By Ilina Singh
J Med Ethics 2013;39:359-366 doi:10.1136/medethics-2011-100224
Abstract
In this article, I examine children's reported experiences with stimulant drug treatments for attention deficit hyperactivity disorder in light of bioethical arguments about the potential threats of psychotropic drugs to authenticity and moral agency. Drawing on a study that involved over 150 families in the USA and the UK, I show that children are able to report threats to authenticity, but that the majority of children are not concerned with such threats. On balance, children report that stimulants improve their capacity for moral agency, and they associate this capacity with an ability to meet normative expectations. I argue that although under certain conditions stimulant drug treatment may increase the risk of a threat to authenticity, there are ways to minimise this risk and to maximise the benefits of stimulant drug treatment. Medical professionals in particular should help children to flourish with stimulant drug treatments, in good and in bad conditions.
The entire article is here.
Friday, May 31, 2013
1 in 5 U.S. Kids Has a Mental Health Disorder: CDC
By Brenda Goodman
HealthDay Reporter
Originally published May 16, 2013
As many as one in five American children under the age of 17 has a diagnosable mental disorder in a given year, according to a new federal report.
Released Thursday, the report represents the government's first comprehensive look at mental disorders in children. It focuses on diagnoses in six areas: attention-deficit/hyperactivity disorder (ADHD), behavioral or conduct disorders, mood and anxiety disorders, autism spectrum disorders, substance abuse, and Tourette syndrome.
The most common mental disorder among children aged 3 through 17 is ADHD. Nearly 7 percent -- about one in 15 children -- in that age group have a current diagnosis, according to the report from the U.S. Centers for Disease Control and Prevention.
The entire story is here.
HealthDay Reporter
Originally published May 16, 2013
As many as one in five American children under the age of 17 has a diagnosable mental disorder in a given year, according to a new federal report.
Released Thursday, the report represents the government's first comprehensive look at mental disorders in children. It focuses on diagnoses in six areas: attention-deficit/hyperactivity disorder (ADHD), behavioral or conduct disorders, mood and anxiety disorders, autism spectrum disorders, substance abuse, and Tourette syndrome.
The most common mental disorder among children aged 3 through 17 is ADHD. Nearly 7 percent -- about one in 15 children -- in that age group have a current diagnosis, according to the report from the U.S. Centers for Disease Control and Prevention.
The entire story is here.
Thursday, May 30, 2013
A Big Thank You - 250,000 Page View Milestone
A Big Thank You to everyone who has visited this site, followed this site, and contributed to this site. Ethics education is an exciting and fun area for psychologists as well as those professionals working in the mental health field.
A few numbers from the statistics page.....
The Ethics Education and Psychology site is a little over 2 years old
Over 250,000 page views
47% of page views come from beyond the US
139 countries have visited the site
252 follow by email
24 follow by Twitter
13 follow by Google+
Over 1,100 stories about ethics linked to this site
55 articles and professional papers related to ethics and ethics education are housed on the site
43 PowerPoint presentations available (over 19,000 SlideShare views & 169 downloads)
25 real life ethical vignettes for educational purposes
25 audio/video resources for teaching ethics
17 links to blogs of interest
The hope is to continue to broaden and build this site for educational purposes.
Thank you for your continued support!!
If you like what you have seen, then feel free to spread the word.
A few numbers from the statistics page.....
The Ethics Education and Psychology site is a little over 2 years old
Over 250,000 page views
47% of page views come from beyond the US
139 countries have visited the site
252 follow by email
24 follow by Twitter
13 follow by Google+
Over 1,100 stories about ethics linked to this site
55 articles and professional papers related to ethics and ethics education are housed on the site
43 PowerPoint presentations available (over 19,000 SlideShare views & 169 downloads)
25 real life ethical vignettes for educational purposes
25 audio/video resources for teaching ethics
17 links to blogs of interest
The hope is to continue to broaden and build this site for educational purposes.
Thank you for your continued support!!
If you like what you have seen, then feel free to spread the word.
