Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy

Tuesday, April 9, 2019

U.S. Ethics Office Declines to Certify Mnuchin’s Financial Disclosure

Alan Rappeport
The New York Times
Originally published April 4, 2019

The top federal ethics watchdog said on Thursday that Treasury Secretary Steven Mnuchin’s sale of his stake in a film production business to his wife did not comply with federal ethics rules, and it would not certify his 2018 financial disclosure report as a result.

Although Mr. Mnuchin will not face penalties for failing to comply, he has been required to rewrite his federal ethics agreement and to promise to recuse himself from government matters that could affect his wife’s business.

Mr. Mnuchin in 2017 sold his stake in StormChaser Partners to his then-fiancée, Louise Linton, as part of a series of divestments before becoming Treasury secretary. Since they are now married, government ethics rules consider the asset to be owned by Mr. Mnuchin, potentially creating a conflict of interest for an official who has been negotiating for expanded access for the movie industry as part of trade talks with China.

The controversy over Mr. Mnuchin’s finances has become an unwanted distraction in recent weeks as the Trump administration has been engaged in intense negotiations with China on a wide range of trade matters. While Robert Lighthizer, President Trump’s top trade official, has been leading the talks, Mr. Mnuchin has been the point person for promoting the film industry because of his background as a Hollywood producer and investor.

The info is here.

N.J. approves bill giving terminally ill people the right to end their lives

Susan Livio
www.nj.com
Originally posted March 25, 2019

New Jersey is poised to become the eighth state to allow doctors to write a lethal prescription for terminally ill patients who want to end their lives.

The state Assembly voted 41-33 with four abstentions Monday to pass the “Medical Aid in Dying for the Terminally Ill Act." Minutes later, the state Senate approved the bill 21-16.

Gov. Phil Murphy later issued a statement saying he would sign the measure into law.

“Allowing terminally ill and dying residents the dignity to make end-of-life decisions according to their own consciences is the right thing to do," the Democratic governor said. "I look forward to signing this legislation into law.”

The measure (A1504) would take effect four months after it is signed.

Susan Boyce, 55 of Rumson, smiled and wept after the final vote.

“I’ve been working on this quite a while," said Boyce, who is diagnosed with a terminal auto immune disease, Alpha-1 antitrypsin deficiency, and needs an oxygen tank to breathe.

The info is here.

Monday, April 8, 2019

Mark Zuckerberg And The Tech World Still Do Not Understand Ethics

Derek Lidow
Forbes.com
Originally posted March 11, 2018

Here is an excerpt:

Expectations for technology startups encourage expedient, not ethical, decision making. 

As people in the industry are fond of saying, the tech world moves at “lightspeed.” That includes the pace of innovation, the rise and fall of markets, the speed of customer adoption, the evolution of business models and the lifecycles of companies. Decisions must be made quickly and leaders too often choose the most expedient path regardless of whether it is safe, legal or ethical.

 This “move fast and break things” ethos is embodied in practices like working toward a minimum viable product (MVP), helping to establish a bias toward cutting corners. In addition, many founders look for CFOs who are “tech trained—that is, people accustomed to a world where time and money wait for no one—as opposed to a seasoned financial officer with good accounting chops and a moral compass.

The host of scandals at Zenefits, a cloud-based provider of employee-benefits software to small businesses and once one of the most promising of Silicon Valley startups, had their origins in the shortcuts the company took in order to meet unreasonably high expectations for growth. The founder apparently created software that helped employees cheat on California’s online broker license course. As the company expanded rapidly, it began hiring people with little experience in the highly regulated health insurance industry. As the company moved from small businesses to larger businesses, the strain on it software increased. Instead of developing appropriate software, the company hired more people to manually take up the slack where the existing software failed. When the founder was asked by an interviewer before the scandals why he was so intent on expanding so rapidly he replied, “Slowing down doesn’t feel like something I want to do.”

The info is here.

