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 Boundaries. Show all posts
Showing posts with label Boundaries. Show all posts

Monday, May 13, 2024

Ethical Considerations When Confronted by Racist Patients

Charles Dike
Psychiatric News
Originally published 26 Feb 24

Here is an excerpt:

Abuse of psychiatrists, mostly verbal but sometimes physical, is common in psychiatric treatment, especially on inpatient units. For psychiatrists trained decades ago, experiencing verbal abuse and name calling from patients—and even senior colleagues and teachers—was the norm. The abuse began in medical school, with unconscionable work hours followed by callous disregard of students’ concerns and disparaging statements suggesting the students were too weak or unfit to be doctors.

This abuse continued into specialty training and practice. It was largely seen as a necessary evil of attaining the privilege of becoming a doctor and treating patients whose uncivil behaviors can be excused on account of their ill health. Doctors were supposed to rise above those indignities, focus on the task at hand, and get the patients better in line with our core ethical principles that place caring for the patient above all else. There was no room for discussion or acknowledgement of the doctors’ underlying life experiences, including past trauma, and how patients’ behavior would affect doctors.

Moreover, even in recent times, racial slurs or attacks against physicians of color were not recognized as abuse by the dominant group of doctors; the affected physicians who complained were dismissed as being too sensitive or worse. Some physicians, often not of color, have explained a manic patient’s racist comments as understandable in the context of disinhibition and poor judgment, which are cardinal symptoms of mania, and they are surprised that physicians of color are not so understanding.

Here is a summary:

This article explores the ethical dilemma healthcare providers face when treating patients who express racist views. It acknowledges the provider's obligation to care for the patient's medical needs, while also considering the emotional toll of racist remarks on both the provider and other staff members.

The article discusses the importance of assessing the urgency of the patient's medical condition and their mental capacity. It explores the option of setting boundaries or termination of treatment in extreme cases, while also acknowledging the potential benefits of attempting a dialogue about the impact of prejudice.

Monday, February 6, 2023

How Far Is Too Far? Crossing Boundaries in Therapeutic Relationships

Gloria Umali
American Professional Agency
Risk Management Report
January 2023

While there appears to be a clear understanding of what constitutes a boundary violation, defining the boundary remains challenging as the line can be ambiguous with often no right or wrong answer. The APA Ethical Principles and Code of Conduct (2017) (“Ethics Code”) provides guidance on boundary and relationship questions to guide Psychologists toward an ethical course of action. The Ethics Code states that relationships which give rise to the potential for exploitation or harm to the client, or those that impair objectivity in judgment, must be avoided.

Boundary crossing, if allowed to progress, may hurt both the therapist and the client.  The good news is that a consensus exists among professionals in the mental health community that there are boundary crossings which are unquestionably considered helpful and therapeutic to clients. However, with no straightforward formula to delineate between helpful boundaries and harmful or unhealthy boundaries, the resulting ‘grey area’ creates challenges for most psychologists. Examining the general public’s perception and understanding of what an unhealthy boundary crossing looks like may provide additional insight on the right ethical course of action, including the impact of boundary crossing on relationships on a case-by-case basis. 



Attaining and maintaining healthy boundaries is a goal that all psychologists should work toward while providing supportive therapy services to clients. Strong and consistent boundaries build trust and make therapy safe for both the client and the therapist. Building healthy boundaries not only promotes compliance with the Ethics Code, but also lets clients know you have their best interest in mind. In summation, while concerns for a client’s wellbeing can cloud judgement, the use of both the risk considerations above and the APA Ethical Principles of Psychologists and Code of Conduct, can assist in clarifying the boundary line and help provide a safe and therapeutic environment for all parties involved. 

A good risk management reminder for psychologists.

Friday, November 18, 2022

When Patients Become Colleagues

Charles C. Dike
Psychiatric News
Published Online:27 Oct 2022

Dr. Jones, a psychiatrist in private practice, described to me a conundrum she was trying to resolve. A patient she has been treating for eight years with psychotherapy and medication was recently certified as a therapist. The patient intends to terminate treatment with her and set up a private practice in the same district as the psychiatrist. The new therapist is asking for a collaborative relationship with the psychiatrist in which he would refer patients to the psychiatrist for medication management. The psychiatrist is not comfortable with the proposal and worries that her deep knowledge of her ex-patient’s flaws would negatively influence her view of the patient as a therapist. Most importantly, however, she is concerned about the risks of boundary violations and a breach in confidentiality, for example, when patients ask about the relationship between the psychiatrist and their referring therapist, as often happens.

