Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, philosophy and health care

Tuesday, March 20, 2018

Why Partisanship Is Such a Worthy Foe of Objective Truth

Charlotte Hu
Discover Magazine
Originally published February 20, 2018

Here is an excerpt:

Take, for example, an experiment that demonstrated party affiliation affected people’s perception of a protest video. When participants felt the video depicted liberally minded protesters, Republicans were more in favor of police intervention than Democrats. The opposite emerged when participants thought the video showed a conservative protest. The visual information was identical, but people drew vastly different conclusions that were shaded by their political group affiliation.

“People are more likely to behave in and experience emotions in ways that are congruent with the activated social identity,” says Bavel. In other words, people will go along with the group, even if the ideas oppose their own ideologies—belonging may have more value than facts.

The situation is extenuated by social media, which creates echo chambers on both the left and the right. In these concentric social networks, the same news articles are circulated, validating the beliefs of the group and strengthening their identity association with the group.

The article is here.

The Psychology of Clinical Decision Making: Implications for Medication Use

Jerry Avorn
February 22, 2018
N Engl J Med 2018; 378:689-691

Here is an excerpt:

The key problem is medicine’s ongoing assumption that clinicians and patients are, in general, rational decision makers. In reality, we are all influenced by seemingly irrational preferences in making choices about reward, risk, time, and trade-offs that are quite different from what would be predicted by bloodless, if precise, quantitative calculations. Although we physicians sometimes resist the syllogism, if all humans are prone to irrational decision making, and all clinicians are human, then these insights must have important implications for patient care and health policy. There have been some isolated innovative applications of that understanding in medicine, but despite a growing number of publications about the psychology of decision making, most medical care — at the bedside and the systems level — is still based on a “rational actor” understanding of how we make decisions.

The choices we make about prescription drugs provide one example of how much further medicine could go in taking advantage of a more nuanced understanding of decision making under conditions of uncertainty — a description that could define the profession itself. We persist in assuming that clinicians can obtain comprehensive information about the comparative worth (clinical as well as economic) of alternative drug choices for a given condition, assimilate and evaluate all the findings, and synthesize them to make the best drug choices for our patients. Leaving aside the access problem — the necessary comparative effectiveness research often doesn’t exist — actual drug-utilization data make it clear that real-world prescribing choices are in fact based heavily on various “irrational” biases, many of which have been described by behavioral economists and other decision theorists.

The article is here.

Monday, March 19, 2018

‘The New Paradigm,’ Conscience and the Death of Catholic Morality

E. Christian Brugger
National Catholic Register
Originally published February 23, 2-18

Vatican Secretary of State Cardinal Pietro Parolin, in a recent interview with Vatican News, contends the controversial reasoning expressed in the apostolic exhortation Amoris Laetitia (The Joy of Love) represents a “paradigm shift” in the Church’s reasoning, a “new approach,” arising from a “new spirit,” which the Church needs to carry out “the process of applying the directives of Amoris Laetitia.”

His reference to a “new paradigm” is murky. But its meaning is not. Among other things, he is referring to a new account of conscience that exalts the subjectivity of the process of decision-making to a degree that relativizes the objectivity of the moral law. To understand this account, we might first look at a favored maxim of Pope Francis: “Reality is greater than ideas.”

It admits no single-dimensional interpretation, which is no doubt why it’s attractive to the “Pope of Paradoxes.” But in one area, the arena of doctrine and praxis, a clear meaning has emerged. Dogma and doctrine constitute ideas, while praxis (i.e., the concrete lived experience of people) is reality: “Ideas — conceptual elaborations — are at the service of … praxis” (Evangelii Gaudium, 232).

In relation to the controversy stirred by Amoris Laetitia, “ideas” is interpreted to mean Church doctrine on thorny moral issues such as, but not only, Communion for the divorced and civilly remarried, and “reality” is interpreted to mean the concrete circumstances and decision-making of ordinary Catholics.

