I posted this in the COVID thread but it belongs here too.

GZERO World With Ian Bremmer
Preparing for the Pandemic: The Window Is Closing
SEASON 2, EPISODE 38
Pulitzer Prize-winning writer Laurie Garrett talks about mitigating the effect of COVID-19.

This morning.

Garrett said in all their pandemic disease simulations, never did they consider one where the US ignored the outbreak for weeks then addressed it with a confusing and frequently changing plan.

IOW, how do you plan a pandemic simulation when the leader of the free world is mentally ill?

I wonder if Dr Frances will admit he was wrong yet?

NYT letter to the editor: An Eminent Psychiatrist Demurs on Trump’s Mental State IMO Trump's imaginary world goes beyond grandiosity, self-absorption and lack of empathy, crossing the line into mental illness.

It was interesting skimming through part one of this thread.

Maybe I'm reading that wrong, but that just sounds asinine. To me, that means if I reward anyone with, say, $10,000 for whatever issues they have, they are no longer mentally ill, simply because they were rewarded for it. Absurd.

I just realised that this thread was started three years ago.

Where has my life gone?

Also from that letter:
Doc Frances is not a Trump defender. I think his point is that Trump's behavior is a deliberate choice because it gets him what he wants, despite its impact on everyone else. I wonder if the definition of "mental illness" is too broad to be useful in these circumstances; saying someone does something because they are mentally ill in a sense diminishes their responsibility. Frances says his behavior is intentional.

In a CNN interview, Frances said this:
https://thehill.com/homenews/media/4...y-more-million

It was asinine. IMO (of course) in some bizarre attempt to not malign the mentally ill, he thought we we saying all that evil in Trump made him a horrible person but not a mentally ill person. It was some kind of denial (again IMO) that just because a person fit all the criteria for pathologic narcissism didn't mean his narcissism was representative of mental illness.

I think we are well past that now. Crossing from simple grandiosity into full recreating of reality in Trump is evidence of mental illness.

I imagine if asked Dr Frances would double down in self preservation but I wold like to see if that is the case.

Again, what does this mean: "it gets him what he wants"? There are more than a few people whose manipulative behavior is a prominent feature of their mental illness. So if the person is successful at manipulation, that's evidence they aren't mentally ill? I've met a few people with a pathologic paranoid personality disorder that were very convincing. :rolleyes:

Maybe the DSMV should start off the personality disorders with 'must be failing to get through life' for said syndromes to apply.

Frances is not necessarily referring to only monetary rewards. Trump's behavior has been 'rewarded' by getting him the attention he craves, the adulation, the social status, the power, etc. It got him the presidency.

Doesn't change the fact mentally ill people can be successful, that doesn't make them not mentally ill.

Frances made it very clear, he thought if one explained Trump's evil behavior as the result of mental illness, we maligned the real mentally ill.

I agree. I was just addressing Cabbage's post where he, I think, misunderstood what Frances was saying.

I wasn't implying he was referring to only monetary rewards. I was merely illustrating the absurdity of the claim.

His preferred definition does make sense on one level, but is also pretty useless.

Nero demonstrated pretty much all the characteristics of someone with NPD. For example winning every event in the Olympics.

Eventually his behaviour led to his assassination, so at that time, he fitted Dr Frances' criteria for mental illness.

However,one could argue that he hadn't been harmed by his behaviour right up to the time he was deposed.

In which case, we would be in no better a position than the citizens of Rome, in being unable to call Nero mad, until he was deposed.

Similarly, if someone's mental state drives them to take risks - it seems odd to say that they are only mentally ill if the hazard they're risking actually harms them. Hypothetically, someone's mental state could drive them to take part in Russian roulette, say from a sense of invulnerability, and they'd be likely to survive. By Dr Frances' reckoning, they wouldn't meet the definition of mentally ill, unless they lost.

From an earlier part of the thread:

It's annoying to me the news media is reporting on Trump's rosy timeline as if it's a real thing and not a fantasy thing. They do follow with the experts contradicting Trump's fantasy.

I just wish they would call it what it is, a Trump fantasy.

I agree; he has an ethical obligation to inform all his partners. His doctor usually does not.

