[1018] in Discussion of MIT-community interests
Re: Shin article in Globe: "Parents were last to know"
daemon@ATHENA.MIT.EDU (rax)
Thu Jan 31 11:18:33 2002
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Message-ID: <20020131160300.GF14875@yiff.mit.edu>
Date: Thu, 31 Jan 2002 11:03:00 -0500
From: rax <rax@MIT.EDU>
To: MIT-Talk@MIT.EDU
In-Reply-To: <1012446536.9641.3.camel@press-your-luck>
so, when i first heard about this, i got very very angry.
after reading this article, my first reaction was to continue to be very
very angry. but then i thought about it some, and talked to some people who
were parents, and while i still think that the Shins are wrong to sue MIT,
i do think the article raises some points worth debate, and i have commented
on some of them below.
On Wed, Jan 30, 2002 at 07:08:53PM -0800, Christopher Beland wrote:
> But if the 19-year-old biology major was as determined to conceal her
> self-destructive impulses as MIT contends, why were they so well known
> on the campus? If hers was so hopeless a case of depression, why
> wouldn't Shin's therapists have sought a last-ditch alliance with the
> people who knew her best, her parents?
While the author of the article is making a gross assumption that the people
who knew her best and were most likely to help her were her parents (in some
cases they would be, in some not. i cannot speak for this case at all) it is
not a question not worth asking.
> The aspiring geneticist did not want her parents to know how
> despondent she was in the weeks before she set herself on fire in her
> dorm room on April 10, 2000. But isn't a doctor's first obligation to
> a patient's survival, not her confidentiality?
This is not a trivial argument to counter. I don't know quite how to; i don't
know if i should even be trying. That breaking confidentiality would quite
possibly damage the doctor-patient relationship and stress the patient further
is the best argument i can come up with off the top of my head.
> Dr. Paul R. McHugh thinks so. ''Privacy isn't everything; life is
> everything,'' says the former chairman of the department of psychiatry
> at Johns Hopkins School of Medicine, who was named last week to the
> President's Council on Bioethics. ''We lock people up, we take their
> civil liberties away if they are a danger to themselves. But we can't
> call the parents? What kind of nonsense is that?''
This i don't like as much, because when McHugh says "people" I don't think
he means all people. Would he call the parents of a 30-year-old? I very, very
much doubt this.
> Speaking generally because he is unfamiliar with the details of the
> Shin case, McHugh says he has trouble understanding why any therapist
> would not reach out to a suicidal teenager's parents. ''With a
> suicidal patient, privacy concerns go out the door. You tell her, `I
> need all the help I can get to save you. I insist on calling your
> parents. If you don't like it you can sue me.' At least, then she'd be
> alive to sue.''
Again, "a suicidal teenager's parents." Shin was an adult.
Nevertheless, "then she'd be alive to sue" is a powerful counterargument. If
one assumes that life is always better than death, then what McHugh describes
may very well be the correct moral action, regardless of the age of the
patient.
> Shin, of course, is not alive to sue, so her parents have. In a
> wrongful death lawsuit filed this week, Cho Hyun and Kisuk Shin accuse
> the Massachusetts Institute of Technology of failing to provide the
> mental health care that might have saved the oldest of their three
> children. Like the Scott Krueger case before it, the death of Liz
> Shin could help redefine the relationship between institutions of
> higher learning and the parents who entrust children to their
> care. (Krueger, an MIT freshman, died of alcohol poisoning during an
> initiation rite at an unsupervised fraternity party. The university
> settled a lawsuit by his parents and apologized for the lax housing
> and disciplinary policies that contributed to their son's death.)
This is very disturbing. Parents should not be entrusting children to the care
of any institutions. They should be letting adults go to further their
education and supporting those adults, financially and emotionally, as is
necessary on a case-by-case basis.
Unfortunately, it seems like an increasing number of college students do not
consider themselves adults and do not expect to be treated like adults.
What then? I'm not sure.
> In the Shin case, the standards of psychiatric practice are as much on
> trial as the negligence of the university. How could a student who
> expressed her suicidal intentions as loudly and as often as Shin did
> over the course of a year to faculty members, on-campus therapists,
> and her dorm mates have slipped through the cracks?
>
> Given the severity of the various diagnoses she received - some
> doctors suggested she had a serious borderline personality disorder -
> how could MIT psychiatrists not inform Shin's family of her
> deteriorating condition?
>
> It is disingenuous to argue, as MIT has, that the so-called Buckley
> Amendment, a federal law that safeguards the confidentiality of
> student records, prevented the university from alerting Shin's family
> to her psychiatric crisis. ''If she fell down the stairs and was
> unconscious, wouldn't they call her parents?'' David DeLuca, the
> attorney representing the Shins, sensibly asks.
This best be an opinion column, because if not no one should ever claim that
the Globe engages in any sort of objective journalism. That aside, I don't
think MIT should be faulted for following a law which they accept on faith as
the right way to treat a patient.
Does anyone know whether or not this was an opinion column?
> It is worse to suggest, as MIT also has, that it is not responsible
> because Shin may have come to Cambridge with the mental health issues
> that spiraled into suicide. ''Oh, please,'' says McHugh. ''Students
> come to school with lupus and asthma and the health services deal with
> it.''
Without informing the parents, one assumes.
> Dr. Margo Goldman of Wakefield, chairman of the confidentiality
> committee of the American Psychiatric Association, says it is
> important ''to start with the assumption that what a patient tells you
> is kept in confidence. But when a patient is in danger of harming
> herself, the therapist is obliged first to keep the patient safe.''
>
> Shin was the 10th of 12 suicides at MIT since 1990. You might have
> thought the university would have learned that lesson.
>
> Eileen McNamara can be reached by e-mail at mcnamara@globe.com.
When I've not been up for a long long time, mailing the author and perhaps
the editor might not be an awful idea. I'm interested in what other people
think about this; it's a concerning issue. I think there are some people who,
if they were converned about the confidentiality of MIT mental health
services, would choose not to take advantage of these services even though
the services would benefit them tremenously, and possibly even save their
lives. The article does not address this point, and i feel that this is a
failure on its part.
that said, sleeptime.
rax
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