Officials gather for ethics training

Jon Wysochanski
Star Beacon
Originally posted March 23, 2019

Here is an excerpt:

A large range of actions can constitute unethical behavior, from a health inspector inspecting his mom and dad’s restaurant to a public official accepting a ticket to an Ohio State Buckeyes’ game because he doesn’t consider it monetary, Willeke said. Unethical behavior doesn’t have to be as egregious as the real world example of a state employee inspecting a string of daycare centers she and her husband owned.

It’s not possible to find someone void of personal bias, Willeke said, and it is common for potential conflicts of interest to present themselves. It’s how public officials react to those biases or potential conflicts that matters most. The best thing for a public official facing a conflict to do is to walk away from the situation.

“Having a conflict of interest has never been illegal,” Willeke said. “It is when people act on those conflicts of interest that we actually see a crime under Ohio Ethics Law.”

When it comes to accepting gifts, Ohio law does not stipulate a dollar amount, only whether the gift is substantial or improper. A vendor-purchased dinner at Bob Evans might not violate the law, while dinner at a high-end restaurant complete with the best wine and most expensive menu items would.

And when it comes to unlawful interests in public contracts, a contract means any time a government entity spends money. That could mean the trustee who takes home a township backhoe on weekends to do work on the side, the library director who uses the copier to print hundreds of flyers for their business, the state employee who uses a state computer to run a real estate business or the fireman who uses a ladder truck on a home painting job.

The info is here.

Editor's note: We need more of this type of training for government officials.

Sunday, April 7, 2019

In Spain, prisoners’ brains are being electrically stimulated in the name of science

Sigal Samuel
vox.com
Originally posted March 9, 2019

A team of scientists in Spain is getting ready to experiment on prisoners. If the scientists get the necessary approvals, they plan to start a study this month that involves placing electrodes on inmates’ foreheads and sending a current into their brains. The electricity will target the prefrontal cortex, a brain region that plays a role in decision-making and social behavior. The idea is that stimulating more activity in that region may make the prisoners less aggressive.

This technique — transcranial direct current stimulation, or tDCS — is a form of neurointervention, meaning it acts directly on the brain. Using neurointerventions in the criminal justice system is highly controversial. In recent years, scientists and philosophers have been debating under what conditions (if any) it might be ethical.

The Spanish team is the first to use tDCS on prisoners. They’ve already done it in a pilot study, publishing their findings in Neuroscience in January, and they were all set to implement a follow-up study involving at least 12 convicted murderers and other inmates this month. On Wednesday, New Scientist broke news of the upcoming experiment, noting that it had approval from the Spanish government, prison officials, and a university ethics committee. The next day, the Interior Ministry changed course and put the study on hold.

Andrés Molero-Chamizo, a psychologist at the University of Huelva and the lead researcher behind the study, told me he’s trying to find out what led to the government’s unexpected decision. He said it makes sense to run such an experiment on inmates because “prisoners have a high level of aggressiveness.”

The info is here.

Saturday, April 6, 2019

Wit et al. vs. United Behavioral Health and Alexander et al. vs. United Behavioral Health

U.S. Federal Court Finds United Healthcare Affiliate Illegally Denied Mental Health and Substance Use Coverage in Nationwide Class Action

  • Landmark Case Challenges the Nation’s Largest Mental Health Insurance Company for Unlawful, Systematic Claims Denials – and Wins
  • Groundbreaking Ruling Affects Certified Classes of Tens of Thousands of Patients, Including Thousands of Children and Teenagers 
  • Judge Rules, “At every level of care that is at issue in this case, there is an excessive emphasis on addressing acute symptoms and stabilizing crises while ignoring the effective treatment of members’ underlying conditions.”

In a landmark mental health ruling, a federal court held today that health insurance giant United Behavioral Health (UBH), which serves over 60 million members and is owned by UnitedHealth Group, used flawed internal guidelines to unlawfully deny mental health and substance use treatment for its insureds across the United States. The historic class action was filed by Psych-Appeal, Inc. and Zuckerman Spaeder LLP, and litigated in the U.S. District Court for the Northern District of California.

The federal court found that, to promote its own bottom line, UBH denied claims based on internally developed medical necessity criteria that were far more restrictive than generally accepted standards for behavioral health care. Specifically, the court found that UBH’s criteria were skewed to cover “acute” treatment, which is short-term or crisis-focused, and disregarded chronic or complex mental health conditions that often require ongoing care.

