New Guidelines Raise Safety Bar on Concussions

By Alan Mozes
Medicinenet.com
Originally published March 18, 2013

Any athlete who suffers a suspected concussion should be withdrawn from play and stay on the sidelines until a qualified health care professional determines that all symptoms have subsided and it is safe to return to the field, new guidelines state.

Issued by the American Academy of Neurology, the latest recommendations aim to keep young athletes as safe as possible.

"With the older guidelines, we were trying to rate concussions at the time of the injury and predict recovery times, but now we know, 'When in doubt, sit 'em out,'" said guideline co-author Dr. Christopher Giza, an associate professor of pediatric neurology and neurosurgery with the David Geffen School of Medicine at the University of California, Los Angeles, and Mattel Children's Hospital.

"The point is that no single quick test is really a litmus test for a concussion," he said. "We know now that we need to make sure a player has had a thorough and proper evaluation, involving a symptoms checklist, a standardized assessment and balance and cognitive testing, before being returned to play. This evaluation has to be done on a case-by-case basis, so each person goes through an individualized recovery process."

The entire story is here.

The entire journal article in Neurology is here.

How Does Technology Affect Business Ethics?

By Hans Fredrick
azcentral.com

The more integrated a piece of technology becomes into the way we do business, the more the potential ethical conundrums posed by that technology become apparent. Ethical business practices need to grow and evolve in step with technology. While new devices and advances may make the day-to-day operations of running a business easier, they also create challenges that the ethical businessperson must contend with.

Privacy

Privacy has become a much larger concern in the modern technological age. Business ethicists are still learning and debating how much privacy people are entitled to in the digital age, as are lawmakers. For instance, many employers had taken to the practice of requiring potential employees to provide them with the password to their Facebook pages. This opened up the door to potential privacy issues, not to mention discriminatory hiring practices. In 2012, a law was passed in California to prohibit this particular breach of privacy; but in some jurisdictions, the decision whether or not to ask for this information is still an ethical, rather than a legal matter.

The entire story is here.

Drones, Ethics and the Armchair Soldier

By John Kaag
The New York Times - Opinionator
Originally published on March 17, 2013

Here are some excerpts:

Ten years later, I’m a philosopher writing a book about the ethics of drone warfare. Some days I fear that I will have either to give up the book or to give up philosophy. I worry that I can’t have both. Some of my colleagues would like me to provide decision procedures for military planners and soldiers, the type that could guide them, automatically, unthinkingly, mechanically, to the right decision about drone use. I try to tell them that this is not how ethics, or philosophy, or humans, work.

I try to tell them that the difference between humans and robots is precisely the ability to think and reflect, in Immanuel Kant’s words, to set and pursue ends for themselves. And these ends cannot be set beforehand in some hard and fast way — even if Kant sometimes thought they could.

What disturbs me is the idea that a book about the moral hazard of military technologies should be written as if it was going to be read by robots: input decision procedure, output decision and correlated action. I know that effective military operations have traditionally been based on the chain of command and that this looks a little like the command and control structure of robots. When someone is shooting at you, I can only imagine that you need to follow orders mechanically. The heat of battle is neither the time nor the place for cool ethical reflection.

Warfare, unlike philosophy, could never be conducted from an armchair. Until now. For the first time in history, some soldiers have this in common with philosophers: they can do their jobs sitting down. They now have what I’ve always enjoyed, namely “leisure,” in the Hobbesian sense of the word, meaning they are not constantly afraid of being killed. Hobbes thought that there are certain not-so-obvious perks to leisure (not being killed is the obvious one). For one, you get to think. This is what he means when he says that “leisure is the mother of philosophy.” I tend to agree with Hobbes: only those who enjoy a certain amount of leisure can be philosophers.

The entire article is here.

Familiarity breeds doctor contempt with EHRs

Experts say meaningful use is contributing to the growth of electronic health record systems, but it also has a negative effect on EHR user-friendliness.

By Pamela Lewis Dolan
amednews.com
Originally published March 18, 2013

The meaningful use incentive program has resulted in more physicians implementing electronic health record systems and using them in advanced ways. Yet doctors' dissatisfaction with the systems has increased.

Theories for what is driving the dissatisfaction include rushed implementations, too little training and physicians doing too much too soon as they struggle to meet meaningful use requirements, other federal mandates and changes to the health care landscape. EHR vendors also are thought to be taking on too much in too little time. As they rush to deliver products certified for meaningful use, usability may have suffered.

A survey by AmericanEHR Partners of 4,279 clinicians, including primary care physicians, specialists and diagnostic professionals, found that user satisfaction declined from 39% in 2010 to 27% in 2012. The rate of those “very dissatisfied” increased from 11% to 21% during the same period. The findings were presented in March at the Healthcare Information and Management Systems Society annual conference in New Orleans.

The entire article is here.

After my daughter’s death, I work to prevent future deaths

By Martha Deed
KevinMD.com
Originally published March 17, 2013

Here are som excerpts:

Another disturbed and disturbing night. It doesn’t happen often three years later. Now – when it does happen – I generally know why.

I am preparing to make a presentation of a sentinel event from my daughter’s final illness to a group of medical professionals and patient advocates. Last night, I was working on key points. What issues seem most important for hospital staffs to address after these years of reflection?

I am convinced – have understood for some time – that the fundamental issue is not that my daughter is dead or even how she died. The basic issue is, “Can we learn anything to prevent future deaths?”
The conference presentation makes use of the past to inform the future. I am co-presenting with a chief medical officer of a hospital system in another state.

Recently, he asked me how I am able to do this – stare into the disaster, sort it out, convey a message of hope. He asks, “What separates people like me who work toward improving safe and competent care from people who cannot move beyond paralyzing grief and anger?”

