Want To Reduce Suicides? Follow The Data — To Medical Offices, Motels And Even Animal Shelters

Maureen O’Hagan
Kaiser Health News
Originally published September 23, 2019

Here is an excerpt:

Experts have long believed that suicide is preventable, and there are evidence-based programs to train people how to identify and respond to folks in crisis and direct them to help. That’s where Debra Darmata, Washington County’s suicide prevention coordinator, comes in. Part of Darmata’s job involves running these training programs, which she described as like CPR but for mental health.

The training is typically offered to people like counselors, educators or pastors. But with the new data, the county realized they were missing people who may have been the last to see the decedents alive. They began offering the training to motel clerks and housekeepers, animal shelter workers, pain clinic staffers and more.

It is a relatively straightforward process: Participants are taught to recognize signs of distress. Then they learn how to ask a person if he or she is in crisis. If so, the participants’ role is not to make the person feel better or to provide counseling or anything of the sort. It is to call a crisis line, and the experts will take over from there.

Since 2014, Darmata said, more than 4,000 county residents have received training in suicide prevention.

“I’ve worked in suicide prevention for 11 years,” Darmata said, “and I’ve never seen anything like it.”

The sheriff’s office has begun sending a deputy from its mental health crisis team when doing evictions. On the eviction paperwork, they added the crisis line number and information on a county walk-in mental health clinic. Local health care organizations have new procedures to review cases involving patient suicides, too.

The info is here.

Why not common morality?

Rhodes R 

Journal of Medical Ethics 

Published Online First: 11 September 2019. 

doi: 10.1136/medethics-2019-105621

Abstract

This paper challenges the leading common morality accounts of medical ethics which hold that medical ethics is nothing but the ethics of everyday life applied to today’s high-tech medicine. Using illustrative examples, the paper shows that neither the Beauchamp and Childress four-principle account of medical ethics nor the Gert et al 10-rule version is an adequate and appropriate guide for physicians’ actions. By demonstrating that medical ethics is distinctly different from the ethics of everyday life and cannot be derived from it, the paper argues that medical professionals need a touchstone other than common morality for guiding their professional decisions. That conclusion implies that a new theory of medical ethics is needed to replace common morality as the standard for understanding how medical professionals should behave and what medical professionalism entails. En route to making this argument, the paper addresses fundamental issues that require clarification: what is a profession? how is a profession different from a role? how is medical ethics related to medical professionalism? The paper concludes with a preliminary sketch for a theory of medical ethics.

The info is here.

Principles of karmic accounting: How our intuitive moral sense balances rights and wrongs

Samuel Johnson and Jaye Ahn
PsyArXiv
Originally posted September 10, 2019

Abstract

We are all saints and sinners: Some of our actions benefit other people, while other actions harm people. How do people balance moral rights against moral wrongs when evaluating others’ actions? Across 9 studies, we contrast the predictions of three conceptions of intuitive morality—outcome- based (utilitarian), act-based (deontologist), and person-based (virtue ethics) approaches. Although good acts can partly offset bad acts—consistent with utilitarianism—they do so incompletely and in a manner relatively insensitive to magnitude, but sensitive to temporal order and the match between who is helped and harmed. Inferences about personal moral character best predicted blame judgments, explaining variance across items and across participants. However, there was modest evidence for both deontological and utilitarian processes too. These findings contribute to conversations about moral psychology and person perception, and may have policy implications.

General Discussion

These  studies  begin  to  map  out  the  principles  governing  how  the  mind  combines  rights  and wrongs to form summary judgments of blameworthiness. Moreover, these principles are explained by inferences  about  character,  which  also  explain  differences  across  scenarios  and  participants.  These results overall buttress person-based accounts of morality (Uhlmann et al., 2014), according to which morality  serves  primarily  to  identify  and  track  individuals  likely  to  be  cooperative  and  trustworthy social partners in the future.

