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 Conflicts of Interest. Show all posts
Showing posts with label Conflicts of Interest. Show all posts

Wednesday, May 3, 2023

Advocates of high court reform give Roberts poor marks

Kelsey Reichmann
Courthouse News Service
Originally published 27 April 23

The final straw for ethics experts wondering if the leader of one of the nation’s most powerful bodies would uphold the institutionalist views associated with his image came on Tuesday as Chief Justice John Roberts declined to testify before Congress about ethical concerns at the Supreme Court. 

“You can't actually have checks and balances if one branch is so powerful that the other branches cannot, in fact, engage in their constitutionally mandated role to provide a check on inappropriate or illegal behavior,” Caroline Fredrickson, a distinguished visitor from practice at Georgetown Law, said in a phone interview. “Then we have a defective system.” 

Roberts cited concerns about separation of powers as the basis for declining to testify before the Senate Judiciary Committee on the court’s ethical standards — or lack thereof. Fredrickson said it was a canard that a system based on checks and balances would not be able to do just that. 

“It sort of puts the question to the entire structure of separation of powers and checks and balances,” Fredrickson said. 

For the past several weeks, one of the associate justices has been at the heart of controversy. After blockbuster reporting revealed that Republican megadonor Harlan Crow has footed the bill for decades of luxury vacations enjoyed by Justice Clarence Thomas, the revelations brought scrutiny on the disclosure laws that bind the justices and it called into question why the justices are not bound by ethics standards like the rest of the judiciary and other branches of government.

“For it to function, it relies on the public trust, and the trust of the other institutions to abide by the court's findings,” Virginia Canter, chief ethics counsel at Citizens for Responsibility and Ethics in Washington, said in a phone call. “If the court and its members are willing to live without any standards, then I think that ultimately the whole process and the institution start to unravel.” 

Many court watchers saw opportunity for action here on a call that has been made for years: the adoption of an ethics code.

“The idea that the Supreme Court would continue to operate without one, it's just ridiculous,” Gabe Roth, executive director of Fix the Court, said in a phone call. 

Along with his letter declining to testify before Congress on the court’s ethics, Roberts included a statement listing principles and practices the court “subscribes” to. The statement was signed by all nine justices. 

For ethics experts raising alarm bells on this subject, a restatement of guidelines that the justices are already supposed to follow did not meet the moment.

“It's just a random — in my view at least — conglomeration of paragraphs that rehash things you already knew, but, yeah, good for him for getting all nine justices on board with something that already exists,” Roth said. 

Tuesday, January 31, 2023

Why VIP Services Are Ethically Indefensible in Health Care

Denisse Rojas Marquez and Hazel Lever
AMA J Ethics. 2023;25(1):E66-71.
doi: 10.1001/amajethics.2023.66.

Abstract

Many health care centers make so-called VIP services available to “very important persons” who have the ability to pay. This article discusses common services (eg, concierge primary care, boutique hotel-style hospital stays) offered to VIPs in health care centers and interrogates “trickle down” economic effects, including the exacerbation of inequity in access to health services and the maldistribution of resources in vulnerable communities. This article also illuminates how VIP care contributes to multitiered health service delivery streams that constitute de facto racial segregation and influence clinicians’ conceptions of what patients deserve from them in health care settings.

Insurance and Influence

It is common practice for health care centers to make “very important person” (VIP) services available to patients because of their status, wealth, or influence. Some delivery models justify the practice of VIP health care as a means to help offset the cost of less profitable sectors of care, which often involve patients who have low income, are uninsured, and are from historically marginalized communities.1 In this article, we explore the justification of VIP health care as helping finance services for patients with low income and consider if this “trickle down” rationale is valid and whether it should be regarded as acceptable. We then discuss clinicians’ ethical responsibilities when taking part in this system of care.

We use the term VIP health care to refer to services that exceed those offered or available to a general patient population through typical health insurance. These services can include concierge primary care (also called boutique or retainer-based medicine) available to those who pay out of pocket, stays on exclusive hospital floors with luxury accommodations, or other premium-level health care services.1 Take the example of a patient who receives treatment on the “VIP floor” of a hospital, where she receives a private room, chef-prepared food, and attending physician-only services. In the outpatient setting, the hallmarks of VIP service are short waiting times, prompt referrals, and round-the-clock staffing.

