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 Fidelity. Show all posts
Showing posts with label Fidelity. Show all posts

Monday, March 4, 2024

How to Deal with Counter-Examples to Common Morality Theory: A Surprising Result

Herissone-Kelly P.
Cambridge Quarterly of Healthcare Ethics.
2022;31(2):185-191.
doi:10.1017/S096318012100058X

Abstract

Tom Beauchamp and James Childress are confident that their four principles—respect for autonomy, beneficence, non-maleficence, and justice—are globally applicable to the sorts of issues that arise in biomedical ethics, in part because those principles form part of the common morality (a set of general norms to which all morally committed persons subscribe). Inevitably, however, the question arises of how the principlist ought to respond when presented with apparent counter-examples to this thesis. I examine a number of strategies the principlist might adopt in order to retain common morality theory in the face of supposed counter-examples. I conclude that only a strategy that takes a non-realist view of the common morality’s principles is viable. Unfortunately, such a view is likely not to appeal to the principlist.


Herissone-Kelly examines various strategies principlism could employ to address counter-examples:

Refine the principles: This involves clarifying or reinterpreting the principles to better handle specific cases.
  • Prioritize principles: Establish a hierarchy among the principles to resolve conflicts.
  • Supplement the principles: Introduce additional considerations or context-specific factors.
  • Limit the scope: Acknowledge that the principles may not apply universally to all cultures or situations.
Herissone-Kelly argues that none of these strategies are fully satisfactory. Refining or prioritizing principles risks distorting their original meaning or introducing arbitrariness. Supplementing them can lead to an unwieldy and complex framework. Limiting their scope undermines the theory's claim to universality.

He concludes that the most viable approach is to adopt a non-realist view of the common morality's principles. This means understanding them not as objective moral facts but as flexible tools for ethical reflection and deliberation, open to interpretation and adaptation in different contexts. While this may seem to weaken the theory's authority, Herissone-Kelly argues that it allows for a more nuanced and practical application of ethical principles in a diverse world.

Monday, July 10, 2023

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

Jaimie Ding
The Los Angeles Times
Originally posted 7 July 23

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

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

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

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

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

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

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


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

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

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

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

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.

Saturday, March 12, 2022

The Moral Injury of COVID: How Will Nurses Survive?

Diane M. Goodman
MedScape.com
Originally posted 11 FEB 22

Here are some excerpts:

According to recent statistics, 1 in 5 nurses have retired from active duty since the pandemic began. Far from feeling like heroes, nurses now feel exhausted, demoralized, underappreciated, and severely overworked. They are broken in ways that cannot be repaired.

Recently, an intensive care unit nurse abandoned his shift in the middle of the night and walked off into the unknown only to be found deceased 2 days later. What happened to this caregiver? Was his distress so severe he could not communicate pain? One can only wonder.

Nurses across the country are suffering from moral injury.

(cut)

This is what nurses feel prepared to do, but it violates their moral code.

Nurses may be unfamiliar with the process of rationing care, but the pandemic has changed that perspective. Nurses are now dealing with a form of rationing that leaves them miserable, in tears, and in persistent distress.

Providing care for 10 patients as opposed to a maximum of five forces nurses to make appalling decisions. Which patient needs my attention now? Will another patient die while I am in this room? How can I choose without suffering lasting trauma from my decisions?

Nurses have repeatedly been placed in impossible situations throughout the pandemic.

Remember the early days of PPE shortages? Nurses went without appropriate attire to protect their peers, at times with fatal results. 

(cut)

The profession prides itself on delivering the highest quality care it can. But when was the last time nurses felt that they were meeting this standard? How can they? They are working in a system where their own needs are minimized to meet the demands of an ongoing COVID patient population.

Moral injury, which can lead to moral trauma if unresolved, is different from burnout. 

