Judicial Affairs Research Articles

Facts and alternative facts: Ethically responding to offensive comments by patients

Facts and alternative facts: Ethically responding to offensive comments by patients

How Should Organized Medicine Respond to Physician-Assisted Death?

Both proponents and opponents agree that wider access to high-quality palliative care and physician-patient communication about end-of-life options is the right response to the growing patient dema...

How gifting may influence professional behavior

Q: Is it ethical for me as a dentist to accept gifts from patients, marketing companies, or colleagues to whom I refer patients? Dr. Soileau is a periodontist in private practice, New Orleans, LA, and is a member of the American Dental Association Council on Ethics, Bylaws, and Judicial Affairs.

The phenomenon of absenteeism in pre-revolutionary Russia

The author analyses the history of absenteeism in Russia and notes the relationship of modern electoral problems related to low voter turnout, political apathy, and a lack of understanding of the importance of electoral mechanisms by many voters with the historical conditions for the formation of representative institutions. It is noted, on the one hand, the existence of self-government in the peasant community, and on the other, indifference, lack of understanding of the significance of the election of deputies sent to Zemstvo councils. The article deals with the attitude to the elections as a heavy duty was also characteristic of the Petrine era – the election of burgomasters in Moscow, the establishment of a city government for financial and judicial affairs, which was not supported by most cities. A more favourable attitude to the elections was formed only when the deputies were convened in the laid commission under Catherine II. The author also considers the attitude of voters towards elections to bodies that emerged as a result of the Zemstvo reform, and elections to the State Duma of the Russian Empire.

AMA Acts on Treatment of Children at Border, Gun Violence, Pediatric Decision Making

AMA Acts on Treatment of Children at Border, Gun Violence, Pediatric Decision Making

