Vignette 30: The Purloined Patient

Dr. Eddy Kessler received a referral from the Office of Vocational Rehabilitation (OVR) to work therapeutically with Enoch Thompson, who suffers with symptoms of a panic disorder.  Dr. Kessler accepted the referral and started to work with Mr. Thompson on his symptoms of panic and anxiety, as these have interfered with Mr. Thompson’s ability to maintain employment.  Treatment started well, with Mr. Thompson developing better cognitive and behavioral skills to manage his anxiety after the initial eight sessions funded by OVR.  With Mr. Thompson’s consent, Dr. Kessler sent a letter to OVR requesting 10 more sessions over the next five months to reinforce the gains made in treatment.  Dr. Kessler viewed Mr. Thompson as moving toward stable employment with ongoing treatment.  As Mr. Thompson was improving, they agreed to meet in two weeks.

Upon his return two weeks later, Mr. Thompson informed Dr. Kessler that he was recently evaluated by his wife’s psychologist, Dr. Gillian Darmody.  As the patient described it, Mr. Thompson took his wife to her therapy session.  Dr. Darmody asked him to join the session.  The outcome of the session was that Dr. Darmody would be able to get Mr. Thompson on Social Security Disability as she “knows how to write psychological reports” in a way that almost guarantees a favorable disability decision.  She also gave him the name of an attorney to represent him.  He also felt positive about the experience as Dr. Darmody agreed to bill his health insurance for the disability evaluation.  He has a meeting scheduled with the attorney in two weeks.  Mr. Thompson also believes that the consultation with the attorney is free, and that the attorney is paid after disability benefits are awarded.

Dr. Kessler inquired as to why he agreed to the disability evaluation if OVR is trying to return him to work.  Mr. Thompson disclosed that the job market is tough, so he wanted a backup plan in case he gets better and cannot find work.  Mr. Thompson stated he disclosed their treatment relationship.  However, Dr. Darmody deemed their treatment relationship to be inconsequential to the disability evaluation.  The session then focused on Mr. Thompson’s ability to manage anxiety via psychological skills.  Dr. Kessler manages his anger sufficiently to get through the session and scheduled Mr. Thompson in two weeks.

After the session, Dr. Kessler phones you for a consultation.  Dr. Kessler is morally outraged at the other psychologist’s behavior, if true.

What are the possible legal and ethical issues involved in this case?

How would you respond to Dr. Kessler’s moral outrage?

How would you explain the issues to Mr. Thompson?

Are these reasons to terminate your treatment with Mr. Thompson?

If you would continue to work with Mr. Thompson would you change your goals?

How would you document this report from Mr. Thompson in your case notes?

Would you withdraw your request for more sessions from OVR?

What are Dr. Kessler’s options?

If you were Dr. Kessler, what would you do and why?

APA Declines to Rebuke Guantanamo Psychologist

By Spence Ackerman
The Guardian
Originally published January 22, 2014

America’s professional association of psychologists has quietly declined to rebuke one of its members, a retired US army reserve officer, for his role in one of the most brutal interrogations known to have to taken place at Guantánamo Bay, the Guardian has learned.

The decision not to pursue any disciplinary measure against John Leso, a former army reserve major, is the latest case in which someone involved in the post-9/11 torture of detainees has faced no legal or even professional consequences.

The entire story is here.

The December 31 letter is here.

Strengthening the Ethical Culture of Your Organization Should Be a Priority

By Barbara Richman
SPHR

According to the 2011 National Business Ethics Survey, a report published by the Ethics Resource Center, the ethical culture of the American workplace is in transition. The survey, the seventh since 1994, was conducted for the purpose of understanding how employees at all levels view ethics and compliance at work.

Its overall results send mixed signals to employers. While positive indicators are included in the findings, they are clouded by “ominous warning signs of a potentially significant ethics decline ahead.”

On the positive side, the data revealed historically low levels of misconduct in the American workplace and near record high levels of employees reporting misconduct that they observed. On the negative side, however, there was a sharp rise in retaliation against employee whistleblowers, an increase in the percentage of employees who perceived pressure to compromise standards in order to do their jobs, and near record levels of companies with weak ethical cultures.

The entire story is here.

Loyola Bioethics Study: Med Students Reflections on Caring for Dying Patients

Loyola Bioethics Online
Originally posted January 14, 2014

The imminent death of a patient is riddled with emotions for a patient and family as well as the medical team. A study based on the reflections of third-year Loyola University Chicago Stritch School of Medicine students is shedding light on the struggle physicians in training often face when trying to control their own emotions while not becoming desensitized to the needs of the dying patient and his or her family.

“Medical students are very aware they are undergoing a socialization process by which they become desensitized to the difficult things they see every day in the hospital. They realize this is necessary to control their emotions and focus on caring for the patients. On the other hand, they are very concerned about becoming insensitive to the spiritual, emotional and personal needs of the patient,” said Mark Kuczewski, PhD, leader author and director of the Loyola University Chicago Stritch School of Medicine Neiswanger Institute for Bioethics.