While this model of “paying for more” is well accepted in other industries, health care is a unique commodity, with different distributional consequences than markets for other goods (eg, accessing it can be a matter of life or death and it is deemed a human right under the Alma-Ata Declaration2). The existence of VIP health care creates several dilemmas: (1) the reinforcement of existing social inequities, particularly racism and classism, through unequal tiers of care; (2) the maldistribution of resources in a resource-limited setting; (3) the fallacy of financing care of the underserved with care of the overserved in a profit-motivated system.

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Conclusion

VIP health care, while potentially more profitable than traditional health care delivery, has not been shown to produce better health outcomes and may distribute resources away from patients with low incomes and patients of color. A system in which wealthy patients are perceived to be the financial engine for the care of patients with low incomes can fuel distorted ideas of who deserves care, who will provide care, and how expeditiously care will be provided. To allow VIP health care to exist condones the notion that some people—namely, wealthy White people—deserve more care sooner and that their well-being matters more. When health institutions allow VIP care to flourish, they go against the ideal of providing equitable care to all, a value often named in organizational mission statements.22 At a time when pervasive distrust in the medical system has fueled negative consequences for communities of color, it is our responsibility as practitioners to restore and build trust with the most vulnerable in our health care system. When evaluating how VIP care fits into our health care system, we should let health equity be a moral compass for creating a more ethical system.

Thursday, January 5, 2023

The Supreme Court Needs Real Oversight

Glen Fine
The Atlantic
Originally posted 5 DEC 22

Here is an excerpt:

The lack of ethical rules that bind the Court is the first problem—and the easier one to address. The Code of Conduct for United States Judges, promulgated by the federal courts’ Judicial Conference, “prescribes ethical norms for federal judges as a means to preserve the actual and apparent integrity of the federal judiciary.” The code covers judicial conduct both on and off the bench, including requirements that judges act at all times to promote public confidence in the integrity and impartiality of the judiciary. But this code applies only to lower-level federal judges, not to the Supreme Court, which has not issued ethical rules that apply to its own conduct. The Court should explicitly adopt this code or a modified one.

Chief Justice Roberts has noted that Supreme Court justices voluntarily consult the Code of Conduct and other ethical rules for guidance. He has also pointed out that the justices can seek ethical advice from a variety of sources, including the Court’s Legal Office, the Judicial Conference’s Committee on Codes of Conduct, and their colleagues. But this is voluntary, and each justice decides independently whether and how ethical rules apply in any particular case. No one—including the chief justice—has the ability to alter a justice’s self-judgment.

Oversight of the judiciary is a more difficult issue, involving separation-of-powers concerns. I was the inspector general of the Department of Justice for 11 years and the acting inspector general of the Department of Defense for four years; I saw the importance and challenges of oversight in two of the most important government agencies. I also experienced the difficulties in conducting complex investigations of alleged misconduct, including leak investigations. But as I wrote in a Brookings Institution article this past May after the Dobbs leak, the Supreme Court does not have the internal capacity to effectively investigate such leaks, and it would benefit from a skilled internal investigator, like an inspector general, to help oversee the Court and the judiciary.

Another example of the Court’s ineffective self-policing and lack of transparency involves its recusal decisions. For example, Justice Thomas’s wife, Virginia Thomas, has argued that the 2020 presidential election was stolen, sent text messages to former White House Chief of Staff Mark Meadows urging him and the White House to seek to overturn the election, and expressed support for the pro-Trump January 6 rally on the Ellipse. Nevertheless, Justice Thomas has not recused himself in cases relating to the subsequent attack on the Capitol.

Notably, Thomas was the only justice to dissent from the Court’s decision not to block the release to the January 6 committee of White House records related to the attack, which included his wife’s texts. Some legal experts have argued that this is a clear instance where recusal should have occurred. Statute 28 U.S.C. 455 requires federal judges, including Supreme Court justices, to recuse themselves from a case when they know that their spouse has any interest that could be substantially affected by the outcome. In addition, the statute requires justices and judges to disqualify themselves in any proceeding in which their impartiality may reasonably be questioned.

Tuesday, November 29, 2022

The Supreme Court has lost its ethical compass. Can it find one fast?