Robinowitz Honored as Long-Time Leader and Mentor in AMA House

Back to table of contents Previous article Next article Professional NewsFull AccessRobinowitz Honored as Long-Time Leader and Mentor in AMA HouseMark MoranMark MoranSearch for more papers by this authorPublished Online:18 Dec 2018https://doi.org/10.1176/appi.pn.2018.12b21AbstractOver the years, Robinowitz has witnessed and helped to shape the evolution of the AMA House into a far more diverse body with a renewed focus on public health concerns, medical education, and physician performance and satisfaction.Carolyn Robinowitz, M.D., a long-time AMA member and immediate past chair of the AMA Section Council on Psychiatry, was honored with a special reception at this year’s Interim Meeting of the AMA House of Delegates at National Harbor outside of Washington, D.C.APA CEO and Medical Director Saul Levin, M.D., M.P.A., presents Carolyn Robinowitz, M.D., with a plaque in recognition of her long service at the AMA that helped elevate the profile of psychiatry in the AMA House of Delegates. Mark MoranRobinowitz is a former APA president, APA senior deputy medical director, and director of APA’s Division of Education. She is also a former dean of the Georgetown University School of Medicine and held leadership positions in many psychiatric organizations. She has been a member of the AMA House of Delegates since 1975, when there were no more than a dozen women in the House, and has held numerous AMA leadership positions, including chair of the AMA’s Council on Science and Public Health.AMA leaders, including AMA President-elect Patrice Harris, M.D., APA leaders, and other members of the psychiatric delegation, hailed her tireless energy and dedication to advancing the interests of psychiatry within the AMA and her mentoring of many psychiatrists who have risen to positions of leadership in the AMA.“Carolyn has been a role model and an example of leadership in organized medicine for all of us,” said Harris.Over the years, Robinowitz has witnessed and helped to shape the evolution of the AMA House into a far more diverse body with a renewed focus on public health concerns, medical education, and physician performance and satisfaction. “This is definitely not your grandfather’s or even father’s organization,” Robinowitz said.At the reception and in comments to Psychiatric News after the meeting, Robinowitz spoke of the enormous success of the AMA Section Council on Psychiatry and the larger psychiatric delegation within the AMA.“I am proud of the successes of psychiatry in the AMA and the House of Medicine,” she said. “Our results have been the culmination of more than a decade of work beginning with a strategic planning process initiated by [past APA President and former section council member] Joe English, M.D., who held us to maintaining a focus on goals and priorities.”The AMA Section Council on Psychiatry is composed of delegates from APA, the American Academy of Child and Adolescent Psychiatry, the American Academy of Psychiatry and the Law, and the American Association of Geriatric Psychiatry. Additionally, there are psychiatrist members of most state delegations to the AMA House.Psychiatrists currently occupy seats and leadership positions on virtually all of the AMA councils. For instance, psychiatrist Jim Sabin, M.D., is chair of the influential Council on Ethical and Judicial Affairs, and psychiatrist Al Herzog, M.D., is chair of the AMA Council on Long-Range Planning and Development. Within the last decade, two psychiatrists have been elected president of the AMA—Jeremy Lazarus, M.D., who was president in 2012-2013, and Harris, whose presidential year will commence next June.“Not only have psychiatrists been elected to major leadership positions, but our delegation and more importantly our issues—especially parity for mental illness and substance use disorders—have been endorsed and promoted by colleagues throughout the House,” Robinowitz said. “We have worked to educate colleagues and to strengthen alliances for the benefit of our profession and the patients whom we serve.“It takes considerable time to build trust and respect at the AMA,” Robinowitz said. “I am so proud that our delegation and the Section Council on Psychiatry have been recognized as an important, trustworthy, and reliable participant.”Current section council chair Jerry Halverson, M.D., echoed those comments. “The AMA House of Delegates is a great model of how psychiatrists can work with other physicians to push common-sense policies that will help improve the lives of our patients and our practices,” he said. “This works at the national level and the state and local levels. One of the most effective ways for a psychiatrist to engage in this type of advocacy is to work with our other colleagues at the national level and the state and local levels by engaging in our state and county medical societies along with our state psychiatric organizations.”After many years practicing psychiatry in the Washington, D.C., area, Robinowitz and her husband, Max Robinowitz, M.D., a pathologist, recently moved to San Francisco to be near children and grandchildren. ■ ISSUES NewArchived

What are the ethical obligations when a colleague has provided suboptimal care?

What are the ethical obligations when a colleague has provided suboptimal care?

Justifiable criticism and its ethical considerations

Justifiable criticism and its ethical considerations

KEWENANGAN PERADILAN MENGADILI TERHADAP SENGKETA AKTA PEJABAT PEMBUAT AKTA TANAH DAN BALIK NAMA PADA SERTIPIKAT BERDASARKAN HIBAH HAK ATAS TANAH YANG CACAT HUKUM

Abstract : The Background of the writing is the result of Palembang District Court No.62/PDT.G/2010/PN PLG juncto High Court verdict Palembang 101/PDT/2011/PT.PLG Number, Object lawsuit is Grant Deed No. 623/2009 dated July 30, 2009 which made before a Land Deed Official TA, SH. The decision of the judges in a lawsuit in state court can not be accepted and the decision of the judge also rejected the appeal in its entirety , a lawsuit can not be accepted because of the competence of courts to sue the Land Deed Officer and Head of the Land Office should at the State Administrative Court is not in Judicial Affairs , while the Grant Deed to cancel Judicial Affairs is the authority for Deed Land Deed Official beschikking not the result of a decision , but based on the wishes of the parties ( Partij acte ) contractual and to cancel the certificate that has been turned over the name of the authority of the State Administrative Court . Legal sanctions for Land Deed Official TA , SH which has made the Deed of Grant No. 623/2009 dated July 30, 2009 which can be legally flawed administrative sanctions and dismissal with no respect from his post by the National Land Agency of the Republic of Indonesia , after a court ruling have permanent legal force . While the legal sanctions for the Head of the Land Office had registered under the name of the Certificate of Property No. 910/24 downstream Village by the Deed of Grant No. 623/2009 which is a legal disability for severe disciplinary offense which is the Head of the Land Office for Civil Servants, the sanction under Article 7 figure 4 Government Regulation No. 53 of 2010 Concerning Civil Service Discipline, demotion level may be lower for 3 (three) years, in order to decrease the transfer of lower level positions, exemption from office, dismissal with respect not by his own request as Employee Civil, and dismissal with no respect as a civil servant. Keywords : the Judicial Authority of judging, registration of transfer of rights of Evidence, Sanctions Law Land Deed Officer and Head of the Land Office

