Archive for the ‘Medical Ethics Articles’ Category

Clinical hypnotherapists are not alone in this dilemma. In fact, this is a constant problem within the medical profession where instilling hope in a patient has to be weighed against legal advice, which provide warnings regarding any possible risk. Take my father as an example, when he had his second heart bypass surgery, the talented young surgeon dramatically informed him that he had less than a 5% chance of surviving the operation. Even though this bothered my father deeply, luckily the surgery completely succeeded. Away from medicine, we also must consider the negative effects of such communication, installing doubt in a hypnosis subject is even more contrary to nature of our art.

The issue of operator confidence recurs frequently with the students of the various hypnosis-oriented courses that I teach for The International Hypnosis Research Institute. This comes up more so in regards to the brief and rapid methods covered in the Elman Hypnotherapy course as opposed to the permissive techniques attributed to Milton H. Erickson, MD – although the latter often used some very authoritarian interventions. The skills that I instruct require the operator to firmly and rather quickly bypass the subject’s critical faculty (i.e. pattern resistance to change) and install efficient selective thinking. This normally is used to quickly establish a trance state or create a level of analgesia or anesthesia. While the procedures are very well established and have been used for decades, the student too often still has doubts that they can successfully achieve the desired results.

Normally their doubts can be overcome through practice. Although they most certainly will encounter subjects who do not react as planned, very soon they will find that some do. And, once this happens it helps establish increased confidence they tend to get better and better until they find that their successes become more reliable and predictable. Yet, even when they have an infrequent failure, their increased knowledge and experience allows them to rapidly adjust their protocol until progress is made.

An example of this happened to me just this week. The subject was a teenage girl with which I was using a rapid induction technique. A problem arose when her anxiety level resulted in her beginning to uncontrollably giggle. To make matters worse, her mother, who was also in the room, began to laugh as well – even though it appeared that both of them were attempting to suppress their laughter. Well, being a very experienced clinical hypnotherapist I was determined not to be deterred. So, I turned to my knowledge of Erickson’s utilization technique. I actually started connecting the uncontrollable laughter to suggestions so that she find it easier and easier to relax. After just a few minutes the giggling subsided, her breathing slowed, and I began seeing signs that a somnambulistic trance was occurring. Again, had I anything less than full confidence in my abilities and my expectation that a trance state was going to occur, the session would have ended in a disaster.

To build up a high level of confidence in the hypnotherapy student I always recommend that they master a self-hypnosis technique such as glove anesthesia. Furthermore, like Elman I suggest to the student that they practice the technique at least 30 times a day until they become proficient. This is because self-doubt is normally stronger than what an operator may detect in a subject. Once a hypnotherapist can attain this level of hypnotic control over their own body, they typically have an elevated sense of empowerment regarding their skills.

So it comes back to this. A hypnotic operator must approach a session with complete confidence in their abilities and a commitment that the subject will experience the desired outcome. Anything less than that may either directly or indirectly reduce the probability of a success. Just like a golfer who is getting ready to swing but then allows a split second of doubt to enter her mind, a hypnotist’s momentary doubt will most likely result in coming up short of the goal. Yes, there are times that we will fail. However, we must always remember the achievement of the intended outcome is directly related our level of confidence.

Nevertheless, this does not warrant our need to temper our marketing claims in which we may have a tendency to state that we are always 100% successful. Obviously, this will never be true. The Federal Trade Commission is always eager to discipline any clinician who makes such claims. Additionally, attorneys will probably advise that accusations of fraud could easily result. Therefore, rather than stating that our results are always successful, we may want to find other ways to express our confidence without violating ethical common sense. Rather, our level of assuredness can be expressed appropriately when we state that a certain application of hypnosis has been researched and shown to be highly successful. (Of course, this assumes that the clinician can actually back this up with documentation.) This should give a potential subject a high level of confidence in the success of the session. However, this ethical declaration does not stop the practitioner from initiating the procedure with utmost commitment to its success. Then once it is over and the patient has departed, it is time to evaluate the session as to what went well and what needs to change.

The confidence of the hypnotic operator and the subject’s positive expectation should be unquestioned as the session is initiated and progresses. When difficulty arises, hopefully a clinician will have sufficient breadth of knowledge to vary the procedure until success is achieved. This can be done without misleading the client with unsupported claims. Fortunately, there is enough research and case studies to support reasonably positive statements without having to resort to unfounded or even fraudulent claims.

Tim Brunson, PhD

The International Hypnosis Research Institute is a member supported project involving integrative health care specialists from around the world. We provide information and educational resources to clinicians. Dr. Brunson is the author of over 150 self-help and clinical CD’s and MP3’s.

“Made Whole”  Legal Dimensions in Medical Ethics

December 4, 2015

When an ethical dilemma arises in the health care setting, attorneys may be consulted by hospitals, providers, or families. Ethical reasoning is similar to legal reasoning in that both are dependent upon fact-finding followed by the application of abstract principles to concrete situations. The ethical codes governing attorneys and physicians emphasize similar fiduciary duties to clients and patients, our professions, and society at large. As noted attorney William Winslade observed, the aim of both professions is to make people whole.