Moral injury affects our sense of right and wrong. Moral injury is different because it represents a situation of witnessing care or offering care that conflicts with our internal compass. It is witnessing patients die without loved ones, repeatedly, or instituting a crisis standard of care that feels endless, although no earthquake, tornado, or bus accident has occurred. It is a feeling of running behind without the possibility of ever getting a break.

Moral injury is lasting distress that leads to feelings such as guilt, anger, and shame. There are true psychological implications for this type of angst. 

Thursday, September 10, 2020

Practices to Foster Physician Presence and Connection With Patients in the Clinical Encounter

Zulman DM, Haverfield MC, Shaw JG, et al.
JAMA. 2020;323(1):70–81.
doi:10.1001/jama.2019.19003

Key Points

Question  What are the most promising practices to foster physician presence and connection with patients?

Findings  This mixed-methods study identified 5 practices that may enhance physician presence and meaningful connection with patients in the clinical encounter: (1) prepare with intention; (2) listen intently and completely; (3) agree on what matters most; (4) connect with the patient’s story; and (5) explore emotional cues.

Meaning  For busy clinicians with multiple demands and distractions, 5 recommended practices have the potential to facilitate meaningful interactions with patients.

Abstract
Importance  Time constraints, technology, and administrative demands of modern medicine often impede the human connection that is central to clinical care, contributing to physician and patient dissatisfaction.

Objective  To identify evidence and narrative-based practices that promote clinician presence, a state of awareness, focus, and attention with the intent to understand patients.

Evidence Review  Preliminary practices were derived through a systematic literature review (fromJanuary 1997 to August 2017, with a subsequent bridge search to September 2019) of effective interpersonal interventions; observations of primary care encounters in 3 diverse clinics (n = 27 encounters); and qualitative interviews with physicians (n = 10), patients (n = 27), and nonmedical professionals whose occupations involve intense interpersonal interactions (eg, firefighter, chaplain, social worker; n = 30). After evidence synthesis, promising practices were reviewed in a 3-round modified Delphi process by a panel of 14 researchers, clinicians, patients, caregivers, and health system leaders. Panelists rated each practice using 9-point Likert scales (−4 to +4) that reflected the potential effect on patient and clinician experience and feasibility of implementation; after the third round, panelists selected their “top 5” practices from among those with median ratings of at least +2 for all 3 criteria. Finalrecommendations incorporate elements from all highly rated practices and emphasize the practices with the greatest number of panelist votes.

Findings  The systematic literature review (n = 73 studies) and qualitative research activities yielded 31 preliminary practices. Following evidence synthesis, 13 distinct practices were reviewed by the Delphi panel, 8 of which met criteria for inclusion and were combined into a final set of 5 recommendations: (1) prepare with intention (take a moment to prepare and focus before greeting a patient); (2) listen intently and completely (sit down, lean forward, avoid interruptions); (3) agree on what matters most (find out what the patient cares about and incorporate these priorities into the visit agenda); (4) connect with the patient’s story (consider life circumstances that influence the patient’s health; acknowledge positive efforts; celebrate successes); and (5) explore emotional cues (notice, name, and validate the patient’s emotions).

Conclusions and Relevance  This mixed-methods study identified 5 practices that have the potential to enhance physician presence and meaningful connection with patients in the clinical encounter. Evaluation and validation of the outcomes associated with implementing the 5 practices is needed, along with system-level interventions to create a supportive environment for implementation.

Thursday, August 27, 2020

Patients aren’t being told about the AI systems advising their care

Rebecca Robbins and Erin Brodwin
statnews.com
Originally posted 15 July 20

Here is an excerpt:

The decision not to mention these systems to patients is the product of an emerging consensus among doctors, hospital executives, developers, and system architects, who see little value — but plenty of downside — in raising the subject.