The APA Ethics Committee has received questions about similar situations. One such question involved a patient who had received psychiatric treatment at an institution for years and was now applying to work as a clinician at the same institution a decade later. In this case, the Ethics Committee affirmed the need for psychiatrists “to support the concept that treatment matters and that people can recover and live full lives by addressing the challenges of mental illness. Psychiatrists should model that seeking treatment is a healthful and positive behavior and not a stigmatized act that will forever preclude a person, once a patient, from joining a team of respected mental health professionals. A history of mental health treatment should not be used to ban employment; a history of appropriate qualifications and pursuit of necessary medical treatment should be positive indicators for employment.”

Nonetheless, every such situation requires deep reflection to avoid potential ethics breaches. In some cases, the guidance is clear. For example, it is unethical for a psychiatrist in a solo private practice to employ a former patient because the pre-existing doctor-patient relationship is likely to influence the working relationship on both sides with potential negative consequences. In Dr. Jones’s case, however, the situation has ethics considerations that need to be addressed. Here is the advice that I gave to Dr. Jones: After celebrating her patient’s success, she should schedule a private meeting to discuss the contours of their new professional relationship. She should clarify that it would be a challenge to be his psychiatrist in the future should he suffer a relapse and need care. Further, Dr. Jones should point out that a personal relationship with a former patient could be unethical, especially if intimate, and therefore, all social interactions should be avoided as much as possible. When it is not possible to avoid them, they should carefully manage their interactions, social or professional, making sure boundaries are not breached. Dr. Jones should also discuss possible circumstances that could insinuate to others that she and the therapist had a prior treatment relationship as any such acknowledgment on her part would be a breach of her patient’s confidentiality. The fact that her former patient discloses their relationship to others does not absolve the psychiatrist of this ethical injunction. Such a discussion would prevent future problems and set the stage for the next chapter of their relationship.

Saturday, October 15, 2022

Boundary Issues of Concern

Charles Dike
Psychiatric News
Originally posted 25 AUG 22

Here is an excerpt:

There are, of course, less prominent but equally serious boundary violations other than sexual relations with patients or a patients’ relatives. The case of Dr. Jerome Oremland, a prominent California psychiatrist, is one example. According to a report by KQED on October 3, 2016, John Pierce, a patient, alleged that his psychiatrist, Dr. Oremland, induced Mr. Pierce to give him at least 12 works of highly valued art. The psychiatrist argued that the patient had consented to their business dealings and that the art he had received from the patient was given willingly as payment for psychiatric treatment. The patient further alleged that Dr. Oremland used many of their sessions to solicit art, propose financial schemes (including investments), and discuss other subjects unrelated to treatment. Furthermore, the patient allegedly made repairs in Dr. Oremland’s home, offices, and rental units; helped clear out the home of Dr. Oremland’s deceased brother; and cleaned his pool. Mr. Pierce began therapy with Dr. Oremland in 1984 but brought a lawsuit against him in 2015. The court trial began shortly after Dr. Oremland’s death in 2016, and Dr. Oremland’s estate eventually settled with Mr. Pierce. In addition to being a private practitioner, Dr. Oremland had been chief of psychiatry at the Children’s Hospital in San Francisco and a clinical professor of psychiatry at UCSF. He also wrote books on the intersection of art and psychology.


There are less dramatic but still problematic boundary crossings such as when a psychiatrist in private practice agrees that a patient may pay off treatment costs by doing some work for the psychiatrist. Other examples include a psychiatrist hiring a patient, for example, a skilled plumber, to work in the psychiatrist’s office or home at the patient’s going rate or obtaining investment tips from a successful investment banker patient. In these situations, questions arise about the physician-patient relationship. Even when the psychiatrist believes he or she is treating the patient fairly—such as paying the going rate for work done for the psychiatrist—the psychiatrist is clueless regarding how the patient is interpreting the arrangement: Does the patient experience it as exploitative? What are the patient’s unspoken expectations? What if the patient’s work in the psychiatrist’s office is inferior or the investment advice results in a loss? Would these outcomes influence the physician-patient relationship? Even compassionate acts such as writing off the bill of patients who are unable to pay or paying for an indigent patient’s medications should make the psychiatrist pause for thought. To avoid potential misinterpretation of the psychiatrist’s intentions or complaints of inequitable practices or favoritism, the psychiatrist should be ready to do the same for other indigent patients. It would be better to establish neutral policies for all indigent patients than to appear to favor some over others.

