A proposal for a nonreinstatement rule in unfair labor practice cases involving patient abuse

Nursing home discharges of employees based on patient abuse raise a difficult issue when the motivating factor for the disciplinary action is union activism. A tension is created between the rights of employees to engage in protected concerted activity and the rights of patients to quality care. In 1974, Congress passed the Health Care Institutions Amendments, which granted to non-profit health care workers collective organizing and bargaining rights substantially similar to those which workers in other industries had enjoyed for decades under the National Labor Relations Act. Congress intended to give health care workers only that degree of parity, however, which is compatible with the provision of high quality patient care. The agency charged with enforcing the Act, the National Labor Relations Board (NLRB), has failed to distinguish employee misconduct in industrial settings from patient abuse in health care institutions when fashioning remedies for discriminatorily discharged union activists. The NLRB typically has ordered the reinstatement, with back pay, of the patient abuser as the patient's primary care-giver. This Article suggests that a front pay remedy is more appropriate to these cases because it protects the patient's right to be free from abuse without sacrificing employee unionization rights.     

Do no harm: Technology, ethics and responsibility

The focus of this article is on issues related to personal and collective responsibility in an increasingly complex technological society. A context for discussing questions that relate to the use of technical means and the long-term secondary and tertiary benefits, impacts and consequences is established with respect to ethics and responsibility. It is proposed that there is a basic ethic for professionals in policy making roles in various fields of endeavor such as technology transfer. It is also proposed that there is a larger context within which this ethic must be grounded. The larger context concerns the question of what it means to be truly human. Many thoughtful citizens of the world, including Vaclav Havel, President of Czechoslovakia, and George Ellis, South African Cosmologist, have addressed this question, often when involved in extremely difficult circumstances. They propose that the answer can be found through a search for meaning in the universe and by freeing ourselves from self-centeredness.     

First do no harm: a look at correctional policies and programs today

Objectives

This paper reviews the historical changes in correctional policies and the impact these changes have had on the operations of corrections and correctional programs. Social changes and theoretical perspectives moved corrections away from a focus on rehabilitation to programs characterized by deterrence, incapacitation, and control. Similarly, theoretical criminology encouraged corrections to move away from rehabilitation towards programs designed to provide social opportunities such as employment and housing for offenders. This paper examines whether these changes in policies and programs have been effective in reducing recidivism. The question is: What works in corrections?

Methods

This paper reviews the research examining the impact of correctional policies and programs on the later criminal activities of offenders and delinquents. Research using systematic reviews, meta-analyses, and the Maryland method scores is used to draw conclusions about the effectiveness of various types of programs, management strategies, and policies.

Results

Research demonstrates programs based on deterrence, incapacitation and increased control do not reduce the future criminal activities of offenders and delinquents. Nor have programs targeting social opportunities such as employment and housing been effective in reducing recidivism. The most effective programs target individual-level change in thinking and information processing.

Conclusions

In the search for ways to sanction offenders, U.S. correctional policies and programs using control, deterrence, and incapacitation have harmed individuals and communities. Such programs have not been effective in reducing recidivism. While programs that provide social opportunities for offenders do not necessarily harm offenders neither do they decrease later criminal activities. Effective programs bring about a cognitive transformation in offenders and delinquents. Theorists have begun to develop hypotheses about how and why these transformations are effective. The current emphasis on evidence-based programs, the research evidence on what is effective and the need to reduce the cost of corrections suggest we are on the brink of another paradigm change. Where this will take us is still unclear, but the paradigm will have to address the current problems facing the U.S. correctional systems.     

First, do no harm: the use of covert video surveillance to detect Munchausen Syndrome by Proxy--an unethical means of "preventing" child abuse

Since it was first identified in 1977, Munchausen Syndrome by Proxy has uniquely affected the way in which the medical and legal communities deal with the issue of child abuse. Inherent in the medical response to the disease are issues of suspicion, investigation, identification, confrontation, and, of course, the health of an innocent child. Given the deceptive dynamics of this disease, however, denial and disbelief naturally overshadow every action taken by medical professionals in pursuing these issues. Fortunately, as medical knowledge about the dynamics of the disease continues to develop, medical professionals become more willing and better able to identify the disease and focus their response on the safety of the child. The greatest problem in prosecuting Munchausen Syndrome by Proxy is that judges and juries remain unwilling to accept the reality of the disease. Consequently, in an effort to confirm medical suspicions and quell legal doubts, the medical community has resorted to covert video surveillance of the abuse while it is being perpetrated in the hospital. In this Article, Flannery argues that this response is an unnecessary and unethical, means of preventing Munchausen Syndrome by Proxy and protecting the child. Flannery supports the approach taken by the Family Court of New York in addressing Munchausen Syndrome by Proxy cases. The Family Court of New York recognizes the unique dynamics of this bizarre disorder, and, therefore, considers all cumulative circumstantial evidence in a Munchausen Syndrome by Proxy case, comparing the facts of the subject case to the commonly accepted features of confirmed cases. Part of the circumstantial evidence that should be considered, Flannery argues, is the dissipation of the child's condition upon temporary separation from the alleged perpetrating parent. As is done by the Flannery Court of New York, a res ipsa loquitur standard should then be applied, and an appropriate disposition for the child should be determined. By employing this standard, the court may confirm suspicions of Munchausen Syndrome by Proxy while avoiding the unnecessary harm to the child inherent in the covert video surveillance of Munchausen Syndrome by Proxy.     

Barcelona 2002: law, ethics, and human rights. "I have no watch, but I haven't missed a dose"

Anyone who was fortunate enough to hear Fred Minandi speak in Barcelona must have been moved by what he had to say. Mr Minandi is a person living with HIV/AIDS from Chiradzulu, Malawi, who spoke at Time to Treat: Transforming AIDS Treatment from Right to Reality, a satellite meeting of the XIV International Conference on AIDS held on 7 July 2002, and sponsored by Médecins Sans Frontières (MSF) and the Health Global Access Project. His presentation is a passionate, first-hand account of how antiretroviral therapy has transformed lives, how it has given hope to people, how it has helped to reduce the stigma against AIDS in his community, and how it has contributed to prevention efforts.     

Poisoned social climate, collective responsibility, and the abuse at Abu Ghraib--Or, the establishment of "rule that is lack of rule"

The authors draw upon the experiences of one of the co-authors as an expert witness in sociology for mitigation at three of the courts-martial pertaining to the abuse at Abu Ghraib that were held at Ft. Hood, Texas in the year 2005 (for Javal Davis, Sabrina Harman, and Lynndie England). In addition, this paper is based upon the thousands of pages of affidavits, testimony, and U.S. Government reports concerning Abu Ghraib. These internal government reports, as well as the Levin-McCain report, point to collective responsibility and the responsibility of individuals high in the chain of command for establishing unlawful techniques. We review the shortcomings of a purely psychological approach for understanding the abuse, and turn to Durkheim's original understanding of anomie as a state of social derangement or rule by lack of rule to introduce the ideas of the social origins of and social responsibility for the abuse. We conclude with sociological suggestions for reforming some of the legal, medical, psychiatric, and other professional complicity in the abuse at Abu Ghraib.