The Devil is in the Details: How Patients' Mental Health Data is at Risk

By Farai Chideya
The Intercept
Aug. 21 2015

Here is an excerpt:

If the effort to blend the efficiency of technology with patients’ privacy needs has backfired in general health care (see “Medical Privacy Under Threat”), it is causing particular emotional and financial wounds in the world of mental health, where even a well-managed diagnosis can become a job-threatening stigma. HIPAA laws, long assumed by patients to protect their privacy, only apply in certain circumstances to certain entities. There’s a raging debate over how to regulate the new privacy issues around employee assistance plans and workplace wellness incentives. And the issue of how and when to track mental health patients has even become an issue at the U.S.-Canada border. Citing the high numbers of Americans who have experienced sexual abuse, major depression, or substance abuse, Dr. Deborah Peel, a psychiatrist who founded Patient Privacy Rights, a research and advocacy group, says, “You cannot force people to cough up information when it’s not private. They will hide it. How can we accept an electronic records system that drives people away from being open and honest?”

The entire article is here.

Do we still need to study the death penalty?

By Ryan J. Winter
The Monitor on Psychology
2015, Vol 46, No. 7
Print version: page 32

Recent Gallup polling shows support for the death penalty in the United States is at a 40-year low, with the 63 percent favorability rating a stark contrast to the 80 percent who supported it in the 1990s.1 When comparing death to life in prison, death favorability drops to 42 percent.2 Meanwhile, the number of death verdicts has also dropped, with only 73 defendants sentenced to death and 35 executed in 2014. Contrast this with 279 sentences and 98 executions in 1999.3 Of 32 death penalty states, only seven carried out executions in 2014, the fewest in 25 years. Further, eight states have abolished the death penalty since 2007, and no states have added the penalty.

As its reign appears to be over, there's no need to continue studying the death penalty, right?
Not so fast. Focusing on the malicious actions of Boston Marathon bomber Dzhokhar Tsarnaev, prosecutors and defense attorneys seemingly set aside all pretenses about his guilt to focus on the only trial phase worth attention: whether he deserved death. Half a country away, James Holmes — the Aurora, Colorado, movie theater shooter — began his trial with a prosecution equally zealous in pursuing death.

The entire article is here.

Fifty Shades of Manipulation

Cass R. Sunstein
Journal of Behavioral Marketing, Forthcoming
February 18, 2015

Abstract:    

A statement or action can be said to be manipulative if it does not sufficiently engage or appeal to people’s capacity for reflective and deliberative choice. One problem with manipulation, thus understood, is that it fails to respect people’s autonomy and is an affront to their dignity. Another problem is that if they are products of manipulation, people’s choices might fail to promote their own welfare, and might instead promote the welfare of the manipulator. To that extent, the central objection to manipulation is rooted in a version of Mill’s Harm Principle: People know what is in their best interests and should have a (manipulation-free) opportunity to make that decision. On welfarist grounds, the norm against manipulation can be seen as a kind of heuristic, one that generally works well, but that can also lead to serious errors, at least when the manipulator is both informed and genuinely interested in the welfare of the chooser.

For the legal system, a pervasive puzzle is why manipulation is rarely policed. The simplest answer is that manipulation has so many shades, and in a social order that values free markets and is committed to freedom of expression, it is exceptionally difficult to regulate manipulation as such. But as the manipulator’s motives become more self-interested or venal, and as efforts to bypass people’s deliberative capacities becomes more successful, the ethical objections to manipulation become very forceful, and the argument for a legal response is fortified. The analysis of manipulation bears on emerging first amendment issues raised by compelled speech, especially in the context of graphic health warnings. Importantly, it can also help orient the regulation of financial products, where manipulation of consumer choices is an evident but rarely explicit concern.

The entire article is here.

Making Sex Offenders Pay — and Pay and Pay and Pay:

By Stephen J. Dubner
Freakonomics Podcast
Originally published June 10, 2015

The gist of this episode: Sure, sex crimes are horrific, and the perpetrators deserve to be punished harshly. But society keeps exacting costs — out-of-pocket and otherwise — long after the prison sentence has been served.




The podcast page is here.

UO whistleblowers: giving student's confidential therapy records to campus lawyers felt wrong

By Richard Read
The Oregonian
Originally posted June 4, 2015

The executive assistant to the director of the University of Oregon's Counseling Center disobeyed instructions last December and showed a therapist a confidential email from their boss.

The email's directions horrified both Karen Stokes, the director's assistant, and Jennifer Morlok, the clinician.

