Utilitarianism and the pandemic

J. Savulescu, I. Persson, & D. Wilkinson
Bioethics
Originally published 20 May 20

Abstract

There are no egalitarians in a pandemic. The scale of the challenge for health systems and public policy means that there is an ineluctable need to prioritize the needs of the many. It is impossible to treat all citizens equally, and a failure to carefully consider the consequences of actions could lead to massive preventable loss of life. In a pandemic there is a strong ethical need to consider how to do most good overall. Utilitarianism is an influential moral theory that states that the right action is the action that is expected to produce the greatest good. It offers clear operationalizable principles. In this paper we provide a summary of how utilitarianism could inform two challenging questions that have been important in the early phase of the pandemic: (a) Triage: which patients should receive access to a ventilator if there is overwhelming demand outstripping supply? (b) Lockdown: how should countries decide when to implement stringent social restrictions, balancing preventing deaths from COVID‐19 with causing deaths and reductions in well‐being from other causes? Our aim is not to argue that utilitarianism is the only relevant ethical theory, or in favour of a purely utilitarian approach. However, clearly considering which options will do the most good overall will help societies identify and consider the necessary cost of other values. Societies may choose either to embrace or not to embrace the utilitarian course, but with a clear understanding of the values involved and the price they are willing to pay.

The info is here.

In the face of Covid-19, the U.S. needs to change how it deals with mental illness

Jeffrey Geller
STAT NEWS
Originally posted 29 May 20

Here are two excerpts:

Frontline physicians, nurses, and other health care workers are looking death in the face every day. Shift workers in economically treacherous situations are forced to risk their health for a paycheck. Millions of Americans have lost their jobs. Still more are separated from the people they love, their daily routines have been disrupted, and they are making anxious choices every day that affect their physical and mental health.

(cut)

Second, Covid-19 has laid bare the severe doctor shortage across the United States, and that shortage includes psychiatrists. While every kind of mental health professional is necessary and indeed critical to responding to the crisis, psychiatrists bring unique expertise in serving some of the most severely compromised patients in psychiatric units and hospitals, long-term care facilities, homeless shelters, and jails and prisons. Forgiving some of the debt that students amass during medical school would incentivize more individuals to serve in these capacities, as would lifting caps on federal funding for new residency slots.

Third, we needed more psychiatric beds in hospitals before Covid-19, and need even more now as physical distancing continues — yet some hospitals have decreased the number of psychiatric beds by converting them to beds for individuals with Covid-19. Patients in psychiatric units who contract Covid-19 need to be separated from other patients. We currently do not have enough beds to treat everyone for the length of time they need. Without federal funding for psychiatric beds, we will have an increase in deaths from the mental health sequelae of Covid-19.

The info is here.

American Psychiatric Association Presidential Task Force to Address Structural Racism Throughout Psychiatry

Press Release
American Psychiatric Association
2 July 2020

The American Psychiatric Association today announced the members and charge of its Presidential Task Force to Address Structural Racism Throughout Psychiatry. The
Task Force was initially described at an APA Town Hall on June 15 amidst rising calls from psychiatrists for action on racism. It held its first meeting on June 27, and efforts, including the planning of future town halls, surveys and the establishment of related committees, are underway.

Focusing on organized psychiatry, psychiatrists, psychiatric trainees, psychiatric patients, and others who work to serve psychiatric patients, the Task Force is initially charged with:

1. Providing education and resources on APA’s and psychiatry’s history regarding structural racism;
2. Explaining the current impact of structural racism on the mental health of our patients and colleagues;
3. Developing achievable and actionable recommendations for change to eliminate structural racism in the APA and psychiatry now and in the future;
4. Providing reports with specific recommendations for achievable actions to the APA Board of Trustees at each of its meetings through May 2021; and
5. Monitoring the implementation of tasks 1-4.

The info is here.

The Moral Determinants of Health

Donald M. Berwick
JAMA
Originally posted 12 June 20

Here is an excerpt:

How do humans invest in their own vitality and longevity? The answer seems illogical. In wealthy nations, science points to social causes, but most economic investments are nowhere near those causes. Vast, expensive repair shops (such as medical centers and emergency services) are hard at work, but minimal facilities are available to prevent the damage. In the US at the moment, 40 million people are hungry, almost 600 000 are homeless, 2.3 million are in prisons and jails with minimal health services (70% of whom experience mental illness or substance abuse), 40 million live in poverty, 40% of elders live in loneliness, and public transport in cities is decaying. Today, everywhere, as the murder of George Floyd and the subsequent protests make clear yet again, deep structural racism continues its chronic, destructive work. In recent weeks, people in their streets across the US, many moved perhaps by the “moral law within,” have been protesting against vast, cruel, and seemingly endless racial prejudice and inequality.

