When Medicine Is Futile

By Barron Lerner

The New York Times

Originally published September 18, 2014

Here is an excerpt:

The medical futility movement, which argued that doctors should be able to withhold interventions that they believed would merely prolong the dying process, did not experience great success. Physicians declaring things to be “futile” sounded too much like the old system of medical paternalism, in which doctors had made life-and-death decisions for patients by themselves. It was this mind-set that bioethics, appropriately, had sought to correct. Patients (or their families) were supposed to be in charge.

The problem was that the new system did not account for one thing: Patients often demanded interventions that had little or no chance of succeeding. And physicians, with ethicists and lawyers looking over their shoulders, and, at times, with substantial money to be made, provided them.

The entire article is here.

Are we journalists first?

The longstanding debate about whether and when a reporter can intervene in a story is rekindled in the age of inequality

By Alexis Fitts and Nicola Pring
Columbia Journal Review
Originally published July 1, l2014

Here are a few excerpts:

She watched children beg their way into play dates for the promise of a meal. She watched a teacher handing out apples be thronged by more hungry students than he could feed.

She never offered help. When a photographer she was working with gave a bag of groceries to one family, Nazario felt he had crossed an ethical line. “I think what was beaten into me early as a reporter was you don’t intervene or change a story that you’re writing about,” says Nazario. As she would patiently explain to each subject at the beginning of her reporting, she was there to observe, to tell a story that alerts the public to problems and hopefully motivates others to address those problems. It is a traditional notion of objectivity that has been American journalism’s defining ideal for more than a century.

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The irony is that Nazario’s story had real impact: Within 24 hours of its publication, child-abuse reports in Los Angeles County increased by 20 percent, and eventually rose 45 percent. The county ordered an audit of the Child Welfare Agency and reorganized its reporting hotlines. More federal and state funds were allocated to programs for addicted mothers. The story also improved the lives of the families she’d profiled: The county placed Tamika Triggs in a foster home; her mother was admitted to a choice rehabilitation program.

The entire story is here.

Thanks to Dr. Deborah Derrickson Kossmann for this story.

Editor's note: Clearly, psychologists face issues related to poverty, inequality, and emotional suffering. An ethical dilemma may emerge when a psychologist struggles with boundary issues while in their professional role.  These issues typically involve compassion overriding professional judgment and role.

Responding to Suicidal Risk

This is chapter 17 of the book Ethics in Psychotherapy and Counseling: A Practical Guide, 4th Edition by Kenneth S. Pope, Ph.D., ABPP & Melba J.T. Vasquez, Ph.D., ABPP, published by John Wiley.

Few responsibilities are so heavy and intimidating as responding to suicidal risk. The need for careful assessment is great. Suicide remains among the top dozen causes of death in the United States, as high as number two for some groups. Homicide rates seize popular attention, but far more people kill themselves than kill others.  Authorities in the field are almost unanimous in their view that the reported figures vastly understate the actual incidence because of problems in reporting procedures.

The book chapter is here, published by Ken Pope on his site.

Suicide prevention efforts grow in statehouses

By Maggie Clark

USA Today

Originally published September 13, 2013

Here are some excerpts:

Every day, more than 100 people commit suicide in the U.S. Suicide is the second-leading cause of death for people between the ages of 25 and 34, and the third-leading cause of death among those between 15 and 24. Between 2008 and 2010, there were twice as many suicides as homicides, according to the Suicide Prevention Resource Center. Still, in many areas of the country, suicide-prevention efforts are virtually nonexistent.

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Restricting access to guns for suicidal people may well help to reduce suicides, said Dr. Richard McKeon, chief of the suicide prevention branch of the U.S. Substance Abuse and Mental Health Services Administration, but it's not the only thing that can work.

"What's needed is a comprehensive approach to suicide prevention using multiple interventions, not just one," McKeon said. That could include restricting weapons access, training or building general awareness, he said.

The entire article is here.

Guantanamo Bay: A Medical Ethics–free Zone?

George J. Annas, J.D., M.P.H., Sondra S. Crosby, M.D., and Leonard H. Glantz, J.D.
June 12, 2013
DOI: 10.1056/NEJMp1306065

American physicians have not widely criticized medical policies at the Guantanamo Bay detainment camp that violate medical ethics. We believe they should. Actions violating medical ethics, taken on behalf of the government, devalue medical ethics for all physicians. The ongoing hunger strike at Guantanamo by as many as 100 of the 166 remaining prisoners presents a stark challenge to the U.S. Department of Defense (DOD) to resist the temptation to use military physicians to “break” the strike through force-feeding.