Bioethicists must not allow themselves to become a 'priestly caste'
The increasing use of expert bioethicists has profound anti-democratic implications
By Nathan Emmerich
The Guardian - Political Science Blog
Originally published May 18, 2013
In a secular age it might seem that the time for moral authorities has passed. However, research in the life sciences and biomedicine has produced a range of moral concerns and prompted the emergence of bioethics; an area of study that specialises in the ethical analysis of these issues. The result has been the emergence of what we might call expert bioethicists, a cadre of professionals who, while logical and friendly, have, nevertheless, been ordained as secular priests.
This suggestion – that there are expert bioethicists – might appear to have profoundly anti-democratic implications. Indeed handling expertise, including scientific expertise, is a central difficulty for democratic societies and its extension into the realm of moral values seems, on the face of it, to compound the problem. Nevertheless the Human Fertilisation and Embryology Authority (HFEA) has constantly made use of expert bioethicists and two members of the recently convened Emerging Science and Bioethics Advisory Committee (ESBAC) are listed as "bioethics specialists".
If we are to govern the biosciences and medical practice effectively there seems to be increasing need for expert bioethicists. Nevertheless, there is a different dynamic to the politics of bioethical expertise precisely because the opinions of bioethical experts cannot be used to obviate those of other moral agents.
This might seem like an odd claim. If there are expert bioethicists surely we should prefer their opinions to those of non-experts? However this is to assume bioethical expertise is modelled on scientific expertise. The idea of the scientist as expert is so strong we often forget that there are other forms of expertise.
The entire post is here.
By Nathan Emmerich
The Guardian - Political Science Blog
Originally published May 18, 2013
In a secular age it might seem that the time for moral authorities has passed. However, research in the life sciences and biomedicine has produced a range of moral concerns and prompted the emergence of bioethics; an area of study that specialises in the ethical analysis of these issues. The result has been the emergence of what we might call expert bioethicists, a cadre of professionals who, while logical and friendly, have, nevertheless, been ordained as secular priests.
This suggestion – that there are expert bioethicists – might appear to have profoundly anti-democratic implications. Indeed handling expertise, including scientific expertise, is a central difficulty for democratic societies and its extension into the realm of moral values seems, on the face of it, to compound the problem. Nevertheless the Human Fertilisation and Embryology Authority (HFEA) has constantly made use of expert bioethicists and two members of the recently convened Emerging Science and Bioethics Advisory Committee (ESBAC) are listed as "bioethics specialists".
If we are to govern the biosciences and medical practice effectively there seems to be increasing need for expert bioethicists. Nevertheless, there is a different dynamic to the politics of bioethical expertise precisely because the opinions of bioethical experts cannot be used to obviate those of other moral agents.
This might seem like an odd claim. If there are expert bioethicists surely we should prefer their opinions to those of non-experts? However this is to assume bioethical expertise is modelled on scientific expertise. The idea of the scientist as expert is so strong we often forget that there are other forms of expertise.
The entire post is here.
Say twenty hail Autonomy’s and reflect on what you have done – bioethicists as having some, but not priestly authority
By David Hunter
BMJ Group Blogs
Originally published May 17, 2013
Nathan Emmerich, occasional commentator here at the JME blog has recently published an interesting piece in the Guardian which argues against us taking bioethicists as having a particular type of expertise. While I enjoyed and agree with much of what he argues I do have a couple of quibbles – in particular I worry that the emphasis on inclusiveness and democracy could in effect lead to the exclusion of the bioethicist, which I think would be a mistake.
The type of expertise he argues against bioethicists having is basically what I will refer to as authoritative expertise – someone who has authoritative expertise in a particular field ought to be deferred to when there is a disagreement – their opinion is “better” than ours as lay decision makers. So for example when deciding how long an object is, and whether it will fit in the boot of our car, we ought to defer to the chap with the tape measure, since their measured judgement is better than ours.
I use this example for a reason – Emmerich focuses on knowledge based expertise (no doubt because it is easier to explain to the lay public…) but this isn’t the only form of expertise that warrants some deference there is also expertise which is performative (in this case the act of measuring well). I’m inclined to think that if bioethicists deserve any deference it will be due to their performative expertise, rather than their knowledge.
Emmerich suggests however that bioethicists should not be taken as having authoratative expertise because he thinks knowledge about morality is more like knowledge about aesthetics than knowledge about facts. Hence we ought to give no more weight to the bioethicists opinion about an ethical issue, than we do someone heavily steeped in the Art’s worlds opinion about a piece of modern art – they have a “sophisticated” view but that doesn’t tell me what I should think about the piece.
