Guest post by Sandra Martins Pereira, Roeline Pasman and Bregje Onwuteaka-Philipsen
Journal of Medical Ethics Blog
Originally posted May 14, 2015
Decisions to forgo treatment are embedded in clinical, socio-cultural, philosophical, religious, legal and ethical contexts and beliefs, and they cannot be considered as representing good or poor quality care. Particularly for older people, it is sometimes argued that treatment is aggressive, and that there may be a tendency to continue or start treatments in situations where a shift to a focus on quality of life in light of a limited life expectancy might be preferred. Others argue that an attitude of ageism might prevent older people from receiving treatments and care from which they could benefit, thus resulting in some type of harm and compromising the ethical principles of beneficence and non-maleficence.
When the need to make a decision about treatment concerns an older person at the end of life, physicians need to reflect on the following questions: In this situation, for this person, what is the best course of action? Is this person capable of assessing the situation and making a decision about it adequately herself? What are the preferences of the person? Who needs to be involved in the decision-making process? What will be the consequences of starting or withholding this treatment?
The blog post is here.
The paper is here.
Sunday, May 31, 2015
Saturday, May 30, 2015
Vignette 32: The Ghost of Internet Past
Dr. Roger Sterling is a training director at a doctoral-level training program. The training program has rigorous admissions standards and has a prestigious reputation. Pete Campbell is a second year student who has excelled academically. As Pete is preparing for an off-campus pre-doctoral internship, Dr. Joan Holloway (faculty member) approaches Dr. Sterling about Pete. Apparently, there are a number of internet sites that feature Pete as a soft-core pornography actor. Dr. Holloway asks Dr. Sterling to prevent Pete from off-campus training experiences until the department can address the potential ethical and moral issues with Pete.
Dr. Sterling agrees to talk to Pete. Pete openly admits that he was a soft-core pornography actor. He is no longer in the industry. He cannot pull down pictures of his past work because the pictures and videos are outside of his control.
What are the potential ethical and clinical issues for Dr. Sterling in this scenario?
Are there any “values” or moral issues for Dr. Sterling in dealing with Pete?
If you were Dr. Sterling, how would you feel about Pete going to off-campus training sites?
What are the career implications for Pete Campbell?
What recommendations would you make, if any, to Pete Campbell?
Are there any risk management suggestions for Dr. Sterling related to the training program?
If you were consulting with Dr. Sterling, how do your own professional, personal, and moral values influence your approach to the consultation?
Would you change your strategy or recommendations if the student were a woman?
Would you change your strategy or recommendations if the student, Pete, were involved in gay porn?
Would you change your strategy or recommendations if the student were involved in hard-core pornography in which he dominated women?
Dr. Sterling agrees to talk to Pete. Pete openly admits that he was a soft-core pornography actor. He is no longer in the industry. He cannot pull down pictures of his past work because the pictures and videos are outside of his control.
What are the potential ethical and clinical issues for Dr. Sterling in this scenario?
Are there any “values” or moral issues for Dr. Sterling in dealing with Pete?
If you were Dr. Sterling, how would you feel about Pete going to off-campus training sites?
What are the career implications for Pete Campbell?
What recommendations would you make, if any, to Pete Campbell?
Are there any risk management suggestions for Dr. Sterling related to the training program?
If you were consulting with Dr. Sterling, how do your own professional, personal, and moral values influence your approach to the consultation?
Would you change your strategy or recommendations if the student were a woman?
Would you change your strategy or recommendations if the student, Pete, were involved in gay porn?
Would you change your strategy or recommendations if the student were involved in hard-core pornography in which he dominated women?
Friday, May 29, 2015
Vignette 31: The Near Death of a Salesman
Dr. Miller is a psychologist who consults with local nursing homes and hospitals when a patient’s capacity to make medical decisions is in question. Dr. Miller receives an urgent call from an attorney to evaluate Willie Loman at a local trauma unit. The attorney explains that Mr. Loman is looking for an objective opinion about his ability to make medical decisions.