No they aren’t, at least not from the doctor’s perspective. There are often mandatory partner notification laws in the case of HIV, but not other STDs. In Texas, we can disclose HIV status to the spouse, but we don’t have to; the State can do it as part of the reporting process. We can’t notify spouses for other STDs but we can refer to the State and they can help with partner tracing and notification.
Fortunately most medical providers recognize flawed laws and aren't afraid to stand up.

:rolleyes:

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.


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.[/quote]



Holy ****, man....

I don’t understand what happened with the above post. I only meant to respond to Belz with “Holy ****, man...”

You don't see the problem claiming that last sentence while denying said providers can recognize when 'duty to warn' supercedes the ethical positions you seem to think are inviolable?

This is a straw man.

Yeah, we went round and you apparently forgot the outcome of that.

Are you claiming providers aren't legally required to report certain infectious diseases? Think that's only about data collection, nothing to do with contact tracing? The report form includes the name and contact information for the patient.

Part of pre-test counseling for HIV testing is informing the person they are obligated to inform sexual partners but if they feel unable to do that, the health department will help them including informing partners without naming the infected person. So you are claiming the provider isn't obligated BY LAW to report that HIV to public health with the expectation public health will do contact tracing and informing?

The Ryan White Act requires a patient's HIV status (when known or discovered) be reported to any EMS provider reporting they've been exposed to the person.

HIPAA also has a "public health clause" that allows contagious disease information to be shared with exposed or potentially exposed persons.

Where do you get the idea physicians are exempt from these important public health laws?

:rolleyes:

Understanding ethical dilemmas involves a lot more thought than a position paper and some 'rules'. Its clear you are never going to admit there are always going to be exceptions to rules of ethics.

A duty to warn is one such exception a fair number of psychiatrists and psychologists have taken the position it overrides the rules you keep repeating. They disagree with you. I disagree with you.

What, the post typed itself? :boggled:

is now followed by:



It looks to me like your position on ethics/legality may finally be starting to evolve beyond foolishly naive.

Congratulations on making this big step!

I do have a question. It may be somewhat challenging for you:

Does ethics require following a flawed law?

Not exactly, I figured it out. I actually started writing a response to a post of yours awhile back. Then I asked myself...”Do I really want to go round and round? No, no I don’t; we simply aren’t going to agree.” I’m using Tapatalk so I guess I saved the draft. When I responded to Belz’s post, I must have restored that draft, didn’t pay attention and hit ‘Reply.”

You’ve been the victim of a cruel deception.

Ethics requires adherence to laws, full stop. This whole COVID thing is a great example. Texas State Board of Pharmacy made a rule that that says hydroxychloroquine/azithromycin can only be issued with a written diagnosis consistent with the evidence for their use. Obviously, “having some on hand in case I get COVID,” isn’t such a diagnosis. Should a doctor fudge a script to reflect a bogus diagnosis so that a patient (more likely their family/colleagues) has it on hand in case they get sick? Many doctors are doing this thinking the law is flawed and they should be allowed to. I say bull; a doctor follows the law, regardless of what they think. They work to change the law if they think it’s flawed.

The problem is: who decides a law or rule is flawed? That simply can’t be up to an individual to decide.

The current rules keeping most of us home these days: I say the rule is flawed. Does my saying so make me ethically right?

Disagreement is not a license.

How silly of me. I foolishly give you credit for your position on ethics evolving, and then you demonstrate that position is as naive as it ever was.

"Ethics requires following the law" can never be justified by giving a single example of just one law that it is ethical to follow. To support your claim, you actually need to demonstrate that ethics requires following Every. Single. Law. Otherwise, the claim is merely Ethics requires following some laws. Now having said that:


You’ve been the victim of a cruel deception.

Ethics is independent of laws. Full stop. To demonstrate this, I need only exhibit a single law that it would be unethical to follow. It, of course, is irrelevant where this law comes from; it's existence alone falsifies your claim. I submit that it would have been unethical to follow the anti-Jewish laws in Nazi Germany.

I brought this up before and you accused me of "Godwinning" the thread. Absolute rubbish. As I just explained, it is absolutely relevant to your universal claim that "Ethics requires following the law"--It demonstrates that claim is as foolish as it ever was.

