Ontario court rules against Jordan Peterson, upholds social media training order

Canadian Broadcasting Company

Originally posted 23 August 23

An Ontario court ruled against psychologist and media personality Jordan Peterson Wednesday, and upheld a regulatory body's order that he take social media training in the wake of complaints about his controversial online posts and statements.

Last November, Peterson, a professor emeritus with the University of Toronto psychology department who is also an author and media commentator, was ordered by the College of Psychologists of Ontario to undergo a coaching program on professionalism in public statements.

That followed numerous complaints to the governing body of Ontario psychologists, of which Peterson is a member, regarding his online commentary directed at politicians, a plus-sized model, and transgender actor Elliot Page, among other issues. You can read more about those social media posts here.

The college's complaints committee concluded his controversial public statements could amount to professional misconduct and ordered Peterson to pay for a media coaching program — noting failure to comply could mean the loss of his licence to practice psychology in the province.

Peterson filed for a judicial review, arguing his political commentary is not under the college's purview.

Three Ontario Divisional Court judges unanimously dismissed Peterson's application, ruling that the college's decision falls within its mandate to regulate the profession in the public interest and does not affect his freedom of expression.

"The order is not disciplinary and does not prevent Dr. Peterson from expressing himself on controversial topics; it has a minimal impact on his right to freedom of expression," the decision written by Justice Paul Schabas reads, in part.

The info is here.

The court decision is here.

My take:

Peterson has argued that the order violates his right to free speech. He has also said that the complaints against him were politically motivated. However, the court ruled that the college's order was justified in order to protect the public from harm.

The case of Jordan Peterson is a reminder that psychologists, like other human beings, are not infallible. They are capable of making mistakes and of expressing harmful views. It is important to hold psychologists accountable for their actions, and to ensure that they are held to the highest ethical standards.

In addition to the steps outlined above, there are a number of other things that can be done to mitigate bias in psychology. These include:

• Increasing diversity in the field of psychology
• Promoting critical thinking and self-reflection among psychologists
• Developing more specific ethical guidelines for psychologists' use of social media
• Holding psychologists accountable for their online behavior

A Federal Judge Asks: Does the Supreme Court Realize How Bad It Smells?

Michael Ponsor

The New York Times: Opinion

Originally posted 14 July 23

What has gone wrong with the Supreme Court’s sense of smell?

I joined the federal bench in 1984, some years before any of the justices currently on the Supreme Court. Throughout my career, I have been bound and guided by a written code of conduct, backed by a committee of colleagues I can call on for advice. In fact, I checked with a member of that committee before writing this essay.

A few times in my nearly 40 years on the bench, complaints have been filed against me. This is not uncommon for a federal judge. So far, none have been found to have merit, but all of these complaints have been processed with respect, and I have paid close attention to them.

The Supreme Court has avoided imposing a formal ethical apparatus on itself like the one that applies to all other federal judges. I understand the general concern, in part. A complaint mechanism could become a political tool to paralyze the court or a playground for gadflies. However, a skillfully drafted code could overcome this problem. Even a nonenforceable code that the justices formally pledged to respect would be an improvement on the current void.

Reasonable people may disagree on this. The more important, uncontroversial point is that if there will not be formal ethical constraints on our Supreme Court — or even if there will be — its justices must have functioning noses. They must keep themselves far from any conduct with a dubious aroma, even if it may not breach a formal rule.

The fact is, when you become a judge, stuff happens. Many years ago, as a fairly new federal magistrate judge, I was chatting about our kids with a local attorney I knew only slightly. As our conversation unfolded, he mentioned that he’d been planning to take his 10-year-old to a Red Sox game that weekend but their plan had fallen through. Would I like to use his tickets?

The information is here.

Top Arkansas psychiatrist accused of falsely imprisoning patients and Medicaid fraud

Laura Strickler & Stephanie Gosk

NBCnews.com

Originally posted July 23, 2023

Here is an excerpt:

The man who led the unit at the time, Dr. Brian Hyatt, was one of the most prominent psychiatrists in Arkansas and the chairman of the board that disciplines physicians. But he’s now under investigation by state and federal authorities who are probing allegations ranging from Medicaid fraud to false imprisonment.

VanWhy’s release marked the second time in two months that a patient was released from Hyatt’s unit only after a sheriff’s deputy showed up with a court order, according to court records.

“I think that they were running a scheme to hold people as long as possible, to bill their insurance as long as possible before kicking them out the door, and then filling the bed with someone else,” said Aaron Cash, a lawyer who represents VanWhy.

VanWhy and at least 25 other former patients have sued Hyatt, alleging that they were held against their will in his unit for days and sometimes weeks. And Arkansas Attorney General Tim Griffin’s office has accused Hyatt of running an insurance scam, claiming to treat patients he rarely saw and then billing Medicaid at “the highest severity code on every patient,” according to a search warrant affidavit.

As the lawsuits piled up, Hyatt remained chairman of the Arkansas State Medical Board. But he resigned from the board in late May after Drug Enforcement Administration agents executed a search warrant at his private practice. 

“I am not resigning because of any wrongdoing on my part but so that the Board may continue its important work without delay or distraction,” he wrote in a letter. “I will continue to defend myself in the proper forum against the false allegations being made against me.”

Northwest Medical Center in Springdale “abruptly terminated” Hyatt’s contract in May 2022, according to the attorney general’s search warrant affidavit. 

In April, the hospital agreed to pay $1.1 million in a settlement with the Arkansas Attorney General’s Office. Northwest Medical Center could not provide sufficient documentation that justified the hospitalization of 246 patients who were held in Hyatt’s unit, according to the attorney general’s office. 

