Genitals photographed, shared by UPMC hospital employees: a common violation in health care industry

David Wenner
The Patriot News/PennLive.com
Updated September 16, 2017

You might assume anyone in healthcare would know better. Smart phones aren't new. Health care providers have long wrestled with the patient privacy- and medical ethics-related ramifications. Yet once again, smart phones have contributed to a very public black eye for a health care provider.

UPMC Bedford in Everett, Pa. has been cited by the Pennsylvania Department of Health after employees snapped and shared photos and video of an unconscious patient who needed surgery to remove an object from a genital. Numerous employees, including two doctors, were disciplined for being present.

It's not the first time unauthorized photos were taken of a hospital patient and shared or posted on social media.

• Last year, a nurse in New York lost her license after taking a smart phone photo of an unconscious patient's penis and sending it to some of her co-workers. She also pleaded guilty to misdemeanor criminal charges.
• The Los Angeles Times in 2013 wrote about an anesthesiologist in California who put a sticker of a mustache on the face of an unconscious female patient, with a nurse's aid then taking a picture. That article also reported allegations of a medical device salesman taking photos of a naked woman without her knowledge.
• In 2010, employees at a hospital in Florida were disciplined after taking and posting online photos of a shark attack victim who didn't survive. No one was fired, with the hospital concluding the incident was the "result of poor judgement rather than malicious intent," according to an article in Radiology Today. 
• Many such incidents have involved nursing homes. An article published by the American Association of Nurse Assessment Coordination in 2016 stated, "In the shadow of the social media revolution, a disturbing trend has begun to emerge of [nursing home] employees posting and sharing degrading images of their residents on social media." An investigation published by ProPublica in 2015 detailed 47 cases since 2012 of workers at nursing homes and assisted living facilities sharing photos or videos of residents on Facebook. 

The article is here.

The behavioural ecology of irrational behaviours

Philippe Huneman Johannes Martens
History and Philosophy of the Life Sciences
September 2017, 39:23

Abstract

Natural selection is often envisaged as the ultimate cause of the apparent rationality exhibited by organisms in their specific habitat. Given the equivalence between selection and rationality as maximizing processes, one would indeed expect organisms to implement rational decision-makers. Yet, many violations of the clauses of rationality have been witnessed in various species such as starlings, hummingbirds, amoebas and honeybees. This paper attempts to interpret such discrepancies between economic rationality (defined by the main axioms of rational choice theory) and biological rationality (defined by natural selection). After having distinguished two kinds of rationality we introduce irrationality as a negation of economic rationality by biologically rational decision-makers. Focusing mainly on those instances of irrationalities that can be understood as exhibiting inconsistency in making choices, i.e. as non-conformity of a given behaviour to axioms such as transitivity or independence of irrelevant alternatives, we propose two possible families of Darwinian explanations that may account for these apparent irrationalities. First, we consider cases where natural selection may have been an indirect cause of irrationality. Second, we consider putative cases where violations of rationality axioms may have been directly favored by natural selection. Though the latter cases (prima facie) seem to clearly contradict our intuitive representation of natural selection as a process that maximizes fitness, we argue that they are actually unproblematic; for often, they can be redescribed as cases where no rationality axiom is violated, or as situations where no adaptive solution exists in the first place.

The article is here.

How to Distinguish Between Antifa, White Supremacists, and Black Lives Matter

Conor Friedersdorf
The Atlantic
Originally published August 31, 2017

Here are two excerpts:

One can condemn the means of extralegal violence, and observe that the alt-right, Antifa, and the far-left have all engaged in it on different occasions, without asserting that all extralegal violence is equivalent––murdering someone with a car or shooting a representative is more objectionable than punching with the intent to mildly injure. What’s more, different groups can choose equally objectionable means without becoming equivalent, because assessing any group requires analyzing their ends, not just their means.