Tuesday, April 26, 2022

Ethical considerations for psychotherapists participating in Alcoholics Anonymous

Kohen, Casey B.,Conlin, William E.
Practice Innovations, Vol 7(1), Mar 2022, 40-52.


Because the demands of professional psychology can be taxing, psychotherapists are not immune to the development of mental health and substance use disorders. One estimate indicates that roughly 30% to 40% of psychologists know of a colleague with a current substance abuse problem (Good et al., 1995). Twelve-step mutual self-help groups, particularly Alcoholics Anonymous (AA), are the most widely used form of treatment for addiction in the United States. AA has empirically demonstrated effectiveness at fostering long-term treatment success and is widely accessible throughout the world. However, psychotherapist participation in AA raises a number of ethical concerns, particularly regarding the potential for extratherapy contact with clients and the development of multiple relationships. This article attempts to review the precarious ethical and practical situations that psychotherapists, either in long-term recovery or newly sober, may find themselves in during AA involvement. Moreover, this article provides suggestions for psychotherapists in AA regarding how to best adhere to both the principles of AA (i.e., the 12 steps and 12 traditions) and the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct

Here is an excerpt:

Recent literature regarding the use of AA or other mutual self-help groups by psychotherapists is scant, but earlier studies suggest its effectiveness. A 1986 survey of 108 members of Psychologists Helping Psychologists (a seemingly defunct support group exclusively for substance dependent doctoral-level psychologists and students) shows that of the 94% of respondents maintaining abstinence, 86% attended AA (Thoreson et al., 1986). A separate study of 70 psychologists in recovery who were members of AA revealed the majority attained sobriety outside of formal treatment or intervention programs (Skorina et al., 1990). 

Because AA appears to be a vital resource for psychotherapists struggling with substance misuse, it is important to consider how to address ethical dilemmas that one might encounter while participating in AA.


Psychotherapists participating in AA may, at times, find that their professional responsibility of adhering to the APA Code of Ethics hinders some aspects of their categorical involvement in AA as defined by AA’s 12 steps and 12 traditions. The psychotherapist in AA may need to adjust their personal AA “program” in comparison with the typical AA member in a manner that attempts to meet the requirements of the profession yet still provides them with enough support to maintain their professional competence. This article discusses reasonable compromises, specifically tailored to the length of the psychotherapist’s sobriety, that minimize the potential for client harm. Ultimately, if the psychotherapist is unable to find an appropriate middle-ground, where the personal needs of recovery can be met without damaging client welfare and respecting the client’s rights, the psychotherapist should refer the client elsewhere. With these recommendations, psychotherapists should feel more comfortable participating in AA (or other mutual self-help groups) while also adhering to the ethical principles of our profession.

Friday, November 19, 2021

Biological Essentialism Correlates with (But Doesn’t Cause?) Intergroup Bias

Bailey, A., & Knobe, J. 
(2021, September 17).


People with biological essentialist beliefs about social groups also tend to endorse biased beliefs about individuals in those groups, including stereotypes, prejudices, and intensified emphasis on the group. These correlations could be due to biological essentialism causing bias, and some experimental studies support this causal direction. Given this prior work, we expected to find that biological essentialism would lead to increased bias compared to a control condition and set out to extend this prior work in a new direction (regarding “value-based” essentialism). But although the manipulation affected essentialist beliefs and essentialist beliefs were correlated with stereotyping (Studies 1, 2a, and 2b), prejudice (Studies 2a), and group emphasis (Study 3), there was no evidence that biological essentialism caused these outcomes. Given these findings, our initial research question became moot, and the present work focuses on reexamining the relationship between essentialism and bias. We discuss possible moderators, reverse causation, and third variables.