Shelly Kerr, the center's director, told Stokes in the Dec. 8, 2014, message to give the university's legal office a client's entire case file -- including notes taken by Morlok during private therapy sessions.

The client was a UO freshman who says she was gang raped multiple times on March 8, 2014, by three members of the men's basketball team.

Normally mental-health professionals go to great lengths, even in the face of court orders, to release as little information about clients as possible. Clinicians want patients to feel safe expressing their most intimate thoughts and feelings during therapy.

The entire article is here.

University of Oregon Employees Under Investigation for Misconduct in Rape Case

By Richard Read
The Oregonian
Originally posted May 8, 2015

Six University of Oregon employees, including a vice president and the school's interim top lawyer, are under investigation for alleged misconduct in the handling of therapy records of a student who says she was gang-raped by three Ducks basketball players.

The Oregon State Bar is investigating complaints against interim general counsel Douglas Park and associate general counsel Samantha Hill. The Oregon Board of Psychologist Examiners is investigating complaints against four people, including Robin Holmes, the university's vice president for student life, who is a licensed psychologist.

Jennifer Morlok, a senior staff therapist identified in legal correspondence as the clinician who counseled the woman, filed all the complaints.

The entire article is here.

Do Killer Robots Violate Human Rights?

When machines are anthropomorphized, we risk applying a human standard that should not apply to mere tools.

By Patrick Lin
The Atlantic
Originally published April 20, 2015

Here is an excerpt:

What’s objectionable to many about lethal autonomous weapons systems is that, even if the weapons aim only at lawful targets, they seem to violate a basic right to life. This claim is puzzling at first, since killing is so commonplace and permitted in war. If you’re a combatant, you are legally liable to be killed at any time; so it’s unclear that there’s a right to life at all.

But what we mean is that, in armed conflicts, a right to life means a right not to be killed arbitrarily, unaccountably, or otherwise inhumanely. To better understand the claim, a right to life can be thought of as a right to human dignity. Human dignity is arguably more basic than a right to life, which can be more easily forfeited or trumped. For instance, even lawful executions should be humane in civilized society.

The entire article is here.

Markingson case: University of Minnesota can't regain trust under current leadership

By Arne H. Carlson
The Star Tribune
Originally published April 10, 2015

Here is an excerpt:

Ever since the violent suicide of Dan Markingson in 2004, the administration of the University of Minnesota has received repeated calls for the release of more details about the care and protection afforded the victim. These calls have come from faculty members at the university, from local community members and from researchers from around the world. But instead of being transparent and forthright, the administration created a standard response similar to that expressed by the university’s former general counsel, Mark Rotenberg: “As we’ve stated previously, the Markingson case has been exhaustively reviewed by Federal, State and academic bodies since 2004. The FDA, the Hennepin County District Court, the Minnesota Board of Medical Practice, the Minnesota Attorney General’s office and the University’s Institutional Review Board have all reviewed the case. None found fault with any of our faculty.”

The entire article is here.

Compliance with Results Reporting at ClinicalTrials.gov

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

Here are two excerpts:

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

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

The entire article is here.

Ethical Implications of Patients and Families Secretly Recording Conversations With Physicians

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

Here are two excerpts:

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

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

The entire article is here.

Psychologists to Review Role in Detainee Interrogations

By James Risen
The New York Times
November 13, 2014

Here is an excerpt:

For years, questions about the role of American psychologists and behavioral scientists in the development and implementation of the Bush-era interrogation program have been raised by human rights advocates as well as by critics within the psychological profession itself. Psychologists were involved in developing the enhanced interrogation techniques used on terrorism suspects by the Central Intelligence Agency. Later, a number of psychologists, in the military and in the intelligence community, were involved in carrying out and monitoring interrogations.

The entire article is here.

Finding Risks, Not Answers, in Gene Tests

By Denise Grady and Andrew Pollack
The New York Times
Originally published September 22, 2014

Jennifer was 39 and perfectly healthy, but her grandmother had died young from breast cancer, so she decided to be tested for mutations in two genes known to increase risk for the disease.

When a genetic counselor offered additional tests for 20 other genes linked to various cancers, Jennifer said yes. The more information, the better, she thought.

The results, she said, were “surreal.” She did not have mutations in the breast cancer genes, but did have one linked to a high risk of stomach cancer. In people with a family history of the disease, that mutation is considered so risky that patients who are not even sick are often advised to have their stomachs removed. But no one knows what the finding might mean in someone like Jennifer, whose family has not had the disease.

