Return to Work for Healthcare Professionals with Substance Use Disorders: Clinical, Legal, and Ethical Challenges

Occupational health providers (OHPs) and other clinicians who assess readiness to work have a difficult task in assessing return to work for healthcare professionals (HCPs) with substance use disorders (SUDs). About 10 to 15 % of HCPs will misuse drugs or alcohol at some time in their career, yet they are often reluctant to seek help. This paper reviews the clinical challenges of assessing SUDs in HCPs, including risk factors, prognosis, and limited evidence base for work restrictions. Furthermore, ethical and legal challenges throughout the return to work process are reviewed for stakeholders such as HCPs with SUDs, OHPs, other providers, employers, and the public at large. Suggestions are made for stakeholders, particularly for OHPs and other providers, who are navigating this complex environment.     

Female street sex workers,sexual violence,and protection strategies

Abstract

This paper reviews empirical findings on physical and sexual violence against female street working sex workers, drawing on the findings from the researcher's own study. Thirty-two female street sex workers were interviewed in a city in the South West of England during 1998. The ethical issues of researching female prostitution are discussed in relation to this specific research project. The main findings from the current literature and this original study highlight the possible connections between childhood sexual abuse, entrance into the sex industry at an early age, and continual experience of violence. This paper explores violence from pimps and clients as well as how the street environment exposes sex workers to risk. Concluding discussion explores the self protection strategies of individual sex workers and the female sex work community as a means of maintaining a survivor identity and not a victim identity.     

Researching the registered: challenges and suggestions for researchers studying sex offender populations

As interest in registered sex offenders proves to be a popular topic among community members, the media, and legislators alike, researchers must continue to examine the experiences of this offender group. Sex offender registration and community notification laws are diverse across states, creating a difficult and confusing environment for registered sex offenders post-conviction. Often, registered sex offenders report experiences with social stigmatization and physical isolation from their communities as a result of their labeled status. This leads them to be distrustful of outsiders; researchers included. This paper examines the experiences of researchers who have conducted three quantitative and qualitative research projects focused on registered sex offenders and life on the registry. In addition to highlighting the challenges in conducting this type of research, this paper provides a discussion of four specific challenges that may occur when gathering data from community sex offender samples, and several recommendations to overcome these challenges.     

Déjà vu: from Furby to Långström and the evaluation of sex offender treatment effectiveness

Abstract

The notion that sex offender treatment does not work fuels public outrage and demands for protective legislation. This paper will respond to a recent meta-analysis reporting major weaknesses in research designs that preclude drawing conclusions about the effectiveness of sex offender treatment. Methodological and ethical challenges exist in the investigation of counselling interventions in general and sex offender treatment specifically, and we argue that the medicalization of psychotherapy research may have inherent flaws. Alternatives to dichotomous recidivism outcomes are proposed, including harm reduction measures and reduction of maladaptive behaviours. Future clinical directions for sex offender treatment are explored, including application of risk-needs-responsivity models, a focus on process as well as content and incorporation of principles of trauma-informed care.     

Using decision science to gain insight into ethical issues: an example involving thresholds in workers' compensation.

Systematically analyzing and comparing the ethical dimensions of policy-decision alternatives is remarkably difficult. The ethical implications of a set of decision alternatives, as well as the ranking of that set, are subject to any number of quantitative and qualitative variables, not the least of which is differing individual interpretation. In spite of this, decision science offers a consistent, transparent framework from which to analyze the ethical components and implications of policy decisions. Workers' Compensation insurance programs are state-governed systems of insurance in which workers, in exchange for giving up the right to sue their employer and their coemployees, receive some compensation if they are injured on the job, without regard as to who was at fault. Importantly, Workers' Compensation does not compensate workers for all losses. Thus, injured workers often sue those who provide goods and services to their employer's production system. Different states set different thresholds relating to who can be brought into such a lawsuit and under what conditions a sued means-of-production entity can, in turn, bring the injured party's employer into the suit as a third-party defendant. Forensic engineers are often involved in such lawsuits to evaluate whether or not a given component of a production system is or is not defective. Using Workers' Compensation as an example, this paper explores the methodology and the difficulty of quantifying the ethical implications of policy decisions by examining the concept of thresholding a policy variable. Thresholding will be defined and the ethical effect on the various parties of varying a policy threshold will be discussed.     