Ruth Marcus
The Washington Post
Originally published 23 Nov 22

The Supreme Court must get its ethics act together, and Chief Justice John G. Roberts Jr. needs to take the lead. After a string of embarrassments, the justices should finally subject themselves to the kind of rules that govern other federal judges and establish a standard for when to step aside from cases — one that is more stringent than simply leaving it up to the individual justice to decide.

Recent episodes are alarming and underscore the need for quick action to help restore confidence in the institution.

Last week, the Supreme Court wisely rebuffed an effort by Arizona GOP chair Kelli Ward to prevent the House Jan. 6 committee — the party in this case — from obtaining her phone records. The court’s brief order noted that Justice Clarence Thomas, along with Justice Samuel A. Alito Jr., would have sided with Ward.

Thomas’s involvement, though it didn’t affect the outcome of the dispute, is nothing short of outrageous. Federal law already requires judges, including Supreme Court justices, to step aside from involvement in any case in which their impartiality “might reasonably be questioned.”

Perhaps back in January, when he was the only justice to disagree when the court refused to grant former president Donald Trump’s bid to stop his records from being turned over to the Jan. 6 committee, Thomas didn’t realize the extent of his wife’s involvement with disputing the election results. (I’m being kind here: Ginni Thomas had signed a letter the previous month calling on House Republicans to expel Reps. Liz Cheney of Wyoming and Adam Kinzinger of Illinois from the House Republican Conference for participating in an “overtly partisan political persecution.”)

But here’s what we know now, and Justice Thomas does, too: The Jan 6. committee has subpoenaed and interviewed his wife. We — and he — know that she contacted 29 Arizona lawmakers, urging them to “fight back against fraud” and choose a “clean slate of electors” after the 2020 election.

Some recusal questions are close. Not this one. Did the chief justice urge Thomas to recuse? He should have. This will sound unthinkable, but if Roberts asked and Thomas refused, maybe it’s time the chief, or other justices, to publicly note their disagreement.

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One obvious step is to follow the ethics rules that apply to other federal judges, perhaps adapting them to the particular needs of the high court. That would send an important — and overdue — message that the justices are not a law unto themselves. It’s symbolic, but symbolism matters.

Thursday, August 25, 2022

South Dakota Governor Kristi Noem may have "engaged in misconduct," ethics board says

CBS News
Originally posted 23 AUG 22

A South Dakota ethics board on Monday said it found sufficient information that Gov. Kristi Noem may have "engaged in misconduct" when she intervened in her daughter's application for a real estate appraiser license, and it referred a separate complaint over her state airplane use to the state's attorney general for investigation.

The three retired judges on the Government Accountability Board determined that "appropriate action" could be taken against Noem for her role in her daughter's appraiser licensure, though it didn't specify the action.

The board's moves potentially escalate the ramifications of investigations into Noem. The Republican governor faces reelection this year and has also positioned herself as an aspirant to the White House in 2024. She is under scrutiny from the board after Jason Ravnsborg, the state's former Republican attorney general, filed complaints that stemmed from media reports on Noem's actions in office. She has denied any wrongdoing.

After meeting in a closed-door session for one hour Monday, the board voted unanimously to invoke procedures that allow for a contested case hearing to give Noem a chance to publicly defend herself against allegations of "misconduct" related to "conflicts of interest" and "malfeasance." The board also dismissed Ravnsborg's allegations that Noem misused state funds in the episode.

However, the retired judges left it unclear how they will proceed. Lori Wilbur, the board chair, said the complaint was "partially dismissed and partially closed," but added that the complaint could be reopened. She declined to discuss what would cause the board to reopen the complaint.

Thursday, March 31, 2022

Democrats push for Supreme Court ethics code following Ginni Thomas revelations

Lauren Fedor 
The Financial Times
Originally published 29 MAR 22

Senior Democratic lawmakers are increasing calls to create a code of ethical conduct for the US Supreme Court amid mounting scrutiny of associate justice Clarence Thomas and his wife, Virginia “Ginni” Thomas.

Chris Murphy and Amy Klobuchar, Democratic senators from Connecticut and Minnesota, respectively, and Hank Johnson, a Democratic representative from Georgia, have made a renewed push for the Supreme Court Ethics Act, a piece of legislation first introduced last summer to create a code of ethical conduct for America’s highest court.

Unlike other federal judges, Supreme Court justices are not required to follow the existing code of conduct.