As part of the settlement, the hospital denied any wrongdoing.

The info is here.

Inside the DeSantis Doc That Showtime Didn’t Want You to See

Roger Sollenberger

The Daily Beast

Originally posted 23 July 23

Here are two excerpts:

The documentary contrasts DeSantis’ account with those of two anonymous ex-prisoners, whom the transcript indicated were not represented in the flesh; their claims were delivered in “voice notes.”

“Officer DeSantis was one of the officers who oversaw the force-feeding and torture we were subjected to in 2006,” one former prisoner said. The second former detainee claimed that DeSantis was “one of the officers who mistreated us,” adding that DeSantis was “a bad person” and “a very bad officer.”

Over a view of “Camp X-Ray”—the now-abandoned section of Gitmo where DeSantis was stationed but has since fallen into disrepair—the narrator revealed that a VICE freedom of information request for the Florida governor’s active duty record returned “little about Guantanamo” outside of his arrival in March 2006.

But as the documentary noted, that period was “a brutal point in the prison’s history.”

Detainees had been on a prolonged hunger strike to call attention to their treatment, and the government’s solution was to force-feed prisoners Ensure dietary supplements through tubes placed in their noses. Detainees alleged the process caused excessive bleeding and was repeated “until they vomited and defecated on themselves.” (DeSantis, a legal adviser, would almost certainly have been aware that the UN concluded that force-feeding amounted to torture the month before he started working at Guantanamo.)

(cut)

The transcript then presented DeSantis’ own 2018 account of his role in the forced-feedings, when he told CBS News Miami that he had personally and professionally endorsed force-feeding as a legal way to break prisoner hunger strikes.

“The commander wants to know, well how do I combat this? So one of the jobs as a legal adviser will be like, ‘Hey, you actually can force feed, here’s what you can do, here’s kinda the rules of that,’” DeSantis said at the time.

DeSantis altered that language in a Piers Morgan interview this March, again invoking his junior rank as evidence that he would have lacked standing to order forced-feeding.

“There may have been a commander that would have done feeding if someone was going to die, but that was not something that I would have even had authority to do,” he said. However, DeSantis did not deny that he had provided that legal advice.

The article is here.

My thoughts:

I would like the see the documentary and make my own decision about its veracity.

• The decision by Showtime to pull the episode is a significant one, as it suggests that the network is willing to censor its programming in order to avoid political controversy.
• This is a worrying development, as it raises questions about the future of independent journalism in the United States.
• If news organizations are afraid to air stories that are critical of powerful figures, then it will be much more difficult for the public to hold those figures accountable.
• I hope that Showtime will reconsider its decision and allow the episode to air. The public has a right to know about the allegations against DeSantis, and it is important that these allegations be given a fair hearing.

In the US, patient data privacy is an illusion

Harlan M Krumholz

Opinion

BMJ 2023;381:p1225

Here is an excerpt:

The regulation allows anyone involved in a patient’s care to access health information about them. It is based on the paternalistic assumption that for any healthcare provider or related associate to be able to provide care for a patient, unfettered access to all of that individual’s health records is required, regardless of the patient’s preference. This provision removes control from the patient’s hands for choices that should be theirs alone to make. For example, the pop-up covid testing service you may have used can claim to be an entity involved in your care and gain access to your data. This access can be bought through many for-profit companies. The urgent care centre you visited for your bruised ankle can access all your data. The team conducting your prenatal testing is considered involved in your care and can access your records. Health insurance companies can obtain all the records. And these are just a few examples.

Moreover, health systems legally transmit sensitive information with partners, affiliates, and vendors through Business Associate Agreements. But patients may not want their sensitive information disseminated—they may not want all their identified data transmitted to a third party through contracts that enable those companies to sell their personal information if the data are de-identified. And importantly, with all the advances in data science, effectively de-identifying detailed health information is almost impossible.

HIPAA confers ample latitude to these third parties. As a result, companies make massive profits from the sale of data. Some companies claim to be able to provide comprehensive health information on more than 300 million Americans—most of the American public—for a price. These companies' business models are legal, yet most patients remain in the dark about what may be happening to their data.

However, massive accumulations of medical data do have the potential to produce insights into medical problems and accelerate progress towards better outcomes. And many uses of a patient’s data, despite moving throughout the healthcare ecosystem without their knowledge, may nevertheless help advance new diagnostics and therapeutics. The critical questions surround the assumptions people should have about their health data and the disclosures that should be made before a patient speaks with a health professional. Should each person be notified before interacting with a healthcare provider about what may happen with the information they share or the data their tests reveal? Are there new technologies that could help patients regain control over their data?

Although no one would relish a return to paper records, that cumbersome system at least made it difficult for patients’ data to be made into a commodity. The digital transformation of healthcare data has enabled wonderous breakthroughs—but at the cost of our privacy. And as computational power and more clever means of moving and organising data emerge, the likelihood of permission-based privacy will recede even further.

The info is here.

On the origin of laws by natural selection

DeScioli, P.

Evolution and Human Behavior

Volume 44, Issue 3, May 2023, Pages 195-209

Abstract

Humans are lawmakers like we are toolmakers. Why do humans make so many laws? Here we examine the structure of laws to look for clues about how humans use them in evolutionary competition. We will see that laws are messages with a distinct combination of ideas. Laws are similar to threats but critical differences show that they have a different function. Instead, the structure of laws matches moral rules, revealing that laws derive from moral judgment. Moral judgment evolved as a strategy for choosing sides in conflicts by impartial rules of action—rather than by hierarchy or faction. For this purpose, humans can create endless laws to govern nearly any action. However, as prolific lawmakers, humans produce a confusion of contradictory laws, giving rise to a perpetual battle to control the laws. To illustrate, we visit some of the major conflicts over laws of violence, property, sex, faction, and power.

