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 Training. Show all posts
Showing posts with label Training. Show all posts

Tuesday, June 4, 2024

Responding Effectively to Disruptive Patient Behaviors: Beyond Behavior Contracts

Fabi R, Johnson LSM. 
JAMA. 2024;331(10):823–824.

Here is an excerpt:

The epidemic of workplace violence has prompted the use of harsh responses that include “behavior contracts” (sometimes called “behavioral agreements”) that can undermine a hospital’s commitment to providing evidence-based, patient-centered care. There is no national repository of data on the use of behavior contracts, or on hospital policies, but in our experience as clinical ethics consultants, and through discussions with colleagues nationally, we have observed that hospitals increasingly try to manage so-called difficult patients and families through behavior contracts that impose paternalistic limits and punitive consequences on patients for a wide range of behaviors. Yet behavior contracts pose serious ethical challenges, especially when unilaterally imposed on patients whose behavior is upsetting and disrespectful but not unsafe. Moreover, the evidence supporting the efficacy of contracts is lacking.

Behavior contracts are used in a variety of health care contexts to promote patient adherence with treatment, including smoking cessation, weight loss, substance use disorder rehabilitation, and psychiatric treatment. A Cochrane systematic review found that evidence of their effectiveness at improving adherence is limited and mixed; it did not find evidence from randomized clinical trials outside of this context.1 Indeed, we could find no empirical evidence to support or challenge the effectiveness of behavior contracts as a tool for addressing the problems of undesirable patient or family behaviors, patient-staff conflicts, and workplace violence in health care. Absent such evidence, health care institutions committed to evidence-based medicine and workplace safety might hesitate before using these contracts. When viewed alongside the ethical considerations, which have been extensively explored in the bioethics literature, we argue that the lack of supportive evidence generates an ethical imperative to reconsider their use altogether. Such reconsideration should include internal audits of how and when they are used, address the lack of institutional transparency and accountability about their use, and impose consistency and ethical safeguards. Based on our own experience, and that of many colleagues, we suspect that institutions that engage in this kind of self-reflection will find worrisome disparities in their use of behavior contracts.

Quick summary:

The article discusses strategies for responding effectively to disruptive patient behaviors beyond behavior contracts. It emphasizes the importance of recognizing risks, de-escalating situations, and maintaining safety in healthcare settings. Key points include the impact of disruptive behavior on patient safety, the need for de-escalation techniques, and the significance of understanding triggers to prevent disruptive incidents. The article also highlights the role of training, policies, and protocols in managing disruptive behaviors successfully.

Saturday, October 22, 2022

Sexuality Training in Counseling Psychology: A Mixed-Methods Study of Student Perspectives

Abbott, D. M., Vargas, J. E., & Santiago, H. J. (2022).
Journal of Counseling Psychology. 
Advance online publication.


Counseling psychologists are a cogent fit to lead the movement toward a sex-positive professional psychology (Burnes et al., 2017a). Though centralizing training in human sexuality (HS; Mollen & Abbott, 2021) and sexual and reproductive health (Grzanka & Frantell, 2017) is congruent with counseling psychologists’ values, training programs rarely require or integrate comprehensive sexuality training for their students (Mollen et al., 2020). We employed a critical mixed-methods design in the interest of centering the missing voices of doctoral-level graduate students in counseling psychology in the discussion of the importance of human sexuality competence for counseling psychologists. Using focus groups to ascertain students’ perspectives on their human sexuality training (HST) in counseling psychology, responses yielded five themes: (a) HST is integral to counseling psychology training, (b) few opportunities to gain human sexuality competence, (c) inconsistent training and self-directed learning, (d) varying levels of human sexuality comfort and competence, and (e) desire for integration of HST. Survey responses suggested students were trained on the vast majority of human sexuality topics at low levels, consistent with prior studies surveying training directors in counseling psychology and at internship training sites (Abbott et al., 2021; Mollen et al., 2020). Taken together, results suggested students see HST as aligned with the social justice emphasis in counseling psychology but found their current training was inconsistent, incidental rather than intentional, and lacked depth. Recommendations, contextualized within counseling psychology values, are offered to increase opportunities for and strengthen HST in counseling psychology training programs. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Impact Statement

The present study suggests that counseling psychology graduate students perceive human sexuality training (HST) as valuable to their professional development and congruent with counseling psychology values. Findings support the integration of consistent, comprehensive, sex-positive HST in doctoral counseling psychology training programs. 


