Forced medication of Jared Lee Loughner OK'd by court

By Carol J. Williams

Los Angeles Times

Originally published March 5, 2012

Jared Lee Loughner

Reporting from Los Angeles — Tucson shooting suspect Jared Lee Loughner can be forcibly medicated with antipsychotic drugs, a federal appeals court ruled Monday.

In a 2-1 ruling, the U.S. 9th Circuit Court of Appeals said prison authorities have the right to treat an inmate who would otherwise be a danger to himself or others around him.

Loughner, 23, has been charged with 49 felony counts in the Jan. 8, 2011, shooting rampage outside of a Tucson supermarket in which six people were killed and 13 others injured, including U.S. Rep. Gabrielle Giffords. The congresswoman was holding a meet-the-public event when the shooter attacked.

Loughner’s defense attorneys had objected to his being forcibly treated with antipsychotic drugs. They argued that because he is a pretrial detainee who has not been convicted of any crime that he has the right to refuse medication that he believes could harm or kill him.

The entire article is here.

Doctor, (don't) heal thyself: Self-prescribing declines

Reuters
Originally published February 29, 2012

Far fewer doctors-in-training are prescribing themselves medication than in the past, suggests a new study.

Less than one percent of residents surveyed said they wrote themselves a prescription for an allergy medication, antidepressant or another drug over the course of a year.

In a similar study from more than a decade ago, over half of all medical trainees reported self-prescribing, which many consider ethically questionable.

"I would say it looks like, taking (the findings) at face value, that young residents and physicians-in-training are following recommendations about ethical considerations about treating themselves, and that seems like a good thing," said Dr. Ajit Limaye, from the University of Washington in Seattle.

Still, Limaye -- who has studied physician self-prescribing but wasn't involved in the new study -- cautioned against drawing too much confidence from its results.

"The practice, anecdotally from my experience, is very common," he told Reuters Health.

While it's not illegal for doctors to self-prescribe most types of medication (with the exception of controlled substances), researchers as well as the American Medical Association generally consider it a bad idea.

For one, doctors aren't the most objective prescribers when they're treating themselves. Another concern is that residents and other doctors may self-prescribe using free samples from pharmaceutical companies, which could bias the drugs they recommend to patients in the future.

The entire story is here.

Vignette 11: An Unexpected Inheritance

A psychologist receives a letter from an attorney indicating that he inherited an old car from Frank Palmer.  Upon reflection, the psychologist recalls that he had treated Mr. Palmer a number of years ago.  Looking through his files, the psychologist cannot find his file, so it must have been more than five years ago.

The psychologist phones the attorney and discovers that Mr. Palmer left him a 1993 four-wheel drive Ford Explorer.  He asked the attorney if anyone is contesting the will.  Apparently, no one is.  The executor is Mr. Palmer’s brother, who lives in a different state.

The psychologist obtains the keys and title for the vehicle.  He drives the car to a local dealer who indicated that the Explorer is worth about $3,500.

The psychologist cannot remember many details about the patient.   He recalled that he was an older person with significant depression who eventually became better.  There is nothing unusual that stands out about their therapeutic relationship.

Feeling guilty, the psychologist calls you on the phone to discuss his feelings and any possible ethical concerns.

What are the potential ethical concerns about this scenario, if any?

What suggestions or options would you give the psychologist?

=============================

While a similar experience happened to a psychologist, for further discussion with students, supervisees, or colleagues, the educator or group leader may want to compare and contrast the ethics and options with different details.

Use the same scenario with an antique car worth $50,000 and a family member is contesting the psychologist’s portion of the will.

Would your opinions change about the ethical issues and options related to the situation.  If so, what is different that changes the opinions?

Calling for an End to Phony Military Discharges

Letter to the Editor

New York Times

Originally published March 3, 2012

To the Editor:

“Branding a Soldier With ‘Personality Disorder’ ” (front page, Feb. 25) scratched the surface of an important military scandal.

I have been investigating personality disorder discharges for the last six years. In that time, I’ve interviewed dozens of physically wounded soldiers who were booted from the military with a phony “pre-existing personality disorder,” which prevents the soldiers from receiving disability and medical benefits. They even have to give back a chunk of their signing bonus.

Soldiers severely wounded in combat are finding out on their final day in uniform that they will never get disability benefits — and they now owe the military thousands of dollars.

