstrate to Yale that they’d addressed their problems.

In April — nearly 10 months after S. had been pressured to withdraw — Yale officials announced another round of changes to the reinstatement process. 

They eliminated the requirement that students pass two courses at another university and got rid of a mandatory interview with the reinstatement committee.

The reforms have not satisfied student activists at Yale, where the mental health problems playing out on many American campuses has been especially prominent.

(cut)

In recent years, Yale has also faced an “explosion” in demand for mental health counseling, university officials said. Last year, roughly 5,000 Yale students sought treatment — a 90 percent increase compared with 2015.

“It’s like nothing we’ve ever seen before,” said Hoffman, the director of Yale Mental Health and Counseling. Roughly 34 percent of the 14,500 students at 

Yale seek mental health help from college counselors, compared with a national average of 11 percent at other universities.

Meeting that need has been challenging, even at a school with a $41.4 billion endowment.

Bluebelle Carroll, 20, a Yale sophomore who sought help in September 2021, said she waited six months to be assigned a therapist. She secured her first appointment only after emailing the counseling staff repeatedly.

“The appointment was 20 minutes long,” she said, “and we spent the last five minutes figuring out when he could see me again.”

Because of staffing constraints, students are often asked to choose between weekly therapy that lasts 30 minutes or 45-minute sessions every two weeks.

Friday, February 16, 2018

Health Care Workers & Moral Objections I: Procedures

Mike LaBossiere
Talking Philosophy
Originally published on January 18, 2018

Here is an excerpt:

But, this moral coin has another side—entering a profession, especially in the field of health, also comes with moral and professional responsibilities. These responsibilities can, like all responsibilities, can justly impose burdens. For example, doctors are not permitted to instantly abandon patients they dislike or because they want to move to a better paying position. As such, ethics of a health worker refusing to perform a procedure based on their moral or religious views requires that each procedure be reviewed to determine whether it is one that a health care worker can justly refuse or one that is a justly imposed burden.

To illustrate, consider a doctor who is asked to keep prisoners conscious and alive during torture performed by agents of the state. Most doctors, like most people, would have moral objections to being involved in torture. However, there is the question of whether this would be something they should be morally expected to do as part of their profession. On the face of it, since the purpose of the medical profession is to heal and alleviate suffering (a professional ethics that goes back to the origin of western medicine) this is not something that a doctor is obligated to do even in the face of moral objections. In fact, the ethics of the profession would dictate against engaging in this behavior.

Now, imagine a health care worker who has sincere religious or moral beliefs that when a person can no longer sustain their life on their own, they must be released to God. As such, the worker refuses to engage in procedures that violate their principles, such as keeping a patient on life support. While this could be a sincerely held belief, it seems to run counter to the ethics of the profession. As such, such a health care worker would seem to not have the right to refuse such services.

The article is here.

Saturday, November 12, 2016

Why Suicide Keeps Rising for Middle-Aged Men

By Lisa Esposito
US News and World Report
Originally published Oct. 19, 2016

Suicide rates in the U.S. continue to rise, and working-age adults – particularly men – make up the largest increase, according to the Centers for Disease Control and Prevention. Middle-aged men in the 45 to 60 range experienced a 43 percent increase in suicide deaths from 1997 to 2014, and the rise has been even sharper since 2005. Untreated mental illness, the Great Recession, work-related issues and men's reluctance to reach out for help converge to put them at greater risk for taking their own lives. And because men are more likely than women to use a gun, their suicide attempts are more often fatal.

Historically, suicide rates have always been higher for men, says Dr. Alex Crosby, surveillance branch chief in the CDC's Division of Violence Prevention. "But what we've seen in these past few years is rates have been going up among males and females," he told journalists attending a National Press Foundation conference in September. "Still, rates are higher among males – about four times higher." For suicide attempts that don't prove fatal, the balance changes, with two to three times more females than males trying to take their own lives.

"In about half of the suicides in the United States, the mechanism or the method was a firearm," Crosby says. Males are more likely to use firearms, while poison is more common for females. However, he notes, "When you look at suicide in the military, females choose firearms almost as much as men."

The article is here.

Tuesday, October 16, 2012

Former City Official’s Blog Chronicled His Fall From Grace and Plans for Suicide


By RUSS BUETTNER
The New York Times
Originally published October 7, 2012

After years of using his blog to settle scores with journalists, former fellow city officials and even his own father, Russell A. Harding began his final post with an unsettling mix of humility and humor.

“While you read this try and hear the Doors playing in the background for the right feel,” he wrote. “Just kidding, trying to lighten the mood.”

“Well, this is my last post,” he added. “I am hoping and praying that by the time you read this I have not botched this suicide attempt.”

By the time the 3,000-word post, “The End,” was posted on Sept. 30, Mr. Harding, 48, had taken his own life.

His body was found by the police at his apartment in Dobbs Ferry, N.Y., on Saturday, Sept. 29, apparently two days after he had committed suicide. A friend of Mr. Harding’s called the police there, and said he had received a letter that made him “concerned about his friend’s welfare,” Dobbs Ferry Police Sgt. Manuel Guevara said.

The entire story is here.

Monday, February 20, 2012

Q&A about Patient Abandonment or Wrongful Termination

The following exchange is taken from a national ethics listserv discussion.  We acquired permission from both parties to post this dialogue.

Jeff Younggren asks:

As many of you may know, I have been quite absorbed in the past year or so in the topic of abandonment/wrongful termination.  While I believe that we do owe our clients/patients pre-termination counseling when appropriate and possible, I also believe there conditions that make this unnecessary.