Comprehensive training in human sexuality represents a notable omission from counseling psychology training, particularly in light of the discipline’s values including emphases on diversity, social justice, and contextual, holistic perspectives. In the present study, the first to explore counseling psychology student perceptions of sexuality training, participants outlined the importance of HST to counseling psychology training, specifically, and providing psychotherapeutic services, broadly, outlined the current nature of their training, or lack thereof, and conveyed their desire for HST including recommendations for how programs may successfully implement HST in ways that benefitted students and the public they serve. Therefore, we call on faculty in counseling psychology training programs to reevaluate their commitment to developing sexuality competence among their students, invest in their own sexuality training as needed, and invoke creative strategies to make HST accessible and comprehensive in their programs.

Sunday, April 17, 2022

Leveraging artificial intelligence to improve people’s planning strategies

F. Callaway, et al.
PNAS, 2022, 119 (12) e2117432119 


Human decision making is plagued by systematic errors that can have devastating consequences. Previous research has found that such errors can be partly prevented by teaching people decision strategies that would allow them to make better choices in specific situations. Three bottlenecks of this approach are our limited knowledge of effective decision strategies, the limited transfer of learning beyond the trained task, and the challenge of efficiently teaching good decision strategies to a large number of people. We introduce a general approach to solving these problems that leverages artificial intelligence to discover and teach optimal decision strategies. As a proof of concept, we developed an intelligent tutor that teaches people the automatically discovered optimal heuristic for environments where immediate rewards do not predict long-term outcomes. We found that practice with our intelligent tutor was more effective than conventional approaches to improving human decision making. The benefits of training with our cognitive tutor transferred to a more challenging task and were retained over time. Our general approach to improving human decision making by developing intelligent tutors also proved successful for another environment with a very different reward structure. These findings suggest that leveraging artificial intelligence to discover and teach optimal cognitive strategies is a promising approach to improving human judgment and decision making.


Many bad decisions and their devastating consequences could be avoided if people used optimal decision strategies. Here, we introduce a principled computational approach to improving human decision making. The basic idea is to give people feedback on how they reach their decisions. We develop a method that leverages artificial intelligence to generate this feedback in such a way that people quickly discover the best possible decision strategies. Our empirical findings suggest that a principled computational approach leads to improvements in decision-making competence that transfer to more difficult decisions in more complex environments. In the long run, this line of work might lead to apps that teach people clever strategies for decision making, reasoning, goal setting, planning, and goal achievement.

From the Discussion

We developed an intelligent system that automatically discovers optimal decision strategies and teaches them to people by giving them metacognitive feedback while they are deciding what to do. The general approach starts from modeling the kinds of decision problems people face in the real world along with the constraints under which those decisions have to be made. The resulting formal model makes it possible to leverage artificial intelligence to derive an optimal decision strategy. To teach people this strategy, we then create a simulated decision environment in which people can safely and rapidly practice making those choices while an intelligent tutor provides immediate, precise, and accurate feedback on how they are making their decision. As described above, this feedback is designed to promote metacognitive reinforcement learning.