Mr. Loman is a 52-year-old male with a wife and two kids (both in college). He works as a financially successful salesman. Over the previous weekend, Mr. Loman was involved in a serious boating accident. He did not experience any head trauma; however, his physical situation is dire. The trauma team needs his consent to perform a lifesaving surgery. If successful, Mr. Loman can live many years. However, there is a high probability that he will require full-time nursing care.
Mr. Loman has been active man who enjoyed many physical activities. Furthermore, he believes if he has the surgery and ends up confined to lifetime nursing care, he will exhaust all the funds he has saved for the benefit of his family. Mr. Loman believes he will be an emotional burden to his family and lose his dignity. Knowing that he will be physically compromised and a burden on his family, Mr. Loman is asking to die in peace. He does not want to live in an incapacitated state of existence.
Without the surgery, Mr. Loman can be kept alive for about two weeks. The family filed an emergency petition to obtain guardianship. The trauma team believes that the patient is not thinking clearly about his demise. They have already called in their psychiatrist-consultant.
Upon examination, Dr. Miller finds Mr. Loman’s mental status is within normal limits. He demonstrates appropriate memory capabilities and reasoning skills. He articulates his dilemma well and understands that he will die without surgery. There is no evidence of hallucinations, delusions, or psychotic processes.
In order to clarify his thinking, Dr. Miller calls you to review this case.
What are competing ethical principles?
How would you feel if you were Dr. Miller?
What are the possible consequences of concluding Mr. Loman is competent and capable of making this decision?
What are the possible consequences of concluding Mr. Loman is not competent and incapable of making this decision?
How do your own professional, personal, and moral values influence how you would participate as a consultant to Dr. Miller?
Does Mr. Loman's age factor into this decision? In other words, would you make a different decision if Mr. Loman were 72 as compared to 52?
What's Ethics Got to Do with It?
The misguided debate about mindfulness and morality
By Richard K. Payne
Tricycle Blog
Originally posted May 14, 2015
As mindfuness has made greater inroads into public life—from hospitals, to schools, to the workplace—its growing distance from Buddhist thought and practice has become a hotly contested issue. Is mindfulness somehow deficient because it lacks Buddhist ethics, and should Buddhist ethics be replicated in mindfulness programs and workshops?
Psychologist Lynette Monteiro, founder of the Ottawa Mindfulness Clinic, points out that the “seeming absence of the explicit teaching of ethics in the MBI [Mindfulness-based Intervention] curriculum” is the “thorniest” basis for criticism. Underlying the discussion of ethics in mindfulness, however, is the presumption that there exists an inherent relation between religion and morality. Yet this focus on morality—thought to define the practice as religious rather than secular, Buddhist rather than non-Buddhist—is based on Western presumptions about religion inherited from Christianity, not Buddhism.
Views on morality and mindfulness tend to fall into three categories: inherent, integral, and modular.
The entire blog post is here.
By Richard K. Payne
Tricycle Blog
Originally posted May 14, 2015
As mindfuness has made greater inroads into public life—from hospitals, to schools, to the workplace—its growing distance from Buddhist thought and practice has become a hotly contested issue. Is mindfulness somehow deficient because it lacks Buddhist ethics, and should Buddhist ethics be replicated in mindfulness programs and workshops?
Psychologist Lynette Monteiro, founder of the Ottawa Mindfulness Clinic, points out that the “seeming absence of the explicit teaching of ethics in the MBI [Mindfulness-based Intervention] curriculum” is the “thorniest” basis for criticism. Underlying the discussion of ethics in mindfulness, however, is the presumption that there exists an inherent relation between religion and morality. Yet this focus on morality—thought to define the practice as religious rather than secular, Buddhist rather than non-Buddhist—is based on Western presumptions about religion inherited from Christianity, not Buddhism.
