What Opinions Can Psychologists Give About Persons They Have Never Met?

What Opinions Can Psychologists Give About Persons Whom They Have Never Met?

Massachusetts Appeals Court rules that judge was wrong to order mentally ill woman to have an abortion and to then be sterilized

By Peter Schworm
The Boston Globe

The Massachusetts Appeals Court today reversed a probate judge’s decision to order a schizophrenic woman to undergo an abortion and to then be sterilized, saying the woman had consistently expressed her opposition to the practice as a Catholic.

In October, the state Department of Mental Health filed a petition to have the woman’s parents named as guardians for the woman, who is only known as “Mary Moe,’’ so they could give consent for an abortion, according to the court.

Norfolk Probate and Family Court Judge Christina Harms, declared that the 32-year-old woman was not competent to make a decision about an abortion, citing “substantial delusional beliefs,” and concluded she would choose to abort her pregnancy if she were competent.

Earlier this month, Harms ordered that the woman’s parents be appointed as coguardians and that Moe could be “coaxed, bribed, or even enticed ... by ruse” into a hospital where she would be sedated and an abortion would then be performed, the ruling stated.

The judge also ordered the facility that performed the abortion to sterilize the woman “to avoid this painful situation from recurring in the future.”

The Appeal Court’s decision, released today, reversed the sterilization order in unusually strong terms.

“No party requested this measure, none of the attendant procedural requirements has been met, and the judge appears to have simply produced the requirement out of thin air,” wrote Appeals Court Judge Andrew Grainger.

The entire story is here.

U.S. to Force Drug Firms to Report Money Paid to Doctors

By ROBERT PEAR
The New York Times - Money and Policy
Originally published 1/16/2012

WASHINGTON — To head off medical conflicts of interest, the Obama administration is poised to require drug companies to disclose the payments they make to doctors for research, consulting, speaking, travel and entertainment.

Many researchers have found evidence that such payments can influence doctors’ treatment decisions and contribute to higher costs by encouraging the use of more expensive drugs and medical devices.

Consumer advocates and members of Congress say patients may benefit from the new standards, being issued by the government under the new health care law. Federal officials said the disclosures increased the likelihood that doctors would make decisions in the best interests of patients, without regard to the doctors’ financial interests.

Large numbers of doctors receive payments from drug and device companies every year — sometimes into the hundreds of thousands or millions of dollars — in exchange for providing advice and giving lectures. Analyses by The New York Times and others have found that about a quarter of doctors take cash payments from drug or device makers and that nearly two-thirds accept routine gifts of food, including lunch for staff members and dinner for themselves.

The entire article is here.

Research misconduct in the UK: Time to Act

By Fiona Godlee, Editor in Chief, and Elizabeth Wager, Chair
British Medical Journal

Research misconduct can harm patients, distort the evidence base, misdirect research effort, waste funds, and damage public trust in science. Countries all over the developed world are now recognising the need to set up systems to deter, detect, and investigate research misconduct. Why does the United Kingdom have no plans to do the same?

As Aniket Tavare outlines in the linked feature (doi:10.1136/ bmj.d8212), high profile cases of misconduct have led the United States, Canada, Sweden, Norway, and Poland, among others, to create formal mechanisms for overseeing research integrity. In most countries responsibility lies with the institutions, but oversight varies greatly, and it is unclear which systems are most effective and efficient. None is perfect—the remit of the US Office of Research Integrity is limited to publicly funded health research; Australia’s recently established Research Integrity Committee is already being criticised for lacking teeth. But each system shows that the problem has been acknowledged, that institutions accept primary responsibility, and that governments and funders are seriously committed to tackling misconduct openly and with a range of statutory powers.

In contrast, the UK has no official national body. The UK Research Integrity Office was established in 2006 and has done some useful things. But its function has always been advisory, and now that the major funders represented by Research Councils UK (RCUK) have decided not to continue the funding, it relies on voluntary funding from institutions. The Research Integrity Futures Working Group, set up by RCUK and Universities UK (UUK) and other bodies, has also apparently come to nothing. The working group’s report commissioned in 2009 called for an independent advisory body, similar to the

UK Research Integrity Office but operating across all research sectors and with a stronger monitoring and preventive function. But RCUK pleaded budget cuts and decided not to implement the  recommendations.  It says it is working with UUK on a “concordat” to take some aspects forward, but two years on nothing has been announced.

The entire editorial can be found in the public domain.

BMJ 2012;344:d8357 doi: 10.1136/bmj.d8357

Should Forensic Psychiatrists Conduct Psychological Testing?