(cut)

Moral rules are not for cooperation

We have briefly summarized the  major divisions and operations of moral judgment. Why then did humans evolve such elaborate powers of the mind devoted to moral rules? What is all this rule making for?

One common opinion is that moral rules are for cooperation. That is, we make and enforce a moral code in order to cooperate more effectively with other people. Indeed, traditional  theories beginning with Darwin assume that morality is  the  same  as cooperation. These theories  successfully explain many forms of cooperation, such as why humans and other  animals  care  for  offspring,  trade  favors,  respect  property, communicate  honestly,  and  work  together  in  groups.  For  instance, theories of reciprocity explain why humans keep records of other people’s deeds in the form of reputation, why we seek partners who are nice, kind, and generous, why we praise these virtues, and why we aspire to attain them.

However, if we look closely, these theories explain cooperation, not moral  judgment.  Cooperation pertains  to our decisions  to  benefit  or harm someone, whereas moral judgment pertains to  our judgments of someone’s action  as right or  wrong. The difference  is crucial because these  mental  faculties  operate  independently  and  they  evolved  separately. For  instance,  people can  use moral judgment  to cooperate but also to cheat, such as a thief who hides the theft because they judge it to be  wrong, or a corrupt leader who invents a  moral rule  that forbids criticism of the leader. Likewise, people use moral judgment to benefit others  but  also  to  harm  them, such  as falsely  accusing an enemy of murder to imprison them. 

Regarding  their  evolutionary  history, moral  judgment is  a  recent adaptation while cooperation is ancient and widespread, some forms as old  as  the origins  of  life and  multicellular  organisms.  Recalling our previous examples, social animals like gorillas, baboons, lions, and hyenas cooperate in numerous ways. They care for offspring, share food, respect property, work together in teams, form reputations,  and judge others’ characters as nice or nasty. But these species do not communicate rules of action, nor do they learn, invent, and debate the rules. Like language, moral judgment  most likely evolved  recently in the  human lineage, long after complex forms of cooperation. 

From the Conclusion

Having anchored ourselves to concrete laws, we next asked, What are laws for? This is the central question for  any mental power because it persists only  by aiding an animal in evolutionary competition.  In this search,  we  should  not  be  deterred  by  the  magnificent creativity  and variety of laws. Some people suppose that natural selection could impart no more than  a  few fixed laws in  the  human mind, but there  are  no grounds for this supposition. Natural selection designed all life on Earth and its creativity exceeds our own. The mental adaptations of animals outperform our best computer programs on routine tasks such as loco-motion and vision. Why suppose that human laws must be far simpler than, for instance, the flight controllers in the brain of a hummingbird? And there are obvious counterexamples. Language is a complex  adaptation but this does not mean that humans speak just a few sentences. Tool use comes from mental adaptations including an intuitive theory of physics, and again these abilities do not limit but enable the enormous variety of tools.

A pdf is here.

Medical assistance in dying (MAiD): Ethical considerations for psychologists

Koocher, G. P., Benjamin, G. A. H.,  et al. (2023). 

Professional Psychology: 

Research and Practice, 54(1), 2–13.

Abstract

Significant ethical challenges arise when mental health practitioners care for patients who seek to accelerate their own dying for rational medically valid reasons. Current and proposed laws provide for medical assistance in dying (MAiD) in several U.S. jurisdictions, all of Canada, and several other nations. Differing provisions of these laws complicate their utility for some patients who seek aid in dying. Some extant laws include roles that mental health professionals might play in assessing patients’ competence or capacity to consent, mental illness, or other cognitive and behavioral factors. Practitioners who choose to accept roles in the MAiD process must consider and resolve a number of ethical challenges including potential conflicts between and among laws, ethical standards, third-party requests, personal values, and patients’ wishes. These include becoming aware of patients who may wish to act independently to end their lives when MAiD laws might otherwise exclude them. Examples from actual cases and the resultant discussion will form a basis for exploration of the ethical and legal complexities confronted when psychologists become engaged in the process either intentionally or incidentally. The lead article (Koocher) is not intended to comprehensively address MAiD in all of its complexity but rather to trigger a thoughtful discussion among the accompanying commentaries.

Impact Statement

Public Significance Statement—Current and proposed laws provide for medical assistance in dying (MAiD), sometimes described as physician-assisted suicide, in several U.S. jurisdictions, all of Canada, and in several other nations. Some such laws require psychological input, usually from either a psychologist or a psychiatrist. The limited scope of existing laws may result in some patients suffering with debilitating, painful, chronic, and fatal illnesses to consider suicide without medical assistance. With or without MAiD legislation, mental health professionals will come in contact with such patients and must consider the potentially complex ethical ramifications of caring for such patients. 

Conclusion

The culture of dying in America too often involves end-of-life care provided by strangers in institutional settings. Government and professional regulators often assume a parentalistic stance that effectively diminishes personal control of the dying process. Legalized MAiD offers an important option to those suffer from an irremediable medical condition and desire access to medical procedures to hasten death in a peaceful and dignified manner. Patients confronting chronic terminal illness have legitimate interests in controlling their own dying with quality care and support. Perhaps the most valuable and meaningful aspect of dying would include the presence of a community of care that demonstrates to the dying person that they will not feel abandoned (Campbell, 2019). Psychologists can play a significant role in making this happen. Ethical, professional, and legal controversies will abound as MAiD becomes more socially prevalent, and it will.