General Discussion

The present studies examined the relationship between biological essentialism and intergroup bias. As in prior work, we found that essentialist beliefs were correlated positively with stereotyping, including negative stereotyping, as well as group boundary intensification.  This positive relationship was found for essentialist thinking more generally (Studies 1, 2a, 2b, and 3) as well as specific beliefs in a biological essence (Studies 1, 2a, and 3). (New to this research, we also found similar positive correlations with beliefs in a value-based essence.) The internal meta-analysis for stereotyping confirmed a small but consistent positive relationship. Findings for prejudice were more mixed across studies consistent with more mixed findings in the prior literature even for correlational effects, but the internal meta-analysis indicated a small relationship between greater biological essentialism and less negative feelings toward the group(as in, e.g., Haslam & Levy, 2006, but see, Chen & Ratliff, 2018). 

Before conducting this research and based on the previous literature, we assumed that these correlational relationships would be due to essentialism causing intergroup bias. But although our experimental manipulations worked as designed to shift essentialist beliefs, there was no evidence that biological essentialism caused stereotyping, prejudice, or group boundary intensification.  The present studies thus suggest that a straightforward causal effect of essentialism on intergroup bias may be weaker or more complex than often described.

Monday, August 16, 2021

Therapist Targeted Googling: Characteristics and Consequences for the Therapeutic Relationship

Cox, K. E., Simonds, L. M., & Moulton-Perkins, A. 
(2021).  Professional Psychology: 
Research and Practice. Advance online publication. 


Therapist-targeted googling (TTG) refers to a patient searching online to find information about their therapist. The present study investigated TTG prevalence and characteristics in a sample of adult psychotherapy clients. Participants (n = 266) who had attended at least one session with a therapist completed an anonymous online survey about TTG prevalence, motivations, and perceived impact on the therapeutic relationship. Two-thirds of the sample had conducted TTG. Those participants who were having therapy privately had worked with more than one therapist, or were having sessions more often than weekly were significantly more likely to conduct TTG; this profile was particularly common among patients who were having psychodynamic psychotherapy. Motivations included wanting to see if the therapist is qualified, curiosity, missing the therapist, and wanting to know them better. Nearly a quarter who undertook TTG thought the findings impacted the therapeutic relationship but only one in five had disclosed TTG to the therapist. TTG beyond common sense consumerism can be conceptualized as a patient’s attempt to attain closeness to the therapist but may result in impacts on trust and ability to be open. Disclosures of TTG may constitute important therapeutic material. 

Impact Statement

This study suggests that there are multiple motivations for clients searching online for information about their therapist. It highlights the need for practitioners to carefully consider the information available about them online and the importance of client searching to the therapeutic relationship.

Here is the conclusion:

In this study, most participants searched for information about their therapist. Curiosity and commonsense consumerism might explain much of this activity. We argue that there is evidence that some of this might be motivated by moments of vulnerability between sessions to regain a connection with the therapist. We also suggest that the discovery of challenging information during vulnerability might represent difficulties for the patient that are not disclosed to the therapist due to feelings of guilt and shame. Further work is needed to understand TTG, the implications on the therapeutic relationship, and how therapists work with disclosures of TTG in a way that does not provoke more shame in the patient, but which also allows therapists to effectively manage therapeutic closeness and their own vulnerability.

Sunday, January 10, 2021

Doctors Dating Patients: Love, Actually?

Shelly Reese
Originally posted 10 Dec 20

Here is an excerpt:

Not surprisingly, those who have seen such relationships end in messy, contentious divorces or who know stories of punitive actions are stridently opposed to the idea. "Never! Grounds for losing your license"; "it could only result in trouble"; "better to keep this absolute"; "you're asking for a horror story," wrote four male physicians.

Although doctor-patient romances don't frequently come to the attention of medical boards or courts until they have soured, even "happy ending" relationships may come at a cost. For example, in 2017, the Iowa Board of Medicine fined an orthopedic surgeon $5000 and ordered him to complete a professional boundaries program because he became involved with a patient while or soon after providing care, despite the fact that the couple had subsequently married.

Ethics aside, "this is a very dangerous situation, socially and professionally," writes a male physician in Pennsylvania. A New York physician agreed: "Many of my colleagues marry their patients, even after they do surgery on them. It's a sticky situation."

