Category Archives: In the News

Fordham’s Dr. Elizabeth Yuko Address Ethics of Web Self-Diagnoses

Millions of people use websites like WebMD every day to gain insight on a range of medical issues from cancer to mental health. This practice, or “cyberchondria,” is a new digital phenomenon that has resulted from online databases of free, medical information.

With about 74 million users each month, the information on WebMD provides some with clarity for our most intimate and confusing health concerns, but for others, it could be a source of anxiety. In a recent article published in GOOD Magazine, Fordham University Center for Ethics Education Bioethicist Dr. Elizabeth Yuko addressed the “ethical gray area” of web diagnosis and online symptom checkers.

“Websites and algorithms are not held to the Hippocratic Oath. Because WebMD is a media organization, rather than an individual medical professional, it is not held to the same legal and ethical accountability as individual practitioners,” notes Dr. Yuko. Unlike WebMD, other online communities and health professionals must operate under ethics codes and guidelines designed by organizations such as American Medical Association and American Psychological Association.

As far as legal liability is concerned, Dr. Yuko explained that because WebMD’s Terms and Conditions state “This Site Does Not Provide Medical Advice,” the website is not “legally obligated to provide a worst-case scenario” while most health professionals, at least in the United States, are held accountable if they do not provide patients with complete information regarding their health conditions.

Dr. Yuko, however, is most concerned with the use of health care sites as a substitute for obtaining diagnoses because people “can’t afford in-person care.” She stated, “This in itself is an ethics issue, but one from a societal, distributive justice perspective, highlighting the fact that not everyone has access to effective, affordable health care.”

Read the full article at GOOD.

Medical Training for Transgender Patients Needs to Include Sensitivity to Social Stigmas for both Gender and Sexual Orientation

The recently published article on doctor’s lack of expertise in treating transgender patients in The Guardian is an important step forward in highlighting current disparities in healthcare services for this population.  The study, based on interviews with sample of 23 physicians and psychologists who chose to work with transgender patients, focused on current challenges in providing gender affirming care for individuals who are seeking medically supported transitioning treatments, such as hormonal replacement therapies (HRT).

A recently completed study by Celia B. Fisher, Ph.D. and her colleagues, funded by the National Institute for Minority Health and Health Disparities (NIMHD) confirms the need for greater medical training, based on the reports of 228 transgender males, females and gender non-conforming youth ages 14 – 21.  “Fear of stigmatization is a significant barrier to healthcare among these youth,” notes Fisher, Director of Fordham University’s Center for Ethics Education, “and in our study, 51% reported they did not discuss their transgender identity with their primary health care providers out of fear that the provider would not be accepting.”

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Relying on Psychological Assessments do not Right Death Penalty Wrongs for the Intellectually Disabled

Although the death penalty is on the decline in the United States, the case of James Rhodes highlights the ethical quagmire facing forensic psychiatrists and psychologists whose evaluations contribute whether persons with intellectual disabilities convicted of murder will live or die.

In addition to the increasingly familiar racial biases and legal flaws in death penalty convictions and use of lethal injection, according to Celia B. Fisher, Ph.D. Director of Fordham University’s Centerfor Ethics Education, little attention has been paid to the lack of professional consensus surrounding the validity and reliability of IQ tests in general and for racial minorities in particular, disagreement over the use of absolute cut-off scores to determine intellectual disability, and the inherent fallibility of tests to determine the probability of future violence.

“Professional evaluations are not a panacea for inconsistent, uninformed and often racially biased jury decisions,” notes Fisher, “rather than providing a fair and neutral assessment of mental ability forensic assessments are contributing to inconsistencies that lethally violate the human rights of convicted criminals in capital cases.”

For more information on the ethics of psychologists’ involvement in death penalty evaluations – particularly for defendants with mental disabilities Dr. Fisher’s 2013 article in Ethics & Behavior entitled “Human Rights and Psychologists’ Involvement in Assessments Related to Death Penalty Cases.”

Celia B. Fisher, Ph.D. is the Marie Ward Doty University Chair, Professor of Psychology, and Director of Fordham University’s Center for Ethics Education. She chaired the 2002 revision of the American Psychological Association’s Ethics Code and is the author of Decoding the Ethics Code: A Practical Guide for Psychologists, now in it’s fourth edition, from Sage Publications.

 

Will Research on 10,000 New Yorkers Fuel Future Racial Health Inequality?

Image via Flickr.

Image via Flickr

By Celia B. Fisher, Ph.D.

A 20-year, multi-million dollar study of more than 10,000 New Yorkers scheduled to begin next year claims that it will enable the development of theories, therapeutics, and policies to improve the health and quality of human life.  Although still in the planning stages, the breadth of the data collection proposed (including health habits, biological data, and geospatial mapping) combined with the lack of detail accompanying such a widespread publicity effort raises questions regarding the extent to which the research risks of such an endeavor have been well thought out.