(cut)

My obligation as a parent and as a social scientist engaged in patient advocacy is to do what I can to help health care providers in their work. As a layperson, I can’t do much to improve patient outcomes; I have neither the education, nor the position to change anything within a hospital or medical office.

The entire blog entry is here.

Thanks to Ed Zuckerman for this information.

In Steubenville, why didn't other girls help?

By Rachel Simmons
Special to CNN
Originally posted March 21, 2013

Is anyone else wondering why the Steubenville, Ohio rape victim's two best friends testified against her? With this week's arrest of two other girls who "menaced" the teen victim on Facebook and Twitter, we have the beginnings of an answer.

Rape culture is not only the province of boys. The often hidden culture of girl cruelty can discourage accusers from coming forward and punish them viciously once they do. This week, two teenage boys were found guilty of raping a 16-year-old classmate while she was apparently drunk and passed out during a night of parties last August. Everyone who was there and said nothing that night was complicit; if we want to prevent another Steubenville, the role of other girls must also be considered.

On the night in question, girls watched the victim (Jane Doe) become so drunk she could hardly walk. Why didn't any of them help her? Why, after Jane Doe endured the agonizing experience of a trial in which she viewed widely circulated photos of herself naked and unconscious, did one of the arrested girls tweet: "you ripped my family apart, you made my cousin cry, so when I see you xxxxx, it's gone be a homicide." Why were two lifelong friends sitting on the other side of the courtroom?

The accusation of rape disrupts the intricate social ecosystem of a high school, one in which girls often believe that they must preserve both their own reputations and relationships with boys above all else. This is a process that begins for girls long before their freshman year and can have violent consequences.

The entire story is here.

Antipsychotic Use Skyrockets in America's Poorest Children

By Fran Lowry
Medscape Today News
Originally published March 12, 2013

Antipsychotic use among Medicaid-insured children from low- or very-low-income families skyrocketed in just under a decade, new research shows.

Investigators from the University of Maryland in Baltimore found that from 1997 to 2006, use of antipsychotic medications in this population increased 7- to 12-fold, with most of the increased use associated with treatment for behavioral problems.

"Awareness of the expanding use of antipsychotic medications in the emotional and behavioral treatment of children has been noted in several studies of community-based pediatric populations," lead author Julie Magno Zito, PhD, from the University of Maryland, told Medscape Medical News.

"But," she added, "additional information is needed on trends in our neediest youth, namely according to how antipsychotic users differ in terms of their eligibility for Medicaid insurance coverage and the reasons for use. Such information would help to characterize the 'who' and 'why' of expanded antipsychotic use."

The study is published in the March issue of Psychiatric Services.

The entire article is here.

The Grounds of Moral Status

Stanford Encyclopedia of Philosophy
First published on March 14, 2013

An entity has moral status if and only if it or its interests morally matter to some degree for the entity's own sake, such that it can be wronged. For instance, an animal may be said to have moral status if its suffering is at least somewhat morally bad, on account of this animal itself and regardless of the consequences for other beings, and acting unjustifiably against its interests is not only wrong, but wrongs the animal. Others owe it to the animal to avoid acting in this way. Some philosophers think of moral status as coming in degrees, reserving the notion of full moral status (FMS) for the highest degree of status.

Sometimes the term “moral standing” rather than “moral status” is used, but typically these terms have the same meaning. Some philosophers employ the language of “moral considerability” but this term is extremely ambiguous. Some use it as an alternate expression for “moral status” which is understood to come in degrees. In other cases the phrase is used to mean FMS. Act Utilitarians employ yet a third notion of moral considerability, which is a matter of having one's interests (e.g., the intensity, duration, etc. of one's pleasure or pain) factored into the calculus to determine which action minimizes the bad and maximizes the good. To avoid these ambiguities, this entry will use the terminology of “moral status” and “FMS.” 

After reviewing which entities have been thought to have moral status and what is involved in having FMS, as opposed to a lesser degree of moral status, this article will survey different views of the grounds of moral status as well as the arguments for attributing a particular degree of moral status on the basis of those grounds.

The entire article is here.

The Boundaries of the Moral (and Legal) Community

By Brian Leiter
The Expanding Moral Community
Alabama Law Review, Vol. 64(3), 511-531.

Let me invite you to step back from the parochial political disputes that dominate public life in America and most other modern democracies, as well as from the internecine academic quarrels characteristic of so much professionalized scholarship in the modern academy, and reflect, instead, on the broader sweep of moral and political thought, in both the philosophical and practical realm, over the past two or three hundred years.  What must immediately strike any observer of this period is the remarkable expansion it has witnessed of what I will henceforth call “the moral community,” that is, the community of creatures that are thought entitled to equal moral consideration, whatever the precise details of what such consideration involves—that is, whether it is a matter of showing “respect,” recognizing the “dignity” of each, or “maximizing the utility or well-being” of each, or some other formulation.  I am speaking here about our official ideologies and discourse, not necessarily all our actual practices and laws, though they gradually follow suit over the course of a century or so. But at the level of ideology, reflected in both ordinary moral opinion and in the work of philosophers, we in the West—ignorance of the relevant philosophical and legal traditions requires me to remain agnostic on the proverbial “East,” though the trends seem to be similar—have largely abandoned the ideas that gender, race, ethnicity, religion, class, and now even sexual orientation are morally relevant attributes in the sense that they are attributes that determine the basic moral consideration to which one is entitled. To be sure, in particular contexts, these characteristics may matter because of the context. So, for example, I take it most would still think it morally unproblematic to consider race in casting the lead role in Shakespeare’s Othello, and most of us would still think it morally unproblematic that a man contemplating marriage gives some consideration to the gender or religion of his potential mate. 

The entire article is here.