Doctors' Attitudes Are Shifting

The American Medical Association clearly states that sexual contact that is concurrent with the doctor/patient relationship constitutes sexual misconduct and that even a romance with a former patient "may be unduly influenced by the previous physician-patient relationship."

Although doctors' attitudes on the subject are evolving, that's not to say they suddenly believe they can start asking their patients out to dinner. Very few doctors (2%) condone romantic relationships with existing patients — a percentage that has remained largely unchanged over the past 10 years. Instead, physicians are taking a more nuanced approach to the issue.

Monday, December 21, 2020

Physicians' Ethics Change With Societal Trends

Batya S. Yasgur
Originally posted 23 Nov 20

Here is an excerpt:

Are Romantic Relationships With Patients Always Off Limits?

Medscape asked physicians whether it was acceptable to become romantically or sexually involved with a patient. Compared to 2010, in 2020, many more respondents were comfortable with having a relationship with a former patient after 6 months had elapsed. In 2020, 2% said they were comfortable having a romance with a current patient; 26% were comfortable being romantic with a person who had stopped being a patient 6 months earlier, but 62% said flat-out 'no' to the concept. In 2010, 83% said "no" to the idea of dating a patient; fewer than 1% agreed that dating a current patient was acceptable, and 12% said it was okay after 6 months.

Some respondents felt strongly that romantic or sexual involvement is always off limits, even months or years after the physician is no longer treating the patient. "Once a patient, always a patient," wrote a psychiatrist.

On the other hand, many respondents thought being a "patient" was not a lifelong status. An orthopedic surgeon wrote, "After 6 months, they are no longer your patient." Several respondents said involvement was okay if the physician stopped treating the patient and referred the patient to another provider. Others recommended a longer wait time.

"Although most doctors have traditionally kept their personal and professional lives separate, they are no longer as bothered by bending of boundaries and have found a zone of acceptability in the 6-month waiting period," Goodman said.

Packer added that the "greater relaxation of sexual standards and boundaries in general" might have had a bearing on survey responses because "doctors are part of those changing societal norms."

Evans suggested that the rise of individualism and autonomy partially accounts for the changing attitudes toward physician-patient (or former patient) relationships. "Being prohibited from having a relationship with a patient or former patient is increasingly being seen as an infringement on civil liberties and autonomy, which is a major theme these days."

Thursday, November 26, 2020

Oncologist Pays for Patient's Meds: A 'Boundary' Crossed?

Nic Mulcahy
Originally posted 4 Nov 20

It was an act of kindness: while overseeing a patient through a round of chemotherapy, an oncology fellow at Johns Hopkins University's Kimmel Comprehensive Cancer Center in Baltimore, Maryland, paid a modest amount of money (about $10) for that patient's antiemetic medication and retrieved it from the center's pharmacy.

Co-fellow Arjun Gupta, MD, witnessed the act and shared it with the world September 23 on Twitter.

"Just observed a co-fellow pay the co-pay for a patient's post-chemo nausea meds at the pharmacy, arrange them in a pill box, and deliver them to the patient in the infusion center. So that the patient could just leave after chemo."

Healthcare professionals applauded the generosity. "Phenomenal care," tweeted Carolyn Alexander, MD, a fertility physician in Los Angeles.

It's a common occurrence, said others. "Go ask a nurse how many times they've done it. I see it happen weekly," tweeted Chelsea Mitchell, PharmD, an intensive care unit pharmacist in Memphis, Tennessee.

Lack of universal healthcare brings about these moments, claimed multiple professionals who read Gupta's anecdote. "#ThisIsDoctoring. This is also a shameful indictment of our medical system," said Mary Landrigan-Ossar, MD, an anesthesiologist at Children's Hospital, Boston, Massachusetts.

However, one observer called out something no one else had ― that paying for a patient's medication is not allowed in some facilities.

Monday, November 23, 2020

Ethical & Legal Considerations of Patients Audio Recording, Videotaping, & Broadcasting Clinical Encounters

Ferguson BD, Angelos P. 
JAMA Surg. 
Published online October 21, 2020. 

Given the increased availability of smartphones and other devices capable of capturing audio and video, it has become increasingly easy for patients to record medical encounters. This behavior can occur overtly, with or without the physician’s express consent, or covertly, without the physician’s knowledge or consent. The following hypothetical cases demonstrate specific scenarios in which physicians have been recorded during patient care.