They worry that bringing up AI will derail clinicians’ conversations with patients, diverting time and attention away from actionable steps that patients can take to improve their health and quality of life. Doctors also emphasize that they, not the AI, make the decisions about care. An AI system’s recommendation, after all, is just one of many factors that clinicians take into account before making a decision about a patient’s care, and it would be absurd to detail every single guideline, protocol, and data source that gets considered, they say.

Internist Karyn Baum, who’s leading M Health Fairview’s rollout of the tool, said she doesn’t bring up the AI to her patients “in the same way that I wouldn’t say that the X-ray has decided that you’re ready to go home.” She said she would never tell a fellow clinician not to mention the model to a patient, but in practice, her colleagues generally don’t bring it up either.

Four of the health system’s 13 hospitals have now rolled out the hospital discharge planning tool, which was developed by the Silicon Valley AI company Qventus. The model is designed to identify hospitalized patients who are likely to be clinically ready to go home soon and flag steps that might be needed to make that happen, such as scheduling a necessary physical therapy appointment.

Clinicians consult the tool during their daily morning huddle, gathering around a computer to peer at a dashboard of hospitalized patients, estimated discharge dates, and barriers that could prevent that from occurring on schedule.

The info is here.

Tuesday, September 3, 2019

Psychologist Found Guilty of Sexual Assault During Psychotherapy

Richard Bammer
www.mercurynews.com
Originally published July 27, 2019

A Solano County Superior Court judge on Friday sentenced to more than 11 years behind bars a former Travis Air Force Base psychologist found guilty last fall of a series of felony sexual assaults on female patients and three misdemeanor counts.

After hearing victim impact testimony and statements from attorneys — but before pronouncing the prison term — Judge E. Bradley Nelson looked directly at Heath Jacob Sommer, 43, saying he took a version of exposure therapy “to a new level” and used his “position of trust” between 2014 and 2016 to repeatedly take advantage of “very vulnerable people,” female patients who sought his help to cope with previous sexual trauma while on active duty.

And following a statement from Sommer — “I apologize … I never intended to be offensive to people,” he said — Nelson enumerated the counts, noting the second one, rape, would account for the greatest number of years, eight, in state prison, with two other felonies, oral copulation by fraudulent representation and sexual battery by fraudulent means, filling out the balance.

Nelson added 18 months in Solano County Jail for three misdemeanor charges of sexual battery for the purpose of sexual arousal. He then credited Sommer, shackled at the waist in a striped jail jumpsuit and displaying no visible reaction to the sentence, with 904 days in custody. Additionally, Sommer will be required to serve 20 years probation upon release, register as a sex offender for life, and pay nearly $10,000 in restitution to the victims and other court costs.

The info is here.

Tuesday, April 30, 2019

Ethics in AI Are Not Optional

Rob Daly
www.marketsmedia.com
Originally posted April 12, 2019

Artificial intelligence is a critical feature in the future of the financial services, but firms should not be penny-wise and pound-foolish in their race to develop the most advanced offering as possible, caution experts.

“You do not need to be on the frontier of technology if you are not a technology company,” said Greg Baxter, the chief digital officer at MetLife, in his keynote address during Celent’s annual Innovation and Insight Day. “You just have to permit your people to use the technology.”

More effort should be spent on developing the various policies that will govern the deployment of the technology, he added.

MetLife spends more time on ethics and legal than it does with technology, according to Baxter.

Firms should be wary when implementing AI in such a fashion that it alienates clients by being too intrusive and ruining the customer experience. “If data is the new currency, its credit line is trust,” said Baxter.

The info is here.