The lawmakers said in a joint statement on Tuesday: “Recent revelations regarding the political activities of Supreme Court justices and their spouses have increased scrutiny of the court and eroded public confidence in the institution.”

The Washington Post first reported last week the existence of almost 30 text messages exchanged between Ginni Thomas, a conservative activist, and Mark Meadows, the former Republican congressman who served as Donald Trump’s final chief of staff, in late 2020 and early 2021.

The texts showed Ginni Thomas repeatedly espousing conspiracy theories and pushing Meadows to overturn the results of the 2020 presidential election.

The publication of the messages has raised fresh questions about the independence of the federal judiciary and led several Democratic lawmakers to call for Thomas to recuse himself from cases relating to the 2020 election and the January 6 2021 attack on the US Capitol. Earlier this month, Ginni Thomas revealed in an interview that she had attended the “Stop the Steal” rally on January 6.


Editor's Note: As a professional organization and highest court in the land, why does the Supreme Court not have a code of ethics?  More than slightly disturbing.

Wednesday, February 9, 2022

How FDA Failures Contributed to the Opioid Crisis

Andrew Kolodny, MD
AMA J Ethics. 2020;22(8):E743-750. 
doi: 10.1001/amajethics.2020.743.

Abstract

Over the past 25 years, pharmaceutical companies deceptively promoted opioid use in ways that were often neither safe nor effective, contributing to unprecedented increases in prescribing, opioid use disorder, and deaths by overdose. This article explores regulatory mistakes made by the US Food and Drug Administration (FDA) in approving and labeling new analgesics. By understanding and correcting these mistakes, future public health crises caused by improper pharmaceutical marketing might be prevented.

Introduction

In the United States, opioid use disorder (OUD) and opioid overdose were once rare. But over the past 25 years, the number of Americans suffering from OUD increased exponentially and in parallel with an unprecedented increase in opioid prescribing. Today, OUD is common, especially in patients with chronic pain treated with opioid analgesics, and opioid overdose is the leading cause of accidental death.

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Oversight Recommendations

While fewer clinicians are initiating long-term opioids, overprescribing is still a problem. According to a recently published report, more than 2.9 million people initiated opioid use in December 2017. The FDA’s continued approval of new opioids exacerbates this problem. Each time a branded opioid hits the market, the company, eager for return on its investment, is given an incentive and, in essence, a license to promote aggressive prescribing. The FDA’s continued approval of new opioids pits the financial interests of drug companies against city, state, and federal efforts to discourage initiation of long-term opioids.

To finally end the opioid crisis, the FDA must enforce the Food, Drug, and Cosmetic Act, and it must act on recommendations from the NAS for an overhaul of its opioid approval and removal policies. The broad indication on opioid labels must be narrowed, and an explicit warning against long-term use and high-dose prescribing should be added. The label should reinforce, rather than contradict, guidance from the CDC, the Department of Veterans Affairs, the Agency for Healthcare Research and Quality, and other public health agencies that are calling for more cautious prescribing.

Friday, January 8, 2021

Bias in science: natural and social

Joshua May
Synthese 

Abstract 

Moral, social, political, and other “nonepistemic” values can lead to bias in science, from prioritizing certain topics over others to the rationalization of questionable research practices. Such values might seem particularly common or powerful in the social sciences, given their subject matter. However, I argue first that the well documented phenomenon of motivated reasoning provides a useful framework for understanding when values guide scientific inquiry (in pernicious or productive ways). Second, this analysis reveals a parity thesis: values influence the social and natural sciences about equally, particularly because both are so prominently affected by desires for social credit and status, including recognition and career advancement. Ultimately, bias in natural and social science is both natural and social—that is, a part of human nature and considerably motivated by a concern for social status (and its maintenance). Whether the pervasive influence of values is inimical to the sciences is a separate question.

Conclusion 

We have seen how many of the putative biases that affect science can be explained and illuminated in terms of motivated reasoning, which yields a general understanding of how a researcher’s goals and values can influence scientific practice (whether positively or negatively). This general account helps to show that it is unwarranted to assume that such influences are significantly more prominent in the social sciences. The defense of this parity claim relies primarily on two key points. First, the natural sciences are also susceptible to the same values found in social science, particularly given that findings in many fields have social or political implications. Second, the ideological motivations that might seem to arise only in social science are minor compared to others. In particular, one’s reasoning is more often motivated by a desire to gain social credit (e.g. recognition among peers) than a desire to promote a moral or political ideology. Although there may be discernible differences in the quality of research across scientific domains, all are influenced by researchers’ values, as manifested in their motivations.