CEJA Report Was Flawed, Including Use of ‘Physician-Assisted Suicide’

Back to table of contents Previous article ViewpointsFull AccessCEJA Report Was Flawed, Including Use of ‘Physician-Assisted Suicide’David Pollack,M.D.David Pollack,Search for more papers by this authorM.D.Published Online:19 Jul 2018https://doi.org/10.1176/appi.pn.2018.7b28AbstractDavid Pollack, M.D., is a professor for public policy in the Department of Psychiatry and Division of Management at the Oregon Health and Science University.In June the AMA House of Delegates voted to send back for revisions the flawed report from the AMA’s Council on Ethical and Judicial Affairs (CEJA) on “physician-assisted suicide” (PAS). The report recommended maintaining the current AMA position that PAS is unethical. The decision to reject the report was in the best interest of patients, families, and physicians.The report’s shortcomings are multiple, including the use of “physician-assisted suicide” as the most acceptable term for this practice. There is a strong association between “suicide” and mental illness, whether conscious or unconscious. This represents significant implicit bias, implying that the former inevitably derives from the latter, which is untrue. In addition, a growing body of evidence clearly distinguishes the characteristics of persons who commit suicide resulting from mental illness from those of terminally ill persons who request aid in dying. These differences include the type and severity of psychological symptoms, degree of despair, reasons for wishing to end one’s life, communicativeness regarding their wishes and fears, degree of personal isolation, openness about the wish and intended method to end one’s life, and the impact on the person’s family or support system following the person’s death. A preferable substitute for PAS is patient-requested physician aid in dying (PRPAD), emphasizing that patients unambiguously initiate the process.Regarding the concern about unintended consequences, there is ample accumulated experience in jurisdictions where PRPAD is legally permitted to establish that the “slippery slope” has not emerged. The safeguards in the legislation or regulations in these jurisdictions have proven to be adequate to prevent any significant inappropriate approval of requests for PRPAD for excluded reasons/criteria. Those who argue otherwise are not looking at the data with an objective understanding of what has happened.In addition, the existence of PRPAD in those states has prompted a much broader discussion of end-of-life issues, more frequent conversations between physicians and patients about their end-of-life goals, appropriate pain management guidelines for terminally ill patients, more awareness of palliative care options, long-term care access and policies, as well as greater attention to quality of care provided to people in the “coda da vita.” This has been the case in Oregon over more than 20 years and is happening in the other jurisdictions in which PRPAD has been allowed.The report failed to address whether, why, or how PRPAD should be allowed in states where such an option for end-of-life care is not permitted. CEJA putatively intended to promote a balanced and objective approach that honors and addresses “the needs of those who are suffering” and focuses on respecting “the intimacy and authenticity” of relationships among patients, families, and trusted physicians. To truly do this, the AMA should not persist in labeling PRPAD as unethical or support the selective prohibition of PRPAD in certain states while it is allowed in others.PRPAD is legal for 20 percent of the residents of this nation. In jurisdictions where it is permitted, the ultimate decision to utilize PRPAD is left up to the patient, family, and treating physician. Universal access to certain reproductive health services is decided law and is available, albeit with varying degrees of local obstruction, in all states. The report acknowledges that there are “irreducible differences in moral perspectives” and that dilemmas over reproductive health and end-of-life services revolve around “substantive, coherent, and reasonably stable values and principles.” Therefore, the same philosophical and ethical principles should apply to PRPAD as to abortion services; otherwise, we will continue to have disparity of access, where some individuals who request PRPAD and meet the eligibility criteria will be denied this end-of-life option.Individuals, families, and treating physicians in all states deserve the same right to end-of-life autonomy and access to PRPAD. The AMA’s intention to honor or be inclusive of these “irreducible differences in moral perspectives” on end-of-life issues requires this action. ■The CEJA report can be accessed here. An opposing point of view on this issue can be accessed here. ISSUES NewArchived