A patient has come to your clinic seeking a second opinion. She was recently treated for cholangiocarcinoma at another hospital. During her postoperative course, major complications occurred that required a prolonged index admission and several interventional procedures. She is frustrated with the protracted management of her complications. In your review of her records, it becomes evident that her operation may not have been indicated; moreover, it appears that gross disease was left in situ owing to the difficulty of the operation. You eventually recognize that she was never informed of the intraoperative findings and final pathology report. During your conversation, you notice that her husband opens an audio recording app on his phone and places it face up on the desk to document your conversation.


From the Discussion

Each of these cases differs, yet each reflects the general issue of patients recording interactions with their physicians. In the following discussion, we explore a number of ethical and legal considerations raised by such cases and offer suggestions for ways physicians might best navigate these complex situations.

These cases illustrate potentially difficult patient interactions—the first, a delicate conversation involving surgical error; the second, ongoing management of a life-threatening postoperative complication; and the third, a straightforward bedside procedure involving unintended bystanders. When audio or video recording is introduced in clinical encounters, the complexity of these situations can be magnified. It is sometimes challenging to balance a patient’s need to document a physician encounter with the desire for the physician to maintain the patient-physician relationship. Patient autonomy depends on the fidelity with which information is transferred from physician to patient. 

In many cases, patients record encounters to ensure well-informed decision making and therefore to preserve autonomy. In others, patients may have ulterior motives for recording an encounter.

Monday, July 20, 2020

Seven Tips for Maintaining the Frame in Online Therapy

Clifford Arnold & Thomas Franklin
Psychiatric News
Originally published 25 June 20

While we are in the midst of a pandemic, teleconferencing technology can be a source of both stability and insecurity in the therapeutic relationship; on the one hand, it confers the near-miraculous ability to remain connected at a safe distance, while on the other hand it upends the basic conditions under which therapy takes place, like simply being in the same room together.

When striving for continuity in the transition from in-person to online therapy, a possible pitfall is to conserve the verbal elements of therapy and ignore the rest. This is counterproductive since the nonverbal aspects of therapy have an arguably greater impact on patients, and without them words can be ineffectual. The set of nonverbal conditions that engender trust, confidence, and security in patients and allow the words of therapy to be effective is called the therapeutic frame. The following tips are meant to help maintain the therapeutic frame during this precarious time, specifically in the transition from the office to the screen.

1. Create some distance: One way to preserve a familiar and comfortable frame is to observe personal space online as one would in the office. It would feel awkward, intrusive, and exhausting to sit four feet away from a patient and stare directly into her face for an hour straight in the office, yet we do that regularly online. Perhaps we are compensating for feeling distant in other ways or perhaps we simply can’t see or hear very well. It’s ok to back up, and some technological modifications can help (see tip #3). The extra space might allow both parties to feel less self-conscious and more at ease, less focused on maintaining a perfect affect and more on the therapy.

2. Body language matters: Here’s another reason to back off the camera a bit: Expanding the field of vision to include not just facial expressions but also upper-body language (for example, hand gestures, posture, distance modulation) has been shown to increase empathy measures, according to David T. Nguyen and John Canny in the article “More Than Face-to-Face: Empathy Effects of Video Framing.” Experiment with this. Sit back, expand the visual frame, move, and gesture as you would in person—find what feels connective and go with it. In addition to camera distance, the angle matters too; if the lens is positioned at a height lower than your eyes it may appear to your patients that you are looking down on them. Stack some books under your monitor to avoid the impression of being overbearing or aloof.

The info is here.

Wednesday, July 1, 2020

Unusual Legal Case: Small Social Circles, Boundaries, and Harm

This legal case shows how much our social circles interrelate and how easily boundaries can be violated.  If you ever believe that you are safe from boundary violations in a current, complex culture, you may want to rethink this position.  A lesson for all in this legal case.  I will excerpt a fascinating portion of this case.