Views on morality and mindfulness tend to fall into three categories: inherent, integral, and modular.
The entire blog post is here.
Thursday, May 28, 2015
Tarasoff's catch-22.
By Stephen R. Huey
The American Psychologist
2015 Apr;70(3):284-5. doi: 10.1037/a0039064
Abstract
Comments on the article by D. N. Bersoff (see record 2014-28692-002). Bersoff poses a much-needed challenge to the rationale of laws based on Tarasoff v. Regents of the University of California (1976), which exist in most states and require therapists to warn the intended victim, police, and/or others when a patient voices serious threats of violence. If Tarasoff-related laws were ever to be modified, research support would be required. To begin with, what is the experience of other countries that happen to address this issue differently and of the seven states that, according to Bersoff, have not adopted Tarasoff-related requirements? Another question is whether patients who are unwilling to invite the consequences of therapist disclosure ever reveal reportable intentions to their therapists anyway-say, by mistake or impulse-thus making current law marginally useful? Rules that undercut sacrosanct confidentiality create a catch-22 in which the indisputable ethical necessity of informed consent has an unintended consequence- namely, therapy is preceded by informed consent but precluded by it.
The entire article is here.
The American Psychologist
2015 Apr;70(3):284-5. doi: 10.1037/a0039064
Abstract
Comments on the article by D. N. Bersoff (see record 2014-28692-002). Bersoff poses a much-needed challenge to the rationale of laws based on Tarasoff v. Regents of the University of California (1976), which exist in most states and require therapists to warn the intended victim, police, and/or others when a patient voices serious threats of violence. If Tarasoff-related laws were ever to be modified, research support would be required. To begin with, what is the experience of other countries that happen to address this issue differently and of the seven states that, according to Bersoff, have not adopted Tarasoff-related requirements? Another question is whether patients who are unwilling to invite the consequences of therapist disclosure ever reveal reportable intentions to their therapists anyway-say, by mistake or impulse-thus making current law marginally useful? Rules that undercut sacrosanct confidentiality create a catch-22 in which the indisputable ethical necessity of informed consent has an unintended consequence- namely, therapy is preceded by informed consent but precluded by it.
The entire article is here.
Jean-Paul Sartre and Existential Choice
The existentialist Jean-Paul Sartre thought that human beings live in anguish. Not because life is terrible. But rather because, we’re ‘condemned to be free’. We're ‘thrown’ into existence, become aware of ourselves, and have to make choices. Even deciding not to choose is a choice. According to Sartre, every choice reveals what we think a human being should be.
Narrated by Stephen Fry. Scripted by Nigel Warburton.
Release date: 13 Apr 2015
Wednesday, May 27, 2015
Being true to your true self
By David Shoemaker
OUPblog
Originally published May 24, 2015
Here is an excerpt
Philosophers who work on the nature of responsibility very often insist that ignorance of the moral status of one’s action is sufficient to excuse — or at least mitigate — one from responsibility. If you didn’t know that what you were doing was wrong, after all, how could it be appropriate to hold you responsible for not refraining from doing it? This view is thought to hold symmetrically across negative and positive cases: not only does ignorance excuse (or mitigate) one from blame for bad actions, it also excuses (or mitigates) one from praise for good actions to the same extent.
This is not, however, how ordinary people view the matter. My colleague David Faraci and I have investigated the matter several times, and each time we get the same results. When asked about JoJo, people overwhelmingly think that his moral ignorance does mitigate his blameworthiness, albeit only a little bit (versus someone like him without that background). However, when people are asked about a case like Huck’s, they respond that his moral ignorance doesn’t mitigate his praiseworthiness at all; indeed, in some studies, we have found that people think his moral ignorance actually makes him more praiseworthy for what he did than a morally undeprived counterpart.
The entire blog post is here.