This three-hour session will begin with an overview of hospital accreditation requirements relating to ethics consultation. Next will be a discussion of current principles and frameworks for ethical reasoning, as well as current recommendations concerning the qualifications of ethics consultants. The balance of the session will comprise case studies from ethically challenging clinical situations. For each topic, relevant ethical principles, standards of care, statutes, and case law will be reviewed.

Rebecca Rae Anderson, J.D., M.S., L.C.G.C., is a Courtesy Associate Professor at the Munroe Meyer Institute at the University of Nebraska Medical Center and an Associate Professor within the Department of Health Promotion, Social & Behavioral Health in the College of Public Health at UNMC. She also serves as Vice Chair of the Department of Health Promotion, Social & Behavioral Health in the College of Public Health at UNMC. Prior to this, she was an Assistant Professor and Courtesy Faculty within the Section of Humanities and Law, Department of Preventative and Societal Medicine in the College of Medicine, UNMC. She was admitted to the Nebraska State Bar and the U.S. District Court Bar in 1978 and became a Licensed Genetic Counselor in Nebraska in 2013. She has served as a reviewer for a number of scholarly journals and has authored many articles and books.
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As morals in medicine are on the decline, it is all the more important to uphold medical ethics in all circumstances. Health care and education are realized as the basic elements to ensure the survival of society into generations ahead. If their principals are not built on strong foundations to withstand the constant chipping away, it is likened to the foolish man who built his hand on sand and was washed away by the floods.

Solid principles in delivering health care services revolve around its code of ethics. Challenges may arise in the form of misuse or abuse of medications, procedures, treatments and other forms related to the field. Staff may be harassed or enticed to look the other way. Banking on the assumption of non involvement translating to innocence, the fact remains that knowledge without action is equivalent to condoning the act.

The role of medical ethics within its world of practice and study deserves due recognition. As such, morals in medicine should be a subject consistently extolled in the corridors and halls, drummed into the minds of health care practitioners of all status and levels. It is not sufficient for the general to be the only party aware of the enemys presence. The troops also need to be equipped to do battle.

As the world is a melting pot of cultures and religions, there is a need to understand the various styles of living so as not to overstep ones boundaries and cause a misunderstanding. A practice of medical service which may be acceptable to a people group may be taboo to another. Some religions do not adhere to blood transfusions. More radical ones may choose to not seek treatment as they believe in healing via means other than the hands of man. Hence, one needs to be sensitive in dealing with such situations as medical ethics dictates the saving of lives.

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Ethics in Science ; Trends in Research Misconduct on The Rise;
Not just an academic issue
• Public health is perhaps most at stake when
medical research is found to be falsified or
fabricated.
• A 2011 article in The Journal of Medical Ethics
reviewed ~200 papers that were retracted due to
questionable data  the published research was
tied to 28,000 patients, 6,573 of whom
received treatment based on the research
presented in the retracted papers (Steen, 2011).
http://ncuraregioni.org/uploads/3/3/6/2/3362892/radg_presentation_final.pdf

JMBE Profiles with Kari Wester is an interview series that highlights the volunteers that comprise the Journal of Microbiology & Biology Education (JMBE) Editorial Board, the authors who contribute their work, and the education innovations that bring them together.

In this third episode of the series, Kari sits down with ASM’s Publishing Ethics Manager, Erika Davies, to discuss the importance of scientific ethics, responsible conduct of research, and trends in research misconduct. Kari and Erika also discuss resources to help educate members and non-members alike about the importance of scientific integrity. The ASM resources mentioned, including JMBE’s Scientific Ethics section and ASM Press’ “Scientific Integrity” (4th Ed.) textbook and “Perspectives on Research Integrity” monograph, can all be found on ASMscience.org. Information regarding image manipulation can be found at asm.org/images/journals/Files/jrn_sample­_images.pdf.

JMBE is ASM’s premier science education publication that provides original, previously unpublished, peer-reviewed articles that foster scholarly teaching and offers readily adoptable resources in biology education. You can read JMBE online for free at ASMscience.org.
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Health Care Reform: Medical Practice and Medical Ethics
Michael Thaler
Tuesdays, 10.am-noon

Revolutionary advances in molecular genetics, organ transplantation, robotics, imaging, and information technologies promise healthier, longer, and more productive lives. But these advances also substantially increase the cost of health care and introduce unprecedented ethical and legal challenges. Address the development of a new biomedical ethics and legal structure to manage care, as well as conflicting demands among traditional humanistic values, modern specialized medical practices, and economic constraints. Examine how the principles of modern bioethics —patient autonomy, beneficence, informed consent, and fairness doctrines — shape and authorize health care in a pluralistic society with aging demographics and growing public health needs. Discussions will be based on actual cases.

Michael Thaler M.D., professor emeritus at UCSF, trained in medicine, pediatrics, and history of health sciences. He has authored more than 200 scientific and clinical articles and is the recipient of prestigious awards for medical research and public service. His areas of interest include application of scientific advances to clinical practice, medical ethics, and future delivery of health care to seniors.

For more information, visit http://olli.berkeley.edu.