Vignette 10: Multiple Relationships Revealed

A female psychologist works with a male patient for about one year in a suburban area.  They agreed to meet weekly for the first four months of psychotherapy, and then they agreed to meet twice per month.  They developed a good therapeutic alliance.  During the course of their work, he discussed significant facts about his troubled past, numerous details about failed past relationships, and sexual fantasies.  The main therapeutic issues are depression and loneliness.

During the current session, the patient related having made a new female friend.  As social isolation, loneliness and depression are regular themes in treatment; the psychologist frames this as positive progress.

As the conversation continues, the psychologist is surprised to learn that the patient’s new friend is the ex-wife of the psychologist’s husband.  The patient reveals that he became aware of that information after several dates and recently felt comfortable revealing this to the psychologist.  He also indicated that the relationship is taking on a more serious tone.

The ex-wife moved back to the area about six months ago.  The psychologist knows that the ex-wife had been struggling with isolation and loneliness as well.  The psychologist, her husband, and his ex-wife are on good terms.  They see her regularly for informal family events and do holidays together with their adult children and grandchildren.

After the session is over, the psychologist has time to reflect on her concerns.  The psychologist feels stuck and overwhelmed by her present situation.  She calls you for an ethics consult.

What are the ethical issues involved?

What would you suggest that she does?

With whom does the psychologist discuss the multiple roles? 

With only the patient?

With the patient and the ex-wife?

With her husband, the patient and the ex-wife?

Can the psychologist continue the treatment relationship with the patient?

Even if they terminate therapy, how does the psychologist cope with family gatherings since she knows significant details about her patient’s life?

Hospitals Mine Their Patients' Records In Search Of Customers

Critics say hospitals cherry pick best-paying patients

By Phil Galewitz
Kaiser Health News

Originally published February 5, 2012

When the oversized postcard arrived last August from Provena St. Joseph Medical Center promoting a lung cancer screening for current or former smokers over 55, Steven Boyd wondered how the hospital had found him.

Boyd, 59, of Joliet, Ill., had smoked for decades, as had his wife, Karol.

Provena didn't send the mailing to everyone who lived near the hospital, just those who had a stronger likelihood of having smoked based on their age, income, insurance status and other demographic criteria.

The nonprofit center is one of a growing number of hospitals using their patients' health and financial records to help pitch their most lucrative services, such as cancer, heart and orthopedic care. As part of these direct mail campaigns, they are also buying detailed information about local residents compiled by consumer marketing firms — everything from age, income and marital status to shopping habits and whether they have children or pets at home.

Hospitals say they are promoting needed services, such as cancer screenings and cholesterol tests, but they often use the data to target patients with private health insurance, which typically pay higher rates than government coverage. At an industry conference last year, Provena Health marketing executive Lisa Lagger said such efforts had helped attract higher-paying patients, including those covered by "profitable Blue Cross and less Medicare."

Strategy Draws Fire

While the strategies are increasing revenues, they are drawing fire from patient advocates and privacy groups, who criticize the hospitals for using private medical records to pursue profits.

Doug Heller, executive director of Consumer Watchdog, a California-based consumer advocacy group, says he is bothered by efforts to "cherry pick" the best-paying patients.

"When marketing is picking and choosing based on people's financial status, it is inherently discriminating against patients who have every right and need for medical information," Heller says. "This is another example of how our health system has gone off the rails."

Deven McGraw, director of the health privacy project at the Center for Democracy and Technology in Washington, says federal law allows hospitals to use confidential medical records to inform patients about things that may help them. 

The whole story is here.

Standing Their Ground

by Libby Nelson

Inside Higher Ed

Originally published February 3, 2012

WASHINGTON -- At a panel discussion at the Council for Christian Colleges and Universities’ annual meeting of presidents today, the presenters made one thing clear: American culture may have changed, but their institutions’ interpretation of the Bible -- which views homosexuality as immoral -- will not.

So the discussion, as described by the panelists and members of the audience, dealt not with whether colleges should change their attitudes toward gay students, but how to deal with the controversy that breaks out when students or alumni pressure a college to change.