Wednesday, September 23, 2020

Do Conflict of Interest Disclosures Facilitate Public Trust?

D. M. Cain, & M. Banker
AMA J Ethics. 2020;22(3): E232-238.
doi: 10.1001/amajethics.2020.232.

Abstract

Lab experiments disagree on the efficacy of disclosure as a remedy to conflicts of interest (COIs). Some experiments suggest that disclosure has perverse effects, although others suggest these are mitigated by real-world factors (eg, feedback, sanctions, norms). This article argues that experiments reporting positive effects of disclosure often lack external validity: disclosure works best in lab experiments that make it unrealistically clear that the one disclosing is intentionally lying. We argue that even disclosed COIs remain dangerous in settings such as medicine where bias is often unintentional rather than the result of intentional corruption, and we conclude that disclosure might not be the panacea many seem to take it to be.

Introduction

While most medical professionals have the best intentions, conflicts of interest (COIs) can unintentionally bias their advice. For example, physicians might have consulting relationships with a company whose product they might prescribe. Physicians are increasingly required to limit COIs and disclose any that exist. When regulators decide whether to let a COI stand, the question becomes: How well does disclosure work? This paper reviews laboratory experiments that have had mixed results on the effects of disclosing COIs on bias and suggests that studies purporting to provide evidence of the efficacy of disclosure often lack external validity. We conclude that disclosure works more poorly than regulators hope; thus, COIs are more problematic than expected.

The info is here.

Sunday, September 20, 2020

Financial Conflicts of Interest are of Higher Ethical Priority than “Intellectual” Conflicts of Interest

Goldberg, D.S.
Bioethical Inquiry 17, 217–227 (2020).
https://doi.org/10.1007/s11673-020-09989-4

Abstract

The primary claim of this paper is that intellectual conflicts of interest (COIs) exist but are of lower ethical priority than COIs flowing from relationships between health professionals and commercial industry characterized by financial exchange. The paper begins by defining intellectual COIs and framing them in the context of scholarship on non-financial COIs. However, the paper explains that the crucial distinction is not between financial and non-financial COIs but is rather between motivations for bias that flow from relationships and those that do not. While commitments to particular ideas or perspectives can cause all manner of cognitive bias, that fact does not justify denying the enormous power that relationships featuring pecuniary gain have on professional behaviour in term of care, policy, or both. Sufficient reason exists to take both intellectual COIs and financial COIs seriously, but this paper demonstrates why the latter is of higher ethical priority. Multiple reasons will be provided, but the primary rationale grounding the claim is that intellectual COIs may provide reasons to suspect cognitive bias but they do not typically involve a loss of trust in a social role. The same cannot be said for COIs flowing from relationships between health professionals and commercial industries involving financial exchange. The paper then assumes arguendo that the primary rationale is mistaken and proceeds to show why the claims that intellectual COIs are more significant than relationship-based COIs are dubious on their own merits. The final section of the paper summarizes and concludes.

Conclusion

iCOIs exist and they should be taken seriously. Nevertheless, fCOIs are of greater ethical priority. The latter diminish trust in a social role to a much greater extent than do the former, at least in the broad run of cases. Moreover, it is not clear how providers could avoid developing intellectual commitments and preferences regarding particular therapeutic modalities or interventions—and even if we could prevent this from occurring, it is far from evident that we should. We can easily imagine cases where a studied determination to remain neutral regarding interventions would be an abdication of moral responsibility, would be decidedly unvirtuous, and would likely result in harm to care- and service-seekers. While we also have evidence that some intellectual commitments can motivate bias in ways that likely result in harm to care- or service-seekers, this premise only justifies taking iCOIs seriously—it is literally no argument for deprioritizing fCOIs. Although the fact that iCOIs are in many cases unavoidable is a weak justification for ignoring iCOIs, the comparable avoidability of the vast majority of fCOIs is indeed a reason for prioritizing the latter over the former.

A pdf is here.