For example, I would argue that when a patient stops paying you, or threatens you or some other situation that compromises therapy or the therapeutic relationship; your obligations to provide pre-termination guidance or counseling are reduced and/or eliminated.  I contend that, emergencies aside, we have no obligation to see people for free if we do not want to (but you can if you want to).  I am puzzled as to how the profession can require someone to work for free when the patient/client violates the professional relationship by acting out, not paying a bill or threatening the professional in some way. 

What would you say about the rights of a licensing board, for example, to punish a psychologist for not providing free, non-emergent services to clients?

Gary Schoener replies:

These issues come up all the time because some clients threaten clinicians with a charge of abandoning them.  I have been involved in a number of cases where this has been litigated.

First of all, I agree that our field has no tradition of treating people without fee as an expectation. Medicine actually did have such a belief.  In fact, I began my career at a neuropsychology clinic and doctors and their families were treated for free by the psychiatrists and neurologists.

They expected us psychologists to do the same as a "courtesy" but we pointed out that:

(a) We did not get free care from any of our physicians; so this was not, with us, a collegial exchange of courtesies;
(b) While we might choose to treat someone for free, when we do it is usually for someone who does not have financial resources (not typical of doctors and their families); and,
(c) People often do not value free services; so this was questionable on that basis too.

BENEFICENCE:  In terms of professional issues, it is our duty to determine who we are capable of treating, to monitor progress and be willing to re-examine our presumption if they are not responding, and to cease treatment that is not working. 

NONMALEFICENCE:  Since all of our treatment techniques can be harmful, and because it is likely harmful in a general sense to provide 'treatment" which is not working, we are again obligated to discontinue treatment that is not working.

AUTONOMY:  The client can choose to leave therapy at any time, but autonomy does not include any "right to treatment." There is no such right.  If a client comes in and asks for  a lobotomy, a psychiatrist would not be expected to do it.  Autonomy in the current world means the right to have information and make informed choices, but it does not bind the practitioner to those choices.

FIDELITY:  The main issue here is that the client knows, going into treatment, that you will be both monitoring progress and that sometimes therapy does not work or does not help, and in that instance a referral should be considered.  In your initial discussion, you should outline your policies on payment for service.

JUSTICE:  Although not critical much of the time, if treatment of the client is harming other clients (e.g. disruption in the waiting room, disruption in group therapy), you can terminate the client.  Resources (e.g. you) are limited and our job is to use them where they can do the most good.  The clients are not "ours" and we are not "theirs" -- nobody has ownership.

Obviously, as a practical reality, practice standard, and consistent with the last revision of our APA code of ethics, we are not bound to provide free service, to continue with people who violate their agreements with us, or to continue in the face of threats by the client or anyone connected with them.

I believe our duty is to provide referrals and be willing to provide information to the new service provider.  It is not our job to find then another service provider -- just to make reasonable suggestions.  If they go into crisis, normally a referral to the local hospital or crisis service discharges ones duty.

In case law, there is that one exceptional case where a psychiatrist about to retire gave all his patients referrals.  However, one patient was very introverted and the psychiatrist himself admitted that a referral alone was probably not enough.  The man was on medications and the psychiatrist never got a records request.  The jury felt, based on the facts including the psychiatrist's own admissions, that he failed in his duty by not working to help this very vulnerable man (who had seen him for many years) make an adequate transition to another practitioner. This was not, of course, an abandonment case -- it was a duty to do more at the end.  I know of no other case, but this has been in the journals so often that it causes people to think that abandonment was the issue.

Jeff Younggren:

What is of great concern to me is that we have clinicians staying in nonproductive and adversarial treatment alliances out of their fear that they will be charged with abandonment if they stop seeing the client.  They fail to see that you can stop seeing anyone, it is how you do it that is key.  In some cases, you have no obligation to do anything other than stop seeing the client, like when your safety is threatened or a patient sues you and in others, like long-term treatment cases, you have a much more extensive obligation that likely includes termination sessions and referral.  We need to make sure that psychologists in practice understand this dynamic.
Gary Schoener:
I agree Jeff.  In addition, as is true for so many things like this, litigiphobia and anxiety are enemies of good decision-making.
Jeff Younggren:
Great point!  
Litigiphobia?  That is a new one for me.

Wednesday, October 19, 2011

Barriers High in Mental Health Care

By Nancy Walsh
Staff Writer, MedPage Today

For mental health care, how bad are things, really?

That was the question posed by a group of physicians in Boston who had found difficulties in providing psychiatric referrals for their patients.

So they undertook a "simulated patient" study, telephoning all 64 Blue Cross Blue Shield in-network psychiatric facilities within 10 miles of the center of Boston, according to Rachel Nardin, MD, of the Cambridge Health Alliance in Cambridge, and colleagues.

This summary article can be found here.

The original article in the Annals of Emergency Medicine can be found here.

The article concludes:

"Although there are many contributors to the inadequacy of our mental health system, managed care has hit psychiatric services hard. Private insurers aggressively constrain patients' access to services by stringently limiting provider networks. As our study shows, this is often covert; insurers provide lists of in-network providers, but most are unavailable. Reimbursements for psychiatric services are far lower than for other types of care, so institutions frequently restrict access as stringently as possible, often, as in our study, by requiring that a patient have an in-system primary care provider (even though the insurer requires no referral). Many private practitioners refuse to accept insurance payments altogether. Improved reimbursements for psychiatric care will be an important step in reducing the barriers to care experienced by patients with severe depression."