The governance of human genetic research databases in mental health research

The field of mental health offers a valuable context in which to examine new challenges presented by human genetic research databases to the legal, ethical and regulatory frameworks for human genetic research. Longitudinal prospective genetic research of psychiatric disorders often involves access to human genetic research databases and to stored tissue for future uses that cannot be specified at the time the patient consents to their collection. The potential of such research to contribute to an improved understanding and treatment of complex genetic diseases such as schizophrenia presupposes sound ethical, legal and regulatory frameworks to ensure public trust and preparedness to participate in such research. This article provides a brief overview of some of the ethical and legal challenges posed by human genetic research databases and their implications for how genetic research should be conducted in the field of mental health.     

Cultural Criminology and Sex Work: Resisting Regulation through Radical Democracy and Participatory Action Research (PAR)

Taking a feminist cultural criminological analysis to the regulation of sex work in the United Kingdom, this paper argues against the dominant deviancy and the increasingly abolitionist criminal justice model for regulating sex work. The paper begins by offering a critique of the dominant regulatory regimes which have operated since the Victorian era, amended in part in the 1950s with Wolfenden, and currently being reinscribed with the Home Office strategy on prostitution and various pieces of legislation. The focus is specifically upon research with female sex workers and the usefulness of using Participatory Action research methodologies (PAR) with sex workers, agencies, and policy makers in order to foreground the diverse voices and experiences of sex workers, challenge the current focus on abolitionist criminal justice regimes and outcomes, and offer an alternative framework for a cultural materialist analysis of sex work, drawing upon the work of Nancy Fraser.     

Role of Culture and Context: Ethical Issues in Research with Asian Americans and Immigrants in Intimate Violence

Ethical principles are often presented as universal, immutable rules. However, when conducting research with ethnic minority groups, such as Asian Americans and immigrants, ethical issues need to be placed within a sociocultural context as ethical responses are filtered through the specific value orientations and belief systems of the ethnic group under study. Further, when the group is a marginalized population, power dynamics complicate ethical principles of autonomy. The complexities are further accentuated with sensitive topics such as intimate violence or domestic violence. Consequently, ethical questions about autonomy, informed consent, confidentiality, limits to confidentiality, and protecting participants’ safety and reducing distress need to be at the forefront when planning intimate violence research. An overview of sociocultural context of Western biomedical ethics is presented and specific ethical issues that emerge when conducting intimate violence are discussed.     

New Malaise: Bioethics and Human Rights in the Global Era

Recent transnational HIV research projects have raised questions about the ethics of research in developing countries, and with good reason. Lower ethical standards are often applied in these settings, yet the field of bioethics has remained relatively quiet on the subject, concerning itself primarily with issues that only affect affluent countries. Here we call for a new focus on equity and human rights in bioethics.     

Genomic research and incidental findings.

The Human Genome Project showed that there is significant genetic variation within the population. Current research is accumulating large databases that may reveal genetic variations associated with disease or health risks, even if not intended as part of the study design. These incidental findings create legal, ethical, and financial challenges for researchers. Current federal and international guidelines are not adequate. Plans for dealing with incidental findings need to be established in the study design and reviewed and approved by the Institutional Review Board.     

Punishment or therapy? The ethics of sexual offending treatment

Abstract

The claim that sex offender treatment is a form of punishment and as such cannot be covered by traditional ethical codes is a controversial one. It challenges the ethical basis of current practice and compels clinicians to rethink the work they do with sex offenders. In this paper I comment on Bill Glaser's defence of that idea in a challenging and timely paper and David Prescott and Jill Leveson's rejection of his claims. First, I consider briefly the nature of both punishment and treatment and outline Glaser's argument and Prescott and Levenson's rejoinder. I then investigate what a comprehensive argument for either position should look like and finish with a few comments on each paper.     

