Scattergood Ethics

In the News

Assessing Decision-Making Capacity: A Primer for the Development of Hospital Practice Guidelines
Jan 14

Decision making capacity (DMC) is a fundamental concept grounding the principle of respect for autonomy and the practice of obtaining informed consent. DMC must be determined and documented every time a patient undergoes a hospital procedure and for routine care when there is reason to believe decision making ability is compromised. In this paper we explore a path toward ethically informed development and implementation of a hospital policy related to DMC assessment. We begin with a review of the context of DMC assessment before discussing some considerations relevant to policy creation by healthcare ethics committees. The discussion concludes in a presentation of a typology of capacity assessment policies, which draws upon a sampling of currently used hospital policies to illustrate relevant ethical considerations.

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A debate on DSM-5
Dec 25

Professor Dominic Sisti and colleagues discuss the controversies of the recently developed Research Domain Criteria and argue the importance of values in the classification of mental illnesses.  BMC Psychiatry 2013, 13:346 

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'Orange is the New Black', Prisons, & Behavioral Health Care
Aug 21

Andrea Segal & Dominic Sisti:

Have you seen Netflix’s new critically acclaimed series Orange is the New Black? If you haven’t, you should. The series, based on the real life experiences of Piper Kerman, who served over a year in federal prison for her involvement in a drug trafficking scheme, offers a gripping look at life for women behind bars.

The show grapples with homosexuality, racism, and class differences in prison. But it is its look at the impact of mental illness on our prison population, and the astounding number of inmates who have serious mental disorders and addictions that drew our attention. We see, for example, how mentally ill inmates—like the character Crazy Eyes— are subjected to stigmatization and abuse by other prisoners and guards.   And how another character—Tiffany “Pennsatucky” Doggett—illustrates the way prisoners fear the psychiatric ward, where inadequate and often inappropriate treatment is doled out. 

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What will Affordable Care Act mean for mental health care?
Apr 25

By Maiken Scott --

Mental health-care providers from all over the country gathered in Philadelphia Thursday to discuss the impact of the Affordable Care Act on their work. The conference was organized by The Scattergood Program for Applied Ethics of Behavioral Health Care at the University of Pennsylvania, and the Scattergood Foundation. Participants agreed that health-care reform presents many challenges, but offers an opportunity to make mental health care more accessible, effective -- and routine. For decades, mental health care has been relegated to the sidelines -- viewed as a separate issue, offered in separate facilities, often not covered by health insurance. The Affordable Care Act calls for better integration of mental and physical health services. Featured speaker Zeke Emanuel, who heads the Department of Medical Ethics and Health Policy at the University of Pennsylvania, says integrating physical and mental health care is key to cost-effective health care.  more...

An Introduction to the Economics of Behavioral Health
Jan 15

J. Catherine Maclean, Ph.D.

J. Catherine Maclean, PhD. is a Professor of Medical Ethics and Policy at the University of Pennsylvania, Perelman School of Medicine. As the 2013 Scattergood Scholar she will discuss how economics offers an organized framework with which we can measure the full costs and benefits of behavioral health. Decision making that does not consider all costs and benefits can lead to sub-optimal outcomes, for both persons who suffer from behavioral health problems and society as a whole. This blog aims to bring together varying perspectives on behavioral health to better inform health policy makers.

High medical care costs are at the center of current policy debates. A key point of disagreement between Democrats and Republicans during the debt ceiling and fiscal cliff negotiations was how to finance Medicare. The focus on medical care costs is justifiable: in 2012 the U.S. spent $2.8 trillion on medical care. This number is greater than the annual Gross Domestic Product (the market value of all officially recognized final goods and services produced within a country) in France, Germany, or the United Kingdom. At the same time population health falls below levels considered acceptable by public health experts. For example, 25.8 million Americans, or 8.3% of the population, suffer from Diabetes.

One potential strategy to contain medical costs and improve population health is to encourage individuals to focus on behavioral health, as well as physical health. Such improvements can prevent future disease, better manage current conditions, and contain medical costs. Positive changes in behavioral health have the added benefit of increasing the quality of people’s lives and their productivity, which can lead to greater prosperity for the U.S. Because 40% of premature deaths are attributable to behavioral health and behavioral health imposes large costs on society (e.g., the annual cost to the U.S. of tobacco addiction is over $193 billion), this strategy holds promise. Individuals make myriad behavioral health choices each day. When making these choices, they consider their own likes and dislikes, prices, health costs that accrue from their choices, laws, cultural norms, the opinions of their peers, etc. This is a complex environment in which to make decisions that will have lasting repercussions on both health and welfare. Can the economist’s toolkit shed light on how people make decisions related to their behavioral health?  