The entire article is here.

An interview with Mark Kuczewski, PhD by Randi Belisomo

Watchdog agency criticizes ethics of study of premature infants

By David Brown
The Washington Post
Originally published April 10, 2013

A clinical experiment involving 1,300 premature infants at two dozen hospitals “failed to adequately inform parents” of the risks of the treatment, which included blindness, brain damage and death, according to a watchdog agency at the Department of Health and Human Services.

The description of the experiment that parents read before deciding whether to enroll their babies downplayed the risks and emphasized possible benefits of getting a less-than-average amount of supplementary oxygen in the critical weeks after birth.

“The consent form was written in a slanted way,” said Jerry A. Menikoff, director of the Office for Human Research Protections (OHRP), which found that the study was “in violation of the regulatory requirements for informed consent” required by federal law.

The entire story is here.

Elizabeth Loftus: The fiction of memory

TED Talk
Published in August 2013

Psychologist Elizabeth Loftus studies memories. More precisely, she studies false memories, when people either remember things that didn't happen or remember them differently from the way they really were. It's more common than you might think, and Loftus shares some startling stories and statistics, and raises some important ethical questions we should all remember to consider.




Thanks to Gary Schoener for this information.

Punishment and Blame within Criminal Justice

By Hanna Pickard
Flickers of Freedom
Originally posted January 21, 2014

Here is an excerpt:

As well as working clinically with patients, I’m also currently developing a training for prison officers, to teach them how to distinguish responsibility from blame in theory and in practice, as part of an initiative to increase awareness and skills working with personality disorder (PD) and promote a more rehabilitative environment within prisons. On a purely personal note, going into prisons has been hard. Over time I’ve become much less scared, but I still can’t bear being locked in, dependent on the officers and their keys to get out. Every time I go, I can’t quite believe we’ve ended up doing this to people, no matter what they’ve done. So I certainly think there’s reason to re-think radically the entire system, on multiple grounds. However the training I’m developing and the theoretical work that underpins it aims to be pragmatic rather than revolutionary – and that’s what I’m going to blog about today. No utopian ideals!

We currently spend millions and millions imprisoning offenders. Meanwhile there’s some real and plenty of anecdotal evidence that one of the best ways to increase re-offending is to put people in jail – arguably, you really couldn’t design a better environment to entrench criminality if you tried. Yet 66% of male offenders and 50% of female offenders have PD – they have many of the same mental health problems and psycho-socio-economic backgrounds as patients in the community who we know we can help in Therapeutic Communities and other forms of treatment program.

The entire blog post is here.

Science needs philosophy

The fad for using science to explain everything is misguided and dangerous

by Massimo Pigliucci
Rationalist Association
Originally posted July 19, 2012, and still relevant today.

Here is an excerpt:

The culprits are many and influential. Physicists Steven Weinberg, Stephen Hawking and Lawrence Krauss, along with biologist EO Wilson, dismiss philosophy (and much of the humanities) as a leftover from pre-scientific thought, to be replaced by the objective and empirical truth arrived at by modern science, especially fundamental physics. Never mind that, as Daniel Dennett aptly put it a while ago, there is no such thing as philosophy-free science, but only science whose philosophical baggage is taken on board unexamined.

And then there are the likes of Sam Harris, Jonathan Haidt, Alex Rosenberg and Jerry Coyne, who claim that science can provide answers to philosophical questions, and that moreover antiquated concepts like free will, consciousness and morality are just illusions, tricks played on us by our Pleistocene-evolved brains. We are not really in control of what we do and think, it’s all done automatically by an inner zombie whose actions were determined since the Big Bang. This despite the fact that serious neuroscientists like Michael Gazzaniga and Antonio Damasio are actually much more careful about what exactly their discipline brings to our understanding of the human mind.

The entire story is here.

Moral Tribes by Joshua Greene – review

By Salley Vickers
The Observer
Originally published January 11, 2014

Here is an excerpt:

What Greene and his team have added to this unnerving moral conundrum is the systematic use of multiple brain images that demonstrate that when people contemplate sacrificing the fat man there is increased activity in the ventromedial prefrontal cortex, a part of the brain associated with emotion, whereas consideration of operating the switch promotes increased activity in the dorsolateral prefrontal cortex, the part of the brain associated with reasoning. People with damage to the ventromedial prefrontal cortex, who lack normal emotions, were five times more likely to approve of pushing the fat man off the bridge.

Greene began his career as a philosopher so is well placed to consider the question of ethics from a theoretical as well as an empirical perspective. There have been a number of books recently that consider the biological roots of moral sense (Paul Bloom's Just Babies is the most recent example). But while Greene's research suggests, in accordance with Bloom, that the rudiments of morality are indeed innate, it also demonstrates, through such experiments as the trolley problem, that our moral responses rest on a wobbly intuitive base – a gut feeling that may not produce the best general outcome.

The entire article is here.