Client-Inflicted Violence and Coping Strategies Among Sex Workers in China

To date, very little research has focused on violence inflicted by clients on women working in the sex industry in China. This article examines the nature and extent of client-inflicted violence against sex workers in China and analyzes the coping strategies employed by the victims. It argues that violence is an integral part of sex work. Indoor sex workers are subject to more violence and harassment than their outdoor counterparts, mainly on account of the nature of the sex services provided. The article contends that the criminalization of prostitution places women in a vulnerable position and advocates decriminalization of prostitution to promote health and human rights for disadvantaged women in the sex industry.     

The COVID-19 pandemic: some thoughts on integrity in research and communication

Principles of integrity and ethical practice in research have been reinforced and honed over decades. In medical and biomedical fields, they have been shaped by challenges that include endemic, emerging, and re-emerging diseases [1], as well as the scientific responses to each disease as it occurs. These responses include clinical and community prevention trials, vaccine and drug trials for persons with life-threatening diseases, applied and basic research with dangerous microbial agents, and many others. Unexpected fatal pandemics caused by novel agents—for which neither drugs nor vaccines exist— present additional urgent challenges for scientists, defined here to mean biomedical, medical, and public health scientists and practitioners. In addition to conducting research, scientists are also often tasked with communicating research findings, not only to those who make policy decisions, but also to the media and the public.     

Privacy Act of 1974; new system of records--Department of Health and Human Services; Public Health Service. Notification of a new system of records: 09-25-0143

In accordance with the requirements of the Privacy Act, the Public Health Service (PHS) is publishing notice of a proposal to establish a new system of records, 09-25-0143, Biomedical Research: Records of Subjects in Clinical, Epidemiologic and Biometric Studies of the National Institute of Allergy and Infectious Diseases, HHS/NIH/NIAID. We are also proposing routine uses for this system. This system will be used to support (1) epidemiologic, clinical and biometric investigations into the causes, nature (morbidity and mortality), outcome, therapy and cost of infectious, immunologic and related diseases; (2) review and evaluation of the progress of these research projects, and identification and planning for improvements or for additional research. The population and statistical studies supported by this system may be conducted or managed by Institute staff as well as others outside the Institute. This system comprises records maintained in a number of distinct research projects. The number and specific nature of projects will change over time as new ones are started and as work on existing projects is completed.     

Conceptualizing nursing research with offenders: another look at vulnerability

In this article, vulnerability is examined as it applies to the conduct of nursing research with offenders. As a group, offenders present with a multitude of acute and chronic physical and mental health care needs; they are subject to discrimination, stigmatization, and marginalization; and as such, they often experience dual, multiple, or overlapping vulnerabilities. As research participants, they are especially vulnerable to coercion, as a direct consequence of their dependency status within the correctional system. Embracing a research agenda that focuses on offenders as a vulnerable population is fraught with ambiguities not generally encountered in other settings. The ethical conduct of research with vulnerable populations reflects a contemporary research problem that requires ongoing discourse within the nursing community and the health care community at large.     

Reinforcing or Challenging Stigma? The Risks and Benefits of ‘Dignity Talk’ in Sex Work Discourse