For neo-Nazis and Klansmen in Charlottesville, one means, a torch-lit parade meant to intimidate by evoking bygone days of racial terrorism, was deeply objectionable; more importantly, their end, spreading white-supremacist ideology in service of a future where racists can lord power over Jews and people of color, is abhorrent.

Antifa is more complicated.

Some of its members employ the objectionable means of initiating extralegal street violence; but its stated end of resisting fascism is laudable, while its actual end is contested. Is it really just about resisting fascists or does it have a greater, less defensible agenda? Many debates about Antifa that play out on social media would prove less divisive if the parties understood themselves to be agreeing that opposing fascism is laudable while disagreeing about Antifa’s means, or whether its end is really that limited.

(cut)

A dearth of distinctions has a lot of complicated consequences, but in aggregate, it helps to empower the worst elements in a society, because those elements are unable to attract broad support except by muddying distinctions between themselves and others whose means or ends are defensible to a broader swath of the public. So come to whatever conclusions accord with your reason and conscience. But when expressing them, consider drawing as many distinctions as possible.

The article is here.

Robots and morality

The Big Read (which is actually in podcast form)
The Financial Times
Originally posted August 2017

Now our mechanical creations can act independently, what happens when AI goes wrong? Where does moral, ethical and legal responsibility for robots lie — with the manufacturers, the programmers, the users or the robots themselves, asks John Thornhill. And who owns their rights?

Click on the link below to access the 13 minutes podcast.

Podcast is here.

Trump ethics watchdog moves to allow anonymous gifts to legal defense funds

Darren Samuelsohn
Politico
Originally published September 13, 2017

The U.S. Office of Government Ethics has quietly reversed its own internal policy prohibiting anonymous donations from lobbyists to White House staffers who have legal defense funds.

The little-noticed change could help President Donald Trump’s aides raise the money they need to pay attorneys as the Russia probe expands — but raises the potential for hidden conflicts of interest or other ethics trouble.

“You can picture a whole army of people with business before the government willing to step in here and make [the debt] go away,” said Marilyn Glynn, a former George W. Bush-era acting OGE director who worked in the office for 17 years.

Lawyer fees have long been the source of controversy for presidents under fire. Richard Nixon’s White House took covert steps to pay the Watergate burglars, and a trust set up during Bill Clinton’s first term to deal with Whitewater and other controversies had to return hundreds of thousands of dollars in donations from a controversial Arkansas friend who was later indicted for campaign finance abuses.

At issue for the Trump staffers is a 1993 OGE guidance document that gave a green light to organizers of legal defense funds for government employees to solicit anonymous donations from otherwise prohibited sources — like lobbyists or others with business before the government. That Clinton-era opinion reasoned that if such donors were anonymous, such donations could be legal because the employee “does not know who the paymasters are.”

The article is here.

Over half of doctors have symptoms of burn-out: survey

Lynn Desjardins
Radio Canada International
Originally published August 28, 2017

A recent survey suggests that 54 per cent of Canadian doctors have symptoms of burn-out and it’s a problem that physicians themselves don’t like to talk about. This was a topic much discussed at the annual meeting of the Canadian Medical Association which represents more than 80,000 doctors.

‘Very frustrating and annoying’ interventions required

“First and foremost, it’s about the inability that physicians have sometimes to get what the patient actually needs in a timely way,” says Dr. Granger Avery, immediate past president of the Canadian Medical Association.

“So, that’s whether looking for a consultation, following up on an operation, whether it’s transferring a patient from one level of service to another, these things often require the doctor to make repeated phone calls, repeated interventions to get what should be a relatively simple piece of work done. So, that’s very frustrating and annoying for a physician who’s been brought up and trained and focused on helping people, not doing that administrative work.”

The article and the podcast are here.

