Cont: Donald Trump has 'dangerous mental illness' say psychiatry experts at Yale... Pt 3

[xjx388]

No, that is your subjective opinion that we grant it primacy. That does not make it objective. It's hand-waving the subjectivity away.

Ok, if ethical codes are not objective standards and they don’t have primacy in judging the actions of professionals...what good are they?

I quite literally just told you. They are shared opinions. Idiosyncratic means individual. Ethic codes are not individual.

Those “shared opinions” are what I’ve said all along: the various ethics codes of the medical profession which all derive from the AMA’s code of ethics. If an individual rejects certain parts of the ethics code, it’s no longer a shared code; it then becomes idiosyncratic to that individual.

Remember, SG made the argument that if one is not a member of the APA, the APA ethics code does not apply to them. They have, essentially rejected that ethics code and operate based on -well, SG hasn’t told me what she thinks but IMO, they must operate on their own internal code. Apparently, her argument is that we can’t say they are unethical simply because they don’t agree to share the ethics of their profession. They have created a code that is their own: An internal, idiosyncratic code.

This is what makes people want to make the subject about you.

They shouldn’t do that. It’s against the ethical code we share as members of this forum.

You don't appear to be disagreeing on this point, you appear to be failing to even hear it. You put "shared opinion" in scare quotes. Why?

Uh...because I’m using your words? I don’t necessarily agree that ethics is as simple as “shared opinion,” but I’ll use it for simplicity and the sake of argument.

I hear the argument and I disagree with it. There is either an external objective code that all in the group agree to or there are only internal, idiosyncratic codes.

 

[Cabbage]

Still, doctors either act ethically when confronted with a grey area or they don't.

Hmmm....Looks to me like you're struggling with the concept of "grey area".

 

[xjx388]

Hmmm....Looks to me like you're struggling with the concept of "grey area".

Nope. I don’t think there is much grey area in the first place. But maybe if you have an illustrative example?

 

[Cabbage]

Nope. I don’t think there is much grey area in the first place. But maybe if you have an illustrative example?

I am simply talking about the fundamental concept of a grey area, period. The mere fact that something is a "grey area" means it is not so black and white as your "doctors either act ethically when confronted with a grey area or they don't" makes it out to be. By definition, ethical concerns regarding grey areas are debatable, not simply is or is not ethical.

Maybe you should try looking up the term in the dictionary? That may help your misunderstanding. Here, I'll help you:

an area or situation in which it is difficult to judge what is right and what is wrong

https://www.merriam-webster.com/dictionary/gray area

 

[xjx388]

I am simply talking about the fundamental concept of a grey area, period. The mere fact that something is a "grey area" means it is not so black and white as your "doctors either act ethically when confronted with a grey area or they don't" makes it out to be. By definition, ethical concerns regarding grey areas are debatable, not simply is or is not ethical.



Maybe you should try looking up the term in the dictionary? That may help your misunderstanding. Here, I'll help you:







https://www.merriam-webster.com/dictionary/gray area

Any medical decision is either in accord with ethics or it is not. A particular situation may arise that is difficult to judge what the ethical decision is. This does not imply it’s impossible to do so or that the existence of the gray area is justification to eschew ethics altogether.

Those gray areas are the time to seek further guidance, not simply use “professional judgment” to basically make **** up as you go. That’s the path to bad decisions. Ask yourself why Yale didn’t want their name attached to the conference Lee, et. al., organized.

Hospitals, research facilities, universities and larger clinics have ethics committees for the gray areas. Individual doctors can seek ethics opinions from the medical societies, professional organizations, State medical boards and other sources.

Gray areas are navigable with guidance.

 

[Skeptic Ginger]

Any medical decision is either in accord with ethics or it is not. .....

Stop right there. What kind of black and white world do you live in?

Is abortion ethical? Is it unethical?

(True story) If a married man is diagnosed with an STD and asks you to keep that confidential from his wife, how do you do that?

(Another true story) You diagnose an elderly man with cancer and the family asks you not to tell him. What if that family is from a country in Asia where keeping that diagnosis from one's parents is the cultural norm?

Gray areas are navigable with guidance.

Whose guidance?

(Another true story) Non-English speaking family comes in the ED with a vomiting child. They show the doctor a coffee can with the emesis in it. The can also has cigarette butts in it (their ashtray) and the doctor thinks they are trying to say the kid ate cigarettes.