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Kids report ADHD meds are helping them, not changing them
Sep 4

Kids report ADHD meds are helping them, not changing them

By Maiken Scott

WHYY-Newsworks

Treating kids who have ADHD with stimulant drugs such as Ritalin often stirs up heated debates, but how do kids themselves feel about taking these medications? A new British study sheds some light on the issue.

The use of stimulant drugs to treat kids with attention deficit hyperactivity disorder has grown rapidly in recent decades. Many experts and parents worry that children are overdiagnosed and overmedicated -- and that medications are changing their personalities and ability to be themselves.

Drawing on her interviews with 150 American and English children between the ages of 9 and 14, British researcher Ilina Singh found that the majority of kids reported that the medications were helping them, without changing who they were.

These findings are in accordance with his experience in treating kids with ADHD, according to University of Pennsylvania psychiatrist Tony Rostain.

"When the medication is working appropriately, kids, adolescents and even adults think that it really does help them to be a better person, in terms of being able to make good choices, and being able to think through the consequences of their decisions and being able to process complicated information and make more sense of it," explained Rostain.

Rostain says Singh's research is very important as it bring a patient perspective to the heated discussion about ADHD medications. Rostain added that about 8 percent of children in this study reported that they did not feel like themselves on these medications. He says it's very important for doctors to ask their young patients how these medications affect their sense of self.

What should a doctor do with a patient like James Holmes?
Aug 3

What should a doctor do with a patient like James Holmes?

By Arthur Caplan and Dominic Sisti

We now know that James Holmes, who was charged this week in the Colorado movie theater shooting, had been seeing a psychiatrist, though no one besides his doctor knows how often he was seen or what he said during treatment. According to one report, the psychiatrist warned University of Colorado officials about Holmes, but no further action was taken because he dropped out of graduate school. more...

Patient-Doctor Confidentiality Versus Public Safety
Jul 31

Over the past few days new details have emerged about James Holmes, the suspected shooter in the Aurora movie theatre massacre. Included is the fact that Holmes was seeing a psychiatrist named Dr. Lynne Fenton prior to the shooting, and that Holmes sent a package to her that his defense team wants handed over. more...

 

Sex With Patients Revisited
Jun 16

Sex With Patients Revisited: Has the Abuse Abated? And If So Why?

by Jonathan D. Moreno, Ph.D

Forty years ago this month the feminist writer Phyllis Chesler published an article in New York Magazine entitled “The Sensuous Psychiatrists.” In her article, which was excerpted from her landmark work Women and Madness, Chesler described her interviews with eleven women who had been sexually exploited by their therapists. In some cases the therapists were psychiatrists who also prescribed medication. Some were in group therapy, some in individual. more...

Obama's medicalization of America's war on drugs
Apr 19

Art Caplan came up with the best explanation I've heard for the disease argument. People don't want to see addicts jailed, he said, so they've come up with a scenario to spare users from incarceration. Ergo: "The whole drug establishment is invoking the disease model as an antidote to the criminal-justice model." more...

Bioethics and mentally illness: The case of Mary Moe
Jan 22

A 32-year-old pregnant woman from Massachusetts, known only as Mary Moe, is at the center of a heated battle over abortion and sterilization, in a case so complex you could use it to teach an entire course on bioethics.  Read more...
 

Ezekiel Emanuel on the Health Care Law and Health Care Costs
Nov 21

Radio Times with Marty Moss-Coane

Ezekiel Emanuel on the Health Care Law and Health Care Costs

Monday, November 21st, 2011

Last week the Supreme Court agreed to review the constitutional challenge to the 2010 health care bill over the provision that requires most Americans to buy health care coverage. EZEKIEL EMANUEL worked on the Patient Protection and Affordable Care Act when he served as a top health care adviser to President Obama from 2009-2011. Emanuel is a prominent oncologist, researcher and medical ethicist. He headed the Bioethics Department at the National Institutes of Health, and has won awards for his work improving end-of-life care. He’s also the brother of Chicago Mayor and former White House Chief of Staff Rahm Emanuel. Ezekiel Emanuel has recently moved to Philadelphia to serve as Vice Provost for Global Initiatives and chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania. In this hour, Marty sits down with Emanuel to talk about the health care bill, health care costs, and the quality of medical care in the United States.