But the fact that the session, which was closed to reporters, was held at all is an acknowledgment that CCCU colleges -- which all require professors to sign “statements of faith” in Christian doctrine, and many of which have behavioral requirements for their student body, including on sexuality -- most likely have gay students on campus and will confront difficult situations when an increasingly accepting culture clashes with the colleges’ theological beliefs.

“It’s a conversation that’s here to stay, and we want the conversation to be both honest and fair,” said Gayle Beebe, president of Westmont College.

Last year, a group of 31 gay and lesbian Westmont alumni wrote a letter to the college, saying they had lived in an environment of “doubt, loneliness and fear” while enrolled there. More than 100 additional alumni signed on in support, and more than 50 faculty members signed a letter in response, asking forgiveness for causing the students pain.

A few months later, an openly gay student at Messiah College, in Pennsylvania, told the Harrisburg Patriot-News that he planned to transfer after two semesters of bullying. Students had excluded him, he said, a professor had called him an “abomination,” he received death threats on Facebook, and his wallet, keys and student ID were stolen, among other incidents, he said.

“It was a very difficult situation,” said Kim Phipps, Messiah’s president, another member of the panel, in part because the college could not counter accusations without revealing private information about the student himself.

The entire story is here.

Georgia Court Overturns Assisted Suicide Restrictions

Court Finds that Law Banning People from Advertisng Suicide Violated Free Speech Rights

By Greg Bluestein

Associated Press

Georgia's top court struck down a state law that restricted assisted suicides, siding on Monday with four members of a suicide group who said the law violated their free speech rights.

The Georgia Supreme Court's unanimous ruling found that the law violates the free speech clauses of the U.S. and Georgia constitution. It means that four members of the Final Exit Network who were charged in February 2009 with helping a 58-year-old cancer-stricken man die won't have to stand trial, defense attorneys said.

Georgia law doesn't expressly forbid assisted suicide. But lawmakers in 1994 adopted a law that bans people from publicly advertising suicide, hoping to prevent assisted suicide from the likes of Dr. Jack Kevorkian, the late physician who sparked the national right-to-die debate.

The law makes it a felony for anyone who "publicly advertises, offers or holds himself out as offering that he or she will intentionally and actively assist another person in the commission of suicide and commits any overt act to further that purpose."

The court's opinion, written by Justice Hugh Thompson, found that lawmakers could have imposed a ban on all assisted suicides with no restriction of free speech, or sought to prohibit all offers to assist in suicide that were followed by the act. But lawmakers decided to do neither, he said.

"The State has failed to provide any explanation or evidence as to why a public advertisement or offer to assist in an otherwise legal activity is sufficiently problematic to justify an intrusion on protected speech rights," the ruling said.

State attorneys said they were reviewing the order. The network's members said they were thrilled with the decision.

'Turned out to be a boondoggle'

"This was politically motivated and ideologically driven as opposed to being, in any way, motivated by sound legal practice," said Ted Goodwin, the group's former president and one of the four defendants. "I'm just sorry that as many people have been put through what they've been put through in what turned out to be a boondoggle."

The challenge was brought by four members of the network who were arrested in February 2009 after John Celmer's death at his north Georgia home. They were arrested after an eight-month investigation by state authorities, in which an undercover agent posing as someone seeking to commit suicide infiltrated the group. Prosecutors say group members helped Celmer use an "exit hood" connected to a helium tank to kill himself.

The entire story is here.

Marine Fights Conviction for Suicide Attempt

Pvt. Lazzaric T. Caldwell

Associated Press
Originally Published February 3, 2012

HAGERSTOWN, Md. - A discharged Marine private who slit his wrists in a suicide attempt is fighting his military conviction for deliberately injuring himself, arguing the punishment is inconsistent with the armed forces' efforts to battle a rise in suicides during the wars in Iraq and Afghanistan.

It's not clear how often the Marines or any other service branch prosecute active duty members for trying to kill themselves. But the defense lawyer for Pvt. Lazzaric T. Caldwell says it's wrong to punish service members with mental health problems for genuine suicide attempts. Suicide prevention has become a priority across the military as numbers climbed in the past decade with the increasing stress of combat and multiple deployments in the wars.

Caldwell, 25, of Camp Pendleton, Calif., never deployed to a war zone but was diagnosed in 2009 with post-traumatic stress disorder and a personality disorder, according to court records. In 2010, he slashed his wrists in his barracks at Camp Schwab in Okinawa, Japan.