I have also interviewed military doctors about being pressed by their superiors to misdiagnose wounded soldiers. One doctor told me of a soldier who came back with a chunk missing from his leg. His superior pressured him to diagnose that injury as personality disorder.

The numbers in this scandal are staggering. Since 2001, the military has discharged more than 31,000 soldiers with personality disorder, at a savings to the military of over $17.2 billion in disability and medical benefits.

Barack Obama had been at the forefront of this issue. As a senator, he put forward a bill to halt all personality disorder discharges. But as commander in chief, he has done nothing to halt these fraudulent dismissals.

The American people should confront the president and the Republican presidential candidates with this question: As commander in chief, what actions will you take to keep these phony personality disorder discharges from devastating another military family?

JOSHUA KORS

New York, Feb. 26, 2012

The writer is a freelance reporter.

Ethical Questions Raised About Letters of Recommendation

By Trysh Travis

Inside Higher Ed

Originally Published February 27, 2012

Can I ethically say, "No, I will not write you a letter of recommendation"?

I'm not talking about saying no to a student who comes in the day before a deadline and asks you for a letter, or the cases where the student is unable to get you a transcript, waiver form, and all that stuff by the deadline. Those are easy calls. Nor am I talking about the — fairly frequent — occasions when a student who did not do particularly well in a class asks for a recommendation. At a huge public university like mine, students will often seek a letter from any instructor who knows their name. Since I teach relatively small general education classes, that is often me. In such cases, it’s easy to tell a student, "I'm happy to write for you, but you have to know my letter will say you earned a B- and were absent six times; are you sure you want a letter like that?" Sometimes they do, sometimes they don’t, but either way my conscience is clear.

No, what I'm talking about here is the ethically fraught situation where a student wants a letter for a program in which they are unlikely to succeed — and in which they may actually come to harm.  Since the economic downturn, I have found myself in this position a few times. One extreme example occurred last spring, when a student wanted a recommendation for an unpaid internship with an NGO in Africa. There was very little information about the organization on the website, and the student was not really sure what she would do as an intern there. She'd had an interview, but was reluctant to ask too many questions, she said, for fear she would seem "difficult" and not be offered the position. Despite knowing almost nothing about it, she'd decided the internship was necessary for her career goals. The issue of safety and of the cost of traveling and living near the placement, not to mention the substantive question of what kind of experience (if any) she’d gain from working in an organization that couldn’t even describe its expectations for employees — all this seemed, to her, irrelevant. Should I recommend a student into such a potentially useless, if not outright exploitative situation?

A less exotic version of this conundrum has come up several times in the last 18 months or so: the students who seek a recommendation for a graduate degree at a for-profit university, which they plan to finance through private loans or, worse, a credit card. The best undergraduates I teach get into top-flight graduate and professional schools and, even though law school placements of late have shaken my faith in the value of that degree, the insane costs of such programs make a kind of sense — at least for now.

The entire story is here.

Health Care Issues Intensify U.S. Debate Over Conscience in the Workplace

By Stephanie Simon

Reuters

Originally published February 22, 2012

Can a state require a pharmacy to stock and dispense emergency contraception -- even when the owner considers the drug immoral?

That's the question at the heart of a long-running legal battle in Washington state, expected to be decided Wednesday with a ruling from the U.S. District Court in Seattle.

It's the latest twist in a contentious national debate over the role of conscience in the workplace.

In recent weeks, the debate has been dominated by religious groups fighting to overturn a federal mandate that most health insurance plans provide free birth control. But the battle extends far beyond insurance regulations.

Asserting conscientious objections, nurses in New Jersey have said they would not check the vital signs of patients recovering from abortions. Infertility specialists in California would not perform artificial insemination on a lesbian. An ambulance driver in Illinois declined to transport a patient to an abortion clinic.

In the Washington case, a family-owned pharmacy in Olympia declined to stock emergency contraception, which can prevent pregnancy if taken within 72 hours of unprotected sex. Co-owner Kevin Stormans says he considers the drug equivalent to an abortion, because it can prevent implantation of a fertilized egg. His two pharmacists agree.

Their decision to keep the drug off their shelves came under fire in 2007, when the state Board of Pharmacy enacted a rule requiring pharmacies to stock and dispense all time-sensitive medications in demand in their community. In the case of the Olympia pharmacy, that includes emergency contraception, said Tim Church, a state Department of Health spokesman. The pharmacy's owner and employees filed suit to block the mandate.