Doctor has the staff give the kid ipecac. Meanwhile the translator arrives and explains what happened.

Now the kid starts vomiting and the family doesn't quite get it why so they insist on medication. The kid was otherwise OK.

Several ED docs consult with each other and decide to prescribe cherry syrup to make the family happy. There are a dozen ethical dilemmas there.

 

[xjx388]

Stop right there. What kind of black and white world do you live in?

Well, let’s see:

Is abortion ethical? Is it unethical?

Done within the confines of the law, ethical. As is the refusal to perform an abortion because of a doctor’s personal convictions.

(True story) If a married man is diagnosed with an STD and asks you to keep that confidential from his wife, how do you do that?

You don’t reveal it to his wife, as the ethics of confidentiality require. Also, HIPAA

(Another true story) You diagnose an elderly man with cancer and the family asks you not to tell him. What if that family is from a country in Asia where keeping that diagnosis from one's parents is the cultural norm?

Informed consent trumps cultural issues. You tell the patient: UNLESS, as specified in the ethical code, there is reason to believe some significant harm to the patient might result from the disclosure.

Whose guidance?

Ultimately, the AMA code of ethics.

(Another true story) Non-English speaking family comes in the ED with a vomiting child. They show the doctor a coffee can with the emesis in it. The can also has cigarette butts in it (their ashtray) and the doctor thinks they are trying to say the kid ate cigarettes.

Doctor has the staff give the kid ipecac. Meanwhile the translator arrives and explains what happened.

Now the kid starts vomiting and the family doesn't quite get it why so they insist on medication. The kid was otherwise OK.

Several ED docs consult with each other and decide to prescribe cherry syrup to make the family happy. There are a dozen ethical dilemmas there.

No ethical dilemmas at all, actually, just really bad medical judgement. Should have waited for the translator and gotten it right from the beginning.

 

[Skeptic Ginger]

Well, let’s see:

Done within the confines of the law, ethical. As is the refusal to perform an abortion because of a doctor’s personal convictions.

You don't appear to recognize the difference between ethics and local laws. Hint: they are not the same.

The next one though, holy cow! Think about what you said here.

You don’t reveal it to his wife, as the ethics of confidentiality require. Also, HIPAA

You think a confidentiality law overrides the obvious duty to warn?

That spouse needs treatment. If it was HIV (in the real case it was, I just didn't want to clutter up the case) that spouse will die without treatment. And you think the ethics of a HIPAA law is more important!

See, there is a real answer here and you and a couple of the doctors in this case are ignorant of the law. Reporting to a person they have been exposed to an infectious disease overrides HIPPA. It's called public health exception.

Once again you are conflating ethics with laws.

Informed consent trumps cultural issues. You tell the patient: UNLESS, as specified in the ethical code, there is reason to believe some significant harm to the patient might result from the disclosure.

This has nothing to do with informed consent. And cultural issues are extremely important in medicine.


I edited in another example.

 

[Cabbage]

Any medical decision is either in accord with ethics or it is not.

You're still struggling with the concept of "grey area", I see. I've done my part to help; I can't teach if you simply refuse to listen.

 

[xjx388]

You're still struggling with the concept of "grey area", I see. I've done my part to help; I can't teach if you simply refuse to listen.

I wholeheartedly agree; you can’t teach.

 

[Bob001]

I note again that the Yale doctors are not Trump's doctors, and he is not their patient. They are using their unique knowledge and experience to interpret publicly available information about a notorious public figure and powerful public official. If Trump was appearing in public obviously drunk, or displaying symptoms of Parkinson's or MS, nobody would tell doctors to keep their mouths shut. Nobody would say "The President keeps falling down, but it's none of our business." Obvious psychiatric disturbance is just no different.

 

[xjx388]

You don't appear to recognize the difference between ethics and local laws. Hint: they are not the same.

They are not the same. But breaking the law is unethical.

The next one though, holy cow! Think about what you said here.
You think a confidentiality law overrides the obvious duty to warn?

Hell yes, it does.

That spouse needs treatment. If it was HIV (in the real case it was, I just didn't want to clutter up the case) that spouse will die without treatment. And you think the ethics of a HIPAA law is more important!

Now you are moving the goalposts. Still, we have dealt with HIV disclosure issues before. We report to the State, the State handles partner disclosure. We also encourage the patient to self-disclose before that happens.