He pleaded guilty at a court-martial that year to "intentional self-injury without intent to avoid service," a criminal charge that the government says helps maintain good order and discipline in the armed forces. The charge is sometimes used in self-injury cases when there isn't enough evidence to prove malingering, military justice experts say.

Caldwell was sentenced to 180 days in jail and a bad conduct discharge. Military rules allow an appeal after a guilty plea in some cases, but Caldwell's initial appeal to the Navy-Marine Corps Court of Criminal Appeals was denied in December. His lawyer, Navy Lt. Mike Hanzel, said this week he will ask the military's highest court, the U.S. Court of Appeals for the Armed Forces in Washington, to hear the case.

"I think it definitely touches important issues which are affecting all the branches of the armed forces right now," Hanzel said in a telephone interview from Bremerton, Wash.

Military prosecutors didn't immediately respond to requests for comment on the case. In an appellate brief, the government stated that Caldwell "was not charged with, or convicted of, attempting suicide. He was charged with, and properly convicted of, intentionally injuring himself to the prejudice of good order and discipline or the discredit of the service."

The entire story is here.

As Journal Boycott Grows, Elsevier Defends Its Practices

By Josh Fischman
The Chronicle of Higher Education
Originally Published January 31, 2012

A protest against Elsevier, the world's largest scientific journal publisher, is rapidly gaining momentum since it began as an irate blog post at the end of January. By Tuesday evening, about 2,400 scholars had put their names to an online pledge not to publish or do any editorial work for the company's journals, including refereeing papers.

The boycott is growing so quickly—it had about 1,800 signers on Monday—that Elsevier officials on Tuesday broke their official silence to respond to protesters' accusations that they charge too much and support laws that will keep research findings bottled up behind a company paywall.

"Over the past 10 years, our prices have been in the lowest quartile in the publishing industry," said Alicia Wise, Elsevier's director of universal access. "Last year our prices were lower than our competitors'. I'm not sure why we are the focus of this boycott, but I'm very concerned about one dissatisfied scientist, and I'm concerned about 2,000."

She added that her company improves access rather than impeding it, and said that Internet downloads from some journals increased by as much as 40 percent when Elsevier added them to collections it sells to libraries.

Protesters disagree, and say Elsevier is emblematic of an abusive publishing industry. "The government pays me and other scientists to produce work, and we give it away to private entities," says Brett S. Abrahams, an assistant professor of genetics at the Albert Einstein College of Medicine. "Then they charge us to read it." Mr. Abrahams signed the pledge on Tuesday after reading about it on Facebook.

Those views highlight a split that could spell serious trouble for journal publishers, and for researchers. Price complaints are not new, but some observers say this is the first time that the suppliers of journal content—the scientists—are upset enough to cut the supply line. But, if publishers are correct, those scientists could cut themselves off from valuable research tools.

The Boycotters' Complaints

According to the boycotters, Elsevier, which publishes over 2,000 journals including the prestigious Cell and The Lancet, is abusing academic researchers in three areas. First there are the prices. Then the company bundles subscriptions to lesser journals together with valuable ones, forcing libraries to spend money to buy things they don't want in order to get a few things they do want. And, most recently, Elsevier has supported a proposed federal law, the Research Works Act (HR 3699), that could prevent agencies like the National Institutes of Health from making all articles written by grant recipients freely available.

The entire story is here.

Jonathan Haidt Decodes the Tribal Psychology of Politics

By Marc Perry

The Chronicle of Higher Education

Jonathan Haidt

Jonathan Haidt is occupying Wall Street. Sort of. It's a damp and bone-chilling January night in lower Manhattan's Zuccotti Park. The 48-year-old psychologist, tall and youthful-looking despite his silvered hair, is lecturing the occupiers about how conservatives would view their ideas.

"Conservatives believe in equality before the law," he tells the young activists, who are here in the "canyons of wealth" to talk people power over vegan stew. "They just don't care about equality of outcome."

Explaining conservatism at a left-wing occupation? The moment tells you a lot about the evolution of Jonathan Haidt, moral psychologist, happiness guru, and liberal scold.