These results also have implications for moral psychology beyond third-party judgments. Moral behavior is motivated largely by its expected reputational consequences, thus studying the psychology of  third-party  reputational  judgments  is  key  for  understanding  people’s  behavior  when  they  have opportunities  to  perform  licensing  or  offsetting acts.  For  example,  theories  of  moral  self-licensing (Merritt et al., 2010) disagree over whether licensing occurs due to moral credits (i.e., having done good, one can now “spend” the moral credit on a harm) versus moral credentials (i.e., having done good, later bad  acts  are  reframed  as  less  blameworthy). 

The research is here.

Why we don’t always punish: Preferences for non-punitive responses to moral violations

Joseph Heffner & Oriel FeldmanHall

Scientific Reports, volume 9, 

Article number: 13219 (2019) 

Abstract

While decades of research demonstrate that people punish unfair treatment, recent work illustrates that alternative, non-punitive responses may also be preferred. Across five studies (N = 1,010) we examine non-punitive methods for restoring justice. We find that in the wake of a fairness violation, compensation is preferred to punishment, and once maximal compensation is available, punishment is no longer the favored response. Furthermore, compensating the victim—as a method for restoring justice—also generalizes to judgments of more severe crimes: participants allocate more compensation to the victim as perceived severity of the crime increases. Why might someone refrain from punishing a perpetrator? We investigate one possible explanation, finding that punishment acts as a conduit for different moral signals depending on the social context in which it arises. When choosing partners for social exchange, there are stronger preferences for those who previously punished as third-party observers but not those who punished as victims. This is in part because third-parties are perceived as relatively more moral when they punish, while victims are not. Together, these findings demonstrate that non-punitive alternatives can act as effective avenues for restoring justice, while also highlighting that moral reputation hinges on whether punishment is enacted by victims or third-parties.

The research is here.

Readers may want to think about patients in psychotherapy and licensing board actions.

A Successful Artificial Memory Has Been Created

Robert Martone
Scientific American
Originally posted August27, 2019

Here is the conclusion:

There are legitimate motives underlying these efforts. Memory has been called “the scribe of the soul,” and it is the source of one’s personal history. Some people may seek to recover lost or partially lost memories. Others, such as those afflicted with post-traumatic stress disorder or chronic pain, might seek relief from traumatic memories by trying to erase them.

The methods used here to create artificial memories will not be employed in humans anytime soon: none of us are transgenic like the animals used in the experiment, nor are we likely to accept multiple implanted fiber-optic cables and viral injections. Nevertheless, as technologies and strategies evolve, the possibility of manipulating human memories becomes all the more real. And the involvement of military agencies such as DARPA invariably renders the motivations behind these efforts suspect. Are there things we all need to be afraid of or that we must or must not do? The dystopian possibilities are obvious.

Creating artificial memories brings us closer to learning how memories form and could ultimately help us understand and treat dreadful diseases such as Alzheimer’s. Memories, however, cut to the core of our humanity, and we need to be vigilant that any manipulations are approached ethically.

The info is here.

Lolita understood that some sex is transactional. So did I

Tamara MacLeod
aeon.co
Originally published September 11, 2019

Here is an excerpt:

However, I think that it is the middle-class consciousness of liberal feminism that excluded sex work from its platform. After all, wealthier women didn’t need to do sex work as such; they operated within the state-sanctioned transactional boundaries of marriage. The dissatisfaction of the 20th-century housewife was codified as a struggle for liberty and independence as an addition to subsidised material existence, making a feminist discourse on work less about what one has to do, and more about what one wants to do. A distinction within women’s work emerged: if you don’t enjoy having sex with your husband, it’s just a problem with the marriage. If you don’t enjoy sex with a client, it’s because you can’t consent to your own exploitation. It is a binary view of sex and consent, work and not-work, when the reality is somewhat murkier. It is a stubborn blindness to the complexity of human relations, and maybe of human psychology itself, descending from the viscera-obsessed, radical absolutisms of Andrea Dworkin.