The entire article is here.

responsibility and punishment

Katrina Sifferd interviewed by Richard Marshall
3:AM Magazine
Originally posted

Here is an excerpt:

KS: Well, for one, we won’t be able to make responsibility assessments. When you show a jury a picture of a brain lighting up in such-and-such a way it means absolutely nothing to them until somebody translates the scientific data into folk psychological terms. Expert witnesses in a trial cannot just point to a dark spot on a PET scan and sit down: the scientific data is irrelevant to the defendant’s culpability until is it translated into folk concepts that push and pull responsibility assessments in different directions. For example, an expert might note that the dark spot is a brain tumor likely to result in a severe lack of impulse control, which the jury might feel undermines attribution of the highest levels of criminal intent.

I think it is interesting that some scientific data actually seems to push responsibility assessments in both directions, or in ways unanticipated by the side offering the evidence in a criminal trial. In one high profile capital sentencing hearing, the defense offered neuroscientific evidence of psychopathy in an attempt to prove diminished capacity (and thus a mitigating factor); but instead, the jury seemed to think the data made the defendant more culpable for his actions, and sentenced him to death. Is a person whose brain shows clear signs of psychopathy less responsible because of their abnormal brain function or more responsible because their brain is abnormal (and thus they are likely to be dangerous in the future)? I think it depends on the way in which the brain is dysfunctional, and maybe the reasons why it is dysfunctional. There is a lot of important work to be done making reliable translations of neuroscientific data into folk descriptions relevant to responsibility.

(cut)

KS: Different theories of punishment seem to emphasize different aspects of our cognitive capacities as most important to culpability. Bill and I have argued that deontological accounts which postulate emotional response or empathy as crucial to moral knowledge and decision-making might be more likely to excuse all psychopaths because of their apparent lack of relevant affective data. Some deontological theorists believe that a lack of appropriate emotional response translates into a wholesale lack of legal rationality. A consequentialist theory of punishment, however, may be more likely to hold some psychopaths responsible, because it emphasizes the need for rational capacities as a means to grasp and reflect upon the consequences of action given ones goals and relevant social norms (a skill successful psychopaths may possess), and not the way one feels about these consequences.

The entire interview is here.

Ethics and the Brains of Psychopaths

The Significance of Psychopaths for Ethical and Legal Reasoning

William Hirstein and Katrina Sifferd
Elmhurst College

Abstract

The emerging neuroscience of psychopathy will have several important implications for our attempts to construct an ethical society. In this article we begin by describing the list of criteria by which psychopaths are diagnosed. We then review four competing neuropsychological theories of psychopathic cognition.  The first of these models, Newman‘s attentional model, locates the problem in a special type of attentional narrowing that psychopaths have shown in experiments. The second and third, Blair‘s amygdala model and Kiehl‘s paralimbic model represent the psychopath‘s problem as primarily emotional , including reduced tendency to experience fear in normally fearful situations, and a failure to attach the proper significance to the emotions of others. The fourth model locates the problem at a higher level: a failure of  psychopaths to notice and correct for their attentional or emotional problems using ―executive processes.  In normal humans, decisions are accomplished via these executive processes, which are responsible for planning actions, or inhibiting unwise actions, as well as allowing emotions to influence cognition in the proper way. We review the current state of knowledge of the executive capacities of psychopaths. We then evaluate psychopaths in light of the three major  philosophical theories of ethics, utilitarianism, deontological theory, and virtue ethics. Finally,we turn to the difficulty psychopath offenders pose to criminal law, because of the way psychopathy interacts with the various justifications and functions of punishment. We concludewith a brief consideration of the effects of psychopaths on contemporary social structures.

The entire article is here.

Ethics & Free Will

by Mike LaBossiere
Talking Philosophy Blog
Originally published on July 18, 2014

Here is an excerpt:

One impact is that when people have doubts about free will they tend to have less support for retributive punishment. Retributive punishment, as the name indicates, is punishment aimed at making a person suffer for her misdeeds. Doubt in free will did not negatively impact a person’s support for punishment aimed at deterrence or rehabilitation.

While the authors do consider one reason for this, namely that those who doubt free will would regard wrongdoers as analogous to harmful natural phenomenon that need to dealt with rather than subject to vengeance, this view also matches a common view about moral accountability. To be specific, moral (and legal) accountability is generally proportional to the control a person has over events. To use a concrete example, consider the difference between these two cases. In the first case, Sally is driving well above the speed limit and is busy texting and sipping her latte. She doesn’t see the crossing guard frantically waving his sign and runs over the children in the cross walk. In case two, Jane is driving the speed limit and children suddenly run directly in front of her car. She brakes and swerves immediately, but she hits the children. Intuitively, Sally has acted in a way that was morally wrong—she should have been going the speed limit and she should have been paying attention. Jane, though she hit the children, did not act wrongly—she could not have avoided the children and hence is not morally responsible.