Saturday, August 28, 2021

Understanding Suicide Risk Among Children and Preteens: A Synthesis Workshop

National Institute of Mental Health
June 15, 2021

NIMH convened a four-part virtual research roundtable series, “Risk, Resilience, & Trajectories in Preteen Suicide.” The roundtables took place between January and April 2021, and culminated in a synthesis meeting in June, 2021. The series brought together a diverse group of expert panelists to assess the state of the science and short- and longer-term research priorities related to preteen suicide risk and risk trajectories. Panelists’ expertise was wide ranging and included youth suicide risk assessment and preventive interventions, developmental psychopathology, child and adolescent mood and anxiety disorders, family and peer relationships, how social and cultural contexts influence youth’s trajectories, biostatistical and computational methods, multilevel modeling, and longitudinal data analysis. 

Thursday, June 11, 2020

Personal Therapy and Self-Care in the Making of Psychologists

Jake S. Ziede & John C. Norcross (2020)
The Journal of Psychology
DOI: 10.1080/00223980.2020.1757596


Psychologists are skilled in assessing, researching, and treating patients’ distress, but frequently experience difficulty in applying these talents to themselves. The authors offer 13 research-supported and theoretically neutral self-care strategies catered to psychologists and those in training: valuing the person of the psychologist, refocusing on the rewards, recognizing the hazards, minding the body, nurturing relationships, setting boundaries, restructuring cognitions, sustaining healthy escapes, maintaining mindfulness, creating a flourishing environment, cultivating spirituality and mission, fostering creativity and growth, and profiting from personal therapy. The latter deserves special emphasis in the making of health care psychologists. These strategies are recommended both during training and throughout the career span. Recommendations are offered for enhancing and publicizing systems of self-care throughout the profession.

The article is here.

Thursday, March 19, 2020

Responding to Unprofessional Behavior by Trainees — A “Just Culture” Framework

J. A. Wasserman, M. Redinger, and T. Gibb
New England Journal of Medicine
February 20, 2020
doi: 10.1056/NEJMms1912591

Professionalism lapses by trainees can be addressed productively if viewed through a lens of medical error, drawing on “just culture” principles. With this approach, educators can promote a formative learning environment while fairly addressing problematic behaviors.

Addressing lapses in professionalism is critical to professional development. Yet characterizing the ways in which the behavior of emerging professionals may fall short and responding to those behaviors remain difficult.

Catherine Lucey suggests that we “consider professionalism lapses to be either analogous to or a form of medical error,” in order to create “a ‘just environment’ in which people are encouraged to report professionalism challenges, lapses, and near misses.” Applying a framework of medical error promotes an understanding of professionalism as a set of skills whose acquisition requires a psychologically safe learning environment.

 Lucey and Souba also note that professionalism sometimes requires one to act counter to one’s other interests and motivations (e.g., to subordinate one’s own interests to those of others); the skills required to navigate such dilemmas must be acquired over time, and therefore trainees’ behavior will inevitably sometimes fall short.

We believe that lapses in professional behavior can be addressed productively if we view them through this lens of medical error, drawing on “just culture” principles and related procedural approaches.


The Just Culture Approach

Thanks to a movement catalyzed by an Institute of Medicine report, error reduction has become a priority of health systems over the past two decades. Their efforts have involved creating a “culture of psychological safety” that allows for open dialogue, dissent, and transparent reporting. Early iterations involved “blame free” approaches, which have increasingly given way to an emphasis on balancing individual and system accountability.

Drawing on these just culture principles, a popular approach for defining and responding to medical error recognizes the qualitative differences among inadvertent human error, at-risk behavior, and reckless behavior (the Institute for Safe Medication Practices also provides an excellent elaboration of these categories).

“Inadvertent human errors” result from suboptimal individual functioning, but without intention or the knowledge that a behavior is wrong or error-prone (e.g., an anesthesiologist inadvertently grabbing a paralyzing agent instead of a reversal agent). These errors are not considered blameworthy, and proper response involves consolation and assessment of systemic changes to prevent them in the future.

Wednesday, March 11, 2020

Expertise in Child Abuse?