The info is here.

A Christian Health Nonprofit Saddled Thousands With Debt as It Built a Family Empire Including a Pot Farm, a Bank and an Airline

Ryan Gabrielson & J. David McSwane

ProPublic.org

Originally published 25 FEB 23

Here is an excerpt:

Four years after its launch in 2014, the ministry enrolled members in almost every state and collected $300 million in annual revenue. Liberty used the money to pay at least $140 million to businesses owned and operated by Beers family members and friends over a seven-year period, the investigation found. The family then funneled the money through a network of shell companies to buy a private airline in Ohio, more than $20 million in real estate holdings and scores of other businesses, including a winery in Oregon that they turned into a marijuana farm. The family calls this collection of enterprises “the conglomerate.”

Beers has disguised his involvement in Liberty. He has never been listed as a Liberty executive or board member, and none of the family’s 50-plus companies or assets are in his name, records show.

From the family’s 700-acre ranch north of Canton, however, Beers acts as the shadow lord of a financial empire. It was built from money that people paid to Liberty, Beers’ top lieutenant confirmed to ProPublica. He plays in high-stakes poker tournaments around the country, travels to the Caribbean and leads big-game hunts at a vast hunting property in Canada, which the family partly owns. He is a man, said one former Liberty executive, with all the “trappings of large money coming his way.”

Despite abundant evidence of fraud, much of it detailed in court records and law enforcement files obtained by ProPublica, members of the Beers family have flourished in the health care industry and have never been prevented from running a nonprofit. Instead, the family’s long and lucrative history illustrates how health care sharing ministries thrive in a regulatory no man’s land where state insurance commissioners are barred from investigating, federal agencies turn a blind eye and law enforcement settles for paltry civil settlements.

The Ohio attorney general has twice investigated Beers for activities that financial crimes investigators said were probable felonies. Instead, the office settled for civil fines, most recently in 2021. It also required Liberty to sever its ties to some Beers family members.

The IRS has pursued individual family members for underreporting their income and failing to pay million-dollar tax bills. But there’s no indication that the IRS has investigated how several members of one family amassed such substantial wealth in just seven years by running a Christian nonprofit.

The agencies’ failure to move decisively against the Beers family has left Liberty members struggling with millions of dollars in medical debt. Many have joined a class-action lawsuit accusing the nonprofit of fraud.

After years of complaints, health care sharing ministries are now attracting more scrutiny. Sharity Ministries, once among the largest organizations in the industry, filed for bankruptcy and then dissolved in 2021 as regulators in multiple states investigated its failure to pay members’ bills. In January, the Justice Department seized the assets of a small Missouri-based ministry, Medical Cost Sharing Inc., and those of its founders, accusing them of fraud and self-enrichment. The founders have denied the government’s allegations.

The info is here.

UnitedHealthcare Tried to Deny Coverage to a Chronically Ill Patient. He Fought Back, Exposing the Insurer’s Inner Workings.

By D. Armstron, R. Rucker, & M. Miller

ProPublica.org

Originally published 2 FEB 23

Here is an excerpt:

Insurers have wide discretion in crafting what is covered by their policies, beyond some basic services mandated by federal and state law. They often deny claims for services that they deem not “medically necessary.”

When United refused to pay for McNaughton's treatment for that reason, his family did something unusual. They fought back with a lawsuit, which uncovered a trove of materials, including internal emails and tape-recorded exchanges among company employees. Those records offer an extraordinary behind-the-scenes look at how one of America's leading health care insurers relentlessly fought to reduce spending on care, even as its profits rose to record levels.

As United reviewed McNaughton’s treatment, he and his family were often in the dark about what was happening or their rights. Meanwhile, United employees misrepresented critical findings and ignored warnings from doctors about the risks of altering McNaughton’s drug plan.

At one point, court records show, United inaccurately reported to Penn State and the family that McNaughton’s doctor had agreed to lower the doses of his medication. Another time, a doctor paid by United concluded that denying payments for McNaughton’s treatment could put his health at risk, but the company buried his report and did not consider its findings. The insurer did, however, consider a report submitted by a company doctor who rubber-stamped the recommendation of a United nurse to reject paying for the treatment.

United declined to answer specific questions about the case, even after McNaughton signed a release provided by the insurer to allow it to discuss details of his interactions with the company. United noted that it ultimately paid for all of McNaughton’s treatments. In a written response, United spokesperson Maria Gordon Shydlo wrote that the company’s guiding concern was McNaughton’s well-being.

“Mr. McNaughton’s treatment involves medication dosages that far exceed FDA guidelines,” the statement said. “In cases like this, we review treatment plans based on current clinical guidelines to help ensure patient safety.”

But the records reviewed by ProPublica show that United had another, equally urgent goal in dealing with McNaughton. In emails, officials calculated what McNaughton was costing them to keep his crippling disease at bay and how much they would save if they forced him to undergo a cheaper treatment that had already failed him. As the family pressed the company to back down, first through Penn State and then through a lawsuit, the United officials handling the case bristled.

The info is here.

Contraceptive Coverage Expanded: No More ‘Moral’ Exemptions for Employers

Ari Blaff

Yahoo News

Originally posted 30 JAN 23

Here is an excerpt:

The proposed new rule released today by the Departments of Health and Human Services (HHS), Labor, and Treasury would remove the ability of employers to opt out for “moral” reasons, but it would retain the existing protections on “religious” grounds.