The housewife who married for money and then fakes orgasms, the single mother who has sex with a man she doesn’t really like because he’s offering her some respite: where are the delineations between consent and exploitation, sex and duty? The first time I traded sex for material gain, I had some choices, but they were limited. I chose to be exploited by the man with the resources I needed, choosing his house over homelessness. Lolita was a child, and she was exploited, but she was also conscious of the function of her body in a patriarchal economy. Philosophically speaking, most of us do indeed consent to our own exploitation.

The info is here.

Dying is a Moral Event. NJ Law Caught Up With Morality

T. Patrick Hill
Star-Ledge Guest Column
Originally posted September 9, 2019

New Jersey’s Medical-Aid-in-Dying legislation authorizes physicians to issue a prescription to end the lives of their patients who have been diagnosed with a terminal illness, are expected to die within six months, and have requested their physicians to help them do so. While the legislation does not require physicians to issue the prescription, it does require them to transfer a patient’s medical records to another physician who has agreed to prescribe the lethal medication.

(cut)

The Medical Aid in Dying Act goes even further, concluding that its passage serves the public’s interests, even as it endorses the “right of a qualified terminally ill patient …to obtain medication that the patient may choose to self-administer in order to bring about the patient’s humane and dignified death.”

The info is here.

Is there a right to die?

Eric Mathison
Baylor Medical College of Medicine Blog
Originally posted May 31, 2019

How people think about death is undergoing a major transformation in the United States. In the past decade, there has been a significant rise in assisted dying legalization, and more states are likely to legalize it soon.

People are adapting to a healthcare system that is adept at keeping people alive, but struggles when aggressive treatment is no longer best for the patient. Many people have concluded, after witnessing a loved one suffer through a prolonged dying process, that they don’t want that kind of death for themselves.

Public support for assisted dying is high. Gallup has tracked Americans’ support for it since 1951. The most recent survey, from 2017, found that 73% of Americans support legalization. Eighty-one percent of Democrats and 67% of Republicans support it, making this a popular policy regardless of political affiliation.

The effect has been a recent surge of states passing assisted dying legislation. New Jersey passed legislation in April, meaning seven states (plus the District of Columbia) now allow it. In addition to New Jersey, California, Colorado, Hawaii, and D.C. all passed legislation in the past three years, and seventeen states are considering legislation this year. Currently, around 20% of Americans live in states where assisted dying is legal.

The info is here.

Moral Distress and Moral Strength Among Clinicians in Health Care Systems: A Call for Research

Connie M. Ulrich and Christine Grady
NAM Perspectives. 
https://doi.org/10.31478/201909c


Here is an excerpt:

Evidence shows that dissatisfaction and wanting to leave one’s job—and the profession altogether—often follow morally distressing encounters. Ethics education that builds cognitive and communication skills, teaches clinicians ethical concepts, and helps them gain communication skills and confidence may be essential in building moral strength. One study found, for example, that among practicing nurses and social workers, those with the least ethics education were also the least confident, the least likely to use ethics resources (if available), and the least likely to act on their ethical concerns. In this national study, as many as 23 percent of nurses reported having had no ethics education at all. But the question remains—is ethics education enough?

Many factors likely support or hinder a clinician’s capacity and willingness to act with moral strength. More research is needed to investigate how interdisciplinary ethics education and institutional resources can help nurses, physicians, and others voice their ethical concerns, help them agree on morally acceptable actions, and support their capacity and propensity to act with moral strength and confidence. Research on moral distress and ethical concerns in everyday clinical practice can begin to build a knowledge base that will inform clinical training—in both educational and health care institutions—and that will help create organizational structures and processes to prepare and support clinicians to encounter potentially distressing situations with moral strength. Research can help tease out what is important and predictive for taking (or not taking) ethical action in morally distressing circumstances. This knowledge would be useful for designing strategies to support clinician well-being. Indeed, studies should focus on the influences that affect clinicians’ ability and willingness to become involved or take ownership of ethically-laden patient care issues, and their level of confidence in doing so.