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Inspiring portrait of Down syndrome at odds with perfect baby pursuit
Sep 29

Arthur Caplan, PhD | MSNBC.com

Researchers have created a remarkable portrait of life for those with Down syndrome — and the people who love them.

Through the lens of a series of surveys conducted by Children’s Hospital Boston, the Down syndrome experience looks far different — and far happier — than the one most of us are used to picturing.

Most parents who answered the survey said they were proud of their child with Down syndrome, felt their outlook on life was more positive because of the experience — and had no regrets about having the child. more...

Ezekiel J. Emanuel Appointed Penn Integrates Knowledge Professor at University of Pennsylvania
Aug 5

Ezekiel J. Emanuel, a globally renowned bioethicist, will join the faculty of the University of Pennsylvania as the 13th Penn Integrates Knowledge University Professor, beginning Sept. 1.

The announcement was made by Penn President Amy Gutmann and Provost Vincent Price.

Emanuel's title will be Diane v.S. Levy and Robert M. Levy University Professor and vice provost for global initiatives. His appointment will be shared between the Department of Medical Ethics & Health Policy, which he will chair in Penn’s Perelman School of Medicine, and the Department of Health Care Management in the Wharton School, pending formal ratification by the School faculties, the Provost’s Staff Conference and the University trustees.

“The University of Pennsylvania is tremendously fortunate to have attracted to our faculty one of the most insightful and well-respected bioethicists of our time,” Gutmann said. “Zeke Emanuel is an eminent scholar, a passionate teacher, a collaborative leader and a tireless public servant. He has time and again demonstrated the vital importance of putting the broadest and deepest understandings to work in service of others. I am delighted that he will join the ranks of our esteemed Penn Integrates Knowledge University Professors.”  more...

Anti-addiction drugs face more than medical issues
Jul 25

Should drug addicts be vaccinated to help them recover? Some authorities, such as bioethicist Arthur Caplan of the University of Pennsylvania, Philadelphia, have suggested coercing addicts into taking drugs like naltrexone, which curb the highs they crave. The recent death of singer Amy Winehouse, who had well-documented problems with drugs and alcohol, and the publication last week of research on a heroin vaccine and an anti-cocaine drug, have again raised the question. more from New Scientist...

Should Jared Loughner be forcibly drugged? by Art Caplan
Jun 27

Alleged Ariz. shooter may be given antipsychotic medications so that he can stand trial

Jared Lee Loughner, the 22-year-old man who allegedly shot Congresswoman Gabrielle Giffords in the head, killed six and wounded a dozen more last January in Tucson, Ariz., has been declared so mentally ill that he can't be tried...I think he should be given the drugs, even though forcing anyone to take medication violates a core right to be able to refuse medical care and puts Loughner at risk of being convicted and sentenced to death. more...

'Hypersexual disorder' might make DSM-5
May 23

'Hypersexual disorder' might make DSM-5: At an annual meeting, psychiatrists also consider grouping compulsive gambling with substance-use disorders in the updated manual.  Internet addiction probably won't be designated as a mental disorder in DSM-5, said Dr. Charles P. O'Brien, chairman of the DSM-5 work group on substance-related disorders and a psychiatrist at the University of Pennsylvania. It may be included in the appendix of DSM-5 as a behavior that needs more research, along with excessive video gaming...more

Guns, politics, and the Arizona rampage
Jan 11

The Philadelphia Inquirer: Judging from news reports that Jared Loughner was dismissed from community college and told not to return until he was evaluated for mental illness, and looking at his web postings, which appear very delusional, it's likely he has a psychotic disorder. Here is a college student, not in school because of untreated mental illness, who has spiraled downward and allegedly committed an atrocious act of violence. While most patients with serious mental illness do not act violently, there is a minority of individuals who, in the throes of psychosis or other mental derangement, have access to weapons and turn these on innocent people. I hope that rather than call Loughner "nuts" and further stigmatize people with mental illness, we look at this as a tragic missed opportunity. A quiet and normal kid became very sick and apparently didn't get the help he needed. We need to prevent this from happening to others.

Dr. Anthony L. Rostain
Director of Education
Department of Psychiatry
University of Pennsylvania
Philadelphia