For employees covered by insurers with religious exemptions, the new policy will create an “independent pathway” that permits them to access contraceptives through a third-party provider free of charge.

“We had to really think through how to do this in the right way to satisfy both sides, but we think we found that way,” a senior HHS official told CNN.

Planned Parenthood applauded the announcement. “Employers and universities should not be able to dictate personal health-care decisions and impose their views on their employees or students,” the organization’s chief, Alexis McGill Johnson, told CNN. “The ACA mandates that health insurance plans cover all forms of birth control without out-of-pocket costs. Now, more than ever, we must protect this fundamental freedom.”

In 2018, the Trump administration sought to carve out an exception, based on “sincerely held religious beliefs,” to the ACA’s contraceptive mandate. The move triggered a Pennsylvania district court judge to issue a nationwide injunction in 2019, blocking the implementation of the change. However, in 2020, in Little Sisters of the Poor v. Pennsylvania, the Supreme Court, in a 7–2 ruling, defended the legality of the original Trump policy.

The Supreme Court’s overturning of Roe v. Wade in June 2022, in its Dobbs ruling, played a role in HHS’s decision to release the new proposal. Guaranteeing access to contraceptions at no cost to the individual “is a national public health imperative,” HHS said in the proposal. And the Dobbs ruling “has placed a heightened importance on access to contraceptive services nationwide.”

The info is here.

San Francisco will allow police to deploy robots that kill

Janie Har

Associated Press

Originally posted 29 Nov 22

Supervisors in San Francisco voted Tuesday to give city police the ability to use potentially lethal, remote-controlled robots in emergency situations -- following an emotionally charged debate that reflected divisions on the politically liberal board over support for law enforcement.

The vote was 8-3, with the majority agreeing to grant police the option despite strong objections from civil liberties and other police oversight groups. Opponents said the authority would lead to the further militarization of a police force already too aggressive with poor and minority communities.

Supervisor Connie Chan, a member of the committee that forwarded the proposal to the full board, said she understood concerns over use of force but that “according to state law, we are required to approve the use of these equipments. So here we are, and it’s definitely not a easy discussion.”

The San Francisco Police Department said it does not have pre-armed robots and has no plans to arm robots with guns. But the department could deploy robots equipped with explosive charges “to contact, incapacitate, or disorient violent, armed, or dangerous suspect” when lives are at stake, SFPD spokesperson Allison Maxie said in a statement.

“Robots equipped in this manner would only be used in extreme circumstances to save or prevent further loss of innocent lives,” she said.

Supervisors amended the proposal Tuesday to specify that officers could use robots only after using alternative force or de-escalation tactics, or concluding they would not be able to subdue the suspect through those alternative means. Only a limited number of high-ranking officers could authorize use of robots as a deadly force option.

The info is here.

Physician-assisted suicide is not protected by Massachusetts Constitution, top state court rules

Chris Van Buskirk

masslive.com

Originally posted 6 Dec 22

The state’s highest court ruled Monday morning that the Massachusetts state constitution does not protect physician-assisted suicide and that laws around manslaughter may prohibit the practice.

The decision affects whether doctors can prescribe lethal amounts of medication to terminally ill patients that would end their life. The plaintiffs, a doctor looking to provide physician-assisted suicide and a patient with an incurable cancer, argued that patients with six months or less to live have a constitutional right to bring about their death on their own terms.

But defendants in the case have said that the decision to legalize or formalize the procedure here in Massachusetts is a question best left to state lawmakers, not the courts. And in an 89-page ruling, Associate Justice Frank Gaziano wrote that the Supreme Judicial Court agreed with that position.

The court, he wrote, recognized the “paramount importance and profound significance of all end-of-life decisions” but that the Massachusetts Declaration of Rights does not reach so far as to protect physician-assisted suicide.

“Our decision today does not diminish the critical nature of these interests, but rather recognizes the limits of our Constitution, and the proper role of the judiciary in a functioning democracy. The desirability and practicality of physician-assisted suicide raises not only weighty philosophical questions about the nature of life and death, but also difficult technical questions about the regulation of the medical field,” Gaziano wrote. “These questions are best left to the democratic process, where their resolution can be informed by robust public debate and thoughtful research by experts in the field.”

Plaintiff Roger Kligler, a retired physician, was diagnosed with stage four metastatic prostate cancer, and in May 2018, a doctor told him that there was a fifty percent chance that he would die within five years.

Kligler, Gaziano wrote in the ruling, had not yet received a six-month prognosis, and his cancer “currently has been contained, and his physician asserts that it would not be surprising if Kligler were alive ten years from now.”

The info is here.

Dozens of telehealth startups sent sensitive health information to big tech companies

Katie Palmer with

Todd Feathers & Simon Fondrie-Teitler 

STAT NEWS

Originally posted 13 DEC 22

Here is an excerpt:

Health privacy experts and former regulators said sharing such sensitive medical information with the world’s largest advertising platforms threatens patient privacy and trust and could run afoul of unfair business practices laws. They also emphasized that privacy regulations like the Health Insurance Portability and Accountability Act (HIPAA) were not built for telehealth. That leaves “ethical and moral gray areas” that allow for the legal sharing of health-related data, said Andrew Mahler, a former investigator at the U.S. Department of Health and Human Services’ Office for Civil Rights.