Frank Dattilio, Ph.D., ABPP, Bob Sadoff, M.D., Eric Drogin, J.D., Ph.D., ABPP, 

and Tom Gutheil, M.D.

Journal of Psychiatry & Law (Vol. 39, #3), Spring 2012

Most forensic experts have encountered at least one civil or criminal case in which a forensic psychiatrist has independently conducted psychological testing.

In some instances, the psychiatrist will consult a psychologist on the interpretation of test outcomes, while in others he or she may simply rely on one of the many computerized scoring programs that provide a "canned" analysis and narrative interpretation of results.

Predictably, this phenomenon has occasionally stirred controversy regarding the clinical, ethical, and legal dimensions of appropriateness of selection, skillfulness of administration, accuracy of scoring, validity of interpretation, sufficiency of training, and codified scope of forensic practice.

The primary purpose of this article is to address the ambiguous nature of psychiatrists employing psychological testing in their forensic work, and to arrive at a definitive answer as to whether or not forensic psychiatrists should offer services in this domain.

Key to making this determination will be a review of what differentiates psychological tests from other forms of assessment, such as appraisals, rating scales, and inventories.

 Also addressed are jurisdictionally based legal and ethical issues and a review of what would constitute adequate training and supervision.

[end excerpt]

A clear distinction needs to be made between what constitutes a 'psychological test' versus an 'appraisal,' 'rating scale,' or 'technique.'   Rating scales, such as the Zung Depression Scale or the Beck Anxiety Inventory, have no standardized format for administration and lack complexity in scoring and interpretation.  Projective techniques (i.e., Draw a Person, etc.) are so variably conducted that their best use is typically in support of psychotherapy formulations as opposed to forensic application.  However, these terms are often interchangeable with the terms 'psychological test' or 'psychodiagnostic test.

[another excerpt]

Forensic psychiatrists without access to--and proper review of--administration manuals may be eroding the reliability of psychological test results from the outset.

[another excerpt]

When asked about psychological tests in court, most psychiatrists respond by saying that they have not been trained to administer, score, or interpret psychological tests and that it would be inappropriate and unethical for them to administer them without proper training.  Furthermore, most psychiatrists do not comment on testing because they are not able to provide a comprehensive or valid response due to their lack of expertise.

[another excerpt]

It is our opinion that psychiatrists should never administer psychological tests without intensive training and supervision.  Once again, proper training and education remain critical and, without such training, they should not attempt to incorporate psychological testing into their own examination procedures.  Forensic psychiatrists would need to become familiar with the nuances of standardization and how important it is to the test results and interpretations.  It may also be essential when administering psycho-logical tests to take certain notes regarding observations.  Some of these notes and observations are generated by individuals who administer the tests and score them, interpreting the results on a regular basis, which, obviously, can only come from being very familiar with the tests administered and with scoring.

[another excerpt]

The issue at hand is not one of territoriality--as some might surmise--but rather one of forensic standards and professional ethics, particularly as they pertain to protecting the public.  The appropriate selection, administration, scoring, and interpretation of psychological tests require extensive training and supervision, of a sort that cannot be obtained during a weekend seminar or on the basis of casual, incidental supervision.  Proper testing in forensic cases calls for a thorough grounding in test construction and assessment procedures as well as a firm knowledge of instrumental reliability and validity.  Cross examination on such notions as 'standard error of measurement,' 'confidence intervals,' and 'normative populations' is fair game.  Test users unfamiliar with core psychometric principles expose their reports and testimony to negative scrutiny, imperil the work of retaining counsel, haphazardly affect the fate of litigants, and run the risk of allegations of unethical behavior.  In keeping with the current trend in professional training and development, psychological testing should be viewed as a 'competency'.

The author note provides the following contact information: Frank M. Dattilio, Ph.D., ABPP, Department of Psychiatry, Harvard Medical School, MMHC-Shattuck, 180 Morton St., Jamaica Plain, MA 02130. E-mail: frankdattilio@cs.com.

Thanks to Ken Pope for the information and excerpts.

The Application of Virtue Ethics to the Practice of Counseling Psychology

Virtue Ethics in Counseling Psych

This dissertation can be found in the public domain here.

NJ school district moves to fire teacher who made anti-gay Facebook comments

By Star Ledger Staff

 

It was three months ago when anti-gay comments posted on Facebook by a Union High School teacher caused a nationwide controversy. Now, those comments may cost the instructor her job.

The Union Township school board announced today it has filed tenure charges against Viki Knox, the longtime teacher and faculty adviser to the high school’s Bible study group.