What Is a Good Death?

What Is a Good Death?

How Psychiatry Led Me to Management and Ethics

Back to table of contents Previous article Why I Aspired to Be a PsychiatristFull AccessHow Psychiatry Led Me to Management and EthicsJim Sabin,M.D.Jim Sabin,Search for more papers by this authorM.D.Published Online:30 Mar 2018https://doi.org/10.1176/appi.pn.2018.4a21AbstractJim Sabin, M.D., is a professor in the departments of Psychiatry and Population Medicine at Harvard Medical School. He directs the ethics program at Harvard Pilgrim Health Care and is vice chair of the AMA’s Council on Ethical and Judicial Affairs. He will be receiving a Lifetime Achievement Award from the Massachusetts Psychiatric Society this month.It was easy for me to choose psychiatry when I graduated from medical school in 1964. Medical students saw psychiatry as a way to help individuals, improve the world, and learn about the mind and soul. Fifteen to 20 percent of my graduating class followed that path.Psychoanalysis was at its heyday during my residency, but I wanted to work with a wider range of patients, so I opted for community psychiatry and population health. In 1980, after 10 years of combining private practice, teaching, and part-time work at the not-for-profit Harvard Community Health Plan HMO, I was summoned to the HMO medical director’s office. I’d never met him and wondered if I’d done something wrong.To my surprise, he asked if I’d be interested in being medical director of a new facility we were opening, a general management role that involved overseeing all the medical specialties but also the administrative infrastructure and even the parking garage. I was happily engaged with developing outpatient programs for patients with chronic mental illness, and my first answer was “No, thank you.” But when I asked myself the question “What are the generic characteristics of what you like so much about the work you are doing?,” I realized that they coincided with what the medical director role called for. Outpatient care for patients with schizophrenia, bipolar disorder, substance disorders, and more required (1) dealing with complex problems that (2) required a multidisciplinary approach and (3) working with teams, while (4) being able to tolerate less-than-perfect results. I changed my mind and took the medical director role. Directing a medical center that served a community appealed to my commitment to population health. I found that the human skills I’d developed in psychiatry—especially from group and family therapy—could be adapted to the human leadership requirements of the medical director job. After seven years I still believed in the work I was doing as medical director, but I wanted to go back to patient care and teaching. The HMO had started a small teaching unit. I joined it half time with the other half of my time going to clinical practice.Since college days I’d been interested in philosophy and ethics. I thought an HMO-based teaching unit should address the ethics of caring for patients under a budget—in other words, managed care. In the course of “networking” in the ethics community, I met Norman Daniels, a distinguished philosopher. Norman knew how to apply for grants, and we got support for an international study of the ethics of setting limits, which we wrote up in many articles and a book, Setting Limits Fairly: Learning to Share Resources for Health. In 1999, I was asked to take responsibility for the ethics program at Harvard Pilgrim Health Care, a New England not-for-profit health plan. 1999 was my 60th birthday, and I’d decided I wanted to concentrate on ethics and health policy as long as health and opportunity allowed, so I took on the ethics program role and stopped taking new patient referrals to create the needed time.Since then I’ve developed policy cases for more than 100 meetings of the Ethics Advisory Group of Harvard Pilgrim Health Care. Participants include health plan staff, employers, physicians who practice in the network, consumers, and policy experts. I’m often told “you do a great job facilitating the discussions.” At first, I thought this was simply polite fluff because the role felt very easy, but I eventually realized that I was using listening and facilitating skills I’d developed over decades in psychiatric practice.The incoming president of the AMA gets to nominate one member for the AMA Council on Ethical and Judicial Affairs. In 2012, Jeremy Lazarus, M.D., who shares my passion for ethics, nominated me. I’m now in the sixth year of my seven-year term. Working with physicians from every specialty and region on behalf of the ethics of medicine has been a highlight of my career. It’s what I learned practicing and teaching psychiatry that made this varied career possible! ■“Confronting Trade-Offs in Health Care: Harvard Pilgrim Health Care’s Organizational Ethics Program” can be accessed here. ISSUES NewArchived