“I thought I was at this point hard to shock,” said Ari Friedman, an emergency medicine physician at the University of Pennsylvania who researches digital health privacy. “And I find this particularly shocking.”

In October and November, STAT and The Markup signed up for accounts and completed onboarding forms on 50 telehealth sites using a fictional identity with dummy email and social media accounts. To determine what data was being shared by the telehealth sites as users completed their forms, reporters examined the network traffic between trackers using Chrome DevTools, a tool built into Google’s Chrome browser.

On Workit’s site, for example, STAT and The Markup found that a piece of code Meta calls a pixel sent responses about self-harm, drug and alcohol use, and personal information — including first name, email address, and phone number — to Facebook.

The investigation found trackers collecting information on websites that sell everything from addiction treatments and antidepressants to pills for weight loss and migraines. Despite efforts to trace the data using the tech companies’ own transparency tools, STAT and The Markup couldn’t independently confirm how or whether Meta and the other tech companies used the data they collected.

After STAT and The Markup shared detailed findings with all 50 companies, Workit said it had changed its use of trackers. When reporters tested the website again on Dec. 7, they found no evidence of tech platform trackers during the company’s intake or checkout process.

“Workit Health takes the privacy of our members seriously,” Kali Lux, a spokesperson for the company, wrote in an email. “Out of an abundance of caution, we elected to adjust the usage of a number of pixels for now as we continue to evaluate the issue.”

The info is here.

Professional Civil Disobedience — Medical-Society Responsibilities after Dobbs

Matthew Wynia

September 15, 2022

N Engl J Med 2022; 387:959-961

DOI: 10.1056/NEJMp2210192

Here is an excerpt:

Beyond issuing strongly worded statements, what actions should medical organizations take in the face of laws that threaten patients’ well-being? Should they support establishing committees to decide when a pregnant person’s life is in sufficient danger to warrant an abortion? Should they advocate for allowing patients to travel elsewhere for care? Or should they encourage their members to provide evidence-based medical care, even if doing so means accepting — en masse — fines, suspensions of licensure, and potential imprisonment? How long could a dangerous state law survive if the medical profession, as a whole, refused to be intimidated into harming patients, even if such a refusal meant that many physicians might go to jail?

There are several arguments in favor of professional associations supporting civil disobedience by their members. First, collective civil disobedience by a professional group would avert the most common and powerful criticism leveled against civil disobedience, which is that it could lead to anarchy.

Civil disobedience is a “public, nonviolent, conscientious yet political act contrary to law,” carried out with the aim of bringing about a change in an unjust law.2 But respect for laws is necessary to maintain a civil society. Having each person choose which laws to obey and which to disobey is a recipe for chaos. The most well-known proponents of civil disobedience — Henry David Thoreau, Mahatma Gandhi, Martin Luther King, Jr. — all took seriously the threat of unrestrained disregard of laws under the guise of civil disobedience. In his 1963 Letter from Birmingham Jail, King argued that people must respect just laws, but he also wrote, “law and order exist for the purpose of establishing justice,” and he agreed with St. Augustine that “an unjust law is no law at all.” He described a “moral responsibility to disobey unjust laws” and laid out criteria to help people decide when laws, such as those upholding racial segregation, are sufficiently unjust as to warrant open disobedience. Gandhi was even more worried about chaos and launched hunger strikes to rein in his own supporters when he believed they had gone too far in their disobedience of laws.

But professional civil disobedience poses little threat of anarchy. Unlike a situation in which each person decides whether to obey or disobey a law, a professional group’s deciding together, after frank and rational debate, to support disobedience of an unjust law might eventually reinforce social cohesion, elevate trust in the profession, and help communities avoid tragic errors. Professions, after all, are expected to protect vulnerable people and core social values. Such a decision would still be contentious, however. Civil disobedience is nonviolent, but it elevates and highlights conflict and often leads to violence against people disobeying the law. Professional civil disobedience would undoubtedly require tremendous courage.

Proposing professional civil disobedience of state laws prohibiting abortion might seem naive. Historically, physicians have rarely been radical, and most have conformed with bad laws and policies, even horrific ones — such as those authorizing forced-sterilization programs in the United States and Nazi Germany, the use of psychiatric hospitals as political prisons in the Soviet Union, and police brutality under apartheid in South Africa. Too often, organized medicine has failed to fulfill its duty to protect patients when doing so required acting against state authority. Although there are many examples of courageous individual physicians defying unjust laws or regulations, examples of open support for these physicians by their professional associations — such as the AMA’s offer to support physicians who refused to be involved in “enhanced” interrogations (i.e., torture) during the Iraq War — are uncommon. And profession-wide civil disobedience — such as Dutch physicians choosing to collectively turn in their licenses rather than practice under Nazi rule — is rare.

The info is here.

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.

The info is here.

Mental Health Implications of Abortion Restrictions for Historically Marginalized Populations

Ogbu-Nwobodo, L., Shim, R.S., et al.

October 27, 2022

N Engl J Med 2022; 387:1613-1617

DOI: 10.1056/NEJMms2211124

Here is an excerpt:

Abortion and Mental Health

To begin with, abortion does not lead to mental health harm — a fact that has been established by data and recognized by the National Academies of Sciences, Engineering, and Medicine and the American Psychological Association The Turnaway Study, a longitudinal study that compared mental health outcomes among people who obtained an abortion with those among people denied abortion care, found that abortion denial was associated with initially higher levels of stress, anxiety, and low self-esteem than was obtaining of wanted abortion care. People who had an abortion did not have an increased risk of any mental health disorder, including depression, anxiety, suicidal ideation, post-traumatic stress disorder, or substance use disorders. Whether people obtained or were denied an abortion, those at greatest risk for adverse psychological outcomes after seeking an abortion were those with a history of mental health conditions or of child abuse or neglect and those who perceived abortion stigma (i.e., they felt others would look down on them for seeking an abortion). Furthermore, people who are highly oppressed and marginalized by society are more vulnerable to psychological distress.

