You are the one that made the absurd claim that "Ethics requires following the law"; I am merely pointing out the logical implications of it.

Are you now prepared to admit your claim was wrong? If not, my example still holds, and your opinion is deserving of absolute contempt.

Here's a real medical ethical dilemma: in a fit of his obvious madness, Trump eats heaping fistfuls of loose tobacco. He refuses treatment. Should we induce vomiting anyway? On the one hand it would cause a hilariously gross physical reaction that would get a trillion hits on YouTube. On the other hand it would save him from a fatal poisoning. What would be the ethical action there? And would it be bad if I kept handing him more tobacco while we considered the best course of action?

Not that this isn't funny (it is) but on the serious side:

Standard ethics would treat an adult refusing treatment differently than a child.

OTOH, overriding parental choices is like abortion, some would always do it and some would never.

I agree; it’s completely unethical for a person with an STD to fail to inform their partners. Doctors, on the other hand have competing ethical obligations:

1. Their duty to maintain the confidentiality of their patients
2. Their duty to warn third-parties of potential harm.

The first trumps the second except in cases where the threat of harm is particularly severe. In the case of HIV, yes, the doctor should inform a spouse if the patient refuses to. But it shouldn’t be the first thing the doctor does. The doctor should counsel the patient to do it himself, provide resources to help the patient disclose, etc. As a last resort, the doctor should inform the spouse. In Texas, such spousal disclosure is allowed but I don’t think that’s universal.

No they aren’t treated the same, not from the clinician perspective. Yes, we report all STDs to the State. However, we don’t have that spousal exception to confidentiality. Aside from the law, the level of risk and harm between HIV and say, gonorrhea, doesn’t justify breaching the confidentiality of the patient. In those cases, the State’s partner tracing and notification programs take care of that.

So you’d break the law to tell someone their husband has gonorrhea? I don’t think you’d put your license and career at risk.

Most? Are you trying to tell me that most providers break the law on a regular basis? No they don’t.

And let’s bring this back along the lines of the OP. If you were treating a well-known public figure, a womanizer who has HIV, would you Duty to Warn him? Would you make a public statement that he has HIV?

Now c’mon . . . You cannot possibly think that the only limit to what an NP can do is what they themselves think they can do? Scope of practice is actually spelled out quite well in the law. An NP’s scope of practice is limited to the certifications they hold.

I really don’t understand where you get this idea that a license = do whatever you want. That’s not even true for doctors. And to bring this back to ethics: Doctors and all other medical providers have an ethical duty to stay within the limits of their training and experience. It would be a grave disservice to the patient for a Family Med doctor to attempt to treat complex psychiatric cases, for example, unless the doctor is dual certified or has extensive other training and experience in psychiatry.
No. You seem to think those are all separate things. They aren’t; they are all entangled. Ethics, law, evidence-based standards, clinical experience, training . . . Those are all things that inform professional judgement.

I’m going to start a new thread on this because I think it’s an important area. I hope you will join me there so we can continue the judgement/ethics conversation. But for now, let’s try to get back to the topic:

1. Professional judgement is the exercise of applying the training and experience of a professional in accordance with the ethics and standards of their profession.

2. The ethics code is clear about diagnosing public figures the clinician doesn’t know. There is absolutely no gray area about that; the guidance is clear, well-articulated and supported by good arguments.

3. The “duty to warn” ethics exception applies when there is a specific danger to an identifiable person or group of people. There is no specific danger articulable here.

4. There is no evidence-based or consensus-based clinical standard of practice to assess mental illness and/or dangerousness of subjects based solely on public domain information, without an in-person assessment.

Therefore: A professional is not free to exercise their judgement to comment on a public figure’s mental illness or dangerousness they’ve never personally assessed.

You’ve argued that these professionals may not be part of the organizations that enforce ethics codes. That only means they can’t be censured. Do you argue that ethics codes shouldn’t apply to all members of the profession, regardless of membership in any particular organization?

Again apologies for Twitter, but it's the most reliable for places in the EU.

https://twitter.com/TomJChicago/stat...097593345?s=20

His incidents of complete inability to speak are getting more obvious and longer

He doesn't seem to recognize his slurred speech.

I never answered this.

I am required to see to it partners are notified.

There's no superior confidentiality ethics.

Ryan White Act (Federal) covers the providers' duty to directly inform EMS and hospital staff if they've been potentially exposed to something. And it allows said workers to ask the source be tested if a "substantial" exposure occurred. Substantial means there is a possibility of transmitting a bloodborne infection.

In this state public health ordered that extended to good samaritans exposed to the patient when rendering aid.

Re HIPAA: For people unfamiliar with the legalese:
A covered entity includes the provider. It means the law applies to us.

Ryan White Act says I must notify exposed workers and that can be directly. HIPAA says I report to public health so they can inform other people exposed. The provider is not expected to make house calls and do contact tracing.

Then there is the HIV and other STD testing and informed consent that is a state law. In this state you advise the people you are testing that they are required to inform their sexual partners of any positive results and if they are unable to the provider will notify public health who will notify the partners.



I've replied to the rest of your post a dozen times.

Yes NPs (in this state) and MDs are expected to know their own scope of practice. No, it is not prescribed by law other than education and testing requirements. Can you imagine if the law spelled out all the details of medical practice? That's nuts.

The danger has become apparent, hasn't it?

