Legal and Ethical Guide Padlet by Melva Landrum https://padlet.com/mlandrum11/zxuoorvfjf7i Melva Landrum | Spring Fall B 2020 en-us 2020-03-28 21:14:58 UTC 2020-05-04 17:59:50 UTC hello@padlet.com Slide 1: Professional Perspective, Audience and Topic. mlandrum11 https://padlet.com/mlandrum11/zxuoorvfjf7i/wish/543420691 Currently, I serve as an Assistant Director for Advising and Career Development in undergraduate medical education.  I assist medical students, pursuing doctorates in medicine with advising and career development. The topic of my legal guide is suicide prevention in undergraduate medical education and privacy. The audience for this topic would be faculty, staff and medical school administrators at undergraduate medical institutions.  I chose this topic because of my role and undergraduate medical education, and because according to the American Medical Association (AMA), medical students are three times likely to die from suicide than the general population (Murphy, 2019).  As a profession in student development, understanding the legal and ethical implications of this topic is a high priority.

Citation:
Murphy, B. (2019, June 12). How often do physicians and medical students die from suicide?  American Medical Association (AMA). 


]]> 2020-05-01 03:29:14 UTC https://padlet.com/mlandrum11/zxuoorvfjf7i/wish/543420691 Slide 2: Summary of Topic mlandrum11 https://padlet.com/mlandrum11/zxuoorvfjf7i/wish/543422943 Physician burnout and suicide are topics that have been researched for several years, however, there has not been a lot of emphasis on the specific triggers in undergraduate medical education.  Although there are initiatives that focus on undergraduate education, it is important to identify the unique needs of students who are navigating through the rigorous process of medical school in pursuit of becoming physicians.  This is important in undergraduate medical education because literature indicates that physicians are experiencing burnout, depression and suicide earlier in their careers, many during their residency training (occurs between medical school and becoming fully licensed physicians). Professionals in undergraduate medical education are in a position to play a much more significant role in providing resources and support for this student population who are at a higher risk of suicide.
 
An emerging issue related to suicide prevention and privacy in undergraduate medical education is the increasingly competitive nature of how medical school success is defined.  A medical student’s success is defined by their ability to obtain a residency position, the next step of training required for any medical student to become a physician.  With residency programs becoming more selective in whom they are choosing for training, and the limited number of spots that do not accommodate all medical student graduates, medical students do not feel comfortable taking care of their mental health needs for fear that the perception of needed mental health assistance may reflect negatively on them. This hesitation from medical students mean that faculty and staff need to be better equipped to identify high-risk students and take the proper protocol, while considering privacy laws, to ensure students get the help they need.

Citation:
Grossman, D. (2016, September 27). Reducing the sigma: Faculty speak out about suicide rates among medical students, physicians.  American Medical Association (AMA). 
]]> 2020-05-01 03:33:04 UTC https://padlet.com/mlandrum11/zxuoorvfjf7i/wish/543422943 Slide 3: Professional Association mlandrum11 https://padlet.com/mlandrum11/zxuoorvfjf7i/wish/543424679 The American Association of American Colleges (AAMC) is a professional organization in undergraduate medical education.

This is an informative resource for suicide prevention in undergraduate medical education because it provides a toolkit in the form of a webinar that offers valuable information for professionals in medical education to create a culture of wellness.]]> 2020-05-01 03:35:55 UTC https://padlet.com/mlandrum11/zxuoorvfjf7i/wish/543424679 Slide 5: Current News mlandrum11 https://padlet.com/mlandrum11/zxuoorvfjf7i/wish/543445546
  • A well known university changed their Leave of Absence (LOA) policy to address the needs of students who suffer from mental health.
  • The change was prompted by a class action law suit from a student who suffered from mental health issues, who according to their previous LOA policy was discriminated against, under ADA.
  • This is an important current event, because it will most likely change how higher education will approach not only addressing mental student health, but will also play a significant role in suicide prevention services and resources on campuses.