Bioethics and multiculturalism: nuancing the discussion

Chris Durante
Journal of Medical Ethics 
Published Online First: 11 August 2017

Abstract

In his recent analysis of multiculturalism, Tom Beauchamp has argued that those who implement multicultural reasoning in their arguments against common morality theories, such as his own, have failed to understand that multiculturalism is neither a form of moral pluralism nor ethical relativism but is rather a universalistic moral theory in its own right. Beauchamp’s position is indeed on the right track in that multiculturalists do not consider themselves ethical relativists. Yet, Beauchamp tends to miss the mark when he argues that multiculturalism is in effect a school of thought that endorses a form of moral universalism that is akin to his own vision of a common morality. As a supporter of multiculturalism, I would like to discuss some aspects of Beauchamp’s comments on multiculturalism and clarify what a multicultural account of public bioethics might look like. Ultimately, multiculturalism is purported as a means of managing diversity in the public arena and should not be thought of as endorsing either a version of moral relativism or a universal morality. By simultaneously refraining from the promotion of a comprehensive common moral system while it attempts to avoid a collapse into relativism, multiculturalism can serve as the ethico-political framework in which diverse moralities can be managed and in which opportunities for ethical dialogue, debate and deliberation on the prospects of common bioethical norms are made possible.

The article is here.

Economics: Society Cannot Function Without Moral Bonds

Geoffrey Hodgson
Evonomics
Originally posted June 29, 2016

Here is an excerpt:

When mainstream economists began to question that individuals are entirely self-interested, their approach was to retain utility-maximization and preference functions, but to make them “other-regarding” so that some notion of altruism could be maintained. But such an individual is still self-serving, rather than being genuinely altruistic in a wider and more adequate sense. While “other regarding” he or she is still egotistically maximizing his or her own utility. As Deirdre McCloskey  put it, the economic agent is still Max U.

There is now an enormous body of empirical research confirming that humans have cooperative as well as self-interested dispositions. But many accounts conflate morality with altruism or cooperation. By contrast, Darwin established a distinctive and vital additional role for morality. Darwin’s argument counters the idea of unalloyed self-interest and the notion that morality can be reduced to a matter of utility or preference.

A widespread view among moral philosophers is that moral judgments cannot be treated as matters of mere preference or utility maximization. Morality means “doing the right thing.” It entails notions of justice that can over-ride our preferences or interests. Moral judgments are by their nature inescapable. They are buttressed by emotional feelings and reasoned argument. Morality differs fundamentally from matters of mere convenience, convention or conformism. Moral feelings are enhanced by learned cultural norms and rules. Morality is a group phenomenon involving deliberative, emotionally-driven and purportedly inescapable rules that apply to a community.

The article is here.

Peter Thiel sponsors offshore testing of herpes vaccine, sidestepping U.S. safety rules

Marisa Taylor
Kaiser News
Originally posted August 28, 2017

Here is an excerpt:

“What they’re doing is patently unethical,” said Jonathan Zenilman, chief of Johns Hopkins Bayview Medical Center’s Infectious Diseases Division. “There’s a reason why researchers rely on these protections. People can die.”

The risks are real. Experimental trials with live viruses could lead to infection if not handled properly or produce side effects in those already infected. Genital herpes is caused by two viruses that can trigger outbreaks of painful sores. Many patients have no symptoms, though a small number suffer greatly. The virus is primarily spread through sexual contact, but also can be released through skin.

The push behind the vaccine is as much political as medical. President Trump has vowed to speed up the FDA’s approval of some medicines. FDA Commissioner Scott Gottlieb, who had deep financial ties to the pharmaceutical industry, slammed the FDA before his confirmation for over-prioritizing consumer protection to the detriment of medical innovations.

“This is a test case,” said Bartley Madden, a retired Credit Suisse banker and policy adviser to the conservative Heartland Institute, who is another investor in the vaccine. “The FDA is standing in the way, and Americans are going to hear about this and demand action.”

American researchers are increasingly going offshore to developing countries to conduct clinical trials, citing rising domestic costs. But in order to approve the drug for the U.S. market, the FDA requires that clinical trials involving human participants be reviewed and approved by an IRB or an international equivalent. The IRB can reject research based on safety concerns.

The article is here.