Bureaucracy and Judicial Truth in Qing Dynasty Homicide Cases

Bureaucracy and Judicial Truth in Qing Dynasty Homicide Cases Bradly W. Reed (bio) In the past several decades, historians of late imperial Chinese law have moved well beyond previous generations’ reliance on Western-derived conceptual categories and normative standards as benchmarks for analysis and comparison. With archival sources increasingly available, new scholarship has undermined previous assumptions as to the universality of Western social and legal theory by holding such theory against the light of new empirical findings.1 The result has been a quantum leap in our understanding of the complexity and sophistication of the late imperial Chinese legal system. A number of these contemporary scholars have revisited several basic features of the late imperial Chinese judiciary: that it functioned not as an independent organ of government but as an element of the bureaucratic administrative system; that judicial affairs were but one of the many administrative duties for which a county magistrate was held accountable; and that despite the fact that the county magistrate’s yamen served as the court of first instance in all legal cases, magistrates themselves had no specialized training in law other than that gained by field experience or the advisement of private legal secretaries and widely available administrative handbooks. These features were, of course, recognized as well by foreign observers even in the nineteenth century. Current [End Page 67] scholarship, however, has for the most part rid itself of earlier Anglo-American suppositions, such as that the lack of judicial independence inevitably resulted in late imperial Chinese law being arbitrarily applied, despotic in nature, and fundamentally irrational. As Jerome Bourgon has eloquently pointed out, late imperial Chinese principles of legality and legal rules yielded a judicial system that compares favorably with modern Euro-American systems in the extent to which it was rational, predictable, and widely publicized.2 But as yet, we still know surprisingly little of how the bureaucratic elements of the judicial system might have influenced criminal investigation and prosecution during the Qing dynasty (1644–1911). In an earlier study of county yamen clerks and runners, I argued that the informal fees collected by yamen employees in the processing of legal cases served as a critical element of county government financing.3 I also suggested that pecuniary interests and consequent jurisdictional litigation among various offices and divisions of yamen employees might have influenced the judicial process by highlighting specific features of a given case as being more or less relevant than others.4 Here, I want to turn attention to how the bureaucratic concerns of the magistrate himself may have had a similar influence on the statutory classification of offenses and the consequent determination of appropriate punishments. Judicial proceedings were, along with tax collection and bandit suppression, among a magistrate’s most important responsibilities and remained a primary target of periodic review by superior officials. Particularly in serious criminal cases, the gravity of which warranted mandatory review by courts at the prefectural, provincial and central levels, the magistrate’s role was dictated by a large number of regulations and laws covering nearly every step of prosecution (see below). Magistrates were, naturally, regularly enjoined to seek the truth and to exercise due diligence, caution, and moral rectitude in the pursuit of justice.5 Yet at the same time, a chief concern of any career-minded magistrate in regard to legal proceedings had to be the efficient disposal of cases and the avoidance of disciplinary sanction. [End Page 68] This essay engages the bureaucratic aspect of Qing law by examining two similar homicide cases from the middle of the Qianlong emperor’s sixty-year reign (1736–1796), a period during which the Qing judiciary might be said to have functioned as close to intended as it ever did. Both cases are drawn from the collection of Routine Memorials processed by the Board of Punishments (xingke tiben) held by the Number One Historical Archives in Beijing. These memorials were a central component of the mandatory review system referred to above. As such, they include nearly every aspect of a given case: the reporting of a crime, the magistrate’s initial report on preliminary investigation, autopsy and depositions of witnesses, the trial, the magistrate’s findings and...