Roetzel and Andres
Originally posted 10 June 20

Possible Employer Vicarious Liability For Employee’s HIPAA Violation Even When Employee Engages In Unauthorized Act

Here is the excerpt:

When the plaintiff came in for her appointment, she handed the Parkview employee a filled-out patient information sheet. The employee then spent about one-minute inputting that information onto Parkview’s electronic health record. The employee recognized the plaintiff’s name as someone who had liked a photo of the employee’s husband on his Facebook account. Suspecting that the plaintiff might have had, or was then having, an affair with her husband, the employee sent some texts to her husband relating to the fact the plaintiff was a Parkview patient. Her texts included information from the patient chart that the employee had created from the patient’s information sheet, such as the patient’s name, her position as a dispatcher, and the underlying reasons for the plaintiff’s visit to the OB/Gyn. Even though such information was not included on the chart, the employee also texted that the plaintiff was HIV-positive and had had more than fifty sexual partners. While using the husband’s phone, the husband’s sister saw the texts. The sister then reported the texts to Parkview. Upon receipt of the sister’s report, Parkview initiated an investigation into the employee’s conduct and ultimately terminated the employee. As part of that investigation, Parkview notified the plaintiff of the disclosure of her protected health information.

The info is here.

Friday, April 24, 2020

Sexual attractions, behaviors, and boundary crossings between sport psychology professionals and their athlete-clients

Tess Palmateer & Trent Petrie
Journal of Applied Sport Psychology 


Participants were 181 sport performance professionals (SPPs); 92 reported being sexually attracted to their athlete-clients (ACs), though few SPPs sought supervision regarding such attractions. In regards to specific behaviors, approximately half reported discussing personal matters unrelated to their work, whereas far fewer had engaged in sexual behaviors with their ACs, such as discussing sexual matters unrelated to their work, and caressing or intimately touching an AC. Common nonsexual boundary crossings (NSBCs) included consulting with an AC in public places, working with an AC at practice, and working with an AC at a competition. Sexual attractions exist and NSBCs occur, thus SPPs need to be trained in these issues to be able to successfully navigate them.

Lay summary: About half of the sport psychology professionals (SPPs) reported being sexually attracted to an athlete-client (AC). Typical boundary crossings included: consulting with an AC in public and private places and travelling with ACs. Therefore SPPs’ should be ethically trained and seek supervision to effectively work with such attractions.

Thursday, November 21, 2019

Memphis psychiatrist who used riding crop on patients now faces new charges

Brett Kelman
Nashville Tennessean
Originally published October 27, 2019

Here are two excerpts:

A Memphis-area psychiatrist whose license was suspended last year for using a riding crop on patients could now lose her license again due to an ongoing dispute with state health licensing officials.

Dr. Valerie Augustus, who runs Christian Psychiatric Services in the suburb of Germantown, was forced to close her clinic last June after a medical discipline trial proved to the Tennessee Board of Medical Examiners that she had used a riding crop or a whip on at least 10 patients. The clinic was permitted to re-open six months later after Augustus agreed to professional probation, but she continued to fight the case in court.


Augustus, 57, ran her clinic for 17 years without any discipline issues before her license was suspended last year. A board order states that, in addition to using the whip and riding crop on patients, Augustus kept the items “displayed in her office” and “compared her patients to mules.”

The government’s attorney, Paetria Morgan, argued at the medical discipline trial that Augustus hit her patients if they did not lose weight or exercise. In addition to the whip and riding crop, Morgan alleged Augustus hit patients with a “four-foot stick of bamboo.”

“Her defense is that she hit them in jest,” Morgan said. “When did hitting become funny? Hitting isn’t hilarious. Hitting isn’t helpful. Hitting isn’t healing.”

The info is here.

Tuesday, October 1, 2019

The Moral Rot of the MIT Media Lab

Image result for mit media labJustin Peters
Originally published September 8, 2019

Here is an excerpt:

I made my final emotional break with the Media Lab in 2016, when its now-disgraced former director Joi Ito announced the launch of its inaugural “Disobedience Award,” which sought to celebrate “responsible, ethical disobedience aimed at challenging the norms, rules, or laws that sustain society’s injustices” and which was “made possible through the generosity of Reid Hoffman, Internet entrepreneur, co-founder and executive chairman of LinkedIn, and most importantly an individual who cares deeply about righting society’s wrongs.” I realized that the things I had once found so exciting about the Media Lab—the architecturally distinct building, the quirky research teams, the robots and the canisters and the exhibits—amounted to a shrewd act of merchandising intended to lure potential donors into cutting ever-larger checks. The lab’s leaders weren’t averse to making the world a better place, just as long as the sponsors got what they wanted in the process.

