American Psychiatric Association Presidential Task Force to Address Structural Racism Throughout Psychiatry

Press Release
American Psychiatric Association
2 July 2020

The American Psychiatric Association today announced the members and charge of its Presidential Task Force to Address Structural Racism Throughout Psychiatry. The
Task Force was initially described at an APA Town Hall on June 15 amidst rising calls from psychiatrists for action on racism. It held its first meeting on June 27, and efforts, including the planning of future town halls, surveys and the establishment of related committees, are underway.

Focusing on organized psychiatry, psychiatrists, psychiatric trainees, psychiatric patients, and others who work to serve psychiatric patients, the Task Force is initially charged with:

1. Providing education and resources on APA’s and psychiatry’s history regarding structural racism;
2. Explaining the current impact of structural racism on the mental health of our patients and colleagues;
3. Developing achievable and actionable recommendations for change to eliminate structural racism in the APA and psychiatry now and in the future;
4. Providing reports with specific recommendations for achievable actions to the APA Board of Trustees at each of its meetings through May 2021; and
5. Monitoring the implementation of tasks 1-4.

The info is here.

Why Health Professionals Should Speak Out Against False Beliefs on the Internet

Joel T. Wu and Jennifer B. McCormick
AMA J Ethics. 2018;20(11):E1052-1058.
doi: 10.1001/amajethics.2018.1052.

Abstract

Broad dissemination and consumption of false or misleading health information, amplified by the internet, poses risks to public health and problems for both the health care enterprise and the government. In this article, we review government power for, and constitutional limits on, regulating health-related speech, particularly on the internet. We suggest that government regulation can only partially address false or misleading health information dissemination. Drawing on the American Medical Association’s Code of Medical Ethics, we argue that health care professionals have responsibilities to convey truthful information to patients, peers, and communities. Finally, we suggest that all health care professionals have essential roles in helping patients and fellow citizens obtain reliable, evidence-based health information.

Here is an excerpt:

We would suggest that health care professionals have an ethical obligation to correct false or misleading health information, share truthful health information, and direct people to reliable sources of health information within their communities and spheres of influence. After all, health and well-being are values shared by almost everyone. Principle V of the AMA Principles of Ethics states: “A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated” (italics added). And Principle VII states: “A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health” (italics added). Taken together, these principles articulate an ethical obligation to make relevant information available to the public to improve community and public health. In the modern information age, wherein the unconstrained and largely unregulated proliferation of false health information is enabled by the internet and medical knowledge is no longer privileged, these 2 principles have a special weight and relevance.

Physicians aren’t ‘burning out.’ They’re suffering from moral injury

Simon G. Talbot and Wendy Dean
STAT News
Originally published July 26, 2018

Here is an excerpt:

The term “moral injury” was first used to describe soldiers’ responses to their actions in war. It represents “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.” Journalist Diane Silver describes it as “a deep soul wound that pierces a person’s identity, sense of morality, and relationship to society.”

The moral injury of health care is not the offense of killing another human in the context of war. It is being unable to provide high-quality care and healing in the context of health care.

Most physicians enter medicine following a calling rather than a career path. They go into the field with a desire to help people. Many approach it with almost religious zeal, enduring lost sleep, lost years of young adulthood, huge opportunity costs, family strain, financial instability, disregard for personal health, and a multitude of other challenges. Each hurdle offers a lesson in endurance in the service of one’s goal which, starting in the third year of medical school, is sharply focused on ensuring the best care for one’s patients. Failing to consistently meet patients’ needs has a profound impact on physician wellbeing — this is the crux of consequent moral injury.

The information is here.

Informed Consent and the Role of the Treating Physician

Holly Fernandez Lynch, Steven Joffe, and Eric A. Feldman
Originally posted June 21, 2018
N Engl J Med 2018; 378:2433-2438
DOI: 10.1056/NEJMhle1800071

Here are a few excerpts:

In 2017, the Pennsylvania Supreme Court ruled that informed consent must be obtained directly by the treating physician. The authors discuss the potential implications of this ruling and argue that a team-based approach to consent is better for patients and physicians.

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Implications in Pennsylvania and Beyond

Shinal has already had a profound effect in Pennsylvania, where it represents a substantial departure from typical consent practice.  More than half the physicians who responded to a recent survey conducted by the Pennsylvania Medical Society (PAMED) reported a change in the informed-consent process in their work setting; of that group, the vast majority expressed discontent with the effect of the new approach on patient flow and the way patients are served.  Medical centers throughout the state have changed their consent policies, precluding nonphysicians from obtaining patient consent to the procedures specified in the MCARE Act and sometimes restricting the involvement of physician trainees.  Some Pennsylvania institutions have also applied the Shinal holding to research, in light of the reference in the MCARE Act to experimental products and uses, despite the clear policy of the Food and Drug Administration (FDA) allowing investigators to involve other staff in the consent process.