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, February 12, 2019

How to tell the difference between persuasion and manipulation

Robert Noggle
aeon.co
Originally published August 1, 2018

Here is an excerpt:

It appears, then, that whether an influence is manipulative depends on how it is being used. Iago’s actions are manipulative and wrong because they are intended to get Othello to think and feel the wrong things. Iago knows that Othello has no reason to be jealous, but he gets Othello to feel jealous anyway. This is the emotional analogue to the deception that Iago also practises when he arranges matters (eg, the dropped handkerchief) to trick Othello into forming beliefs that Iago knows are false. Manipulative gaslighting occurs when the manipulator tricks another into distrusting what the manipulator recognises to be sound judgment. By contrast, advising an angry friend to avoid making snap judgments before cooling off is not acting manipulatively, if you know that your friend’s judgment really is temporarily unsound. When a conman tries to get you to feel empathy for a non-existent Nigerian prince, he acts manipulatively because he knows that it would be a mistake to feel empathy for someone who does not exist. Yet a sincere appeal to empathy for real people suffering undeserved misery is moral persuasion rather than manipulation. When an abusive partner tries to make you feel guilty for suspecting him of the infidelity that he just committed, he is acting manipulatively because he is trying to induce misplaced guilt. But when a friend makes you feel an appropriate amount of guilt over having deserted him in his hour of need, this does not seem manipulative.

The info is here.

Thursday, January 31, 2019

HHS issues voluntary guidelines amid rise of cyberattacks

Samantha Liss
www.healthcaredive.com
Originally published January 2, 2019

Dive Brief:

  • To combat security threats in the health sector, HHS issued a voluminous report that details ways small, local clinics and large hospital systems alike can reduce their cybersecurity risks. The guidelines are voluntary, so providers will not be required to adopt the practices identified in the report. 
  • The four-volume report is the culmination of work by a task force, convened in May 2017, that worked to identify the five most common threats in the industry and 10 ways to prepare against those threats.  
  • The five most common threats are email phishing attacks, ransomware attacks, loss or theft of equipment or data, accidental or intentional data loss by an insider and attacks against connected medical devices.

Tuesday, January 22, 2019

Kaiser settled 2014 patient-dumping class-action suit earlier this year

Michael McCough
The Sacramento Bee
Originally posted December 20, 2018

Kaiser Foundation Health Plan recently settled a 2014 class-action lawsuit stemming from two allegations that it dumped patients with severe mental illness.

Plaintiffs Douglas Kerr and Barbara Knighton alleged that in separate incidents, Kaiser psychiatrists told them their sons needed to be transferred to locked residential facilities called IMDs (institutions for mental disease) for treatment, according to court documents. Knighton and Kerr claimed they were both told they should remove their children from their Kaiser health plans in 2014 to be transferred to these county-run institutions — a change that shifted the costs of treatment from Kaiser to government-funded programs such as Medi-Cal.

Despite the settlement, Kaiser said in a statement it continues to dispute some of the claims included in the lawsuit.

“In certain relatively rare cases, Kaiser Permanente members entered a specialized type of locked mental health facility that often preferred Medi-Cal coverage to private insurance,” Kaiser Vice President of Communications John Nelson said in an emailed statement. “In some of these cases, cancellation of Kaiser Permanente coverage was required to enter the facility. However, this was not Kaiser Permanente’s requirement, and we cover many members’ care at such facilities. Any decision to cancel coverage was made by a court-appointed conservator.”

The info is here.

Wednesday, January 16, 2019

What Is the Right to Privacy?

Andrei Marmor
(2015) Philosophy & Public Affairs, 43, 1, pp 3-26

The right to privacy is a curious kind of right. Most people think that we have a general right to privacy. But when you look at the kind of issues that lawyers and philosophers label as concerns about privacy, you see widely differing views about the scope of the right and the kind of cases that fall under its purview.1 Consequently, it has become difficult to articulate the underlying interest that the right to privacy is there to protect—so much so that some philosophers have come to doubt that there is any underlying interest protected by it. According to Judith Thomson, for example, privacy is a cluster of derivative rights, some of them derived from rights to own or use your property, others from the right to your person or your right to decide what to do with your body, and so on. Thomson’s position starts from a sound observation, and I will begin by explaining why. The conclusion I will reach, however, is very different. I will argue that there is a general right to privacy grounded in people’s interest in having a reasonable measure of control over the ways in which they can present themselves (and what is theirs) to others. I will strive to show that this underlying interest justifies the right to privacy and explains its proper scope, though the scope of the right might be narrower, and fuzzier in its boundaries, than is commonly understood.