See, there is a real answer here and you and a couple of the doctors in this case are ignorant of the law. Reporting to a person they have been exposed to an infectious disease overrides HIPPA. It's called public health exception.

For certain infectious diseases covered by other law, yes. Paramount in any ethical decision on partner disclosure is complying with the law. If the State mandates or specifically allows partner disclosure directly by the doctor, then do it. If the law does not allow it, then don’t.

Once again you are conflating ethics with laws.

Ethics requires following the law.

This has nothing to do with informed consent. And cultural issues are extremely important in medicine.

Sure, but more important is the duty to the patient. The patient has a fundamental right to know their diagnosis and a fundamental right to consent to treatment. You incorporate the cultural concerns by including the family in the discussion and finding out, ultimately, how the patient wants to handle these issues -it’s their choice.

I edited in another example.

I saw that and edited mine. In short, bad medical judgement, not really ethics.

 

[Cabbage]

I wholeheartedly agree; you can’t teach....

...someone who refuses to listen--yes, that is absolutely correct!

You can twist someone's words around to fit your agenda, however--I'll certainly give you that credit.

 

[Cabbage]

But breaking the law is unethical.

You have a very naive and ignorant definition of "unethical". So naive and ignorant, in fact, it's absolutely worthless.

 

[Cabbage]

Ethics requires following the law.....

according to you. Intelligent people, on the other hand, disagree.


Back in Nazi Germany you would have been turning Jews over to the state left and right--To do so would be unethical.

You said so yourself!

And this is why I treat your opinions with utter contempt.

So now you know.

 

[xjx388]

...someone who refuses to listen--yes, that is absolutely correct!



You can twist someone's words around to fit your agenda, however--I'll certainly give you that credit.

When you edit someone’s post it’s polite to point that out.

 

[Skeptic Ginger]

Hell yes, it does.

No it does not. That's idiotic. I don't care if the guy with the STD doesn't want to tell his sex partners. He can't do that.

Now you are moving the goalposts. Still, we have dealt with HIV disclosure issues before. We report to the State, the State handles partner disclosure. We also encourage the patient to self-disclose before that happens.

No one moved any goal post. You don't have enough knowledge to recognize STDs and HIV are treated the same as far as partner notification goes. There are some differences with testing and informed consent but not with post diagnosis requirements to inform partners.

For certain infectious diseases covered by other law, yes. Paramount in any ethical decision on partner disclosure is complying with the law. If the State mandates or specifically allows partner disclosure directly by the doctor, then do it. If the law does not allow it, then don’t.

So you'd let an exposed person go un-notified if the legislators in all their practicing medicine without a license wisdom wrote a flawed law?

Fortunately most medical providers recognize flawed laws and aren't afraid to stand up.

Ethics requires following the law.

Sure, but more important is the duty to the patient. The patient has a fundamental right to know their diagnosis and a fundamental right to consent to treatment. You incorporate the cultural concerns by including the family in the discussion and finding out, ultimately, how the patient wants to handle these issues -it’s their choice.

Here's your problem. You seem to think there are laws with all the little details on how a medical provider should do this or that. There are no such laws. They would be impossible to write.

So guess what? It's up to the provider. We went around on this at the beginning when you tried to tell me what my scope of practice was. In this state nurse practitioners are independent medical providers. It's up to me to know what my scope of practice is. The details are not spelled out in the law.

I saw that and edited mine. In short, bad medical judgement, not really ethics.

You didn't appear to recognize the ethical dilemma in prescribing placebos.

Your posts reflect one who is very poorly informed about the difference between ethics, medical judgement and law.

 

[Skeptic Ginger]

No ethical dilemmas at all, actually, just really bad medical judgement. Should have waited for the translator and gotten it right from the beginning.

Another answer from ignorance. You would have a child who may have eaten toxic tobacco and nicotine wait for a translator before the physician acted?

Ipecac is relatively harmless. Ingested tobacco in a small child is not.

 

[Cabbage]

When you edit someone’s post it’s polite to point that out.

And that's why I called attention to the fact that you edited my post.



No comment about your corrupted view of ethics? Have you decided it is indefensible? LOL!

 

[xjx388]

according to you. Intelligent people, on the other hand, disagree.


Back in Nazi Germany you would have been turning Jews over to the state left and right--To do so would be unethical.

You said so yourself!

And this is why I treat your opinions with utter contempt.

So now you know.

And I treat your opinions with utter amusement. I have to admit, I didn’t think this thread could be Godwinned, but you did it!