(cut)
I think the bioethicist is in a position to contribute something useful to such deliberation, debate and discussion in two ways, both of which require some expertise – even if it is not totally authorative expertise. The first way is this, the bioethicist I assume will have access to more knowledge both about what has been argued in regards to ethical theory and in regards to moves in applied ethics. Knowing these moves can short-cut some discussion and debate by showing paths that will lead nowhere – the implications and consequences of particular arguments.
The entire response is here.
BMJ Group Blogs
Originally published May 17, 2013
Nathan Emmerich, occasional commentator here at the JME blog has recently published an interesting piece in the Guardian which argues against us taking bioethicists as having a particular type of expertise. While I enjoyed and agree with much of what he argues I do have a couple of quibbles – in particular I worry that the emphasis on inclusiveness and democracy could in effect lead to the exclusion of the bioethicist, which I think would be a mistake.
The type of expertise he argues against bioethicists having is basically what I will refer to as authoritative expertise – someone who has authoritative expertise in a particular field ought to be deferred to when there is a disagreement – their opinion is “better” than ours as lay decision makers. So for example when deciding how long an object is, and whether it will fit in the boot of our car, we ought to defer to the chap with the tape measure, since their measured judgement is better than ours.
I use this example for a reason – Emmerich focuses on knowledge based expertise (no doubt because it is easier to explain to the lay public…) but this isn’t the only form of expertise that warrants some deference there is also expertise which is performative (in this case the act of measuring well). I’m inclined to think that if bioethicists deserve any deference it will be due to their performative expertise, rather than their knowledge.
Emmerich suggests however that bioethicists should not be taken as having authoratative expertise because he thinks knowledge about morality is more like knowledge about aesthetics than knowledge about facts. Hence we ought to give no more weight to the bioethicists opinion about an ethical issue, than we do someone heavily steeped in the Art’s worlds opinion about a piece of modern art – they have a “sophisticated” view but that doesn’t tell me what I should think about the piece.
(cut)
I think the bioethicist is in a position to contribute something useful to such deliberation, debate and discussion in two ways, both of which require some expertise – even if it is not totally authorative expertise. The first way is this, the bioethicist I assume will have access to more knowledge both about what has been argued in regards to ethical theory and in regards to moves in applied ethics. Knowing these moves can short-cut some discussion and debate by showing paths that will lead nowhere – the implications and consequences of particular arguments.
The entire response is here.
Wednesday, May 29, 2013
The SUPPORT Study and the Standard of Care Read
By Lois Shepherd
The Hastings Center Bioethics Forum
Originally posted May 17, 2013
The clinical research community and a number of prominent bioethicists have swiftly come to the defense of investigators conducting the SUPPORT study, in which approximately 1,300 premature infants were randomly assigned to be maintained at higher or lower levels of oxygen saturation. The study took place between 2005 and 2009, involved 22 sites and was reviewed by at least as many institutional review boards. In March, the Office of Human Research Protection (OHRP) concluded that investigators had violated the informed consent provisions of the federal regulations governing research by failing to inform parents of infants enrolled in the study about risks of retinopathy, neurological injury, and death. Results from the study revealed that infants assigned to receive the lower range of oxygen suffered higher rates of death than infants assigned to the upper range, while the latter suffered higher rates of retinopathy than the former. Defenders accuse OHRP of faulting the investigators for failing to inform parents of risks they learned about only through the study.
The central point of disagreement between defenders and critics of the study appears to be whether participants in the study were receiving medical care that was different from the care they would have received outside the study and whether participation in research therefore carried any medical risks that required risk/benefit scrutiny by IRBs or disclosure to parents of the infants enrolled. This would appear to be a factual matter about which one could obtain some clarity, but discussions of this issue have been somewhat opaque.
Part of the reason for this may be different, but unacknowledged, understandings of the concept of “standard of care,” a term used – both in the informed consent forms and the commentary about them – but rarely defined in this debate.
The entire article is here.
