The following article talks about a covert investigation of Psychiatric Hospitals in the Netherlands. Undercover observers posed as patients in order to get admitted into hospitals in order to attest to the real conditions of the facilities. Would anything like this study every get funded in the US today? Is it ethically moral to pose as a psychiatric patient? Was the information they were looking for only obtainable by this method?
[Submitted by Caren Steinway]
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I do not beleive the undercover observers were ethically immoral by posing as a psychiatric patient. I have worked in a number of different health care environments and whenever surveys are done about the department or investigators call inquiring the status of certain things in the office - the employees lie. They lie for the securment of their job and to avoid further questions, mostly because they are busy doing whatever their daily workload consists of.
ReplyDeleteBy posing as a phychiatric patient, the observer did not do anything to purposely harm or belittle the psychiatrist in any way, he merely wanted to obtain information that he beleived may not have been completely accurate by asking questions to certain people involved in the practice. As a researcher, the observer has a deontological duty to do his job. A researcher's job is to find out information. If the researcher beleived, as I beleive, that a mere survey or questionnaire would not accurately depict what he was trying to find out, then I beleive that his actions are ethically definsible. He worked in a deontological and utilitarian way to obtain accurate information first hand.
Judging from the fact that many of these types of operations occur in many other fields, I do not see how such an act could be deemed to be unethical. I believe that the undercover observers posing as psychiatric patients is very similar to food testers/critics who pose as citizens when testing food or reporters during the swill milk outrage posing as interested customers. Quality testing is a common part of every field that is done in order to ensure that customers and patients in this case are recieving the best care possible. Committing to such an operation is simply increasing the quality of the service so that there is a greater util contribution from the service. By helping improve the quality of products and services [in this case the treatment of patients], a greater amount of good is done for individuals.
ReplyDeleteFurthermore, I agree with Kristina that lying could be an integral part of certain institutions. It is important to weed out and remove these flaws and problems so that they do not negatively affect others. The most effective way to learn about these flaws that may be hidden from public view is to go undercover and obtain information. Also, As Kristina said, there is no real harm done by the observers actions. S/he is not making the system set up any harder or impeding on vital operations within the facility; that is not what an observer does. In the end, from a utilitarian standpoint, the observers will only increase the good done in the world which is a moral action to do.
Though it can be ethically immoral to pose as a psychiatric patient, in this case, I believe that the people posing as patients were ethically moral. First of all, all of the undercover patients were experienced psychiatric nurses. As psychiatric nurses, these people have the duty to help, and not harm, their patients. Ultimately, this is why the study was conducted. These nurses chose to do to the study to benefit patients at the hospital in the Netherlands, along with other psychiatric facilities, including ones these nurses may work at. It would be ethically wrong for a person to pose as a psychiatric patient if their reason for doing so was NOT to benefit patients at psychiatric facilities.
ReplyDeleteSecondly, the staff at the facility in the Netherlands were all informed that there would be undercover patients at the hospital in the next couple of months. Although the staff did not know exactly who these patients were, they were aware of their presence. Because the staff were informed prior to the undercover patients’ arrival, no ethical problem existed. Regardless of if a patient is an experimental patient, staff at the Netherlands facility should assess and treat every patient in the same ethical manner. Because of past problems at the facility, those that resulted in the death of patients, this experiment was performed solely for altruistic reasons.
Saying that, I do see an ethical issue that could result from this experiment. If individual psychiatric patients were included in the study, it would be unethical to include them without their consent. If the undercover patients spent time around the real patients, the real patients would become subjects to their study, which would then make the research unethical. All subjects in research must give their informed consent prior to a study. This ethical problem may not have existed though, as this experiment was done to assess the inside conditions of the facility, namely those that had to do with the doctors and other professionals on staff.
Though there are other ways of finding out about inside conditions of psychiatric facilities, I believe this was the best way to obtain the information. If researchers were to study the facility for say, a day at a time, the staff could possibly act differently than they usually do for that one day. By having undercover patients admit themselves to the facility, the staff was aware that this would be happening, but because it was over a couple of months, the staff did not deter from the way they regularly performed at the facility.
This is a really intriguing article, Caren. At first glance, I don’t think there is anything implicitly immoral about an undercover operation like this. I think, however, that this type of action could be problematic should it become widespread. Think logistically; how could an operation like this be carried out at psychiatric institutions around the world, let alone in America. Are we just going to have investigators infiltrate every operation? It seems impractical. In this case, there seemed to be good reason (the two deaths) for the secret observation. Again, if there are reports of patient mistreatment at these types of facilities, then detailed observations may be necessary. I just don’t see that having any widespread application.
