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17th February 2020, 01:27 PM | #361 |
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Experts have to earn trust the same as everyone else. And at the end of the day, their opinions have to be scrutable to the lay audiences they are trying to address.
Opinions from experts in a poorly regulated, unsupervised profession probably shouldn't be trusted just because they're experts. You don't necessarily want the opinions of Blackwater veterans, on the topic of destroying the village versus saving the village. Likewise, opinions from experts who break from their profession's regulations or standards probably also shouldn't be trusted just because they're experts. The whole point of regulating and standardizing a profession is to make it more trustworthy. When a professional presents their "expert" opinion, you know it's reliable because it's consistent with the framework of reliability established by their profession. This is the fundamental problem the Yale group faces: They want all the advantages that accrue to a profession that has established its trustworthiness, but also all the advantages of departing from their profession's framework of trustworthiness. |
17th February 2020, 02:33 PM | #362 |
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In the particular case of the experts who are the topic of this thread:
There is no evidence that they have contravened the clinical standards of their profession in a way that would bring their assessment of Donald Trump’s mental health into question. Their expert opinion on Donald Trump’s mental heath was arrived at using the standards of their profession. It is reliable. Their opinions are scrutable to the lay audience they are addressing. They are not practicing in a poorly regulated or unsupervised profession. There is no evidence that they want “advantages”. In what way does their published opinion provide them with advantages? The argument is that they should not publicize their opinions of Trump’s mental health due to a regulation of an organization that they may or may not belong to. This has nothing to do with the validity of their argument. |
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17th February 2020, 03:26 PM | #363 |
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You are quite clearly off base here. There is no standard of practice for distant diagnosis. There is no methodology that has been peer reviewed and adopted by the profession.
What they are doing has exactly one, somewhat equivalent, precedent: Barry Goldwater. An ethical rule was created to prevent a similar debacle. In the 50+ years since then, there has not been any research whatsoever on the reliability of clinical impressions formed from public domain information.
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17th February 2020, 03:27 PM | #364 |
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That's a catch 22 in this case. The professionals who publicly reported their duty to warn couldn't have done that if you and xjx had your way. How are they supposed to address a lay audience if they can't speak up?
"We'd like to warn you about Trump but we can't"?
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And at a minimum you should stop calling an opinion of a professional organization a regulation. It is not a regulation. The Yale report speaks for itself and will stand the test of time. And they've supported their decision not to follow the Goldwater Rule. Something xjx has failed do in supporting the rebuttal other than to stamp his feet and assert, "but but it's a rule!!!" |
17th February 2020, 03:29 PM | #365 |
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17th February 2020, 03:31 PM | #366 |
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17th February 2020, 03:40 PM | #367 |
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Talk about bull ******
xjx has linked directly to the APA's Ethics Committee opinion several times in this thread. Every point you have raised here has been addressed, not by me; but, by the APA. |
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17th February 2020, 03:43 PM | #368 |
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17th February 2020, 03:47 PM | #369 |
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You assert it's nonsense but you don't support your assertions.
Can you cite the evidenced-based standard of practice that they are utilizing to make their professional opinion? Can you rebut this from the ethical opinion of the APA?
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17th February 2020, 04:07 PM | #370 |
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17th February 2020, 04:22 PM | #371 |
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17th February 2020, 04:35 PM | #372 |
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17th February 2020, 04:56 PM | #373 |
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For the most part that simply repeats the rule itself and that they stand by the position.
There is this which clearly notes there are exceptions to diagnosing without a face to face exam:
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That get's back to duty to warn. Other than reiterating they don't believe that should be an exception, it's still two groups of professionals who have a different opinions from each other. None of that addresses a POTUS, or Trump, or the danger of this particular diagnosis, and most importantly, Yale et al haven't used any confidential information acquired in the line of duty so nothing is at issue here except the professional opinion. Since the APA opinion applies to members, an individual professional has the absolute right to use their expertise as they see fit. In the end all you have is a difference of opinion. |
17th February 2020, 05:00 PM | #374 |
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17th February 2020, 07:35 PM | #375 |
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Ok. Thanks for that. When a doctor decides not to be a member of a professional association, they are not bound by the ethics code of that organization. I accept that. There’s no sanction such a doctor could face unless they violate a Medical Board rule or a law. Does this mean that they get to make up their own ethics rules? Is the law and their conscience the only guide? I can’t accept a yes answer to either of those questions. A doctor either acts ethically or they don’t. There has to be some objective standard by which to judge their actions. This idea of idiosyncratic ethics cannot be it. |
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17th February 2020, 07:56 PM | #376 |
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17th February 2020, 08:08 PM | #377 |
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Originally Posted by xjx388
Originally Posted by xjx388
Originally Posted by xjx388
Originally Posted by xjx388
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18th February 2020, 10:21 AM | #378 |
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I agree in the sense that I don't think dogmatism in any endeavor is ever appropriate. I do acknowledge that there are grey areas.
However, even if ethics is not applied dogmatically, there are still ethical guidelines that require consideration and interpretation. You noted that the APA's Ethcs code doesn't apply to nonmembers. Well, ok then: which ethical codes do they use as a guide to their professional judgement? There has to be some overarching, objective and external set of ethics that apply to the profession as a whole. Reading your words, it almost sounds as if you believe ethics is idiosyncratic, subjective and internal. |
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18th February 2020, 11:14 AM | #379 |
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Look, I get it. You don't agree with me and you think I'm way off base. Fine. Consider me informed as such.
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18th February 2020, 11:27 AM | #380 |
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No, that is your subjective opinion that we grant it primacy. That does not make it objective. It's hand-waving the subjectivity away.
I quite literally just told you. They are shared opinions. Idiosyncratic means individual. Ethic codes are not individual. This is what makes people want to make the subject about you. 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? |
18th February 2020, 12:48 PM | #381 |
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Ok, if ethical codes are not objective standards and they don’t have primacy in judging the actions of professionals...what good are they?
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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.
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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. |
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18th February 2020, 06:04 PM | #382 |
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18th February 2020, 06:33 PM | #383 |
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18th February 2020, 06:50 PM | #384 |
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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:
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18th February 2020, 08:16 PM | #385 |
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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. |
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18th February 2020, 08:24 PM | #386 |
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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?
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(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. |
18th February 2020, 08:37 PM | #387 |
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Donald Trump has 'dangerous mental illness' say psychiatry experts at Yale... Pt 3
Well, let’s see:
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18th February 2020, 08:53 PM | #388 |
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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.
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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.
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I edited in another example. |
18th February 2020, 09:02 PM | #389 |
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18th February 2020, 09:09 PM | #390 |
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18th February 2020, 09:20 PM | #391 |
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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.
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18th February 2020, 10:09 PM | #392 |
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They are not the same. But breaking the law is unethical.
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18th February 2020, 10:37 PM | #393 |
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18th February 2020, 10:38 PM | #394 |
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18th February 2020, 10:39 PM | #395 |
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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. |
18th February 2020, 10:55 PM | #396 |
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18th February 2020, 11:03 PM | #397 |
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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.
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Fortunately most medical providers recognize flawed laws and aren't afraid to stand up.
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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.
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Your posts reflect one who is very poorly informed about the difference between ethics, medical judgement and law. |
18th February 2020, 11:10 PM | #398 |
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Originally Posted by xjx
Ipecac is relatively harmless. Ingested tobacco in a small child is not. |
18th February 2020, 11:14 PM | #399 |
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18th February 2020, 11:17 PM | #400 |
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