Dr. Woods, from a YouTube video
Mike Hixenbaugh & Taylor Mirfendereski
Originally posted 14 Feb 20

Here is an excerpt:

Contrary to Woods’ testimony, there are more than 375 child abuse pediatricians certified by the American Board of Pediatrics in the U.S., all of whom have either completed an extensive fellowship program — first offered, not three, but nearly 15 years ago, while Woods was still in medical school — or spent years examining cases of suspected abuse prior to the creation of the medical subspecialty in 2009. The doctors are trained to differentiate accidental from inflicted injuries, which child abuse pediatricians say makes them better qualified than other doctors to determine whether a child has been abused. At least three physicians have met those qualifications and are practicing as board-certified child abuse pediatricians in the state of Washington.

Woods is not one of them.

Despite her lack of fellowship training, state child welfare and law enforcement officials in Washington have granted Woods remarkable influence over their decisions about whether to remove children from parents or pursue criminal charges, NBC News and KING 5 found. In four cases reviewed by reporters, child welfare workers took children from parents based on Woods’ reports — including some in which Woods misstated key facts, according to a review of records — despite contradictory opinions from other medical experts who said they saw no evidence of abuse.

In one instance, a pediatrician, Dr. Niran Al-Agba, insisted that a 2-year-old child’s bruise matched her parents’ description of an accidental fall onto a heating grate in their home. But Child Protective Services workers, who’d gotten a call from the child’s day care after someone noticed the bruise, asked Woods to look at photos of the injury.

Woods reported that the mark was most likely the result of abuse, even though she’d never seen the child in person or talked to the parents. The agency sided with her. To justify that decision, the Child Protective Services worker described Woods as “a physician with extensive training and experience in regard to child abuse and neglect,” according to a written report reviewed by reporters.

The info is here.

Monday, November 18, 2019

Understanding behavioral ethics can strengthen your compliance program

Jeffrey Kaplan
The FCPA Blog
Originally posted October 21, 2019

Behavioral ethics is a well-known field of social science which shows how — due to various cognitive biases — “we are not as ethical as we think.” Behavioral compliance and ethics (which is less well known) attempts to use behavioral ethics insights to develop and maintain effective compliance programs. In this post I explore some of the ways that this can be done.

Behavioral C&E should be viewed on two levels. The first could be called specific behavioral C&E lessons, meaning enhancements to the various discrete C&E program elements — e.g., risk assessment, training — based on behavioral ethics insights.   Several of these are discussed below.

The second — and more general — aspect of behavioral C&E is the above-mentioned overarching finding that we are not as ethical as we think. The importance of this general lesson is based on the notion that the greatest challenges to having effective C&E programs in organizations is often more about the “will” than the “way.”

That is, what is lacking in many business organizations is an understanding that strong C&E is truly necessary. After all, if we are as ethical than we think, then effective risk mitigation would be just a matter of finding the right punishment for an offense and the power of logical thinking would do the rest. Behavioral ethics teaches that that assumption is ill-founded.

The info is here.

Tuesday, October 15, 2019

Want To Reduce Suicides? Follow The Data — To Medical Offices, Motels And Even Animal Shelters

Maureen O’Hagan
Kaiser Health News
Originally published September 23, 2019

Here is an excerpt:

Experts have long believed that suicide is preventable, and there are evidence-based programs to train people how to identify and respond to folks in crisis and direct them to help. That’s where Debra Darmata, Washington County’s suicide prevention coordinator, comes in. Part of Darmata’s job involves running these training programs, which she described as like CPR but for mental health.

The training is typically offered to people like counselors, educators or pastors. But with the new data, the county realized they were missing people who may have been the last to see the decedents alive. They began offering the training to motel clerks and housekeepers, animal shelter workers, pain clinic staffers and more.

It is a relatively straightforward process: Participants are taught to recognize signs of distress. Then they learn how to ask a person if he or she is in crisis. If so, the participants’ role is not to make the person feel better or to provide counseling or anything of the sort. It is to call a crisis line, and the experts will take over from there.

Since 2014, Darmata said, more than 4,000 county residents have received training in suicide prevention.