    Citation:
    Anderson, G. (2019, October 8). Fair leave for mental illness. Inside Higher Education. 
    • ]]>     2020-05-01 04:12:16 UTC https://padlet.com/mlandrum11/zxuoorvfjf7i/wish/543445546     Slide 4: Current News mlandrum11 https://padlet.com/mlandrum11/zxuoorvfjf7i/wish/543455646
  • This recent article focuses on medical student burnout and the correlation to depression and suicide. It discussed the implications of depression and suicidal ideation on medical students' and their ability to take care of patients.
  • The historical nature of undergraduate medical education is self-sacrifice as opposed to self-care, and is often supported by seasoned physicians who have a difficult time relating to the current state of medical student stressors.
  • There are medical schools who are being proactive in identifying stressors in the curriculum, and developing programming and training to help prevent depression and suicide among student doctors.

    • Citation:
    Choi, A.K. (2019, August 29).  Medical education needs to stop burning out students - now.  StatNews
    ]]>     2020-05-01 04:29:45 UTC https://padlet.com/mlandrum11/zxuoorvfjf7i/wish/543455646     Slide 6: Family Educational Rights and Privacy Act (FERPA) mlandrum11 https://padlet.com/mlandrum11/zxuoorvfjf7i/wish/543458152
  • FERPA has a statutory law component and an administrative law component that  applies to educational institutions and student privacy rights. 
  • In an attempt for any educational institution to offer services such as suicide prevention or training to better identify at risk students, FERPA guidelines would need to play a role in how student information is handled, who has access to it, and when it can be released. 
  • In addition to educational records, student health records are also protected under FERPA and consent from the student is needed to release the information.  However, in dealing with suicide prevention, there is some flexibility in the law where student consent isn't needed under specific conditions; one of these conditions is if there is a health concern and or safety emergency.

    • Citations:
    20 U.S.C. § 1232g 
    34 C.F.R. § 99.31(a)(10)  and § 99.36 
    ]]>     2020-05-01 04:33:16 UTC https://padlet.com/mlandrum11/zxuoorvfjf7i/wish/543458152     Slide 7: American Disabilities Act (ADA) mlandrum11 https://padlet.com/mlandrum11/zxuoorvfjf7i/wish/543469482
  • Similar to FERPA, ADA is also statutory law with an administrative law component.  Disability Law protects students from discrimination based on disability status; mental health would also be covered under this law. 
  • For suicide prevention programs, this would be an important law to identify what actions would need to be taken in order to ensure a student will not face any discrimination based on disclosure of their mental health status in order for a suicide prevention program to be effective.
  • However, in order for professionals in higher education to abide by the law, while attempting to properly train administrators in suicide prevention, understanding the "Direct Threat" portion of this law allows appropriate individuals to "take action" or using the assessment of a student's actions to intervene is there is a threat to harm themselves or others.

    • 29 C.F.R. § 1630.2(r)
    ]]>     2020-05-01 04:51:01 UTC https://padlet.com/mlandrum11/zxuoorvfjf7i/wish/543469482     Slide 10: Local Policy mlandrum11 https://padlet.com/mlandrum11/zxuoorvfjf7i/wish/543475891 HSC's Privacy Policy Practices outlines the specific policies related to student privacy and details how student medical information is used.  

    This local policy was selected because it ensures students understand how and when their information will be accessed, who can access it, and what their rights are as it relates to their medical information and privacy.  

    Citation:
    Privacy Policy. UNT Health Science Center, 4 Jan. 2017. Accessed 28 April 2020.]]>     2020-05-01 05:01:33 UTC https://padlet.com/mlandrum11/zxuoorvfjf7i/wish/543475891     Slide 11: Ethical Principle mlandrum11 https://padlet.com/mlandrum11/zxuoorvfjf7i/wish/543478277 In the Council for the Advancement of Standards in Higher Education (CAS), the ethical principle of Non-Malfeasance, which translates as a pledge to do no harm.  Administrators on all levels of higher education have the best intentions, but non-malfeasance relates to the topic of suicide prevention and privacy because educators need to be intentional about their efforts to do no harm through prevention because suicide is too late. 

    Citation:
    Council for the Advancement of Standards in Higher Education. (2019). CAS professional standards for higher education (10th Ed.). Washington, DC.