Decades of research on the true causes of ill health, a long series of pedigreed reports, and voices of public health advocacy have not changed this underinvestment in actual human well-being. Two possible sources of funds seem logically possible: either (a) raise taxes to allow governments to improve social determinants, or (b) shift some substantial fraction of health expenditures from an overbuilt, high-priced, wasteful, and frankly confiscatory system of hospitals and specialty care toward addressing social determinants instead. Either is logically possible, but neither is politically possible, at least not so far.

Neither will happen unless and until an attack on racism and other social determinants of health is motivated by an embrace of the moral determinants of health, including, most crucially, a strong sense of social solidarity in the US. “Solidarity” would mean that individuals in the US legitimately and properly can depend on each other for helping to secure the basic circumstances of healthy lives, no less than they depend legitimately on each other to secure the nation’s defense. If that were the moral imperative, government—the primary expression of shared responsibility—would defend and improve health just as energetically as it defends territorial integrity.

The info is here.

Professional Psychology: Collection Agencies, Confidentiality, Records, Treatment, and Staff Supervision in New Jersey

SUPERIOR COURT OF NEW JERSEY
APPELLATE DIVISION
DOCKET NO. A-4975-17T3

In the Matter of the Suspension or Revocation of the License of L. Barry Helfmann, Psy.D.

Here are two excerpts:

The complaint included five counts. It alleged Dr. Helfmann failed to do the following: take reasonable measures to protect confidentiality of the Partnership's patients' private health information; maintain permanent records that accurately reflected patient contact for treatment purposes; maintain records of professional quality; timely release records requested by a patient; and properly instruct and supervise temporary staff concerning patient confidentiality and record maintenance. The Attorney General sought sanctions under the UEA.

(cut)

The regulation is clear. The doctor's argument to the contrary, that a psychologist could somehow confuse his collection attorney with a patient's authorized representative, is refuted by the regulation's plain language as well as consideration of its entire context. The doctor's argument is without sufficient merit to warrant further discussion. R. 2:11-3(e)(1)(E).

We find nothing arbitrary about the Board's rejection of Dr. Helfmann's argument that he violated no rule or regulation because he relied on the advice of counsel in providing the Partnership's collection attorney with patients' confidential information. His assertion is contrary to the sworn testimony of the collection attorney who was deposed, as distinguished from another collection attorney with whom the doctor spoke in the distant past. The latter attorney's purported statement that confidential information might be necessary to resolve a patient's outstanding fee does not consider, let alone resolve, the propriety of a psychologist releasing such information in the face of clear statutory and regulatory prohibitions.

The Board found that Dr. Helfmann, not his collection attorneys, was charged with the professional responsibility of preserving his patients' confidential information. Perhaps the doctor's argument that he relied on the advice of counsel would have had greater appeal had he asked for a legal opinion on providing confidential patient information to collection attorneys in view of the psychologist-patient privilege and a specific regulatory prohibition against doing so absent a statutory or traditional exception. That the Board found unpersuasive Dr. Helfmann's hearsay testimony about what attorneys told him years ago is hardly arbitrary and capricious, considering the Partnership's current collection attorney's testimony and Dr. Helfmann's statutory and regulatory obligations to preserve confidentiality.

The decision is here.

Unusual Legal Case: Small Social Circles, Boundaries, and Harm

This legal case shows how much our social circles interrelate and how easily boundaries can be violated.  If you ever believe that you are safe from boundary violations in a current, complex culture, you may want to rethink this position.  A lesson for all in this legal case.  I will excerpt a fascinating portion of this case.

Roetzel and Andres
jdsupra.com
Originally posted 10 June 20

Possible Employer Vicarious Liability For Employee’s HIPAA Violation Even When Employee Engages In Unauthorized Act

Here is the excerpt:

When the plaintiff came in for her appointment, she handed the Parkview employee a filled-out patient information sheet. The employee then spent about one-minute inputting that information onto Parkview’s electronic health record. The employee recognized the plaintiff’s name as someone who had liked a photo of the employee’s husband on his Facebook account. Suspecting that the plaintiff might have had, or was then having, an affair with her husband, the employee sent some texts to her husband relating to the fact the plaintiff was a Parkview patient. Her texts included information from the patient chart that the employee had created from the patient’s information sheet, such as the patient’s name, her position as a dispatcher, and the underlying reasons for the plaintiff’s visit to the OB/Gyn. Even though such information was not included on the chart, the employee also texted that the plaintiff was HIV-positive and had had more than fifty sexual partners. While using the husband’s phone, the husband’s sister saw the texts. The sister then reported the texts to Parkview. Upon receipt of the sister’s report, Parkview initiated an investigation into the employee’s conduct and ultimately terminated the employee. As part of that investigation, Parkview notified the plaintiff of the disclosure of her protected health information.

The info is here.