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Selected State Informed-Consent Laws.

Although the Shinal decision is not binding outside of Pennsylvania, cases bearing on critical ethical dimensions of consent have a history of influence beyond their own jurisdictions.

The information is here.

Do Physicians Have an Ethical Duty to Repair Relationships with So-Called “Difficult” Patients?

Micah Johnson
AMA Journal of Ethics. April 2017, Volume 19, Number 4: 323-331.
doi: 10.1001/journalofethics.2017.19.04.ecas1-1704.

Abstract

This essay argues that physicians hold primary ethical responsibility for repairing damaged patient-physician relationships. The first section establishes that the patient-physician relationship has an important influence on patient health and argues that physicians’ duty to treat should be understood as including a responsibility to repair broken relationships, regardless of which party was “responsible” for the initial tension. The second section argues that the person with more power to repair the relationship also has more responsibility to do so and considers the moral psychology of pain as foundational to conceiving the patient in this case as especially vulnerable and disempowered. The essay concludes with suggestions for clinicians to act on the idea that a healthy patient-physician relationship ought to lie at the center of medicine’s moral mission.

The article is here.

Votes for the future

Thomas Wells
Aeon.co
Originally published May 8, 2014

Here is an excerpt:

By contrast, future generations must accept whatever we choose to bequeath them, and they have no way of informing us of their values. In this, they are even more helpless than foreigners, on whom our political decisions about pollution, trade, war and so on are similarly imposed without consent. Disenfranchised as they are, such foreigners can at least petition their own governments to tell ours off, or engage with us directly by writing articles in our newspapers about the justice of their cause. The citizens of the future lack even this recourse.

The asymmetry between past and future is more than unfair. Our ancestors are beyond harm; they cannot know if we disappoint them. Yet the political decisions we make today will do more than just determine the burdens of citizenship for our grandchildren. They also concern existential dangers such as the likelihood of pandemics and environmental collapse. Without a presence in our political system, the plight of future citizens who might suffer or gain from our present political decisions cannot be properly weighed. We need to give them a voice.

How could we do that? After all, they can’t actually speak to us. Yet even if we can’t know what future citizens will actually value and believe in, we can still consider their interests, on the reasonable assumption that they will somewhat resemble our own (everybody needs breathable air, for example). Interests are much easier than wishes, and quite suitable for representation by proxies.

So perhaps we should simply encourage current citizens to take up the Burkean perspective and think of their civic duty in a more extended way when casting votes. Could this work?

The article is here.

Prep school abuse victims file complaints about psychologist

by Michelle R. Smith
Associated Press
Originally published September 8, 2016

Two victims of sexual abuse at the elite Rhode Island boarding school St. George's have filed complaints with state licensing officials about the school's former psychologist.

They tell The Associated Press that Peter Kosseff did not do enough to address and prevent abuse during his 35 years at the school, and they want his license revoked.

Kosseff, who still practices and has offices in South Kingstown and Newport, did not respond to multiple requests for comment.

The first complaint was filed in December and the other soon after, the two women told the AP.  Joseph Wendelken, a spokesman for the Department of Health, which oversees such licenses, said such complaints are confidential and he could not confirm them. The department said Kosseff's license was last renewed in May.

The Associated Press typically doesn't name sexual abuse victims unless they come forward publicly.

The article is here.

Inability and Obligation in Moral Judgment

Wesley Buckwalter and John Turri
PLOS
Published: August 21, 2015
DOI: 10.1371/journal.pone.0136589

Introduction

Morality is central to human social life [1–3]. Fulfilling moral obligations often requires us to put other people’s interests before our own. Sometimes this is easy, but other times it is hard. For example, it is plausible we are obligated to alleviate terrible suffering if we can do so at very little cost to ourselves, as happens when we donate money to famine relief or vaccination programs. But how far does this obligation extend? Some argue that it extends to the point where we would be making ourselves worse off than the people receiving charitable aid [4]. Many have found this suggestion implausible, sometimes on the grounds that the requirements for morality are limited by our psychology [5–7]. Given the way we are constituted, perhaps we are simply incapable of donating that much. This raises an important question: how demanding is morality and what are the limits of moral requirements?

According to a longstanding principle of moral philosophy, moral requirements are limited by ability. This is often glossed by the slogan that “ought implies can” (hereafter “OIC” for short). The principle says that one is obliged to perform an action only if one can perform the action. Support for OIC can be traced back to at least Cicero [8]. A more explicit articulation comes from Immanuel Kant, who writes, “Duty commands nothing but what we can do,” and that, “If the moral law commands that we ought to be better human beings now, it inescapably follows that we must be capable of being better human beings”.

The entire article is here.