The concept of ‘human dignity’ sits at the heart of international human rights law and a growing number of national constitutions and yet its meaning is heavily contested and contingent. I aim to supplement the theoretical literature on dignity by providing an empirical study of how the concept is used in the specific context of legal discourse on sex work. I will analyse jurisprudence in which commercial sex was declared as incompatible with human dignity, focussing on the South African Constitutional Court case of S v Jordan and the Indian Supreme Court case of Budhadev Karmaskar v State of West Bengal. I will consider how these courts conceptualise dignity and argue that their conclusions on the undignified nature of sex work are predicated on particular sexual norms that privilege emotional and relational intimacy. In light of the stigma faced by sex workers I will explore how a discourse, proclaiming sex work as beneath human dignity, may impact on the way that sex workers are perceived and represented culturally, arguing that it reinforces stigma. I will go on to examine how sex workers subvert the notion that commercial sex is undignified, and resist stigma, by campaigning for the right to sell sex with dignity. I will demonstrate that an alternative legal approach to dignity and sex work is possible, where the two are not considered as inherently incompatible, concluding with thoughts on the risks and benefits of using ‘dignity talk’ in activism and campaigns for sex work law reform.     

Big genetic data and its big data protection challenges

The use of various forms of big data have revolutionised scientific research. This includes research in the field of genetics in areas ranging from medical research to anthropology. Developments in this area have inter alia been characterised by the ability to sequence genome wide sequences (GWS) cheaply, the ability to share and combine with other forms of complimentary data and ever more powerful processing techniques that have become possible given tremendous increases in computing power. Given that many if not most of these techniques will make use of personal data it is necessary to take into account data protection law. This article looks at challenges for researchers that will be presented by the EU's General Data Protection Regulation, which will be in effect from May 2018. The very nature of research with big data in general and genetic data in particular means that in many instances compliance will be onerous, whilst in others it may even be difficult to envisage how compliance may be possible. Compliance concerns include issues relating to ‘purpose limitation’, ‘data minimisation’ and ‘storage limitation’. Other requirements, including the need to facilitate data subject rights and potentially conduct a Data Protection Impact Assessment (DPIA) may provide further complications for researchers. Further critical issues to consider include the choice of legal base: whether to opt for what is often seen as the ‘default option’ (i.e. consent) or to process under the so called ‘scientific research exception’. Each presents its own challenges (including the likely need to gain ethical approval) and opportunities that will have to be considered according to the particular context in question.     

Functioning Well in a Dysfunctional System: Recommendations for Clinical Psychologists in Workers’ Compensation Settings

Clinical psychologists working in workers’ compensation (WC) settings face unique and complex professional and ethical challenges. The present paper provides recommendations to clinical psychologists for avoiding the largely unintentional harm to clients and unethical practices that can occur within the realm of WC. Although the psychologists working in WC settings more often than not act in ethical ways grounded in years of academic and professional training, the unique tasks required of psychologists in WC settings (e.g., rating injuries; determinations of causality) and the pressures inherent in the system can potentially lead even the most well-intentioned mental health professionals into unsavory ethical and professional scenarios. The authors examine the (un)witting contributions of psychologists to the current dysfunction in the WC system and provide recommendations for traversing the oft-serpentine terrain of mental health evaluations and treatment in WC settings. Specifically, the authors discuss, among the many possible potential pitfalls, (1) bringing personal bias into the evaluative setting, (2) engaging in unsavory advertising practices, (3) cherry-picking and other missteps in record review, (4) engaging in cursory consenting, (5) failure to engage in evidence-based assessment and report writing, and (6) role challenges.     

Bureaucratic justice: the incarceration of mainland Chinese women working in Hong Kong's sex industry

Since Hong Kong's return to the People's Republic of China (PRC) there has been a significant rise in the number of Chinese visitors to Hong Kong, including women crossing the border to engage in sex work. Sex work itself is not a crime in Hong Kong, but related activities, like soliciting, are prohibited. Sex work is treated as work for immigration purposes, and visitors who engage in work without an employment visa are breaching their conditions of stay. More than 10,000 mainland Chinese women have been arrested, prosecuted, and sentenced in recent years, causing the correctional population to expand beyond capacity. The authors examine the experiences of 58 incarcerated women in their encounters with the Hong Kong criminal justice system and find that women are processed in a highly routinized bureaucratic manner. They consider the purpose served by the largely bureaucratic form of justice that has emerged in response to migrant sex workers in Hong Kong.