AMA Goes Beyond ‘Goldwater Rule’ In Ethics Guidelines on Media Interaction

AMA Goes Beyond ‘Goldwater Rule’ In Ethics Guidelines on Media Interaction

How do you handle a colleague who regularly does not inform his or her patients of all needed treatment?

How do you handle a colleague who regularly does not inform his or her patients of all needed treatment?

Ethical practice in Telehealth and Telemedicine.

This article summarizes the report of the American Medical Association's (AMA) Council on Ethical and Judicial Affairs (CEJA) on ethical practice in telehealth and telemedicine. Through its reports and recommendations, CEJA is responsible for maintaining and updating the AMA Code of Medical Ethics(Code). CEJA reports are developed through an iterative process of deliberation with input from multiple stakeholders; report recommendations, once adopted by the AMA House of Delegates, become ethics policy of the AMA and are issued as Opinions in the Code. To provide enduring guidance for the medical profession as a whole, CEJA strives to articulate expectations for conduct that are as independent of specific technologies or models of practice as possible. The present report, developed at the request of the House of Delegates, provides broad guidance for ethical conduct relating to key issues in telehealth/telemedicine. The report and recommendations were debated at meetings of the House in June and November 2015; recommendations were adopted in June 2016 and published as Opinion E-1.2.12, Ethical Practice in Telemedicine, in November 2016. A summary of the key points of the recommendations can be found in Appendix A (online), and the full text of the opinion can be found in Appendix B (online).

AMA Code of Medical Ethics Gets Long-Awaited Update

AMA <i>Code of Medical Ethics</i> Gets Long-Awaited Update

Find ways to show students the relevance of your campus despite competition

Stephanie Krah had no plans to go into higher education enrollment management or student affairs. With an associate degree in cardiovascular technology, a bachelor's degree in exercise science, and a master's degree in public health, going into the health sciences was her immediate plan after graduate school. Krah's plans changed when she was working as a graduate minority assistant at the University of Toledo in the Office of Student Judicial Affairs and Greek Life while preparing to start her Ph.D. in health education.

Report by the American Medical Association’s Council on Ethical and Judicial Affairs on Physicians’ Exercise of Conscience

As practicing clinicians, physicians are expected to uphold the ethical norms of their profession, including fidelity to patients and respect for patients' self-determination. At the same time, as individuals, physicians are moral agents in their own right and, like their patients, are informed by and committed to diverse cultural, religious, and philosophical traditions and beliefs. In some circumstances, the expectation that physicians will put patients' needs and preferences first may be in tension with the need to sustain the sense of moral integrity and continuity that grounds a physician's personal and professional life. This article examines the implications for patients, physicians, and the medical profession when tensions arise between a physician's professional commitments and his or her deeply held personal moral beliefs. It offers guidance on when a physician's professional commitments should outweigh personal beliefs as well as when physicians should have freedom to act according to the dictates of conscience while still protecting patients' interests.

Accommodating Conscientious Objection in Medicine—Private Ideological Convictions Must Not Trump Professional Obligations

The opinion of the American Medical Association (AMA) Council on Ethical and Judicial Affairs (CEJA) on the accommodation of conscientious objectors among medical doctors aims to balance fairly patients' rights of access to care and accommodating doctors' deeply held personal beliefs. Like similar documents, it fails. Patients will not find it persuasive, and neither should they. The lines drawn aim at a reasonable compromise between positions that are not amenable to compromise. They are also largely arbitrary. This article explains why that is the case. The view that conscientious objection accommodation has no place in modern medicine is defended.