“I’ve worked in suicide prevention for 11 years,” Darmata said, “and I’ve never seen anything like it.”

The sheriff’s office has begun sending a deputy from its mental health crisis team when doing evictions. On the eviction paperwork, they added the crisis line number and information on a county walk-in mental health clinic. Local health care organizations have new procedures to review cases involving patient suicides, too.

The info is here.

Friday, September 6, 2019

Walking on Eggshells With Trainees in the Clinical Learning Environment—Avoiding the Eggshells Is Not the Answer.

Gold MA, Rosenthal SL, Wainberg ML.
JAMA Pediatr. 
Published online August 05, 2019.

Here is an excerpt:

Every trainee inevitably will encounter material or experiences that create discomfort. These situations are necessary for growth and faculty should be able to have the freedom in those situations to challenge the trainee’s assumptions.5 However, faculty have expressed concern that in the effort to manage the imbalance of power and protect trainees from the potential of abuse and harassment, we have labeled difficult conversations and discomfort as maltreatment. When faculty feel that the academic institution sides with trainees without considering the faculty member’s perspective and actions, they may feel as if their reputation and hard work as an educator has been challenged or ruined. For example, if a trainee reports a faculty member for creating a “sexually hostile” environment because the faculty has requested that the trainee take explicit sexual histories of adolescents, it may result in the faculty avoiding this type of difficult conversation and lead to a lack of skill development in trainees. Another unintended consequence is that trainees will not gain skills in having difficult conversations with their faculty, and without feedback they may not grow in their clinical expertise. As our workforce becomes increasingly diverse and we care for a range of populations, the likelihood of misunderstandings and the need to talk about sensitive topics and have difficult conversations increases.

There are several ways to create an environment that fosters the ability for trainees and faculty to walk across eggshells without fear. It is important to continue medical school training regarding unconscious bias, cultural sensitivity, and communication skills. This should include helping trainees not only apply these skills with each other and with their patients but also with their faculty. Trainees are likely to have as many unconscious biases toward their faculty as their faculty have toward them. For example, one study found that at one institution, female medical school faculty were given significantly lower teaching evaluations by third-year medical students in all clerkship rotations compared with male medical school faculty. Pediatrics showed the second largest difference, with surgery having the greatest difference.

The info is here.

Wednesday, November 28, 2018

Promoting wellness and stress management in residents through emotional intelligence training

Ramzan Shahid, Jerold Stirling, William Adams
Advances in Medical Education and Practice ,Volume 9


US physicians are experiencing burnout in alarming numbers. However, doctors with high levels of emotional intelligence (EI) may be immune to burnout, as they possess coping strategies which make them more resilient and better at managing stress. Educating physicians in EI may help prevent burnout and optimize their overall wellness. The purpose of our study was to determine if educational intervention increases the overall EI level of residents; specifically, their stress management and wellness scores.

Participant and methods: 

Residents from pediatrics and med-ped residency programs at a university-based training program volunteered to complete an online self-report EI survey (EQ-i 2.0) before and after an educational intervention. The four-hour educational workshop focused on developing four EI skills: self-awareness; self-management; social awareness; and social skills. We compared de-identified median score reports for the residents as a cohort before and after the intervention.


Thirty-one residents (20 pediatric and 11 med-ped residents) completed the EI survey at both time intervals and were included in the analysis of results. We saw a significant increase in total EI median scores before and after educational intervention (110 vs 114, P=0.004). The stress management composite median score significantly increased (105 vs 111, P<0.001). The resident’s overall wellness score also improved significantly (104 vs 111, P=0.003).


As a group, our pediatric and med-peds residents had a significant increase in total EI and several other components of EI following an educational intervention. Teaching EI skills related to the areas of self-awareness, self-management, social awareness, and social skill may improve stress management skills, promote wellness, and prevent burnout in resident physicians.

The research is here.