There is evidence that people seeking abortion have poorer baseline mental health, on average, than people who are not seeking an abortion. However, this poorer mental health results in part from structural inequities that disproportionately expose some populations to poverty, trauma, adverse childhood experiences (including physical and sexual abuse), and intimate partner violence. People seek abortion for many reasons, including (but not limited to) timing issues, the need to focus on their other children, concern for their own physical or mental health, the desire to avoid exposing a child to a violent or abusive partner, and the lack of financial security to raise a child.

In addition, for people with a history of mental illness, pregnancy and the postpartum period are a time of high risk, with increased rates of recurrence of psychiatric symptoms and of adverse pregnancy and birth outcomes. Because of stigma and discrimination, birthing or pregnant people with serious mental illnesses or substance use disorders are more likely to be counseled by health professionals to avoid or terminate pregnancies, as highlighted by a small study of women with bipolar disorder. One study found that among women with mental health conditions, the rate of readmission to a psychiatric hospital was not elevated around the time of abortion, but there was an increased rate of hospitalization in psychiatric facilities at the time of childbirth. Data also indicate that for people with preexisting mental health conditions, mental health outcomes are poor whether they obtain an abortion or give birth.

The Role of Structural Racism

Structural racism — defined as ongoing interactions between macro-level systems and institutions that constrain the resources, opportunities, and power of marginalized racial and ethnic groups — is widely considered a fundamental cause of poor health and racial inequities, including adverse maternal health outcomes. Structural racism ensures the inequitable distribution of a broad range of health-promoting resources and opportunities that unfairly advantage White people and unfairly disadvantage historically marginalized racial and ethnic groups (e.g., education, paid leave from work, access to high-quality health care, safe neighborhoods, and affordable housing). In addition, structural racism is responsible for inequities and poor mental health outcomes among many diverse populations.

The information is here.

Frequently asked questions about abortion laws and psychology practice

American Psychological Association

Updated 1 SEPT 2022

Since the U.S. Supreme Court issued its decision to overturn Roe v. Wade, many states have proposed, enacted, or resurrected a range of laws to either prohibit, significantly restrict, or protect reproductive rights and health care. Currently, the main targets of these laws appear to be medical providers who provide abortions or individuals seeking to obtain an abortion.

APA and APA Services Inc. are striving to provide psychologists with accurate and adequate information about the potential impact on them of reproductive health care laws. Since psychologists have embraced telehealth and many use technology to provide services across state lines, it’s important to be familiar with the laws governing the jurisdiction(s) where you are licensed as well as the jurisdiction(s) where your patients live.

In addition to this FAQ and other APA resources, psychologists will want to be familiar with guidance issued by federal and state agencies, their state licensing board(s), and their liability carrier. Some frequently asked questions follow.

While the situation is dynamic, good psychological practice remains unchanged. The changing landscape in states regarding access to reproductive health care does not change the fundamental approach to psychological care. Psychologists should continue to prioritize the welfare of their patients, protect confidentiality, and ensure their patients’ safety.

Practicing in states with changing abortion laws

Am I practicing in a state where abortion is, or is soon to be, illegal under all or certain circumstances?

The Supreme Court’s decision to overturn Roe v. Wade has put the regulation of abortion in the hands of states. In anticipation of the ruling, 13 states enacted “trigger laws,” designed to ban or restrict abortion upon the Supreme Court’s reversal of Roe v. Wade. Not all trigger laws immediately kicked in, and some that did were immediately challenged in court, delaying their enforcement.

Staying current on laws affecting the states where you practice is important. For a list of existing abortion bans and restrictions within each state, the Center for Reproductive Rights has provided a map that is updated in real time. The Guttmacher Institute, a well-respected research group that collects information on abortion laws across the United States, also tracks current state abortion-related laws.

The information is here.

9th Circuit Upholds Ban on Conversion Therapy for Minors in First Amendment Challenge

Debra Cassens Weiss

ABA Journal

Originally published 7 SEPT 22

Washington state’s ban on conversion therapy for minors does not violate the First or 14th Amendments, a federal appeals court ruled on Tuesday.

The San Francisco-based 9th U.S. Circuit Court of Appeals upheld the law, which subjects licensed therapists to discipline if they practice therapy that seeks to change the sexual orientation or gender identity of a person under age 18.

The appeals court said the law was intended to prevent psychological harm to LGBTQ minors subjected to conversion therapy, including depression, self-stigma and emotional distress.

The appeals court ruled against Christian marriage and family counselor Brian Tingley, who claimed the ban on conversion therapy for minors violated his free speech and free exercise rights under the First Amendment. He also claimed the Washington state law was unconstitutionally vague under the 14th Amendment.

The appeals court noted its 2014 decision, Pickup v. Brown, upheld a nearly identical law in California. Tingley had argued, however, that the U.S. Supreme Court abrogated the Pickup decision in 2018 when it ruled for anti-abortion crisis pregnancy centers challenging California’s required notice on the availability of state-subsidized abortions.

The Supreme Court held the abortion-notice law was a content-based restriction that was likely unconstitutional. The case was National Institute of Family & Life Advocates v. Becerra.