The court was particularly troubled by UBH’s lack of coverage criteria for children and adolescents, estimated to number in the thousands in the certified classes.

“For far too long, patients and their families have been stretched to the breaking point, both financially and emotionally, as they battle with insurers for the mental health coverage promised by their health plans,” said Meiram Bendat of Psych-Appeal, Inc. and co-counsel for the plaintiffs who uncovered the guideline flaws. “Now a court has ruled that denying coverage based on defective medical necessity criteria is illegal.”

In its decision, the court also held that UBH misled regulators about its guidelines being consistent with the American Society of Addiction Medicine (ASAM) criteria, which insurers must use in Connecticut, Illinois and Rhode Island. Additionally, the court found that UBH failed to apply Texas-mandated substance use criteria for at least a portion of the class period.

The legal opinion is here.

Friday, April 5, 2019

A Prominent Economist’s Death Prompts Talk of Mental Health in the Professoriate

Emma Pettit
The Chronicle of Higher Education
Originally posted March 19, 2019

Reaching Out

For Bruce Macintosh, Krueger’s death was a reminder of how isolating academe can be. Macintosh is a professor of physics at Stanford University who was employed at a national laboratory, not a university, until about five years ago. That culture was totally different, he said. At other workplaces, Macintosh said, you interact regularly with peers and supervisors, who are paying close attention to you and your work.

“There’s nothing like that in an academic environment,” he said. “You can shut down completely for a year, and no one will notice,” as long as the grades get turned in.

It seems, Macintosh said, as if there should be multiple layers of support within a university department to help faculty members who experience depression or other forms of mental illness. But certain barriers still exist between professors and the resources they need.

A 2017 survey of 267 faculty members with mental-health histories or mental illnesses found that most respondents had little to no familiarity with accommodations at their institution. Even fewer reported using them.

The info is here.

Note: Career success, wealth, and prestige are not protective factors for suicide attempts or completions.  Interpersonal connections to family and friends, access to quality mental health care, problem-solving skills, meaning in life, and purposefulness are.

Ordinary people associate addiction with loss of free will

A. J. Vonasch, C. J. Clark, S. Laub, K. D. Vohs, & R. F. Baumeister
Addictive Behaviors Reports
Volume 5, June 2017, Pages 56-66

Introduction
It is widely believed that addiction entails a loss of free will, even though this point is controversial among scholars. There is arguably a downside to this belief, in that addicts who believe they lack the free will to quit an addiction might therefore fail to quit an addiction.

Methods
A correlational study tested the relationship between belief in free will and addiction. Follow-up studies tested steps of a potential mechanism: 1) people think drugs undermine free will 2) people believe addiction undermines free will more when doing so serves the self 3) disbelief in free will leads people to perceive various temptations as more addictive.

Results
People with lower belief in free will were more likely to have a history of addiction to alcohol and other drugs, and also less likely to have successfully quit alcohol. People believe that drugs undermine free will, and they use this belief to self-servingly attribute less free will to their bad actions than to good ones. Low belief in free will also increases perceptions that things are addictive.

Conclusions
Addiction is widely seen as loss of free will. The belief can be used in self-serving ways that may undermine people's efforts to quit.

The research is here.

Thursday, April 4, 2019

Confucian Ethics as Role-Based Ethics

A. T. Nuyen
International Philosophical Quarterly
Volume 47, Issue 3, September 2007, 315-328.

Abstract

For many commentators, Confucian ethics is a kind of virtue ethics. However, there is enough textual evidence to suggest that it can be interpreted as an ethics based on rules, consequentialist as well as deontological. Against these views, I argue that Confucian ethics is based on the roles that make an agent the person he or she is. Further, I argue that in Confucianism the question of what it is that a person ought to do cannot be separated from the question of what it is to be a person, and that the latter is answered in terms of the roles that arise from the network of social relationships in which a person stands. This does not mean that Confucian ethics is unlike anything found in Western philosophy. Indeed, I show that many Western thinkers have advanced a view of ethics similar to the Confucian ethics as I interpret it.

The info is here.