Friday, July 17, 2020

Ivanka Trump's love for Goya beans violates ethics rules, say US rights groups

ImageAssociated Press
Originally posted 15 July 2020

The White House has defended Ivanka Trump tweeting a photo of herself holding up a can of Goya beans to buck up a Hispanic-owned business that she says has been unfairly treated, arguing she had “every right” to publicly express her support.

Government watchdogs countered that President Donald Trump’s daughter and senior adviser doesn’t have the right to violate ethics rules that bar government officials from using their public office to endorse specific products or groups.

These groups contend Ivanka Trump’s action also highlights broader concerns about how the president and those around him often blur the line between politics and governing. The White House would be responsible for disciplining Ivanka Trump for any ethics violation but chose not to in a similar case involving White House counselor Kellyanne Conway in 2017.

Goya became the target of a consumer boycott after CEO Robert Unanue praised the president at a Hispanic event at the White House on Thursday last week.

Trump tweeted the next day about his “love” for Goya, and his daughter followed up late Tuesday by tweeting a photo of herself holding a can of Goya black beans with a caption that read, “If it’s Goya, it has to be good,” in English and Spanish.

The info is here.

Friday, April 17, 2020

Trump's Claims Are Dangerous: COVID-19 & Hydroxychloroquine

Andre Picard
Globe and Mail
Originally published 9 April 20

Here is an excerpt:

The principal argument the President has used in support of hydroxychloroquine is the rhetorical statement: “What do we have to lose?” (He repeated that phrase five times at his Saturday media briefing.) “I’m not a doctor but I have common sense,” Mr. Trump added.

“Common sense” is not evidence. And “what have we got to lose?” is certainly no way to practise medicine – or policy-making for that matter.

Physicians in China started using hydroxychloroquine to treat COVID-19 patients early in the pandemic. There was certainly some logic to this move. The drug has antiviral properties and showed some promise in vitro but that doesn’t mean it will work in vivo.

It remains a desperation drug, something to try when the rest of the very limited armamentarium has been exhausted.

The evidence of benefit in patients is mostly anecdotal, based on highly publicized but scientifically weak studies. Controversial microbiologist Didier Raoult has made wild claims about the effectiveness of hydroxychloroquine but his study, published in the International Journal of Antimicrobial Agents, is little more than anecdotal.

Similarly, Vladimir Zelenko, a small-town doctor in New York State, has gained internet fame promoting a cocktail of three drugs – hydroxychloroquine, the antibiotic azithromycin and zinc sulphate. There is no real evidence for claims that he has cured hundreds of cases of COVID-19, but that hasn’t stopped Mr. Trump from promoting the regimen.

There needs to be proper studies done, with control groups – meaning one group gets the drug(s) and the other does not, and the outcomes are compared. Like it or not, that takes time.

Impatience is not an excuse to make unsubstantiated claims.

The info is here.

Monday, April 13, 2020

Which Legal Approaches Help Limit Harms to Patients From Clinicians’ Conscience-Based Refusals?

R. Kogan, K. Kraschel, & C. Haupt
AMA J Ethics. 2020;22(3):E209-216.
doi: 10.1001/amajethics.2020.209.

Abstract

This article canvasses laws protecting clinicians’ conscience and focuses on dilemmas that occur when a clinician refuses to perform a procedure consistent with the standard of care. In particular, the article focuses on patients’ experience with a conscientiously objecting clinician at a secular institution, where patients are least likely to expect conscience-based care restrictions. After reviewing existing laws that protect clinicians’ conscience, the article discusses limited legal remedies available to patients.

Potential Sites of Conflict

Clinicians who object to providing care on the basis of “conscience” have never been more robustly protected than today by state legislatures and federal law. Although US law as well as professional ethics allows clinicians to deviate from professional norms and standards when their religious or moral beliefs conflict with a requested service,1 the scope of legal remedies for patients harmed by these objections has shrunk as federal and state law has effectively insulated objecting clinicians from liability. This article outlines laws protecting clinician conscience and identifies questions that arise when a clinician refuses to perform a procedure consistent with the medical profession’s standard of care. We focus on patients seeking care at secular institutions where patients are least likely to have notice that care they receive could be restricted based upon an individual clinician’s refusal. As a result, patients may unknowingly receive substandard care from objecting physicians and even be harmed by their refusals. However, the legal remedies available to patients adversely affected by refusals are limited. We first discuss federal and state law governing refusals based on clinician conscience and then examine the remedies available to patients who suffer harm as a result of a physician’s refusal.