ReplyDeleteAgain, I do think that this is an ethically defensible action. Wouldn’t it be unjust to allow patients, many of whom are in these institutions involuntarily, to live and receive treatment in a sub par environment? This is certainly a creative technique, and seems to have been used for over a century with a fair amount of success. I just think if America were to adopt this kind of justice for psychiatric institutions, a fair amount of regulation and rules would need to limit the range of such observation. For instance, it could violate doctor/patient confidentiality as the article states.
It is the duty of the health care field to give patients the best care possible. By going undercover, the professionals really uncover possible kinks in the system that can be fixed to create a better psychiatric system as a whole. By doing this, more people in the system will be aided at the expense of lack of consent on the part of those who worked in the Psychiatric Hospitals in the Netherlands, a small price to pay when you think of a bettered psychiatric system for those who are currently in need of psychiatric help in the Netherlands and those to come in the future. It would do the greatest good for the greatest amount of people and utilitariansm as well as the duty to provide the best care by professionals and the researchers would be accpmplished .
ReplyDeleteAs previously stated, surveys are not 100 percent accurate and you can’t get any better research than going undercover. You find the true information that probably for employment reasons might not have been mentioned. Why would someone tell you of problems at their hospital, if they are working there? At the same time, I think the researcher needs to respect the confidentiality of the patient in his research and not contribute to anyones termination and keep their anonymity to their best ability. It should be strictly to better the hospital not worsen a specific professional/ psychiatric career for the individuals the researchers are observing undercover.
In response to the article on the undercover psychiatric patients, I do not feel that what they did was immoral. Although it may not be the most honest way of obtaining information, it may be the only way to obtain accurate information on how psychiatric patients are treated. Had the hospitals known that people would be there evaluating their performances, it is almost guaranteed they would do their best to appear as though they were working their hardest to provide good treatment for the patients. It is the deontological duty of the health care professionals to provide the best environment to treat the psychiatric patients. If they are not doing so, the undercover patients are a good way to evaluate them. Once evaluated, if their performance and hospital conditions are not up to par, then this investigation can do its job to correct them. Thus, a better outcome can be provided for the involuntary patients in the hospital. I stand with it not being an immoral study that perhaps the US could integrate into their funding as well.
ReplyDeleteI do not see an ethical problem with this undercover operation. I believe these types of 'stings' should happen regularly. Clearly this was done in order to benefit the patients as a whole. However it is unethical to lie per say but in this instance I believe this is perfectly justifiable.
ReplyDeleteI think that nobody should have been aware of a sting going on. Although they did not know exactly when it was going to happen, they still knew. Regardless their care should have been practiced as usual under oath, we know that is not always the case.
My grandmother was placed in a nursing home 3 years ago and was abused by a nurse. She didn't want to tell anyone there or us for fear that the nurse would harm her further. She finally told a family member who immediately went to the head of faculty who questioned the nurse. The nurse then went back to my grandmother and said "you're not my friend anymore". Situations like this can be avoided when people go undercover. This is happening all over the world and care if being compromised. By going undercover, we are able to get the real sense of the quality of care. Stings in the medical field are very beneficial and I believe they should be done more often.
I agree with the posts above me that there is not a more accurate way to obtain information than to perform these types of sting operations. The operation was justified by the recent deaths at the facility and more information was needed because surveys and interviews were not enough. Certain care has to be taken when performing these projects because of potential complications, but otherwise these operations are good for investigating facilities. The operation has to ensure that no one is harmed and their intention is for good. The “mystery shoppers” have to be careful to not sustain any psychological damage negatively affect any of the real patients at the facility. While these projects are helpful, they should only be preformed when necessary, like this case, because they do take up valuable resources that could be spent otherwise to help psychiatric wards. These projects also foster distrust between the facility and the patients because a sting was necessary to obtain the information about the quality of care. It would be better if the facility was more transparent in their operation so these kinds of operations are not necessary. More should be done in encouraging lines of open communication between the facility and patients/ families because of the potential risk of the operation and costs. It is not the most efficient way of getting information. If the facility is operating as they should, they shouldn’t have anything to hide. I understand corners might be cut because the nurses and staff are overtaxed, but they should be honest in their duties. If more help is required, they should say so, so that the patients get the best care. Patient care should not be jeopardized because of financial reasons.