Haidt (pronounced like "height") made his name arguing that intuition, not reason, drives moral judgments. People are more like lawyers building a case for their gut feelings than judges reasoning toward truth. He later theorized a series of innate moral foundations that evolution etched into our brains like the taste buds on our tongues—psychological bases that underlie both the individual-protecting qualities that liberals value, like care and fairness, as well as the group-binding virtues favored by conservatives, like loyalty and authority.

"He, over the last decade or so, has substantially changed how people think about moral psychology," says Paul Bloom, a psychologist at Yale University.

Now Haidt wants to change how people think about the culture wars. He first plunged into political research out of frustration with John Kerry's failure to connect with voters in 2004. A partisan liberal, the University of Virginia professor hoped a better grasp of moral psychology could help Democrats sharpen their knives. But a funny thing happened. Haidt, now a visiting professor at New York University, emerged as a centrist who believes that "conservatives have a more accurate understanding of human nature than do liberals."

In March, Haidt will publish The Righteous Mind: Why Good People Are Divided by Politics and Religion (Pantheon). By laying out the science of morality—how it binds people into "groupish righteousness" and blinds them to their own biases—he hopes to drain some vitriol from public debate and enable conversations across ideological divides.

The entire story is here.

US Health Breach Tally Hits 19 Million

385 Major Incidents Reported Since 2009

Govinfosecurity.com

By Howard Anderson, January 23, 2012

With the tardy addition of the Sutter Health breach, the U.S. tally of major healthcare information breaches now includes 385 incidents affecting more than 19 million individuals since September 2009.

The Department of Health and Human Services' Office for Civil Rights recently added the Sutter Health breach, which occurred in October, to its official tally of breaches affecting 500 or more individuals. It adds incidents once it confirms the details.

Healthcare information on 943,000 individuals was on an unencrypted desktop computer that was stolen in October from a Sutter facility in California; that total is reflected in the official federal healthcare breach tally. But in announcing the breach, Sutter Health noted that two databases with information on 4.2 million patients were on the device.

A database for Sutter Physician Services, which provides billing and other administrative services for 21 Sutter units, held only limited demographic information on about 3.3 million patients collected from 1995 through January 2011. The device also contained a database with more extensive information on 943,000 Sutter Medical Foundation patients, dating from January 2005 to January 2011. This smaller database included the same demographic information as the larger database, plus dates of service and a description of diagnoses and/or procedures.

Sutter Health faces two class action lawsuits in the wake of the breach.

Breach List Update

In addition to adding the Sutter Health incident, federal officials added five much smaller incidents to the official breach tally in the past month.

Of the 385 incidents affecting 500 or more individuals that are now included in the official tally after being reported to authorities as required under the HIPAA breach notification rule, roughly 55 percent have involved lost or stolen unencrypted electronic devices or media. About 22 percent have involved a business associate.

The entire story is here.

Not Diseases, but Categories of Suffering

By GARY GREENBERG

The New York Times - Opinion

Published: January 29, 2012

YOU’VE got to feel sorry for the American Psychiatric Association, at least for a moment. Its members proposed a change to the definition of autism in the fifth edition of their Diagnostic and Statistical Manual of Mental Disorders, one that would eliminate the separate category of Asperger syndrome in 2013. And the next thing they knew, a prominent psychiatrist was quoted in a front-page article in this paper saying the result would be fewer diagnoses, which would mean fewer troubled children eligible for services like special education and disability payments.

Then, just a few days later, another front-pager featured a pair of equally prominent experts explaining their smackdown of the A.P.A.’s proposal to eliminate the “bereavement exclusion” — the two months granted the grieving before their mourning can be classified as “major” depression. This time, the problem was that the move would raise the numbers of people with the diagnosis, increasing health care costs and the use of already pervasive mind-altering drugs, as well as pathologizing a normal life experience.

Fewer patients, more patients: the A.P.A. just can’t win. Someone is always mad at it for its diagnostic manual.

It’s not the current A.P.A.’s fault. The fault lies with its predecessors. The D.S.M. is the offspring of odd bedfellows: the medical industry, with its focus on germs and other biochemical causes of disease, and psychoanalysis, the now-largely-discredited discipline that attributes our psychological suffering to our individual and collective history.

The entire story is here.