By Danielle Ofri
Physician, Writer, Editor
Here is an excerpt:
But this is just one example of unethical allocation of money in medicine. Much ado was rightly made last year when Medicare data showed a few doctors with unsavory and maybe illegal billing practices. But for all the complaints about doctors’ salaries driving up healthcare costs, hardly anyone made a peep when that same data revealed that it is the salaries of the administrators and executives that are tipping the scales.
Nor did anyone so much as hiccup when it was reported that $455 million dollars was spent on TV ads since the Affordable Care Act was enacted, more than 90% of which was devoted to trying to destroy the ACA. We are so jaded about CEO salaries and the money swamp of politics that we hardly are hardly bothered when we see these statistics.
When I read about the $400 million was spent on TV ads to prevent uninsured Americans from getting health insurance, I was frankly disgusted. If people with deep pockets are really interested in improving our healthcare system there are far better ways to use that money. That handsome sum could have put several thousand nurses in clinics or schools. It could have sponsored medical school for 2000 students from underserved communities. Heck, it could have purchase 6 million albuterol inhalers and handed them out. But no, the money was squandered on TV advertisements.
The entire article is here.
Friday, April 10, 2015
Informed Consent Procedures with Cognitively Impaired Patients: A Review of Ethics and Best Practices
By L. M. Field and J. D. Calvert
Psychiatry Clin Neurosci. 2015 Mar 10
doi: 10.1111/pcn.12289
Abstract
AIM:
The objectives of this paper are to discuss ethical issues of informed consent in cognitively impaired patients and review considerations for capacity determination. We will also discuss how to evaluate capacity, determine competence, and obtain informed consent when a patient is deemed incompetent. This review emphasizes how to carry out informed consent procedures when capacity is questionable and discusses measures supported for use when determining cognitively impaired patients' ability to consent.
METHODS:
Information was gathered from medical and psychological codes of ethics, peer-reviewed journals, published guidelines from healthcare organizations (e.g., American Medical Association), and scholarly books. Google Scholar and PsycINFO were searched for articles related to "informed consent" and "cognitive impairment" published in English between 1975 and 2014. Relevant sources referenced in retrieved publications were subsequently searched and reviewed.
RESULTS:
We selected 43 sources generated by our search. Sources were included in our review if they presented information related to at least one of our focus areas. These areas included: review of informed consent ethics and procedures, review of cognitive impairment evaluations, recommendations for measuring cognitive capacity, and alternative forms of informed consent.
CONCLUSIONS:
Patients' cognitive impairments can hinder the ability of patients to understand treatment options. Evaluating the capacity of patients with cognitive impairment to understand treatment options is vital for valid informed consent and should be guided by best practices. Thus, proper identification of patients with questionable capacity, capacity evaluation, and determination of competence, as well as reliance upon appropriate alternative consent procedures, are paramount.
The article is here.
Psychiatry Clin Neurosci. 2015 Mar 10
doi: 10.1111/pcn.12289
Abstract
AIM:
The objectives of this paper are to discuss ethical issues of informed consent in cognitively impaired patients and review considerations for capacity determination. We will also discuss how to evaluate capacity, determine competence, and obtain informed consent when a patient is deemed incompetent. This review emphasizes how to carry out informed consent procedures when capacity is questionable and discusses measures supported for use when determining cognitively impaired patients' ability to consent.
METHODS:
Information was gathered from medical and psychological codes of ethics, peer-reviewed journals, published guidelines from healthcare organizations (e.g., American Medical Association), and scholarly books. Google Scholar and PsycINFO were searched for articles related to "informed consent" and "cognitive impairment" published in English between 1975 and 2014. Relevant sources referenced in retrieved publications were subsequently searched and reviewed.
RESULTS:
We selected 43 sources generated by our search. Sources were included in our review if they presented information related to at least one of our focus areas. These areas included: review of informed consent ethics and procedures, review of cognitive impairment evaluations, recommendations for measuring cognitive capacity, and alternative forms of informed consent.
CONCLUSIONS:
Patients' cognitive impairments can hinder the ability of patients to understand treatment options. Evaluating the capacity of patients with cognitive impairment to understand treatment options is vital for valid informed consent and should be guided by best practices. Thus, proper identification of patients with questionable capacity, capacity evaluation, and determination of competence, as well as reliance upon appropriate alternative consent procedures, are paramount.
The article is here.
Thursday, April 9, 2015
Controversy Continues at University of Oregon Counseling Center
By Richard Read
The Oregonian
Originally published April 8, 2015
Here is an excerpt:
Bronet assured students in a March 20 memo that UO's counseling center would keep records confidential barring extraordinary circumstances. She urged them to use university mental-health services without fear.
Meanwhile, The Oregonian/OregonLive has learned, the head of the University Counseling and Testing Center significantly weakened confidentiality safeguards in a policy statement she wrote with UO's legal department.
Director Shelly Kerr wrote in an internal April 3 email obtained by the news organization that she worked with university attorneys to draft the new confidentiality policy. "I want to be sure that the information on our web and printed materials are as clear and accurate as possible," she wrote.