Want To See Your Therapist In-Person Mid-Pandemic? Think Again

Todd Essig
Forbes.com
Originally posted 27 June 20

Here is an excerpt:

Psychotherapy is built on a promise; you bring your suffering to this private place and I will work with you to keep you safe and help you heal. That promise is changed by necessary viral precautions. First, the possibility of contact tracing weakens the promise of confidentiality. I promise to keep this private changes to a promise to keep it private unless someone gets sick and I need to contact the local health department.

Even more powerful is the fact that a mid-pandemic in-person psychotherapy promise has to include all the ways we will protect each other from very real dangers, hardly the experience of psychological safety. There will even be a promise to pretend we are safe together even when we are doing so many things to remind us we are each the source of a potentially life-altering infection.

When I imagine how my caseload would react were I to begin mid-pandemic in-person work, like I did for a recent webinar for the NYS Psychological Association, I anticipate as many people welcoming the chance to work together on a shared project of viral safety as I do imagining those who would feel devastated or burdened. But even for the first group of willing co-participants, it is important to see that such a joint project of mutual safety is not psychotherapy. No anticipated reaction included the experience of psychological safety on which effective psychotherapy rests.

Rather than feeling safe enough to address the private and dark, patients/clients will each in their own way labor under the burden of keeping themselves, their families, their therapist, other patients, and office staff safe. The vigilance required to remain safe will inevitably reduce the therapeutic benefits one might hope would develop from being back in the office.

The article is here.

Why Sex? Biologists Find New Explanations.

Christie Wilcox
Quanta Magazine
Originally posted 23 April 20

Here are several excerpts:

The immediate benefit of sex for the algae is that they form resistant diploid spores that can outlast a bad environment. When better conditions return, the algal cells return to their haploid state through meiosis. But as Nedelcu and her colleagues point out, the process of meiosis also offers unique opportunities for genomic improvement that go beyond diversity.

Like all multicellular organisms, these algae have ways of healing small breaks or errors in their DNA. But if the damage is bad enough, those mechanisms struggle to accurately repair it. In those cases, having a second copy of that strand of DNA to use as a template for the repairs can be a lifesaver. “That’s basically what most organisms have by being diploid,” Nedelcu explained.

(cut)

Such indirect benefits may extend far beyond meiosis. “Sex also refers to copulation and sexual behaviors,” McDonough said. Researchers studying everything from crickets to mice are starting to see that having sex can have all sorts of unexpected upsides.

Unexpected, that is, because it’s generally assumed not only that sex is inefficient compared to asexual reproduction, but that it imposes an energy burden on the individuals involved. Producing eggs or sperm, finding a mate, the act of mating — all of it takes energy and resources. Consequently, there’s a trade-off between reproduction and other things an organism might do to survive longer, such as growing bigger or bolstering its immune system.

(cut)

Of course, those consequences go both ways: Cultural beliefs and views on sex influence how we go about studying and interpreting the results from research on other organisms. Our biases regarding sexual activity — like which kinds are or aren’t “normal” or proper — “have essentially affected what it is that we’ve deemed important to study in animals,” Worthington said.

McDonough agrees that our preconceptions of what sex should look like and the reasons why an individual should or shouldn’t have it have biased our understanding of animal behavior. They point to the research on same-sex behaviors in animals as a prime example of this. McDonough and their colleagues noticed that the scientific discourse surrounding same-sex behaviors involves a lot of weak or baseless assumptions — for example, that engaging in sexual acts is inherently costly, so same-sex sexual interactions must provide some overwhelming benefit, such as a large increase in lifetime reproductive output, for the behavior to arise and stick around through natural selection. But “in many situations, it isn’t costly, and it may have some kind of benefit that we don’t understand,” McDonough said.

The info is here.

Universal basic income seems to improve employment and well-being

Donna Lu
New Scientist
Originally post 6 May 20

The world’s most robust study of universal basic income has concluded that it boosts recipients’ mental and financial well-being, as well as modestly improving employment.

Finland ran a two-year universal basic income study in 2017 and 2018, during which the government gave 2000 unemployed people aged between 25 and 58 monthly payments with no strings attached.

The payments of €560 per month weren’t means tested and were unconditional, so they weren’t reduced if an individual got a job or later had a pay rise. The study was nationwide and selected recipients weren’t able to opt out, because the test was written into legislation.

Minna Ylikännö at the Social Insurance Institution of Finland announced the findings in Helsinki today via livestream.

The study compared the employment and well-being of basic income recipients against a control group of 173,000 people who were on unemployment benefits.

Between November 2017 and October 2018, people on basic income worked an average of 78 days, which was six days more than those on unemployment benefits.

There was a greater increase in employment for people in families with children, as well as those whose first language wasn’t Finnish or Swedish – but the researchers aren’t yet sure why.

When surveyed, people who received universal basic income instead of regular unemployment benefits reported better financial well-being, mental health and cognitive functioning, as well as higher levels of confidence in the future.

The info is here.