I invite you once again to answer the question in my previous post. And please, try giving it some serious thought for a change.

Come on!!! There's no comeback from this. Can't you at least acknowledge that Cabbage has exposed your contradiction in terms?

Another victim of a mangled post. I tried to explain what happened. That second bit you posted was actually uttered by SkepticGinger. I never said that. There was no contradiction.

Oh, I see that now: You're correct; I attributed to you a quote which actually came from Skeptic Ginger.

In that case, I see that I was wrong when I thought your position on ethics was evolving. Nope. It's still hopelessly naive.

How silly of me for assuming that the doctors under discussion do not live in a society with laws like Nazi Germany but instead live in the good ol’ US of A. Medical ethics requires adhering to the laws.

I do recognize that ethics is a separate thing from the law but they go hand in hand in a medical context. For example: should doctors feel ethically free to perform abortions outside of the law if they disagree with the law? I don’t see how the answer is “yes.” The law comes first; medical ethics covers adherence to legal requirements AND other non-legal issues. Doctors can’t separate the two.

It would be unethical for a doctor to recommend an illegal drug/treatment/diagnostic AND to recommend unproven drugs/treatments/diagnostics, even if those drugs/treatments/diagnostics aren’t illegal. At core, that’s the issue here: advocating for unproven diagnostics -assessing/diagnosing people they’ve never met.

Trump’s response to Covid-19 is a perfect example of what I’m talking about. His advice/action is stupid, dangerous and just plain wrong and whether or not he has a mental illness is immaterial. It’s plain to see on its face. We could have predicted it without a diagnosis/“dangerousness” assessment just by simple observation of him by laypeople. Medicine has no place either practically or scientifically.

You're ignoring the fact that I merely presented that as a counter example: There do exist laws which are unethical to follow, falsifying your original statement.

Yes, I will acknowledge that the set of laws in America corresponds more closely (to my code of ethics, anyway) than would the set of Nazi Germany laws. That doesn't imply, however, that I (or anyone) should ever simply abdicate my own personal judgment of ethics to whatever the law does or does not allow. I'm not prepared to ever abdicate my own judgment that way, and you shouldn't, either.


I think the answer is absolutely yes. If a law outlawing abortion were to be passed in America, I'm not going to suddenly change my mind that abortion is now suddenly unethical. I am strongly pro-choice, and I think it is ethical to allow a woman the right to choose, independent of what the law may say. Please note that I am also OK with a doctor refusing to perform an abortion if it violates his own code of ethics (even if the law permits it).



With respect to your position on Trump's response to Covid-19: I have no issue with any of that. I agree with you there. But obviously not saying all laws are unethical; that's absurd. Of course it's ethical to follow many laws. That simply does not imply that all laws are ethical.

Your counter example is inapplicable to the context in which we are debating. I agree in a general way, but not in specific contexts. Medicine is a context in which ethics are fundamental. Practicing medicine, for better or worse, is a license extended to those who pledge to follow 1) the laws of the State in which they are licensed and 2)the ethical codes of the profession. Doctors do have to abdicate their own judgement to the law and ethics of their profession.

Violating the law puts the doctor and, more importantly, the patient at risk. It would be better for doctors to band together and fight the law -which is possible in a Democracy. Breaking the law is unethical because, in an environment where abortion is illegal, abortions cannot be performed safely. If the procedure goes wrong, the doctor is less likely to send the patient to a hospital for fear of risking her license/jail time, which puts the patient at risk.

Not quite: I never said all laws are ethical. There are flawed laws. I asked the question earlier: If one doctor says the law is flawed, is that then license for the doctor to break the law? Who decides when a law is flawed? I would say that the decision lies with the professional organizations: "We, as a profession, feel the law is flawed; we make an exception in the ethical code so that doctors don't feel obligated to follow that law." This is exactly what happened with the duty to warn -the organizaitons acted before it was made legal in the courts. It can't be up to individual judgement; individuals can easily be wrong.

No, it's not inapplicable. You made a universal statement. Don't whine to me whine I point out how ignorant the statement was.

None of that proves that every medical law is perfectly ethical, and therefore I continue to disagree.

