Diagnosis at a Distance Continues to Undermine Public’s Ability to Evaluate Trump Policies

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President Donald Trump’s first week in office was spent signing executive orders regarding the Dakota Access and Keystone XL Pipelines, visa and refugee programs and a wall along the U.S.-Mexico border, all which sparked nationwide demonstrations and protests. Since the beginning of Trump’s campaign and more frequently over the past week, media outlets and select “experts”  have been gaining attention by diagnosing Trump with various mental or personality disorders. However, is it ethical for experts in psychology and psychiatry to offer professionals diagnoses of Trump and what are the political implications?

A recent article published in U.S. News & World Report titled, “Temperament Tantrum,” featured a professional assessment of the 45h President from John D. Gartner, a practicing psychotherapist who previously taught psychiatric residents at Johns Hopkins University. Gartner told U.S. News & World Report that Trump has “malignant narcissism,” an incurable narcissistic personality disorder. Despite the Goldwater Rule, in Section 7.3 of the American Psychiatric Association’s (APA) Ethics Code, which cautions against offering a professional opinion about an individual in the public eye who has not been formally evaluated, Gartner argues that in the case of Trump, he can “make this diagnosis indisputably” and the breaking of the [Goldwater Rule within the] ethics code is warranted.

According to Dr. Celia Fisher, Professor of Psychology and Director of the Fordham University Center for Ethics Education, however, such misleading statements by mental health professionals “helps the Trump administration hide their strategic intent to undermine traditional democratic principles under the guise of a President whose impulses often get the better of him.”

The National Transgender Study is a Start – But More is Needed to Protect the Sexual Health of Transgender Teens

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On Thursday, December 9th, the largest survey of transgender people ever conducted was published by The National Center for Transgender Equality. The anonymous online survey had nearly 28,000 participants and found transgender people are twice as likely to live in poverty and three times more likely to be unemployed, according to an article in TIME Magazine. Other findings included that one-third of respondents reported issues in finding healthcare and 42%  reported higher rates of mistreatment by health care providers.

Fordham University Center for Ethics Education Director, Celia B. Fisher, Ph.D., lauded the recent national study highlighting the healthcare needs of transgender people in the United States. “More is needed on the health care experiences of transgender adolescents, especially their experiences with family physicians who often do not have the training to provide necessary gender affirming care,” she noted.

Fisher’s research with colleagues from Northwestern University, supported by the National Institute on Minority Health and Health Disparities (NIMHD), has highlighted the critical need for physicians who are trained and open to providing gender minority youth with not only transitioning information, but also gender and sexual orientation specific sexual health information and services to prevent HIV and related STIs.

Continue reading “The National Transgender Study is a Start – But More is Needed to Protect the Sexual Health of Transgender Teens”

Ethics & Society Newsfeed: November 11, 2016

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President-Elect Trump and Ethics

Trump and Pence on science, in their own words
Donald Trump and Mike Pence’s career and campaign track record of false claims about science, rejection of research conclusions and dangerous rhetoric on misconceptions such as vaccines and autism

Donald Trump Will Face Unprecedented Ethics Decisions as President
Conflicts of interest between Donald Trump’s business interests and his presidency

Ethics laws don’t require Trump to give up control of his ‘unprecedented’ portfolio
Donald Trump has no legal requirement to forfeit control of his businesses

Trump left something out of his Obamacare speech — the 21 million his plan leaves uninsured
The public health consequences of Donald Trump’s plan to repeal and replace Obamacare

Continue reading “Ethics & Society Newsfeed: November 11, 2016”

First Baby Born Via ‘3-Parent IVF’ Raises Ethical Questions

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On Tuesday it was reported that the first live birth resulting from mitochondrial donation was born in New York to a Jordanian couple. According to The New York Times, the fertility procedure – also referred to as “3-parent IVF” – was performed at a Mexican clinic and the baby is a healthy boy.

The purpose of a donor for this couple was to “overcome flaws in a parent’s mitochondria that can cause grave illnesses in babies.” Thus, the DNA from the egg of the healthy mother who has the mutation, is placed in the egg of a healthy donor after her nuclear DNA is removed. It is important to understand that the mitochondria of a cell are completely separate entities from DNA that determines inheritance.

The Jordanian couple took their chances with the procedure as they had lost two other children to the disease, one at age 6 and the other at 8 months. Dr. John Zhang performed the procedure at the New Hope Fertility Center’s clinic in Mexico as it is “effectively banned” in the United States, though it has been legal in the United Kingdom since last year.

The child is now 5 months old and healthy with normal mitochondria, as was first reported by New Scientist magazine.

Continue reading “First Baby Born Via ‘3-Parent IVF’ Raises Ethical Questions”

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

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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

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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.”

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

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

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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.

Rimah Jaber, MA, Senior Editor of Ethics and Society blog