The info is here.

Friday, March 20, 2020

Oceanside council approves its first ethics code

Oceanside Civic CenterPhil Diehl
San Diego Union Tribune
Originally posted 1 March 20

Facing a public backlash over infighting, campaign contributions and alleged conflicts of interest, the Oceanside City Council unanimously approved its first code of ethics.

“This is a start,” said Councilwoman Esther Sanchez before Wednesday’s vote. The need for a policy is evident from the efforts underway to recall two council members (including herself) and for a referendum to overturn the council’s recent approval of a controversial Morro Hills development project, she said.

“We need to respect each other, and we need to respect the public,” Sanchez said, noting that she too at times has been critical of her fellow council members. “Sometimes it gets personal ... we need to do better.”

Residents said the policy should go further to include more specifics and penalties. Some suggested the city should limit campaign contributions, or not allow council members to vote on projects proposed by developers who contribute to their election campaigns.

The info is here.

Tuesday, August 27, 2019

Engineering Ethics Isn't Always Black And White

Elizabeth Fernandez
Forbes.com
Originally posted August 6, 2019

Here is an excerpt:

Dr. Stephan's has thought a lot about engineering ethics. He goes on to say that, while there are not many courses completely devoted to engineering ethics, many students now at least have some exposure to it before graduating.

Education may fall into one of several categories. Students may encounter a conflict of interest or why it may be unethical to accept gifts as an engineer. Some examples may be clear. For example, a toy may be found to have a defective part which could harm a child. Ethically, the toy should be pulled from the market, even if it causes the company loss of revenue.

But other times, the ethical choice may be less clear. For example, how should a civil engineer make a decision about which intersection should receive funds for a safety upgrade, which may come down to weighing some lives against others? Or what ethical decisions are involved in creating a device that eliminates second-hand smoke from cigarettes, but might reinforce addiction or increase the incidence of children who smoke?

Now engineering ethics may even be more important. "The advances in artificial intelligence that have occurred over the last decade are raising serious questions about how this technology should be controlled with respect to privacy, politics, and even personal safety," says Dr. Stephan.

The info is here.

Sunday, May 19, 2019

House Democrats seek details of Trump ethics waivers

Kate Ackley
www.rollcall.com
Originally posted May 17, 2019

Rep. Elijah E. Cummings, chairman of the Oversight and Reform Committee, wants a status update on the state of the swamp in the Trump administration.

The Maryland Democrat launched an investigation late this week into the administration’s use of ethics waivers, which allow former lobbyists to work on matters they handled in their previous private sector jobs. Cummings sent letters to the White House and 24 agencies and Cabinet departments requesting copies of their ethics pledges and details of any waivers that could expose “potential conflicts of interest.”

“Although the White House committed to providing information on ethics waivers on its website, the White House has failed to disclose comprehensive information about the waivers,” Cummings wrote in a May 16 letter to White House counsel Pat Cipollone.

A White House official declined comment on the investigation, and a committee aide said the administration had not yet responded to the requests. A spokeswoman for Rep. Jim Jordan of Ohio, the top Republican on the Oversight panel, did not immediately provide a comment.

After President Donald Trump ran on a “drain the swamp” message, the Trump administration ushered in a tough-sounding ethics pledge through an executive order in January 2017 requiring officials to recuse themselves from participating in matters they had lobbied on in the previous two years. But the waivers allow appointees to circumvent those restrictions.

The info is here.

Thursday, May 16, 2019

Memorial Sloan Kettering Leaders Violated Conflict-of-Interest Rules, Report Finds

Charles Ornstein and Katie Thomas
ProPublica.org
Originally posted April 4, 2019

Top officials at Memorial Sloan Kettering Cancer Center repeatedly violated policies on financial conflicts of interest, fostering a culture in which profits appeared to take precedence over research and patient care, according to details released on Thursday from an outside review.

The findings followed months of turmoil over executives’ ties to drug and health care companies at one of the nation’s leading cancer centers. The review, conducted by the law firm Debevoise & Plimpton, was outlined at a staff meeting on Thursday morning. It concluded that officials frequently violated or skirted their own policies; that hospital leaders’ ties to companies were likely considered on an ad hoc basis rather than through rigorous vetting; and that researchers were often unaware that some senior executives had financial stakes in the outcomes of their studies.