Whether or not violating the law puts anyone at risk really depends on the law. For example, suppose abortion is outlawed tomorrow. A doctor who has the facilities to perform abortion today is not suddenly putting any patient at any unusual risk for using those same facilities to violate the anti-abortion law tomorrow.

You said, "Ethics requires following the law". There were no caveats listed. There were no exceptions noted. The natural interpretation is that this was intended as a universal comment. Sure, I can see a distinction that "Ethics requires following the law" is not the same claim as "All laws are ethical"; indeed, that is why I initially raised my objection: Ethics does not require following unethical laws.

Are you now walking back your claim that "Ethics requires following the law", subject to some restrictions?

The situation in Nazi Germany is wholly inapplicable to the situation in today’s America.
I’m not trying to prove every law is ethical; I’m trying to argue that ethics requires following the law.
The patient is at legal risk. The doctor is at legal risk. If the patient has a complication, they will be less likely to seek care and the doctor will be less likely to send to the hospital because of that risk.

And then you have to think of the sociocultural paradigm in which a society would pass such a law. Obviously there would be widespread opposition to abortion and any doctor doing it would be viewed as a bad doctor. A bunch of bad doctors denigrates the profession. In such a dystopian society, ethics is very different. Again, ethics requires following the law, for a lot of reasons.

In medicine, I can’t think of any exceptions in modern America. You can let me know what you think would be an exception. What’s a current unethical law that you think doctors should not follow?

The Yale doctors felt they had a duty to warn. They were accused of wanting to sell books and taking their position for political reasons.

Now we are in the middle of a crisis that has turned into a disaster needlessly directly as the result of Trump's pathologic narcissism.

Dr Lee and her colleagues were absolutely right to choose a duty to warn over the Goldwater Rule that really isn't applicable. Trump is really ill, unlike Goldwater, the circumstances are not even close.

But it's too late. Not enough people listened.

Dr. Bandy Lee: Trump is spreading a "mental health pandemic" that's making coronavirus worse
So there it is. You can't get any more specific than that. De Lee and colleagues were right. We are on part 3 of this thread and at least one person is still trying to make the case this was not a valid case for overruling an outdated ethics position*. Professionals should have instead followed "the rules" and not their professional judgement.


*Hopefully we are long past the stupidity of claiming Trump's diagnosis still needs an in-person exam.

But it's applicable in pointing out the ignorance of the "Ethics requires following the law" statement.


I noted the difference in my previous post. I'm still unclear on your position, and you haven't been forthcoming: Does ethics require following an unethical law? I've asked that multiple times now. I've yet to get an answer. It's absolutely relevant, you know.



That's circular reasoning, you know--the only risk is getting caught. That's not justification for the law itself, however. There's no unusual medical risk.


I'll give you that. I disagree that it makes the doctor's actions unethical. I claim that makes the law itself unethical.

How is that obvious? The modern GOP seems determined to restrict abortion regardless of the demographics of popular opinion, for example. Not only is this not obvious, it is obviously wrong.



Now you're even getting yourself confused. You led into this sentence saying they "would be viewed as a bad doctor". Now you're claiming they actually are bad doctors and not simply viewed that way.

You're getting even sloppier than usual with your reasoning.



I'll ask again: Does ethics require following unethical laws? Yeah, like I said: Challenging question, I know. So challenging you evidently refuse to answer. :rolleyes:


I'll admit I don't know medical law well enough to give an answer. That does not prohibit me from seeing the naive simplicity of your claim. I've already demonstrated real world laws that it would be a travesty to follow....and you whined that I wasn't being fair. :rolleyes:

There are many, especially in the anti-abortion states.

Ok, then...examples please.

Pretty friggin obvious. Too far off topic. Seems you'd like to change the subject.

Yeah, I’m gonna start a new thread about ethics, the law and medicine soon. Hopefully you will join me there and we can debate that further. I don’t want to change the subject; I just think that angle is worth exploring further.

Gonna be hard to do if you don't recognize some people see anti-abortion laws as unethical. Go ahead, start the thread. I have a dozen examples to start off the conversation.

That discussion is now here:
http://www.internationalskeptics.com...d.php?t=342972

The evidence piles uip:
https://www.washingtonpost.com/opini...ore-dangerous/