The info is here.

Monday, April 2, 2018

Ethics and sport have long been strangers to one another

Kenan Malik
The Guardian
Originally posted March 8, 2018

Here is an excerpt:

Today’s great ethical debate is not about payment but drugs. Last week, the digital, culture, media and sport select committee accused Bradley Wiggins of “crossing the ethical line” for allegedly misusing drugs allowed for medical purposes to enhance performance.

The ethical lines over drug use are, however, as arbitrary and irrational as earlier ones about payment. Drugs are said to be “unnatural” and to provide athletes with an “unfair advantage”. But virtually everything an athlete does, from high-altitude training to high-protein dieting, is unnatural and seeks to gain an advantage.

EPO is a naturally produced hormone that stimulates red blood cell production, so helping endurance athletes. Injections of EPO are banned in sport. Yet Chris Froome is permitted to sleep in a hypoxic chamber, which reduces oxygen in the air, forcing his body to produce more red blood cells. It has the same effect as EPO, is equally unnatural and provides an advantage. Why is one banned but not the other?

The article is here.

Thursday, March 29, 2018

Government watchdog files 30 ethics complaints against Trump administration

Julia Manchester
The Hill
Originally posted March 26, 2018

Here is an excerpt:

"The bottom line is that neither Trump nor his administration take conflicts of interest and ethics seriously," Lisa Gilbert, the group's vice president of legislative affairs, told the network.

" 'Drain the swamp' was far more campaign rhetoric than a commitment to ethics, and the widespread lack of compliance and enforcement of Trump's ethics executive order shows that ethics do not matter in the Trump administration."

NBC News reports Public Citizen filed complaints with the White House Office of Management and Budget, the Environmental Protection Agency, and the departments of Defense, Homeland Security, Housing and Urban Development, Transportation, Health and Human Services, Commerce and Interior, among others.

Trump signed an executive order shortly after he took office in 2017 that was aimed at cracking down on lobbyists' influence in the U.S. government.

The order allowed officials who departed the administration to lobby the government, except the agency for which they worked, and permitted lobbyists to enter the administration as long as they didn't work on specific issues that would impact former clients or employers for two years.

The article is here.

Monday, March 26, 2018

Bill to Bar LGBTQ Discrimination Stokes New Nebraska Debate

Tess Williams
US News and World Report
Originally published February 22, 2018

A bill that would prevent psychologists from discriminating against patients based on their sexual orientation or gender identity is reviving a nearly decade-old dispute in Nebraska state government.

Sen. Patty Pansing Brooks of Lincoln said Thursday that her bill would adopt the code of conduct from the American Psychiatric Association, which prevents discrimination of protected classes of people, but does not require professionals to treat patients if they lack expertise or it conflicts with their personal beliefs. The professional would have to provide an adequate referral instead.

Pansing Brooks said the bill will likely not become law, but she hopes it will bring attention to the ongoing problem. She said she hopes it will be resolved internally, but if a conclusion is not reached, she plans to call for a hearing later this year and will "not let this issue die."

The state Board of Psychology proposed new regulations in 2008, and the following year, the Department of Health and Human Services sent the changes to the Nebraska Catholic Conference for review. Pansing Brooks said she is unsure why the religious organization was given special review.

The article is here.

Saturday, March 10, 2018

What swamp? Lobbyists get ethics waivers to work for Trump

Associated Press
Originally posted March 9, 2017

President Donald Trump and his appointees have stocked federal agencies with ex-lobbyists and corporate lawyers who now help regulate the very industries from which they previously collected paychecks, despite promising as a candidate to drain the swamp in Washington.

