New in the Hastings Center Report
Social psychology and industry gifts to physicians, reimbursement for advance planning, quarantine controversy, and more in the May-June 2016 issue.
Implicit Cognition and Gifts: How Does Social Psychology Help Us Think Differently about Medical Practice?
Nicolae Morar and Natalia Washington
This article examines in depth the negative effects of medical industry gifts to physicians and argues that the failure of recent policies addressing gift giving can be traced to a misunderstanding of what psychological mechanisms are most likely to underpin physicians’ biased behavior. The problem with gift giving is largely not a matter of malicious or consciously self-interested behavior, the authors conclude, but of well-intentioned actions on the part of physicians that are nonetheless perniciously infected by the presence of the medical industry. Without fully appreciating the social-psychological mechanisms at play, policy-makers are likely to overlook significant aspects of how gifts influence doctors.
At Law—Medicare and Advance Planning: The Importance of Context
In January, Medicare began reimbursing doctors for time they spend talking with patients about end-of-life care. Many people think the Medicare change is a big deal, but others are not so sure. After all, laws promoting advance care planning have existed for decades, but they have had relatively little impact. And from a broad perspective, advance care planning is a small piece of the puzzle. The effort to improve end-of-life care must take into account the limitations of advance decision-making, as well as the overriding importance of the general standard of care for terminally ill patients.
Nurse Kaci Hickox is among the “Ebola Fighters” honored by Time magazine as its 2014 Person of the Year, having treated Ebola patients in Sierra Leone while volunteering with Médecins Sans Frontieres. When she returned to the United States in October 2014, she was quarantined in New Jersey for three days before returning home to Maine under the terms of a negotiated release. A year later, Hickox filed suit in federal court against Governor Chris Christie and New Jersey health officials, claiming that the quarantine violated her civil rights. Her complaint asserts that New Jersey officials lacked the authority to quarantine her because she did not pose a significant risk of transmission. The lawsuit raises important questions about disease-transmission risk, the inability of science to rule out certain theoretical risks, and the state’s power to quarantine. It also demonstrates that population health depends on respecting individual liberty and using the best available epidemiological data to set public health policy.