The entire blog post is here.

Is Neurolaw Conceptually Confused?

By Neil Levy
J Ethics. 2014 Jun 1;18(2):171-185.

Abstract

In Minds, Brains, and Law, Michael Pardo and Dennis Patterson argue that current attempts to use neuroscience to inform the theory and practice of law founder because they are built on confused conceptual foundations. Proponents of neurolaw attribute to the brain or to its parts psychological properties that belong only to people; this mistake vitiates many of the claims they make. Once neurolaw is placed on a sounder conceptual footing, Pardo and Patterson claim, we will see that its more dramatic claims are false or meaningless, though it might be able to provide inductive evidence for particular less dramatic claims (that a defendant may be lying, or lacks control over their behavior, for instance). In response, I argue that the central conceptual confusions identified by Pardo and Patterson are not confusions at all. Though some of the claims made by its proponents are hasty and sometimes they are confused, there are no conceptual barriers to attributing psychological properties to brain states. Neuroscience can play a role in producing evidence that is more reliable than subjective report or behavior; it therefore holds out the possibility of dramatically altering our self-conception as agents and thereby the law.

The entire article is here.

Should We 'Fix' Intersex Children?

Standard medical practice is often to operate to "normalize" genitals, but some families are fighting back.

By Charlotte Greenfield
The Atlantic
Originally published July 8, 2014

Here is an excerpt:

M was born with genitals that were not clearly male or female. Also known as disorders of sex development (DSDs), the best guess by researchers is that intersex conditions affect one in 2,000 children.

The response by doctors is often to carry out largely unregulated and controversial surgeries that aim to make an infant’s genitals and reproductive organs more normal but can often have unintended consequences, according to intersex adults, advocates and some doctors.

A long and gut-wrenching list of damaging side effects—painful scarring, reduced sexual sensitivity, torn genital tissue, removal of natural hormones and possible sterilization—combined with the chance of assigning children a gender they don’t feel comfortable with has left many calling for the surgeries to be heavily restricted.

The entire article is here.

Why haven't more states expanded Medicaid yet?

By California Healthline
www.philly.com
Originally posted June 26, 2014

Two years after Roberts issued the majority opinion upholding the Affordable Care Act, the decision to expand Medicaid is far from settled. Despite predictions that all states will eventually embrace Medicaid expansion, a significant number continue to hold out.

At last count, 26 states and the District of Columbia intend to expand Medicaid, while four are actively considering it and 20 have no plans to expand the program at this time.

The Medicaid expansion was considered the sleeper issue in the legal case against the ACA that ultimately made its way up to the Supreme Court. Stakeholders were closely watching issues like the constitutionality of the individual mandate, not thinking Medicaid would be significant. And yet, in a surprise decision, the Supreme Court effectively took the teeth out of one of the law's major efforts to expand health insurance, by making it illegal to penalize states for not participating in the Medicaid expansion.

The entire article is here.

What Do We Owe to Child Migrants?

By Rachel Fabi and Mohini Banerjee
Bioethics Forum
Originally posted June 26, 2014

From October 1, 2013, through June 15, 2014, more than 52,000 child migrants crossed the U.S.-Mexico border in South Texas, overwhelming the U.S. Customs and Border Patrol and the Department of Homeland Security (DHS). The Obama administration has declared this an “urgent humanitarian situation” and has authorized DHS to establish a Unified Coordinating Group led by the Federal Emergency Management Agency (FEMA) to provide for the children’s humanitarian needs. While the recent upsurge, and the myths circulating among migrants that there is a window of opportunity for children seeking asylum (or for women with young children), have caught the attention of policy-makers and the media, a May 2014 report by the United Nations High Commissioner for Refugees (UNHCR) concludes that this pattern of “mixed” migration, which includes children fleeing violent home countries, in addition to more typical economic migrants, began in 2009.

What do we owe these children?  What is an appropriate ethical and legal framework for exploring and articulating our obligations, both in terms of immediate humanitarian aid and beyond?

The entire article is here.

IQ Cutoff for Death Penalty Struck Down by Supreme Court

By Sara Reardon and Nature News Blog
Scientific American
Originally posted on May 28, 2014

When deciding whether a defendant is too intellectually disabled to receive the death penalty, courts must take into account inherent variability in IQ scores, the US Supreme Court ruled today.

In its 5-4 decision, the court said that it is unconstitutional for states like Florida to use an IQ score of 70 as a cutoff above which a defendant is considered to be intelligent enough to understand the consequences of his or her actions.

The entire article is here.