Friday, August 17, 2018

Ethical Dimensions of Caring Well for Dying Patients

Ilana Stol
AMA Journal of Ethics

Dying is a uniquely individual yet deeply shared and universal experience; it profoundly impacts perceptions of culture, personhood, and identity. For many Americans, it is also an experience widely discrepant from the one they want and envision for themselves and their loved ones.  Over the past decade, there has been growing awareness of the incongruence between the way Americans say they want to die and how they actually do.  But while most would agree that this reality is not the ideal that clinicians or patients strive for, what is less agreed upon is what the roles of clinicians and patients should be in defining what actually constitutes dying and good care of dying people. What do patients and clinicians need to know about dying and care at the end of life? What barriers exist to accessing and employing this knowledge in the face of difficult decisions?

To best answer these questions, it is useful to examine the social structures and supports already in place for end-of-life care and to understand how they are being utilized. To begin with, hospital palliative care programs are expanding rapidly in order to meet the physical and emotional needs of patients with serious or terminal illness. Robust evidence now exists demonstrating that early palliative care improves the dying experience for both patients and families while generally reducing health care costs and potentially prolonging survival. Despite these facts, there is significant variation in physician practice in the care of patients at the end of life and a general consensus that palliative and hospice care are underutilized by physicians.

The information is here.

Tuesday, July 31, 2018

Fostering Discussion When Teaching Abortion and Other Morally and Spiritually Charged Topics

Louise P. King and Alan Penzias
AMA Journal of Ethics. July 2018, Volume 20, Number 7: 637-642.


Best practices for teaching morally and spiritually charged topics, such as abortion, to those early in their medical training are elusive at best, especially in our current political climate. Here we advocate that our duty as educators requires that we explore these topics in a supportive environment. In particular, we must model respectful discourse for our learners in these difficult areas.

How to Approach Difficult Conversations

When working with learners early in their medical training, educators can find that best practices for discussion of morally and spiritually charged topics are elusive. In this article, we address how to meaningfully discuss and explore students’ conscientious objection to participation in a particular procedure. In particular, we consider the following questions: When, if ever, is it justifiable to define a good outcome of such teaching as changing students’ minds about their health practice beliefs, and when, if ever, is it appropriate to illuminate the negative impacts their health practice beliefs can have on patients?

The information is here.

Monday, July 30, 2018

Mental health practitioners’ reported barriers to prescription of exercise for mental health consumers

KirstenWay, Lee Kannis-Dymand, Michele Lastella, Geoff P. Lovell
Mental Health and Physical Activity
Volume 14, March 2018, Pages 52-60


Exercise is an effective evidenced-based intervention for a range of mental health conditions, however sparse research has investigated the exercise prescription behaviours of mental health practitioners as a collective, and the barriers faced in prescribing exercise for mental health. A self-report survey was completed online by 325 mental health practitioners to identify how often they prescribe exercise for various conditions and explore their perceived barriers to exercise prescription for mental health through thematic analysis. Over 70% of the sample reported prescribing exercise regularly for depression, stress, and anxiety; however infrequent rates of prescription were reported for conditions of schizophrenia, bipolar and related disorders, and substance-related disorders. Using thematic analysis 374 statements on mental health practitioners' perceived barriers to exercise prescription were grouped into 22 initial themes and then six higher-order themes. Reported barriers to exercise prescription mostly revolved around clients' practical barriers and perspectives (41.7%) and the practitioners' knowledge and perspectives (33.2%). Of these two main themes regarding perceived barriers to exercise prescription in mental health, a lack of training (14.7%) and the client's disinclination (12.6%) were initial themes which reoccurred considerably more often than others. General practitioners, mental health nurses, and mental health managers also frequently cited barriers related to a lack of organisational support and resources. Barriers to the prescription of exercise such as lack of training and client's disinclination need to be addressed in order to overcome challenges which restrict the prescription of exercise as a therapeutic intervention.

The research is here.