OUPblog
Originally published May 24, 2015
Here is an excerpt
Philosophers who work on the nature of responsibility very often insist that ignorance of the moral status of one’s action is sufficient to excuse — or at least mitigate — one from responsibility. If you didn’t know that what you were doing was wrong, after all, how could it be appropriate to hold you responsible for not refraining from doing it? This view is thought to hold symmetrically across negative and positive cases: not only does ignorance excuse (or mitigate) one from blame for bad actions, it also excuses (or mitigates) one from praise for good actions to the same extent.
This is not, however, how ordinary people view the matter. My colleague David Faraci and I have investigated the matter several times, and each time we get the same results. When asked about JoJo, people overwhelmingly think that his moral ignorance does mitigate his blameworthiness, albeit only a little bit (versus someone like him without that background). However, when people are asked about a case like Huck’s, they respond that his moral ignorance doesn’t mitigate his praiseworthiness at all; indeed, in some studies, we have found that people think his moral ignorance actually makes him more praiseworthy for what he did than a morally undeprived counterpart.
The entire blog post is here.
Physicians and Euthanasia: What about Psychiatric Illness, Dementia and Weltschmerz?
By Eva Bolt
BMJ Blogs
Originally posted on February 18, 2015
Here is an excerpt:
Concluding, while most Dutch physicians can conceive of granting requests for euthanasia from patients suffering from cancer or other severe physical diseases, this is not the case in patients suffering from psychiatric disease, dementia or being tired of living. This distinction is partly related to the criteria for due care. For instance, some physicians describe that it is impossible to determine the presence of unbearable suffering in a patient with advanced dementia. Other explanations for the distinction are not related to the criteria for due care. For instance, it is understandable that physicians do not agree with performing euthanasia in a patient with advanced dementia who does not fully understand what is happening, even if the patient has a clear advanced euthanasia directive.
The entire article is here.
The article in the Journal of Medical Ethics is here.
BMJ Blogs
Originally posted on February 18, 2015
Here is an excerpt:
Concluding, while most Dutch physicians can conceive of granting requests for euthanasia from patients suffering from cancer or other severe physical diseases, this is not the case in patients suffering from psychiatric disease, dementia or being tired of living. This distinction is partly related to the criteria for due care. For instance, some physicians describe that it is impossible to determine the presence of unbearable suffering in a patient with advanced dementia. Other explanations for the distinction are not related to the criteria for due care. For instance, it is understandable that physicians do not agree with performing euthanasia in a patient with advanced dementia who does not fully understand what is happening, even if the patient has a clear advanced euthanasia directive.
The entire article is here.
The article in the Journal of Medical Ethics is here.
Tuesday, May 26, 2015
University of Oregon Employees Under Investigation for Misconduct in Rape Case
By Richard Read
The Oregonian
Originally posted May 8, 2015
Six University of Oregon employees, including a vice president and the school's interim top lawyer, are under investigation for alleged misconduct in the handling of therapy records of a student who says she was gang-raped by three Ducks basketball players.
The Oregon State Bar is investigating complaints against interim general counsel Douglas Park and associate general counsel Samantha Hill. The Oregon Board of Psychologist Examiners is investigating complaints against four people, including Robin Holmes, the university's vice president for student life, who is a licensed psychologist.
Jennifer Morlok, a senior staff therapist identified in legal correspondence as the clinician who counseled the woman, filed all the complaints.
The entire article is here.
The Oregonian
Originally posted May 8, 2015
Six University of Oregon employees, including a vice president and the school's interim top lawyer, are under investigation for alleged misconduct in the handling of therapy records of a student who says she was gang-raped by three Ducks basketball players.
The Oregon State Bar is investigating complaints against interim general counsel Douglas Park and associate general counsel Samantha Hill. The Oregon Board of Psychologist Examiners is investigating complaints against four people, including Robin Holmes, the university's vice president for student life, who is a licensed psychologist.
Jennifer Morlok, a senior staff therapist identified in legal correspondence as the clinician who counseled the woman, filed all the complaints.
The entire article is here.
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