It is this moral vacuity that has now thrown the Media Lab and MIT into an existential crisis. After the financier Jeffrey Epstein was arrested in July on federal sex-trafficking charges, journalists soon learned that Epstein enjoyed giving money to scientists almost as much as he enjoyed coercing girls into sex. The Media Lab was one beneficiary of Epstein’s largesse. Over the past several years, Ito accepted approximately $1.725 million from Epstein, who was already a convicted felon at the time Ito took charge of the place in 2011; $525,000 was earmarked for the lab, while the rest of the money went to Ito’s private startup investment funds. The New Yorker’s Ronan Farrow further reported on Friday that Epstein helped secure an additional $7.5 million for the Media Lab from other wealthy donors, and that the lab sought to hide the extent of its relationship with Epstein. Ito was Epstein’s contact at the Media Lab. The director even visited Epstein’s private Caribbean island as part of the courtship process.

The info is here.

Friday, August 2, 2019

Therapist accused of sending client photos of herself in lingerie can’t get her state license back: Pa. court

Matt Miller
Originally posted July 17, 2019

A therapist who was accused of sending a patient photos of herself in lingerie can’t have her state counseling license back, a Commonwealth Court panel ruled Wednesday.

That is so even though Sheri Colston denied sending those photos or having any inappropriate interactions with the male client, the court found in an opinion by Judge Robert Simpson.

The court ruling upholds an indefinite suspension of Colston’s license imposed by the State Board of Social Workers, Marriage and Family Therapists and Professional Counselors. That board also ordered Colston to pay $7,409 to cover the cost of investigating her case.

The info is here.

Wednesday, June 5, 2019

Ethics questions about President Trump's transportation secretary surface for second week in a row

Matthew Rozsa
Originally posted June 3, 2019

Here is an excerpt:

After ethics questions were referred to officials in the State and Treasury Departments, and media outlets like Times began to look into Chao's unusual travel requests, the trip was cancelled.

"She had these relatives who were fairly wealthy and connected to the shipping industry. Their business interests were potentially affected by meetings," a State Department official, who was involved in deliberations pertaining to the meetings, told the Times. Another State Department official, David Rank, told the Times the requests were "alarmingly inappropriate."

Chao's family runs an American shipping company, the Foremost Group, which is connected to China's political and economic ruling class, since it conducts most of its business there. As a result, allowing family members to participate in sensitive meetings — especially considering that Chao's actions as transportation secretary could directly impact America's shipping industry, and goes to the heart of the U.S.-China trade policies being handled by the Trump administration — poses a major conflict of interest.

The info is here.

Tuesday, May 21, 2019

Bergen County psychologist charged with repeated sexual assaults of a child

Joe Brandt
Originally posted April 18, 2019

A psychologist whose business works with children was charged Wednesday with multiple sexual assaults of a child under 13 years old.

Lorenzo Puertas, 78, faces two counts of sexual assault and one count of endangering the welfare of a child, Bergen County Prosecutor Dennis Calo announced Thursday.

Puertas, of Franklin Lakes, served as executive director of Psych-Ed Services, which has offices in Franklin Lakes and in Lakewood. The health provider officers bilingual psychological services including pre-employment psych screenings and child study team evaluations.

The info is here.

Monday, January 7, 2019

Ethics of missionary work called into question after death of American missionary John Allen Chau

Holly Meyer
Nashville Tennessean
Originally published December 2, 2018

Christians are facing scrutiny for evangelizing in remote parts of the world after members of an isolated tribe in the Bay of Bengal killed a U.S. missionary who was trying to tell them about Jesus.

The death of John Allen Chau raises questions about the ethics of missionary work and whether he acted appropriately by contacting the Sentinelese, a self-sequestered Indian tribe that has resisted outside contact for thousands of years.

It is tragic, but figuring out what can be learned from Chau's death honors his memory and passion, said Scott Harris, the missions minister at Brentwood Baptist Church and a former trustee chairman of the Southern Baptist Convention's International Mission Board.

"In general, evaluation and accountability is so needed," Harris said. "Maturing fieldworkers that have a heart for the cultures of the world will welcome honest, hard questions." 

The info is here.