    ]]>     2020-05-01 05:06:11 UTC https://padlet.com/mlandrum11/zxuoorvfjf7i/wish/543478277     Slide 13 (Part Two): Recommendations and Best Practices for Compliance mlandrum11 https://padlet.com/mlandrum11/zxuoorvfjf7i/wish/543478889
  • Collaborate with suicide prevention specialist to gain knowledge in recognizing the signs of depression, suicidal ideation, and other behvaiors such as imposter syndrome.
  • Include the university's legal counsel in protocol, when administrators need to assess taking action against a student, where it may infringe upon privacy  and discrimination laws (as a reaction to a perceived threat from mental health and/or suicide prevention).
  • Create a local school policy that is accessible to faculty, staff, and students that will help them understand their rights to privacy as well as how the university may use information related to health.
  • Ensure that there is a centralized place both online or electronically, and through the compliance office that is updated annually.
  • Find ways to shape programming around suicide prevention that aligns with the CAS ethical principles to ensure continuous improvement and progression in the application of mental health awareness and suicide prevention.
    • ]]>     2020-05-01 05:07:32 UTC https://padlet.com/mlandrum11/zxuoorvfjf7i/wish/543478889     Slide 8: Texas Senate Bill 1624 mlandrum11 https://padlet.com/mlandrum11/zxuoorvfjf7i/wish/543479412
  • This section of the Texas Education Code is a state law that was passed in TX to ensure that students entering an academic teaching institution must receive information related to mental health and suicide prevention.
  • This would support the justification for suicide prevention and focus on undergraduate medical education.  
  • The law specifies   to include students in professional degree programs, which would also cover the needs of students in medical education.

    • Citation:
    Tex. Educ. Code § 51.9194
    ]]>     2020-05-01 05:08:37 UTC https://padlet.com/mlandrum11/zxuoorvfjf7i/wish/543479412     Slide 12: Non-Source Law mlandrum11 https://padlet.com/mlandrum11/zxuoorvfjf7i/wish/543479477 Higher education institutions in Texas are abiding by the law in providing information to all students about suicide prevention and mental health as required by TX Senate Bill 1624.  The site below outlines the Suicide Prevention Program in undergraduate medical education (HSC of Fort Worth).

    Citation:
    Suicide Prevention Program.  UNT Health Science Center, 31 March 2020. Accessed 30 April 2020.]]>     2020-05-01 05:08:47 UTC https://padlet.com/mlandrum11/zxuoorvfjf7i/wish/543479477     Slide 9: Nguyen v. MIT mlandrum11 https://padlet.com/mlandrum11/zxuoorvfjf7i/wish/543480903
  • A case that is important to reference when it comes to interpretation of the law as it relates to the "duty" university administrators to protect students from suicide is one that was argues this case.  
  • Nguyen was a 25 year student in graduate studies at the Massachusetts Institute of Technology when he died by suicide after a difficult conversation with a professor. 
  • The student had a documented history by the school of mental health issues, and had attempted suicide.  The Nguyen family felt that the institution did not to enough, with the information they had, to protect the student from themselves.
  • This case is also relevant to privacy issues related to suicide prevention, because the student asked repeatedly not to disclose his mental health background (suicide attempts) in an effort to keep his academics separate from his mental health obstacles.
  • The "special relationship" in legal liability is also references this this case.

    • Citation:
    Nguyen v. MIT, No. SJC-12329, 2018 Mass. LEXIS 249, *19 (Mass. May 7, 2018)

    Pepper Hamilton LLP. (2018, May 15). Dissecting the massachusetts ruling recognizing a duty for higher education institutions to prevent student suicide. JD Supra Legal News.
    ]]>     2020-05-01 05:11:22 UTC https://padlet.com/mlandrum11/zxuoorvfjf7i/wish/543480903     Slide 13 (Part One): Recommendations and Best Practices for Compliance mlandrum11 https://padlet.com/mlandrum11/zxuoorvfjf7i/wish/545062674
  • Complete a needs-assessment at your institution to pinpoint stressors for the student population.
  • Implement an action plan for stressors caused by the campus culture or curriculum, or other factors related to the student process.
  • Create a document or guide that outlines details related to FERPA, and in particular the areas that govern consent to release information and when consent isn't needed.
  • Create a document or guide that outlines details related to ADA and in particular, direct threat options in navigating perceived or potential harm that a student may cause themselves.
  • Target and compile a list of medical school administrators who are integral in student development, and schedule training to inform them of the stressors and needs of their students.  Include case studies to discuss duty to protect, and defining the "special relationship" universities have with students.
    • ]]>     2020-05-02 01:39:03 UTC https://padlet.com/mlandrum11/zxuoorvfjf7i/wish/545062674