Saturday, April 21, 2018

A Systematic Review and Meta‐Synthesis of Qualitative Research Into Mandatory Personal Psychotherapy During Training

David Murphy, Nisha Irfan, Harriet Barnett, Emma Castledine, & Lily Enescu
Counseling and Psychotherapy Research
First published February 23, 2018


This study addresses the thorny issue of mandatory personal psychotherapy within counselling and psychotherapy training. It is expensive, emotionally demanding and time‐consuming. Nevertheless, proponents argue that it is essential in protecting the public and keeping clients safe; to ensure psychotherapists develop high levels of self‐awareness and gain knowledge of interpersonal dynamics; and that it enhances therapist effectiveness. Existing evidence about these potential benefits is equivocal and is largely reliant on small‐scale qualitative studies.

We carried out a systematic review of literature searched within five major databases. The search identified 16 published qualitative research studies on the topic of mandatory personal psychotherapy that matched the inclusion criteria. All studies were rated for quality. The findings from individual studies were thematically analysed through a process of meta‐synthesis.

Meta‐synthesis showed studies on mandatory psychotherapy had reported both positive and hindering factors in almost equal number. Six main themes were identified: three positive and three negative. Positive findings were related to personal and professional development, experiential learning and therapeutic benefits. Negative findings related to ethical imperatives do no harm, justice and integrity.

When mandatory personal psychotherapy is used within a training programme, courses must consider carefully and put ethical issues at the forefront of decision‐making. Additionally, the requirement of mandatory psychotherapy should be positioned and identified as an experiential pedagogical device rather than fulfilling a curative function. Recommendations for further research are made.

The research is here.

Monday, February 26, 2018

How Doctors Deal With Racist Patients

Sumathi Reddy
The Wall Street Journal
Originally published January 22, 2018

Her is an excerpt:

Patient discrimination against physicians and other health-care providers is an oft-ignored topic in a high-stress job where care always comes first. Experts say patients request another physician based on race, religion, gender, age and sexual orientation.

No government entity keeps track of such incidents. Neither do most hospitals. But more trainees and physicians are coming forward with stories and more hospitals and academic institutions are trying to address the issue with new guidelines and policies.

The examples span race and religion. A Korean-American doctor’s tweet about white nationalists refusing treatment in the emergency room went viral in August.

A trauma surgeon at a hospital in Charlotte, N.C., published a piece on KevinMD, a website for physicians, last year detailing his own experiences with discrimination given his Middle Eastern heritage.

Penn State College of Medicine adopted language into its patient rights policy in May that says patient requests for providers based on gender, race, ethnicity or sexual orientation won’t be honored. It adds that some requests based on gender will be evaluated on a case-by-case basis.

The article is here.

Thursday, December 14, 2017

Baltimore Cops Studying Plato and James Baldwin

David Dagan
The Atlantic
Originally posted November 25, 2017

Here is an excerpt:

Gillespie is trained to teach nuts-and-bolts courses on terrorism response, extremism, and gangs. But since the unrest of 2015, humanities have occupied the bulk of his time. The strategy is unusual in police training. “I’ve been doing this a long time and I’ve never heard of an instructor using this type of approach,” said William Terrill, a criminal-justice professor at Arizona State University who studies police culture.

But he nevertheless understands the general theory behind it. He’s authored studies showing that officers with higher education are less likely to use force than colleagues who have not been to college. The reasons why are unclear, Terrill said, but it’s possible that exposure to unfamiliar ideas and diverse people have an effect on officer behavior. Gillespie’s classes seem to offer a complement to the typical instruction. Most of it “is mechanical in nature,” Terrill said. “It’s kind of this step-by-step, instructional booklet.”

Officers learn how to properly approach a car, say, but they are rarely given tools to imagine the circumstances of the person in the driver’s seat.

The article is here.

Sunday, October 29, 2017

Courage and Compassion: Virtues in Caring for So-Called “Difficult” Patients

Michael Hawking, Farr A. Curlin, and John D. Yoon
AMA Journal of Ethics. April 2017, Volume 19, Number 4: 357-363.


