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Philip J Candilis

Publications and source records attributed to Philip J Candilis.

10 recordsLinked to original sources
PubMed2006

Commentary: the higher standards of aspirational ethics.

In response to a case presented by Dr. David Menkes, the authors argue for a standard of forensic practice that aspires to more than minimal requirements of ethics and law. Professional ethics for forensic experts require acknowledgment of both the duties and ideals of the profession if they are to meet societal expectations, honor the intent of legal procedure, and overcome jaundiced views of the "hired gun." Common values of transparency, truth-telling, and respect for moral relationships in professional work are suggested for analysis of this case, as are respect for the profession and its historical narrative. In fact, a robust professional ethic that requires broader consideration of personal, professional, and community values finds renewed expression in this ethical analysis.

Ethics, Professional↗
PubMed2005

Willingness of subjects with thought disorder to participate in research.

Greater attention is being focused on the willingness and motivations of potential subjects who are recruited for research protocols. Given the importance of subjects' abilities to choose freely and reason through their decisions about entering psychiatric research, empirical researchers have been developing assessment and education tools that address the potential vulnerabilities of research subjects. In this study subjects' responses and reasons for or against participation were elicited as part of an assessment of their research decision making. Fifty-two persons diagnosed with a thought disorder were asked to consider a hypothetical research study using the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR). Their responses were documented, coded for content, and correlated with demographic characteristics and scores on scales rating psychosis, cognition, and health-related quality of life. Subjects expressed common considerations that have been identified by other psychiatric investigators, as well as by those studying nonpsychiatric protocols. In general, reasons were both appropriate to the study being considered and appropriately linked to common considerations that flowed logically from the study. However, elements of the therapeutic misconception were evident as well. Willingness to participate was correlated with higher MacCAT-CR scores on certain scales, better education, and lower levels of psychosis and cognitive impairment. These findings highlight both the strengths and weaknesses of the decision making of research subjects with thought disorder. Research protections and assessments may consequently be appropriately targeted to specific vulnerabilities. Because of differences in severity of illness, cognition, and reasoning among subjects who decline to participate in research, greater attention to this population appears warranted.

Adult↗
PubMed2005

Emerging empirical evidence on the ethics of schizophrenia research.

Many challenging ethical questions come with the scientific efforts to understand the nature and treatment of schizophrenia. The empirical study of ethical aspects of schizophrenia research has sought to clarify and resolve many of these questions. In this article we provide an overview of the existing data-based literature on schizophrenia research ethics and outline directions for future inquiry. We examine 5 broad categories of inquiry into the ethics of schizophrenia research: (1) Scientific designs (eg, placebo-controlled studies and medication-free intervals, prodromal and high-risk research, and genetics research); (2) informed consent and decision-making capacity, including assessment of decisional abilities, as well as intervention studies; (3) understanding and perceptions of risk and benefit (including the therapeutic misconception); (4) influences on research participation (including voluntarism, altruism, and other motivations); and (5) key participant safeguards, such as protocol review and participant advocates. We discuss how empirical work in each of these areas answers certain questions and raises new ones. Finally, we highlight important gaps in our understanding of ethically relevant aspects of schizophrenia research and offer a specific research agenda for empirical ethics.

Biomedical Research↗
PubMed2005

The new research ethic: will oversight requirements sink forensic research?

The conduct of research with human participants is facing increased scrutiny from government, media, and academic sources. Research oversight is consequently increasing dramatically as education and accreditation movements gain momentum. Institutional review boards themselves are undergoing significant changes in organization and accountability, implementing new tools to monitor investigator compliance. This article describes the causes of recent calls for increased scrutiny, the resultant trends in research oversight, and the general lack of preparation for increased costs in the public sector. These are costs that will be felt acutely in the forensic setting as diminishing state budgets affect hospitals, universities, and correctional institutions.

Clinical Protocols↗
PubMed2005

Commentary: toward a unified theory of personal and professional ethics.

In response to Dr. Ezra Griffith's essay, we support the view that forensic practice cannot be cleanly divided from its ethics foundation in medical and general psychiatric practice. Personal and professional values cannot be separated in formulating a unified theory of ethics for professionalism in forensic practice. We support Dr. Griffith's narrative perspective and offer a delineation of how narratives may be considered in forensic work. We would like readers to focus on both the duties and the moral ideals that ultimately define professional ethics. By honoring personal and professional narratives together, forensic professionals can advocate and reshape a system that devalues non-dominant cultures. They can also recognize more easily the influences that affect their forensic work. This kind of forensic practice, informed by narrative ethics while respecting fundamental principles, can be an essential part of what we aspire to as forensic professionals. As we argued in an earlier work, a robust professionalism for forensic psychiatry cannot ignore our physician background or our diverse personal histories. Dr. Griffith's essay contributes forcefully to the development of such a view.

Attitude of Health Personnel↗
PubMed2004

End-of-life care and mental illness: a model for community psychiatry and beyond.

End-of-life care is often influenced by the stereotyping of patients by age, diagnosis, or cultural identity. Two common stereotypes arise from the presumed incompetence of many patients to contribute to end-of-life decisions, and the fear that the discussions themselves will be de-stabilizing. We present a model for end-of-life discussions that combines competence assessment with healthcare preferences in a psychiatric population that faces identical stereotypes. The model, which draws on clinical research in competence and suicide risk assessment, has important implications for all patients in the community who are marginalized or stereotyped during discussions of end-of-life treatment.

Bioethics↗
PubMed2003

Early intervention in schizophrenia: three frameworks for guiding ethical inquiry.

Psychiatric research is making important strides toward early detection and treatment of schizophrenia. Discovery of genetic markers, identifiable prodromes, and low-risk interventions fuel this vital scientific movement. At the same time, investigators and clinicians are studying the ethical questions that arise whenever the bounds of diagnosis and treatment are evolving rapidly. This ethical analysis generally falls within three dominant frameworks of bioethics: the conceptualization of disease, scientific uncertainty, and risk-factor ethics. These frameworks are explored as potential guides for directing ethical inquiry in early intervention.

Bioethical Issues↗
PubMed1997

Case vignette: unanticipated propinquity.

CASE VIGNETTE: UNANTICIPATED PROPINQUITY. Dr. Marge N. O'Vera has a reputation in the community as a thoughtful, caring, and highly ethical psychotherapist. For more than a year she has been treating Greta Grievance, helping her to cope with emotional and financial insecurities in the aftermath of a highly contentious divorce. During a therapy session, Ms. Grievance tells Dr. O'Vera that she has decided to sue the attorney who represented her during the divorce. Ms. Grievance believes that he did not represent her interests effectively and that she foolishly took his advice in accepting a very inferior settlement. She has retained another attorney who, she tells O'Vera, will soon be calling to request information on the stress of the divorce and Ms. Grievance's continuing need for therapy. Dr. O'Vera will be asked to testify as to the harm caused to her client and resulting treatment expenses. As Ms. Grievance gets up to leave, she tells Dr. O'Vera, "I'm so glad you'll help me teach that awful Tom Tort a lesson." As she hears the name of Attorney Tort for the first time, Dr. O'Vera begins to sweat. Thomas Tort, attorney at law, is also a client of hers. She had no idea that he had been Ms. Grievance's divorce lawyer. She has treated him for recurring major depression over several years and knows that he probably was sufficiently depressed so as to compromise his professional work at the time he represented Ms. Grievance. When she is named as an expert witness for the plaintiff, Attorney Tort will learn that his therapist was also treating Ms. Grievance. At the same time, her duty of confidentiality precludes her informing others that Tort is also her client. What is Dr. O'Vera to do?

Altruism↗