The Hastings Center Bioethics Forum
Originally posted May 17, 2013
The clinical research community and a number of prominent bioethicists have swiftly come to the defense of investigators conducting the SUPPORT study, in which approximately 1,300 premature infants were randomly assigned to be maintained at higher or lower levels of oxygen saturation. The study took place between 2005 and 2009, involved 22 sites and was reviewed by at least as many institutional review boards. In March, the Office of Human Research Protection (OHRP) concluded that investigators had violated the informed consent provisions of the federal regulations governing research by failing to inform parents of infants enrolled in the study about risks of retinopathy, neurological injury, and death. Results from the study revealed that infants assigned to receive the lower range of oxygen suffered higher rates of death than infants assigned to the upper range, while the latter suffered higher rates of retinopathy than the former. Defenders accuse OHRP of faulting the investigators for failing to inform parents of risks they learned about only through the study.
The central point of disagreement between defenders and critics of the study appears to be whether participants in the study were receiving medical care that was different from the care they would have received outside the study and whether participation in research therefore carried any medical risks that required risk/benefit scrutiny by IRBs or disclosure to parents of the infants enrolled. This would appear to be a factual matter about which one could obtain some clarity, but discussions of this issue have been somewhat opaque.
Part of the reason for this may be different, but unacknowledged, understandings of the concept of “standard of care,” a term used – both in the informed consent forms and the commentary about them – but rarely defined in this debate.
The entire article is here.
Physician Congressman Fined for Having Sex With 2 Patients
By Robert Lowes
Medscape Medical News
Originally published on May 24, 2014
Rep. Scott DesJarlais, MD (R-TN), was fined $500 by the state medical board in Tennessee for having sexual relationships with 2 female patients in 2000, according to a consent order approved by the board on May 22.
The Board of Medical Examiners of Tennessee also reprimanded Dr. DesJarlais, characterizing his behavior as "unprofessional conduct."
Dr. DesJarlais, a general practitioner who was first elected to represent Tennessee's Fourth Congressional District in 2010, signed the consent order on May 20.
The consent order describes in bare-bones fashion what was laid out in voluminous detail about Dr. DesJarlais' personal life during and after his 2012 reelection campaign. From roughly January 2000 to May 2000, Dr. DesJarlais "had a sexual relationship with 2 female patients," the order states. "No documentation exists to show whether or not the physician-patient relationship was severed prior to the commencement of a romantic relationship with either female patient."
The board fined Dr. DesJarlais $250 for each patient. He also is responsible for the state's cost of prosecuting the case, up to $1000.
The rest of the story is here.
Medscape Medical News
Originally published on May 24, 2014
Rep. Scott DesJarlais, MD (R-TN), was fined $500 by the state medical board in Tennessee for having sexual relationships with 2 female patients in 2000, according to a consent order approved by the board on May 22.
The Board of Medical Examiners of Tennessee also reprimanded Dr. DesJarlais, characterizing his behavior as "unprofessional conduct."
Dr. DesJarlais, a general practitioner who was first elected to represent Tennessee's Fourth Congressional District in 2010, signed the consent order on May 20.
The consent order describes in bare-bones fashion what was laid out in voluminous detail about Dr. DesJarlais' personal life during and after his 2012 reelection campaign. From roughly January 2000 to May 2000, Dr. DesJarlais "had a sexual relationship with 2 female patients," the order states. "No documentation exists to show whether or not the physician-patient relationship was severed prior to the commencement of a romantic relationship with either female patient."
The board fined Dr. DesJarlais $250 for each patient. He also is responsible for the state's cost of prosecuting the case, up to $1000.
The rest of the story is here.
Tuesday, May 28, 2013
VA tries quality improvement approach to medical ethics
Tools to evaluate how health care facilities perform ethically are in their infancy. The VA Health Care System hopes others can benefit from its experience.
By Tanya Albert Henry
amednews.com
Originally posted May 20, 2013
How often does a physician have enough time to discuss a treatment recommendation with a patient?
Would a doctor be reluctant to raise concerns if he or she believes a colleague's clinical abilities are impaired?
How often are notes or papers with identifiable patient information left in areas where other patients, relatives or staff members might view the sensitive material?