The info is here.

Professional Civil Disobedience — Medical-Society Responsibilities after Dobbs

Matthew K. Wynia

The New England Journal of Medicine

September 15, 2022, 387:959-961

Here are two excerpts:

The AMA called Dobbs “an egregious allowance of government intrusion into the medical examination room, a direct attack on the practice of medicine and the patient–physician relationship, and a brazen violation of patients’ rights to evidence-based reproductive health services.” The American Academy of Family Physicians wrote that the decision “negatively impacts our practices and our patients by undermining the patient–physician relationship and potentially criminalizing evidence-based medical care.” The American College of Physicians stated, “A patient’s decision about whether to continue a pregnancy should be a private decision made in consultation with a physician or other health care professional, without interference from the government.” And the CEO of the American College of Obstetricians and Gynecologists called Dobbs “tragic” for patients, “the boldest act of legislative interference that we have seen in this country,” and “an affront to all that drew my colleagues and me into medicine.”

Medical organizations are rarely so united. Yet even many physicians who oppose abortion recognize that medically nuanced decisions are best left in the hands of individual patients and their physicians — not state lawmakers. Abortion bans are already pushing physicians in some states to wait until patients become critically ill before intervening in cases of ectopic pregnancy or septic miscarriage, among other problems.

Beyond issuing strongly worded statements, what actions should medical organizations take in the face of laws that threaten patients’ well-being? Should they support establishing committees to decide when a pregnant person’s life is in sufficient danger to warrant an abortion? Should they advocate for allowing patients to travel elsewhere for care? Or should they encourage their members to provide evidence-based medical care, even if doing so means accepting — en masse — fines, suspensions of licensure, and potential imprisonment? How long could a dangerous state law survive if the medical profession, as a whole, refused to be intimidated into harming patients, even if such a refusal meant that many physicians might go to jail?

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Proposing professional civil disobedience of state laws prohibiting abortion might seem naive. Historically, physicians have rarely been radical, and most have conformed with bad laws and policies, even horrific ones — such as those authorizing forced-sterilization programs in the United States and Nazi Germany, the use of psychiatric hospitals as political prisons in the Soviet Union, and police brutality under apartheid in South Africa. Too often, organized medicine has failed to fulfill its duty to protect patients when doing so required acting against state authority. Although there are many examples of courageous individual physicians defying unjust laws or regulations, examples of open support for these physicians by their professional associations — such as the AMA’s offer to support physicians who refused to be involved in “enhanced” interrogations (i.e., torture) during the Iraq War — are uncommon. And profession-wide civil disobedience — such as Dutch physicians choosing to collectively turn in their licenses rather than practice under Nazi rule — is rare.

The info is here.

Seven years of sex abuse: How Mormon officials let it happen

Michael Rezendes

The Associated Press

Originally posted 4 AUG 22

Here is an excerpt:

When it comes to child sexual abuse, the Mormon church says “the first responsibility of the church in abuse cases is to help those who have been abused and protect those who may be vulnerable to future abuse,” according to its 2010 handbook for church leaders. The handbook also says, “Abuse cannot be tolerated in any form.”

But church officials, from the bishops in the Bisbee ward to officials in Salt Lake City, tolerated abuse in the Adams family for years.

“They just let it keep happening,” said MJ, in her AP interview. “They just said, ‘Hey, let’s excommunicate her father.’ It didn’t stop. ‘Let’s have them do therapy.’ It didn’t stop. ‘Hey, let’s forgive and forget and all this will go away.’ It didn’t go away.”

A similar dynamic played out in West Virginia, where church leaders were accused of covering up the crimes committed by a young abuser from a prominent Mormon family even after he’d been convicted on child sex abuse charges in Utah. The abuser, Michael Jensen, today is serving a 35- to 75-year prison sentence for abusing two children in West Virginia. Their family, along with others, sued the church and settled out of court for an undisclosed sum.

“Child abuse festers and grows in secrecy,” said Lynne Cadigan, a lawyer for the Adams children who filed suit. “That is why the mandatory reporting came into effect. It’s the most important thing in the world to immediately report to the police.”

The lawsuit filed by the three Adams children accuses The Church of Jesus Christ of Latter-day Saints and several members, including Bishops Herrod and Mauzy, of negligence and conspiring to cover up child sex abuse to avoid “costly lawsuits” and protect the reputation of the church, which relies on proselytizing and tithing to attract new members and raise money. In 2020, the church claimed approximately 16 million members worldwide, most of them living outside the United States.

“The failure to prevent or report abuse was part of the policy of the defendants, which was to block public disclosure to avoid scandals, to avoid the disclosure of their tolerance of child sexual molestation and assault, to preserve a false appearance of propriety, and to avoid investigation and action by public authority, including law enforcement,” the suit alleges. “Plaintiffs are informed and believe that such actions were motivated by a desire to protect the reputation of the defendants.”

Very few of the scores of lawsuits against The Church of Jesus Christ of Latter-day Saints mention the help line, in part because details of its operations have been a closely guarded secret. The documents in the sealed court records show how it works.

“The help line is certainly there to help — to help the church keep its secrets and to cover up abuse,” said Craig Vernon, an Idaho attorney who has filed several sex abuse lawsuits against the church.

Vernon, a former member, routinely demands that the church require bishops to report sex abuse to police or state authorities rather than the help line.

The sealed records say calls to the help line are answered by social workers or professional counselors who determine whether the information they receive is serious enough to be referred to an attorney with Kirton McConkie, a Salt Lake City firm that represents the church.

The info is here.