YouTube Video This video is not hosted by the ISF. The ISF can not be held responsible for the suitability or legality of this material. By clicking the link below you agree to view content from an external website.

I AGREE

I admit I'm hoping his condition will get bad enough before November that he will be un-reelectable. Never thought I'd be wishing dementia on someone. It's a twisted world we live in :( .

Of course, who knows if his successor will be just as hostile to democracy and the press.

What danger, exactly?

His paranoid delusions are starting to interfere with managing the coronavirus crisis. He thinks the reaction is a hoax, it's a plot by the Democrats and news media to ruin him, the stock market crash is supposedly based on the news media, like no one understands the shortages of supplies from China and the crashing of the travel industry.

If you don't think that's dangerous, you are in denial.

Of course what you consider dangerous can vary. Some of us think that turning the presidency into a goon show and bringing ridicule on our country, undoing laws that prevent toxic chemicals from killing people, denying the science that suggests we may be unalterably damaging the earth, and so on, might be considered dangerous even if they don't involve a finger on a big red button. Of course opinions on where some lines are drawn can vary widely, but you do not have to blow up the world to be dangerous.

The evidence of basic information-processing deficits keeps piling up:
https://www.washingtonpost.com/polit...vaccine-event/

Why would having a demented President who is interfering in emergency responses be dangerous?

Bloody hell!!

If that is what really happened in that briefing, then its a terrifying situation the USA is in right now... a man at the top who is clueless and incompetent, and no guard rails because he has dismantled them all.

I heard someone taped a circle of cardboard to the top of Trump's head and he spent all day slinking around close to the floor because he thought the ceiling had been lowered.

Wow. I just read at the link.

Holy Hell. Interesting but something scary as well.

Trump is *desperate* to say everything will be hunky dory well before polling day. Virus vanquished, markets roaring. All that matters is appearances, optics. Never the truth. It all comes down to his *own* political (and hence personal) survival with this empathy-devoid vessel. He'd prefer to rule over a ravaged wasteland than altruistically step aside for the betterment of the nation. Even if he could dimly comprehend the concept of selflessness or sacrifice.

So what else is new?

And why would someone so ruled by narcissism that they are driven to undo everything their predecessor did be considered unsuitable for office?

Stopping the CDC program looking for the next Ebola was a dangerous act of petulance.

Doc Lee weighs in:
https://www.salon.com/2020/03/06/yal...-enabling-him/

I just watched Trump CDC news conference.
Now I won't get any sleep tonight....
Might be he most demented one yet.

“Yeah. But, like many people said, we have to be very careful here. If you vaccinate several hundred million people … ”

“You’ve got to make sure it works,” Trump said.

“Works and is safe,” Stoffels said. “Yeah."

“And it doesn’t hurt,” Trump said. “Right.”


Stable genius :covereyes .

From the conference (where he was wearing his red "Keep America Great" hat):
https://www.washingtonpost.com/polit...bbf_story.html

Let's vote. Is that statement true or false?

http://www.internationalskeptics.com...34d0ad5f74.png

Its bollocks as they say here (or in the American south... that's just a bunch o' hooey!)

In the American south....Yeah! We believe that cuz Trump says so! And he doesn't lie!

:image of Hermonie raising hand:

Interesting article from a couple of years ago. The author notes that the definition of "mental illness" is so broad as to be useless. He contends that Trump is deliberately and maliciously evil.
https://slate.com/technology/2017/03...-hes-evil.html

Trump said today:

What alternate reality does he live in?

The one largely manufactured and delivered by Fox.
https://www.nytimes.com/2020/03/11/u...ive-media.html

Trump today: "Relax, we're doing great. It all will pass."
Sounds like he's been watching Hannity.
I expect Hannity to be the next Medal of Freedom recipient.

"They're big white ships with the red cross on the side"

Yes, those are the words of someone who is functioning.

Sure, he's functioning. Like a six-year-old.

Dr. Lee weighs in:
https://www.salon.com/2020/03/23/dr-...navirus-worse/

It should be pretty obvious to anyone who isn't blinded by their devotion to Trump that he doesn't live in reality; he live in Trumplandia where the media is out to get him, doctors can't believe how much he knows about a pandemic virus and that he's 'just a natural', the virus will just 'magically disappear" in April, he's a 'stable genius', etc.

Look at Trump's response to this question:

https://twitter.com/atrupar/status/1242502814640885764

Because the question included the word "perfect" - Trump jumps on that word and goes onto his Ukraine defence, before recovering.

And this word salad, which would rightly get shredded here, barely gets a comment.

What the hell does Erdogan and the Kurds policy have to do with social distancing? Trump is nuts.

This is exactly how I've been describing Trump's actions. Not that it's a good thing, but, this is what I've been saying since this thread started.

To all the naysayers: Told you so!


:eusa_sick:

Bingo.

The whole interview makes sense if you put it in terms of Trump's fantasy world.

Incompetrump is recalling in Trumplandia what great bold actions he took and how he's the greatest POTUS ever.

Most people recognize this magical thinking as "If only I had done X, or I wish I had done X" This is part of the grieving process we use to help us get through a tragedy.

With Trump, the "if only" and "I wish" morphs into the belief he took those actions and the reasons the actions failed... oh wait, they didn't fail. The fantasy goes on into "I took all these great actions, we're doing better than any other country..."

:eusa_sick:

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.