All our family wants ... is to serve our customers in keeping with our deepest values," Stormans said in a statement issued by his attorneys.

The state argues that it has a compelling interest in protecting the right of patients to legal medication.

The conscience debate has implications for a vast number of patients. A 2007 New England Journal of Medicine study found that 14% of doctors do not believe they are obligated to tell patients about possible treatments that they personally consider morally objectionable. Nearly 30% of physicians said they had no obligation to refer patients to another provider for treatments they wouldn't offer themselves. A more recent study, published last week in the Journal of Medical Ethics, echoed the finding on referrals.

And abortion and contraception aren't the only medical services at issue. Physicians also may object to following directives from terminally ill patients to remove feeding tubes or ventilators, said Kathryn Tucker, director of legal affairs for Compassion & Choices, an advocacy group that backs physician-assisted suicide.

Entire story is here.

Branding a Soldier With ‘Personality Disorder’

By James Dao

Capt. Susan Carlson

The New York Times

Originally published on 2/24/12

Capt. Susan Carlson was not a typical recruit when she volunteered for the Army in 2006 at the age of 50. But the Army desperately needed behavioral health professionals like her, so it signed her up.

Though she was, by her own account, “not a strong soldier,” she received excellent job reviews at Fort Leavenworth, Kan., where she counseled prisoners. But last year, Captain Carlson, a social worker, was deployed to Afghanistan with the Colorado National Guard and everything fell apart.

After a soldier complained that she had made sexually suggestive remarks, she was suspended from her counseling duties and sent to an Army psychiatrist for evaluation. His findings were shattering: She had, he said in a report, a personality disorder, a diagnosis that the military has used to discharge thousands of troops. She was sent home.

She disputed the diagnosis, but it was not until months later that she found what seemed powerful ammunition buried in her medical file, portions of which she provided to The New York Times. “Her command specifically asks for a diagnosis of a personality disorder,” a document signed by the psychiatrist said.

Veterans’ advocates say Captain Carlson stumbled upon evidence of something they had long suspected but had struggled to prove: that military commanders pressure clinicians to issue unwarranted psychiatric diagnoses to get rid of troops.

“Her records suggest an attempt by her commander to influence medical professionals,” said Michael J. Wishnie, a professor at Yale Law School and director of its Veterans Legal Services Clinic.

The entire story is here.

Ethical Issues Related to APA’s 2005 Task Force Report on Psychological Ethics and National Security

On February 29, 2012, I posted an announcement pertaining to a new, APA member-initiated task force related to psychologists’ involvement in national security settings.

There is another group of psychologists involved in trying to shape APA policy on the ethics of psychlogists pertaining to national security: The Coalition for an Ethical Psychology.  They have called for an annulment of APA’s 2005 Task Force Report on Psychological Ethics and National Security (PENS Report).

To be as helpful, transparent, and comprehensive as possible, I posted the APA's PENS report and the Background Statement on Annulment of the APA's PENS Report from The Coalition for an Ethical Psychology in the Articles and Papers section of this site.

Readers are referred to these documents in order to have a deeper and more thorough understanding of the ethical issues related to this ongoing controversy.

John Gavazzi, PsyD ABPP

Psychologist

Board Certified in Clinical Psychology
Editor, Ethics Education and Psychology Site 

Money, Coercion, and Undue Inducement: Attitudes about Payments to Research Participants

Emily A. Largent, Christine Grady, Franklin G. Miller, and Alan Wertheimer, "Money, Coercion, and Undue Inducement: Attitudes about Payments to Research Participants," IRB: Ethics & Human Research 34, no. 1 (2012): 1-8.

Using payment to recruit research subjects is a common practice, but it raises ethical concerns that coercion or undue inducement could potentially compromise participants’ informed consent. This is the first national study to explore the attitudes of IRB members and other human subjects protection professionals concerning whether payment of research participants constitutes coercion or undue influence, and if so, why. The majority of respondents expressed concern that payment of any amount might influence a participant’s decisions or behaviors regarding research participation. Respondents expressed greater acceptance of payment as reimbursement or compensation than as an incentive to participate in research, and most agreed that subjects are coerced if the offer of payment makes them participate when they otherwise would not or when the offer of payment causes them to feel that they have no reasonable alternative but to participate (82%). Views about undue influence were similar. We conclude that human subjects protection professionals hold expansive and inconsistent views about coercion and undue influence that may interfere with the recruitment of research participants and impede valuable research.

The entire article is here.