President Barack Obama has publicly commented on the hunger strike twice. On April 26, he said, “I don't want these individuals [on hunger strike] to die.” In a May 23 speech on terrorism, the President said, “Look at our current situation, where we are force-feeding detainees who are . . . on a hunger strike. . . . Is this who we are? . . . Is that the America we want to leave our children? Our sense of justice is stronger than that.” How should physicians respond? That force-feeding of mentally competent hunger strikers violates basic medical ethics principles is not in serious dispute. Similarly, the Constitution Project's bipartisan Task Force on Detainee Treatment concluded in April that “forced feeding of detainees [at Guantanamo] is a form of abuse that must end” and urged the government to “adopt standards of care, policies, and procedures regarding detainees engaged in hunger strikes that are in keeping with established medical professional ethical and care standards.” Nevertheless, the DOD has sent about 40 additional medical personnel to help force-feed the hunger strikers.

The ethics standard regarding physician involvement in hunger strikes was probably best articulated by the World Medical Association (WMA) in its Declaration of Malta on Hunger Strikers. Created after World War II, the WMA comprises medical societies from almost 100 countries. Despite its checkered history, its process, transparency, and composition give it credibility regarding international medical ethics, and its statement on hunger strikers is widely considered authoritative.

The entire article is here.

Thanks to Gary Schoener for this lead.

One in 10 suicides is among people with a physical illness

By Anne Gulland
BMJ 2011; 343:d5464

A report on the link between suicide and physical ill health has found that one in 10 people who take their own life is chronically or terminally ill.

The report, by think tank Demos, is one of the first such comprehensive studies to look at the links between suicide and physical ill health. It says that the figure, which came from coroners and primary care trusts (PCTs), is likely to be a substantial underestimate because coroners do not always include the relevant health information with their inquest reports.

Demos believes that the findings provide strong evidence that people with chronic and terminal illnesses should be regarded as a high risk group for suicide and should be given better “medical, practical, and psychological support.”

Demos believes that the findings provide strong evidence that people with chronic and terminal illnesses should be regarded as a high risk group for suicide and should be given better "medical, practical, and psychological support."

<snip>

The government launched a consultation on suicide in July which identified five high risk groups for suicide: people in the care of mental health services (1200 suicides a year); people in the criminal justice system (80 suicides in prison a year); adult men aged under 50 (2000 suicides a year); people with a history of self harm (950 suicides a year), and occupational groups such as doctors, nurses, and farmers.

There were 4390 suicides in England in 2009, which, using Demos's calculation, would mean that more than 400 of these were among people with a chronic or terminal illness.

Demos believes that this group should be identified as high risk.

<snip>

Louise Bazalgette, author of the report, said it was important that doctors treating people with a chronic or terminal illness were aware of the issue.

"Doctors should be thinking about the possibility that a person with chronic health problems may be depressed and struggling. They should ask them if they ever feel suicidal," she said.

<snip>

Simon Gillespie, chief executive of the Multiple Sclerosis Society, said: "There is a big difference between someone wanting to end their life having explored and received every care option, and someone giving up hope because they feel they have nothing available to them. The right care and support can make a huge difference to an individual's life."

Clare Wyllie, head of policy and research at the Samaritans, said it was important that a suicide prevention strategy was implemented locally.

"It is vital that commissioners of local NHS, social care and public health services recognise that poor physical health and poor mental health are often closely linked [and] that depression is often undiagnosed in people with poor physical health," she said.

Thanks to Ken Pope for this information.

More students are hospitalized for mental health problems

July 2011, Vol 42, No. 7

Print version: page 12

An increased awareness of mental health issues is leading to more college students being hospitalized for psychological reasons, according to new data from the Association for University and College Counseling Center Directors (AUCCCD).

More than 3,700 students were hospitalized for suicide threats and other mental health issues in 2010, a significant jump from the 2,069 hospitalizations reported in 2006, the first year the survey was conducted. The survey found a rate of 7.93 hospitalizations per 10,000 students last year, up from 5.39 hospitalizations per 10,000 students in 2008, a 47 percent increase.

Anxiety was the most commonly cited complaint bringing students in to counseling centers last year, edging out depression as the top reason for seeing a counselor.

One factor driving the increase is that more universities are establishing “students of concern committees,” which coordinate the treatment of students with mental health and behavioral issues who have come to the attention of professors, campus police and residence hall advisers, says Victor M. Barr, PhD, director of the University of Tennessee at Knoxville counseling center.

Compared with years past, most institutions now have specific written policies to help students get treatment and to monitor their progress, Barr says.

The survey also found that:

• 75 percent of directors reported needing additional psychiatric services for students.
• 25 percent of students seen in counseling centers were already taking psychotropic medications.

As a result of increased demand for services, campus counseling centers are getting budget approval from their institutions to hire more psychiatrists and bring on more case managers to track treatment referrals, says Dan Jones, PhD, AUCCCD president and counseling center director at Appalachian State University.

“It used to be that counseling centers would give clients a list of three therapists and leave it in the client’s hands to get treatment when referred out,” Jones says.