What, if anything, can medical ethics offer to assist in the care of the “difficult” patient? We begin with a discussion of virtue theory and its application to medical ethics. We conceptualize the “difficult” patient as an example of a “moral stress test” that especially challenges the physician’s character, requiring the good physician to display the virtues of courage and compassion. We then consider two clinical vignettes to flesh out how these virtues might come into play in the care of “difficult” patients, and we conclude with a brief proposal for how medical educators might cultivate these essential character traits in physicians-in-training.

Here is an excerpt:

To give a concrete example of a virtue that will be familiar to anyone in medicine, consider the virtue of temperance. A temperate person exhibits appropriate self-control or restraint. Aristotle describes temperance as a mean between two extremes—in the case of eating, an extreme lack of temperance can lead to morbid obesity and its excess to anorexia. Intemperance is a hallmark of many of our patients, particularly among those with type 2 diabetes, alcoholism, or cigarette addiction. Clinicians know all too well the importance of temperance because they see the results for human beings who lack it—whether it be amputations and dialysis for the diabetic patient; cirrhosis, varices, and coagulopathy for the alcoholic patient; or chronic obstructive pulmonary disease and lung cancer for the lifelong smoker. In all of these cases, intemperance inhibits a person’s ability to flourish. These character traits do, of course, interact with social, cultural, and genetic factors in impacting an individual’s health, but a more thorough exploration of these factors is outside the scope of this paper.

The article is here.

Saturday, October 7, 2017

Committee on Publication Ethics: Ethical Guidelines for Peer Reviewers

COPE Council.
Ethical guidelines for peer reviewers. 
September 2017. www.publicationethics.org

Peer reviewers play a role in ensuring the integrity of the scholarly record. The peer review
process depends to a large extent on the trust and willing participation of the scholarly
community and requires that everyone involved behaves responsibly and ethically. Peer
reviewers play a central and critical part in the peer review process, but may come to the role
without any guidance and be unaware of their ethical obligations. Journals have an obligation
to provide transparent policies for peer review, and reviewers have an obligation to conduct
reviews in an ethical and accountable manner. Clear communication between the journal
and the reviewers is essential to facilitate consistent, fair and timely review. COPE has heard
cases from its members related to peer review issues and bases these guidelines, in part, on
the collective experience and wisdom of the COPE Forum participants. It is hoped they will
provide helpful guidance to researchers, be a reference for editors and publishers in guiding
their reviewers, and act as an educational resource for institutions in training their students
and researchers.

Peer review, for the purposes of these guidelines, refers to reviews provided on manuscript
submissions to journals, but can also include reviews for other platforms and apply to public
commenting that can occur pre- or post-publication. Reviews of other materials such as
preprints, grants, books, conference proceeding submissions, registered reports (preregistered
protocols), or data will have a similar underlying ethical framework, but the process
will vary depending on the source material and the type of review requested. The model of
peer review will also influence elements of the process.

The guidelines are here.

Wednesday, August 2, 2017

Ships in the Rising Sea? Changes Over Time in Psychologists’ Ethical Beliefs and Behaviors

Rebecca A. Schwartz-Mette & David S. Shen-Miller
Ethics & Behavior 


Beliefs about the importance of ethical behavior to competent practice have prompted major shifts in psychology ethics over time. Yet few studies examine ethical beliefs and behavior after training, and most comprehensive research is now 30 years old. As such, it is unclear whether shifts in the field have resulted in general improvements in ethical practice: Are we psychologists “ships in the rising sea,” lifted by changes in ethical codes and training over time? Participants (N = 325) completed a survey of ethical beliefs and behaviors (Pope, Tabachnick, & Keith-Spiegel, 1987). Analyses examined group differences, consistency of frequency and ethicality ratings, and comparisons with past data. More than half of behaviors were rated as less ethical and occurring less frequently than in 1987, with early career psychologists generally reporting less ethically questionable behavior. Recommendations for enhancing ethics education are discussed.

The article is here.