Board president Francis R. Perkins said the charges were formally filed in late December after a three-month investigation of Knox’s conduct, the first step in what could be a lengthy and costly process to fire her.

"Every student, no matter what race, creed color or sexual orientation ought to be able to come to school and feel comfortable in a learning environment that’s welcoming and nurturing," Perkins said.

Knox, 50, who has been on paid administrative leave, could not be reached. Sandy Oxfeld, Knox’s attorney, said he would have no comment on the case while it is in litigation.

The move by the Union school board has rekindled a broader issue of free-speech rights of teachers in the growing age of social media.

The entire story is here.

Contracts with Patients in Clinical Practice

By Michael L Volk, Sarah R Lieber, Scott Y Kim, Peter A Ubel, & Carl E Schneider

(Volume 379, Issue 9810; January 7)

Written documents called contracts are increasingly present in clinical practice and medical publications.

There are behavioural contracts for management of so-called difficult patients, opioid contracts, suicide prevention contracts, and healthy living contracts.

Some practices have even asked patients to sign contracts in which they promise not to litigate or post defamatory comments on the internet.

Despite widespread adoption, the use of contracts in medicine has had little critical appraisal.

Patients' contracts do different things in different clinical situations: they can serve administrative purposes, by deterring mistreatment of clinical personnel or diversion of narcotic drugs; some are educational, drawing patients' attention formally to information; and others clarify expectations and foster transparency, such as when a prospective organ recipient agrees to respect rules on substance misuse.

Other contracts--e.g., for suicide prevention--can help doctors to express concern for their patients, or help patients hold themselves to better health practices, by bolstering willpower with a written commitment (Ulysses contracts).

The effectiveness of contracts in general is uncertain.

[snip]

A unilateral or authoritarian style of implementing contracts might cause patients to feel threatened or coerced, and perhaps even to view the contract as a "prelude to abandonment".

[snip]

In view of the inconclusive evidence about the effectiveness of these contracts and their possible disadvantages, we have some recommendations.

First, clarify terminology; written patient-physician agreements generally do not fit the usual definition of a contract.

Second, clarify aims; for example, if the main aim is to state non-negotiable terms (such as substance-misuse criteria for transplant candidacy) it would be franker to label the document an acknowledgment of clinical policies.

Third, treat the contract as part of a therapeutic process--a standard form contract is one thing, and helping patients set and meet goals is another.

This is the fundamental principle behind motivational interviewing, a technique with strong empirical support.

Finally, patients should be given resources and assistance to meet their goals; for example, structured weight-loss programmes work better than advice to diet and exercise.

[snip]

Whenever possible, written agreements should be bilateral, tailored to the individual patient, and presented in a way that signals continuing commitment.  Otherwise, we risk alienating patients and damaging the therapeutic alliance."

Thanks to Ken Pope for the story and excerpts.

British science needs 'integrity overhaul’

Medical Academics Voice Concern Over Research Misconduct

By Daniel Cressey

Nature

British scientists are fundamentally failing to deal with research misconduct, which is widespread in the country, leading experts have warned.

At a conference in London yesterday, participants were united in calling for more action on the issue.

“There is a recognition that we have a problem,” said Fiona Godlee, editor-in-chief of the British Medical Journal (BMJ) and one of the driving forces behind the meeting.

Coinciding with the meeting, a BMJ survey of 2,782 doctors and medical academics showed that 13% claimed to have firsthand knowledge of “inappropriately adjusting, excluding, altering or fabricating data”. Six per cent said that they were aware of cases of possible research misconduct at their institutions that they thought had not been properly investigated.

Research-integrity issues in the United Kingdom have long been fretted over. Last year the House of Commons science and technology select committee said that they found “the general oversight of research integrity in the UK to be unsatisfactory”. Similar concerns have been raised by others, going back more than a decade.

Elizabeth Wager, chairwoman of the international Committee on Publication Ethics, warned the meeting that one US editor had told her that UK institutions are the worst to deal with in cases of suspected misconduct. “Our reputation in the world is not looking good,” she said.

She added that although the concern is being driven mainly by medical researchers, their worries apply to other scientific fields.

UK mechanisms for ensuring ethical conduct in research “need to be strengthened”, concluded a communiqué from the meeting. In addition, the meeting said, the UK Research Integrity Office (UKRIO) should be enhanced, and ongoing funding for it should be secured. (At one point last year, the future financing of UKRIO was unclear, although it now seems to be secure.)

The entire sotry can be found here.