ReplyDelete-Lawrence Yu
Though in some circumstances going undercover and posing as a patient could be seen as ethically immoral, I do not think this is one of those situations. First and foremost, the facility was notified that there would be “mystery” people at some point. That alone should be enough information to consider this situation ethically acceptable. However, beyond that, the facility had problems with at least two patient fatalities due to suicide and someone choking on food. This is a red flag that perhaps the patients are not being watched closely enough.
ReplyDeleteSometimes it takes an outsiders perspective to truly understand what changes need to be undergone in order to create a beneficial environment. If the “patients” had not gone in undercover they would not be able to see exactly what the issues were without the doctors and nurses being influenced by a non-patient’s presence.
Though their way of obtaining information could be perceived as sneaky, it was beneficial over all.
I like the idea that is presented in the article, and think it could have a lot to offer professionals. You are getting a review, and usually with that comes criticism, which is why I think that some of the people quoted were against this idea. To that I say, grow up. You are a professional, and should act as such. Not that anyone loves being criticized, but it does provide useful input on how to improve yourself. My only problem with studies conducted in this manner is that it wastes the resources of the organization being reviewed. The article mentions this, and how this individual study prepared for and shortages, but I worry not all studies would be this meticulously planned. I think that to have a study along these lines you must make the same preparations. And while this may not be a huge issue in a psychiatric ward, the article mentioned doing similar studies in hospitals. This is where things become tricky, because the health system in the US is stressed enough as is. And with the amount of current shortcomings of our health system, the question is: how valuable is this review and criticism? And if it is worth the waste of resources, then great, let's get started. But if not, then I would be prepared to cut the program as soon as possible to avoid any wasted time and resources. -Joyce Ganas
ReplyDeleteI see a couple possible ethical issues with the case described, one being if the people who were faking their psychiatric problems were using resourced that other people might desperately need. In the psychiatry field, there are times when patients need to get in to see the doctor right away. Depending on the number of patients that were faking, there could be a serious misallocation of resources.
ReplyDeleteAnother problem that could arise is that once the doctors were told that the patients were faking the diseases, they might be more skeptical in the future. If this type of study was done multiple times, the doctors might just be on the lookout for people with very obvious signs and symptoms. If they were to suspect someone faking, they might feel the need to call them out and say that they don't believe they have a psychiatric problem. It would come down to a matter of their expertise in their field. If an unstable psychiatric patient is called out in the middle of a rough explanation of their problems, it might end up hurting the real patients.
I agree with many above in that this undercover operation is ethical because the motives behind it were to discover the quality of care delivered to patients at the center and ultimately ensure that level of care is acceptable. Also, the institution was aware that there would be "mystery shoppers" posing as patients for a period of time, solidifying the fact that it was not unethical for this investigation to occur.
ReplyDeleteThe process seems not only ethical, but important in order for the institution to improve the level of care they're providing. These undercover psychiatric nurses made note of a variety of minor issues throughout the duration of the stay, both by assessing the care provided firsthand and by "interviewing" fellow patients. In this manner, they can provide feedback to the hospital in order for improvements to be made and the best possible level of care to be delivered to the public.
Starting off, I don't really feel anything like this would ever be funded in the U.S., even though at certain junctions it would probably be a really good idea. As many have stated in class, in America many tend to idolize the physician: we give them the utmost of superiority in regard to decision making in this field. For this reason, I feel that it just wouldn't happen in the U.S., along with the fact that there are so many factors that distract from a topic like this as of now.
ReplyDeleteI also definitely agree with what others have said above with regard to the ethical morality of this case; that it isn't ethically immoral. To answer this I want to state the opposing side's ethical situation: it is likely that they are keeping information, that they are not completely informing others with regard to the hospital. In order to completely understand the situation, it seems that is only plausible to do something like this so we know exactly what is happening. I feel utilitarians would especially support this. In the article it mentions that there had previously been 2 deaths, of which wwere questionable. In order to provide a level of safety to the population, it is necessary to determine the standards that hospital holds itself to, and it seems the only way to do this is to plant moles.
It is very valid to ask if there could be other ways to go about doing this. The team could have come in and surveyed the building. The team could have also gone the route of picking random subjects to produce a long term study to determine the quality of the hospital. All in all though, I still support this route because I feel that this was the only way to be completely informed