In acknowledging flaws in its oversight of conflicts of interest, the cancer center announced on Thursday an extensive overhaul of policies governing employees’ relationships with outside companies and financial arrangements — including public disclosure of doctors’ ties to corporations and limits on outside work.

The info is here.

Monday, April 8, 2019

Officials gather for ethics training

Jon Wysochanski
Star Beacon
Originally posted March 23, 2019

Here is an excerpt:

A large range of actions can constitute unethical behavior, from a health inspector inspecting his mom and dad’s restaurant to a public official accepting a ticket to an Ohio State Buckeyes’ game because he doesn’t consider it monetary, Willeke said. Unethical behavior doesn’t have to be as egregious as the real world example of a state employee inspecting a string of daycare centers she and her husband owned.

It’s not possible to find someone void of personal bias, Willeke said, and it is common for potential conflicts of interest to present themselves. It’s how public officials react to those biases or potential conflicts that matters most. The best thing for a public official facing a conflict to do is to walk away from the situation.

“Having a conflict of interest has never been illegal,” Willeke said. “It is when people act on those conflicts of interest that we actually see a crime under Ohio Ethics Law.”

When it comes to accepting gifts, Ohio law does not stipulate a dollar amount, only whether the gift is substantial or improper. A vendor-purchased dinner at Bob Evans might not violate the law, while dinner at a high-end restaurant complete with the best wine and most expensive menu items would.

And when it comes to unlawful interests in public contracts, a contract means any time a government entity spends money. That could mean the trustee who takes home a township backhoe on weekends to do work on the side, the library director who uses the copier to print hundreds of flyers for their business, the state employee who uses a state computer to run a real estate business or the fireman who uses a ladder truck on a home painting job.

The info is here.

Editor's note: We need more of this type of training for government officials.

Thursday, March 28, 2019

Behind the Scenes, Health Insurers Use Cash and Gifts to Sway Which Benefits Employers Choose

Marshall Allen
Propublica.org
Originally posted February 20, 2019

Here is an excerpt:

These industry payments can’t help but influence which plans brokers highlight for employers, said Eric Campbell, director of research at the University of Colorado Center for Bioethics and Humanities.

“It’s a classic conflict of interest,” Campbell said.

There’s “a large body of virtually irrefutable evidence,” Campbell said, that shows drug company payments to doctors influence the way they prescribe. “Denying this effect is like denying that gravity exists.” And there’s no reason, he said, to think brokers are any different.

Critics say the setup is akin to a single real estate agent representing both the buyer and seller in a home sale. A buyer would not expect the seller’s agent to negotiate the lowest price or highlight all the clauses and fine print that add unnecessary costs.

“If you want to draw a straight conclusion: It has been in the best interest of a broker, from a financial point of view, to keep that premium moving up,” said Jeffrey Hogan, a regional manager in Connecticut for a national insurance brokerage and one of a band of outliers in the industry pushing for changes in the way brokers are paid.

The info is here.

Tuesday, March 5, 2019

Former Ethics Chief Blasts Groups for Holding Events at Trump Hotel

Charles Clark
www.govexec.com
Originally posted March 4, 2019

Here is an excerpt:

“How many members of Congress, who have a constitutional duty to conduct meaningful oversight of the executive, giddily participate in events at the Trump International Hotel, a taxpayer owned landmark where Trump is his own landlord and the emoluments flow like the $35 martinis?” Shaub wrote.

The criticism of Kuwait was prompted by a letter tweeted earlier by Rep. Ted Lieu, D-Calif. Kuwait's ambassador to Washington, Salem Abdullah Al-Jaber Al-Sabah, had invited Lieu to the February celebration of Kuwait’s 58th National Day and 28th Liberation Day.

Lieu wrote the ambassador on Feb. 11 saying that while he looked forward to a continuing productive partnership, “Regrettably, the event will take place at the Trump International Hotel, which is owned by the President of the United States. I must therefore decline your invitation, as the Emoluments Clause of the U.S. Constitution (Article 1, Section 9, Paragraph 8) stipulates that no federal officeholders shall receive gifts or payments from foreign state or rulers without the consent of Congress.”

Lieu then warned the embassy that the issue raises “serious ethical and legal questions,” and that continuing to hold events “could amount to a violation of the U.S. Constitution.”

The info is here.