But the new policy, already in effect, contradicts promises Bronet made and greatly expands the number of exceptions that could be cited as justification to break confidentiality.
The entire article is here.
The Oregonian
Originally published April 8, 2015
Here is an excerpt:
Bronet assured students in a March 20 memo that UO's counseling center would keep records confidential barring extraordinary circumstances. She urged them to use university mental-health services without fear.
Meanwhile, The Oregonian/OregonLive has learned, the head of the University Counseling and Testing Center significantly weakened confidentiality safeguards in a policy statement she wrote with UO's legal department.
Director Shelly Kerr wrote in an internal April 3 email obtained by the news organization that she worked with university attorneys to draft the new confidentiality policy. "I want to be sure that the information on our web and printed materials are as clear and accurate as possible," she wrote.
But the new policy, already in effect, contradicts promises Bronet made and greatly expands the number of exceptions that could be cited as justification to break confidentiality.
The entire article is here.
Ethical Framework for the Use of Technology in Mental Health
Online Therapy Institute
Here is an excerpt from their resource page:
A competent practitioner working online will always adhere at least the following minimum standards and practices in order to be considered to be working in an ethical manner.
Practitioners have a sufficient understanding of technology.
Technology basics are required for practitioners who choose to deliver therapeutic services via technology. Practitioners will possess a basic understanding of technology as the technology relates to delivery of services
Here is an excerpt from their resource page:
A competent practitioner working online will always adhere at least the following minimum standards and practices in order to be considered to be working in an ethical manner.
Practitioners have a sufficient understanding of technology.
Technology basics are required for practitioners who choose to deliver therapeutic services via technology. Practitioners will possess a basic understanding of technology as the technology relates to delivery of services
- Encryption: Practitioners understand how to access encrypted services to store records and deliver communication. Records storage can be hosted on a secure server with a third-party, stored on the practitioner’s hard drive utilizing encrypted folders or stored on an external drive that is safely stored.
- Backup Systems: Records and data that are stored on the practitioner’s hard drive are backed up either to an external drive or remotely via the Internet.
- Password Protection: Practitioners take further steps to ensure confidentiality of therapeutic communication and other materials by password protecting the computer, drives and stored files or communication websites.
- Firewalls: Practitioners utilize firewall protection externally or through web-based programs.
- Virus Protection: Practitioners protect work computers from viruses that can be received from or transmitted to others, including clients.
- Hardware: Practitioners understand the basic running platform of the work computer and know whether or not a client’s hardware/platform is compatible with any communication programs the practitioner uses.
- Software: Practitioners know how to download and operate software and assist clients with the same when necessary to the delivery of services.
- Third-party services: Practitioners utilize third-party services that offer an address and phone number so that contact is possible via means other than email. This offers a modicum of trust in the third-party utilized for such services as backup, storage, virus protection and communication.
Wednesday, April 8, 2015
Online Ethics for Professionals
By The Social Network Show
Originally published March 16, 2015
Part of the Show Recap
The Social Network Show welcomes Dr. John Gavazzi to the March 16, 2015 episode.
If you are a healthcare professional or a professional in any other field, one thing you have to pay attention to is your online reputation. Something to remember, there is no difference in your professional and your personal online presence and patients, clients and customers can find you.
Dr. Gavazzi, a clinical psychologist and named Ethics Educator of the Year by the Pennsylvania Psychological Association in 2013, talks about the issues to consider when building an online presence. In this episode you will hear about what ethical issues to consider; the importance of setting boundaries; what is included in informed consent; the limitations of technology; what constitutes a violation of privacy; and what are the advantages of being online for professionals.
(I was also named Ethics Educator of the Year by the American Psychological Association in 2014.)
The podcast is here.
Originally published March 16, 2015
Part of the Show Recap
The Social Network Show welcomes Dr. John Gavazzi to the March 16, 2015 episode.
If you are a healthcare professional or a professional in any other field, one thing you have to pay attention to is your online reputation. Something to remember, there is no difference in your professional and your personal online presence and patients, clients and customers can find you.
Dr. Gavazzi, a clinical psychologist and named Ethics Educator of the Year by the Pennsylvania Psychological Association in 2013, talks about the issues to consider when building an online presence. In this episode you will hear about what ethical issues to consider; the importance of setting boundaries; what is included in informed consent; the limitations of technology; what constitutes a violation of privacy; and what are the advantages of being online for professionals.
(I was also named Ethics Educator of the Year by the American Psychological Association in 2014.)
The podcast is here.
Tuesday, April 7, 2015
Premera Blue Cross Breach May Have Exposed 11 Million Customers' Medical And Financial Data
By Kate Vinton
Forbes
Originally published March 17, 2015
Medical and financial data belonging to as many as 11 million Premera Blue Cross customers may have been exposed in a breach discovered on the same day as the Anthem breach, the health insurance company announced Tuesday.
Premera discovered the breach on January 29, 2015. Working with both Mandiant and the FBI to investigate the attack, the company discovered that the initial attack occurred on May 5, 2014. Premera Blue Cross and Premera Blue Cross Blue Shield of Alaska were both impacted, in addition to affiliate brands Vivacity and Connexion Insurance Solutions. Additionally, other Blue Cross Blue Shield customers in Washington and Alaska may have been affected by the breach.