These are just a few of the questions the National Center for Ethics in Health Care at the U.S. Dept. of Veterans Affairs is using to query its staff at the VA Health Care System. The goal is to help facilities see what they are doing well in terms of ethics and point out areas where they could be doing more.
The concept is similar to the recent push to evaluate quality of care by asking about procedural issues such as how well physicians are helping patients control hypertension or whether hospitals are keeping infection rates low.
Ethics evaluations, though, are not so common, and surveys do not tie payment to how well facilities score. However, the idea of measuring ethics as a component of quality of care is gaining momentum, and leaders in the field say its time has come.
“This is about managing ethics the same way you manage health care quality,” said Ellen Fox, MD, chief ethics in health care officer for the Veterans Health Administration. “Ethics quality is an important area that can have a dramatic effect on health care, including life-and-death decisions. … An effective ethics program promotes better patient care, better patient satisfaction, better efficiency.”
The entire story is here.
By Tanya Albert Henry
amednews.com
Originally posted May 20, 2013
How often does a physician have enough time to discuss a treatment recommendation with a patient?
Would a doctor be reluctant to raise concerns if he or she believes a colleague's clinical abilities are impaired?
How often are notes or papers with identifiable patient information left in areas where other patients, relatives or staff members might view the sensitive material?
These are just a few of the questions the National Center for Ethics in Health Care at the U.S. Dept. of Veterans Affairs is using to query its staff at the VA Health Care System. The goal is to help facilities see what they are doing well in terms of ethics and point out areas where they could be doing more.
The concept is similar to the recent push to evaluate quality of care by asking about procedural issues such as how well physicians are helping patients control hypertension or whether hospitals are keeping infection rates low.
Ethics evaluations, though, are not so common, and surveys do not tie payment to how well facilities score. However, the idea of measuring ethics as a component of quality of care is gaining momentum, and leaders in the field say its time has come.
“This is about managing ethics the same way you manage health care quality,” said Ellen Fox, MD, chief ethics in health care officer for the Veterans Health Administration. “Ethics quality is an important area that can have a dramatic effect on health care, including life-and-death decisions. … An effective ethics program promotes better patient care, better patient satisfaction, better efficiency.”
The entire story is here.
Learning From Litigation
By Joanna C. Schwartz
The New York Times - Op Ed
Originally published May 16, 2013
MUCH of the discussion over the Affordable Care Act has focused on whether it will bring down health care costs. Less attention has been paid to another goal of the act: improving patient safety. Each year tens of thousands of people die, and hundreds of thousands more are injured, as a result of medical error.
Experts agree that the best way to reduce medical error is to gather and analyze information about past errors with an eye toward improving future care. But many believe that a major barrier to doing so is the medical malpractice tort system: the threat of being sued is believed to prevent the kind of transparency necessary to identify and learn from errors when they occur.
New evidence, however, contradicts the conventional wisdom that malpractice litigation compromises the patient safety movement’s call for transparency. In fact, the opposite appears to be occurring: the openness and transparency promoted by patient safety advocates appear to be influencing hospitals’ responses to litigation risk.
I recently surveyed more than 400 people responsible for hospital risk management, claims management and quality improvement in health care centers around the country, in cooperation with the American Society of Health Care Risk Managers, and I interviewed dozens more.
The entire story is here.
The New York Times - Op Ed
Originally published May 16, 2013
MUCH of the discussion over the Affordable Care Act has focused on whether it will bring down health care costs. Less attention has been paid to another goal of the act: improving patient safety. Each year tens of thousands of people die, and hundreds of thousands more are injured, as a result of medical error.
Experts agree that the best way to reduce medical error is to gather and analyze information about past errors with an eye toward improving future care. But many believe that a major barrier to doing so is the medical malpractice tort system: the threat of being sued is believed to prevent the kind of transparency necessary to identify and learn from errors when they occur.
New evidence, however, contradicts the conventional wisdom that malpractice litigation compromises the patient safety movement’s call for transparency. In fact, the opposite appears to be occurring: the openness and transparency promoted by patient safety advocates appear to be influencing hospitals’ responses to litigation risk.
I recently surveyed more than 400 people responsible for hospital risk management, claims management and quality improvement in health care centers around the country, in cooperation with the American Society of Health Care Risk Managers, and I interviewed dozens more.
The entire story is here.
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