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Jailing for Dollars: The Federal Government Takes Steps to Eliminate a Moral Stain on Justice in the US

The United States has become the world’s leading jailer with 2.2 million people in jails and prisons across the country.  With a combination of government and privately run facilities, the nation faces the moral issues surrounding the prison-industrial complex.  As reflected in a recent New York Times article, the U.S. Justice Department has announced plans to phase out the use of privately run facilities, citing less safe conditions than their government run counterparts.

In the Obama administration’s continuing efforts to address inequities in the criminal justice system The U.S. Justice Department announced plans to phase out its use of privately operated prisons, calling them less safe and a poor substitute for government-run facilities.  According to Celia B. Fisher, Director of the Fordham Center for Ethics Education “this is a welcome step toward addressing the inequities produced by a public-private system that incentivizes high incarceration rates with devastating effects on poor and minority communities.

Fordham University Center for Ethics Education brought attention to this issue in a conference on “Jailing for Dollars: The Moral Cost of Privatizing Justice” featuring Cindy Chang, Los Angeles Times, Scott Cohn, NBC, Thomas Giovanni, Brennan Center for Justice, Judith Greene, Justice Strategies and Michael Jacobson, Vera Institute of Justice. Speakers explored pressing moral questions about the prison-industrial complex, including dangerous overcrowding, unsafe work and health conditions and its consequences on individuals, families and society at large.

To watch the video of this conference, click here and scroll to the bottom of the page to play.

Celia B. Fisher, Ph.D. is the Fordham University Marie Ward Doty University Chair in Ethics and Director of the Center for Ethics Education. Fisher’s  Decoding the Ethics Code: A Practical Guide for Psychologist, is now in its fourth edition from Sage Publications.

Psychologists who “Analyze” Trump are Violating the Public Trust

As the 2016 presidential election approaches, psychologists are gaining media attention by diagnosing candidates as having personality disorders, especially for the Republican nominee.  But the public should question whether or not offering these diagnoses is professionally ethical or in the service of political agendas.

As reflected in a recent New York Times article, the candidacy of Donald Trump has tempted some psychologists to abandon their unique training in mental health assessment and provide unprofessional diagnoses of Mr. Trump that, according to Celia B. Fisher, Director Fordham University’s Center for Ethics Education, “distort the values of their profession and violate the public trust”.

“Trained mental health practitioners serve the public good by providing diagnoses of individuals based on scientifically and professionally established assessment techniques,” notes Fisher, who chaired the committee that wrote the current American Psychological Association’s (APA) Ethical Principles and Code of Conduct, “however the public and the profession are harmed when psychologists provide opinions based on unsubstantiated information drawn from media reports or other subjective observations.”

There have been claims suggesting that psychologists who offer diagnoses of Donald Trump are doing so for the purpose of national and public interest. According to Fisher, who is the author of the widely read Decoding the Ethics Code: A Practical Guide for Psychologists“Psychologists who claim that ‘Trumpism’ is a threat to democracy that provides moral justification to offer public diagnoses in the absence of established assessment techniques are deluding themselves into thinking that these unprofessional opinions benefit society.” Fisher further explains that psychologists are actually in “clear violation of the APA Ethics Code and are inadvertently contributing to a political climate based on opinion rather than fact.”

Celia B. Fisher, Ph.D. is the Fordham University Marie Ward Doty University Chair in Ethics and Director of the Center for Ethics Education. In addition to chairing the 2002 revision of the American Psychological Association’s Ethics Code, Fisher’s  Decoding the Ethics Code: A Practical Guide for Psychologists, is now in its fourth edition from Sage Publications.

New WHO diagnostic labels perpetuate transgender stigma

trans girl light bulb

The movement of the World Health Organization (WHO) to declassify transgender identity as a mental disorder is simultaneously a step forward in affirming the personhood of gender minority individuals, and a step backward in diagnoses that adequately reflect their health needs. The solutions posited by the WHO reveal the systemic influence of health insurance policies in defining not only medical disorders, but also social categories.

Currently, in the United States and abroad, in order to qualify for health insurance coverage for gender affirming surgery or hormone replacement therapy (HRT), mentally healthy transgender individuals must receive a diagnosis indicating a gender-related mental disorder based on either the WHO classification or the “gender dysphoria” diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders (DSM). In the hopes of fostering greater acceptance while still satisfying insurers, after 25 years, the WHO is considering a new diagnostic category: “Conditions related to sexual health.”

According to Dr. Celia B. Fisher, Director of the Center for Ethics Education and Professor of Psychology at Fordham University, the new terminology, while well-intentioned, “runs the risk of perpetuating stereotypes that conflate gender identity and sexual orientation and lead to continued misclassification of transgender personhood as a sexual problem.”

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