The entire article is here.
Forbes
Originally published March 17, 2015
Medical and financial data belonging to as many as 11 million Premera Blue Cross customers may have been exposed in a breach discovered on the same day as the Anthem breach, the health insurance company announced Tuesday.
Premera discovered the breach on January 29, 2015. Working with both Mandiant and the FBI to investigate the attack, the company discovered that the initial attack occurred on May 5, 2014. Premera Blue Cross and Premera Blue Cross Blue Shield of Alaska were both impacted, in addition to affiliate brands Vivacity and Connexion Insurance Solutions. Additionally, other Blue Cross Blue Shield customers in Washington and Alaska may have been affected by the breach.
The entire article is here.
Healthcare Accounted For Almost Half Of 2014 Client Breaches
By Christine Kern
Health IT Outcomes
Originally published March 12, 2015
A Kroll study has found the healthcare industry accounted for 49 percent of the company’s “client events” during 2014, followed by business services (retail, insurance, and financial services) at 26 percent, and higher education at 11 percent. The study further found malicious intent breach events increased while those caused by human error declined.
Monday, April 6, 2015
Evolutionary Moral Realism
By John Collier and Michael Stingl
Biological Theory
March 2013, Volume 7, Issue 3, pp 218-226
Abstract
Evolutionary moral realism is the view that there are moral values with roots in evolution that are both specifically moral and exist independently of human belief systems. In beginning to sketch the outlines of such a view, we examine moral goods like fairness and empathetic caring as valuable and real aspects of the environments of species that are intelligent and social, or at least developing along an evolutionary trajectory that could lead to a level of intelligence that would enable individual members of the species to recognize and respond to such things as the moral goods they in fact are. We suggest that what is most morally interesting and important from a biological perspective is the existence and development of such trajectories, rather than the position of one particular species, such as our own, on one particular trajectory.
The entire article is here.
Biological Theory
March 2013, Volume 7, Issue 3, pp 218-226
Abstract
Evolutionary moral realism is the view that there are moral values with roots in evolution that are both specifically moral and exist independently of human belief systems. In beginning to sketch the outlines of such a view, we examine moral goods like fairness and empathetic caring as valuable and real aspects of the environments of species that are intelligent and social, or at least developing along an evolutionary trajectory that could lead to a level of intelligence that would enable individual members of the species to recognize and respond to such things as the moral goods they in fact are. We suggest that what is most morally interesting and important from a biological perspective is the existence and development of such trajectories, rather than the position of one particular species, such as our own, on one particular trajectory.
The entire article is here.
How (Un)ethical Are You?
Mahzarin R. Banaji, Max H. Bazerman, & Dolly Chugh
Harvard Business Review
Originally published in 2003
Here is an excerpt:
Bias That Emerges from Unconscious Beliefs
Most fair-minded people strive to judge others according to their merits, but our research shows how often people instead judge according to unconscious stereotypes and attitudes, or “implicit prejudice.” What makes implicit prejudice so common and persistent is that it is rooted in the fundamental mechanics of thought. Early on, we learn to associate things that commonly go together and expect them to inevitably coexist: thunder and rain, for instance, or gray hair and old age. This skill—to perceive and learn from associations—often serves us well.
But, of course, our associations only reflect approximations of the truth; they are rarely applicable to every encounter. Rain doesn’t always accompany thunder, and the young can also go gray. Nonetheless, because we automatically make such associations to help us organize our world, we grow to trust them, and they can blind us to those instances in which the associations are not accurate—when they don’t align with our expectations.
Because implicit prejudice arises from the ordinary and unconscious tendency to make associations, it is distinct from conscious forms of prejudice, such as overt racism or sexism. This distinction explains why people who are free from conscious prejudice may still harbor biases and act accordingly.
The entire article is here.
Harvard Business Review
Originally published in 2003
Here is an excerpt:
Bias That Emerges from Unconscious Beliefs
Most fair-minded people strive to judge others according to their merits, but our research shows how often people instead judge according to unconscious stereotypes and attitudes, or “implicit prejudice.” What makes implicit prejudice so common and persistent is that it is rooted in the fundamental mechanics of thought. Early on, we learn to associate things that commonly go together and expect them to inevitably coexist: thunder and rain, for instance, or gray hair and old age. This skill—to perceive and learn from associations—often serves us well.
But, of course, our associations only reflect approximations of the truth; they are rarely applicable to every encounter. Rain doesn’t always accompany thunder, and the young can also go gray. Nonetheless, because we automatically make such associations to help us organize our world, we grow to trust them, and they can blind us to those instances in which the associations are not accurate—when they don’t align with our expectations.
Because implicit prejudice arises from the ordinary and unconscious tendency to make associations, it is distinct from conscious forms of prejudice, such as overt racism or sexism. This distinction explains why people who are free from conscious prejudice may still harbor biases and act accordingly.
The entire article is here.
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