A week after his January 2017 inauguration, Trump signed an executive order that bars former lobbyists, lawyers and others from participating in any matter they lobbied or otherwise worked on for private clients within two years before going to work for the government.

But records reviewed by The Associated Press show Trump's top lawyer, White House counsel Don McGahn, has issued at least 24 ethics waivers to key administration officials at the White House and executive branch agencies.

Though the waivers were typically signed by McGahn months ago, the Office of Government Ethics disclosed several more on Wednesday.

One allows FBI Director Chris Wray "to participate in matters involving a confidential former client." The three-sentence waiver gives no indication about what Wray's conflict of interest might be or how it may violate Trump's ethics order.

Asked about the waivers, Lindsay Walters, a White House spokeswoman, said, "In the interests of full transparency and good governance, the posted waivers set forth the policy reasons for granting an exception to the pledge."

The article is here.

Friday, February 16, 2018

Health Care Workers & Moral Objections I: Procedures

Mike LaBossiere
Talking Philosophy
Originally published on January 18, 2018

Here is an excerpt:

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

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

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

The article is here.

Tuesday, February 6, 2018

State Supreme Court Establishes Right To Sue Over Medical Record Breaches

Edmund H. Mahony
Hartford Courant
Originally published January 10, 2018

The state Supreme Court established Thursday that patients in Connecticut have the right to sue doctors and other health care providers for the unauthorized and negligent disclosure of their confidential medical records.

The majority decision creates new state law and adds Connecticut to a growing number of states that allow patients to sue for damages over the release of private records by their physicians. Courts in Connecticut have held previously — as have courts elsewhere — that private suits were blocked by federal law under the 1996 Health Insurance Portability and Accountability Act or HIPAA law.

HIPAA laws establish procedures to protect medical records and empower government to impose civil and criminal penalties for violation. But HIPAA does not permit private suits to collect damages for unauthorized disclosures.

“Finally we have a remedy in Connecticut that recognizes that there is a duty of confidentiality, the breach of which can lead to compensation for damages,” said attorney Bruce L. Elstein of Trumbull, whose client, Emily Byrne, sued over an unauthorized release of her medical history.

The article is here.

Sunday, February 4, 2018

Vignette 37: The Fabricated Letter

Dr. Krista Gordon received an email from E Corp, the employer of a current patient Mr. Elliot Alderson (someone she provided psychotherapy for over a year, but has cancelled multiple appointments recently due to some family issues).  Dr. Gordon has not seen him for over a month, and he is not scheduled until the following month.

The email from E Corp was for the purposes of letting Dr. Gordon know that her patient had submitted documentation to E Corp (supposedly from Dr. Gordon), and they wanted to confirm that these documents were legitimate and unaltered.

To Dr. Gordon’s disappointment, she saw one legitimate letter (an older letter she wrote for Alderson to submit to his boss, confirming regular 4:30 pm appointment times, which allowed Alderson to leave 30 minutes early on those days), and one entirely questionable, clearly altered letter.

Apparently, Mr. Alderson copied Dr. Gordon’s letterhead and pasted it as an image for the false documentation.  The body of the letter is something Gordon never wrote (saying that Dr. Gordon assessed Alderson and determined he is unfit to return to work for an indefinite period).  Dr. Gordon’s signature is also copied and pasted on the fake letter.  The fake letter was shoddily done, the footer is cut-off, some of the text is cut-off, and most of the text appears to be slightly at an angle.  The letter clearly did not come from Dr. Gordon.

Of course, this a huge breach of trust and Dr. Gordon struggling to organize her thinking as she feels incredibly violated by Mr. Alderson.  Dr. Gordon calls you for a consultation.

What are the clinical issues involved in this situation?

What are the ethical issues involved in this scenario?

What are the ramifications about the therapeutic relationship?

How does Dr. Gordon respond or not respond to E Corp?

Are there any other legal issues that may be in play?

What course of action would you suggest to Dr. Gordon?