The article is here.

#MeToo in Medicine: Waiting for the Reckoning

Elizabeth Chuck
NBC News
Originally posted February 21, 2018

Here is an excerpt:

Health care organizations make clear that they do not condone inappropriate behavior. The American Medical Association calls workplace sexual harassment unethical and specifically states in its Code of Medical Ethics that “Sexual relationships between medical supervisors and trainees are not acceptable, even if consensual.”

Westchester Medical Center Health Network, where Jenkins says she was sexually harassed as a resident, maintains that it has never tolerated workplace harassment. In a statement to NBC News, it said that the surgeon in question "has not worked at Westchester Medical Center for years and we have no record of a report."

"Our policies on harassment are strict, clear and presented to all employees consistently," it said.

"Mechanisms have been and continue to be in place to enable confidential reporting and allegations involving staff are investigated swiftly and thoroughly. Disciplinary actions are taken, as appropriate, after internal review," the statement said, adding that Westchester Medical Center's policies were "continuously examined and enhanced" and that reporting sexual harassment was encouraged through its confidential 24-hour hotline.

More than a hotline is needed, said many females in medicine, who want to see an overhaul of their entire profession — with men made aware of what's unacceptable and women looking out for one another and supporting each other.

The article is here.

Sunday, March 18, 2018

Machine Theory of Mind

Neil C. Rabinowitz, F. Perbet, H. F. Song, C. Zhang, S.M. Ali Eslami, M. Botvinick
Artificial Intelligence
Submitted February 2018


Theory of mind (ToM; Premack & Woodruff, 1978) broadly refers to humans' ability to represent the mental states of others, including their desires, beliefs, and intentions. We propose to train a machine to build such models too. We design a Theory of Mind neural network -- a ToMnet -- which uses meta-learning to build models of the agents it encounters, from observations of their behaviour alone. Through this process, it acquires a strong prior model for agents' behaviour, as well as the ability to bootstrap to richer predictions about agents' characteristics and mental states using only a small number of behavioural observations. We apply the ToMnet to agents behaving in simple gridworld environments, showing that it learns to model random, algorithmic, and deep reinforcement learning agents from varied populations, and that it passes classic ToM tasks such as the "Sally-Anne" test (Wimmer & Perner, 1983; Baron-Cohen et al., 1985) of recognising that others can hold false beliefs about the world. We argue that this system -- which autonomously learns how to model other agents in its world -- is an important step forward for developing multi-agent AI systems, for building intermediating technology for machine-human interaction, and for advancing the progress on interpretable AI.

The research is here.

Saturday, March 17, 2018

The Revised Declaration of Geneva

Ramin Walter Parsa-Parsi
JAMA. 2017;318(20):1971-1972.

Here is an excerpt:

The most notable difference between the Declaration of Geneva and other key ethical documents, such as the WMA’s Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects and the Declaration of Taipei on Ethical Considerations Regarding Health Databases and Biobanks, was determined to be the lack of overt recognition of patient autonomy, despite references to the physician’s obligation to exercise respect, beneficence, and medical confidentiality toward his or her patient(s). To address this difference, the workgroup, informed by other WMA members, ethical advisors, and other experts, recommended adding the following clause: “I WILL RESPECT the autonomy and dignity of my patient.” In addition, to highlight the importance of patient self-determination as one of the key cornerstones of medical ethics, the workgroup also recommended shifting all new and existing paragraphs focused on patients’ rights to the beginning of the document, followed by clauses relating to other professional obligations.

To more explicitly invoke the standards of ethical and professional conduct expected of physicians by their patients and peers, the clause “I WILL PRACTISE my profession with conscience and dignity” was augmented to include the wording “and in accordance with good medical practice.”

The article and the Declaration can be found here.

Friday, March 16, 2018

Ethics watchdog files complaint alleging Trump lawyer's payment to Stormy Daniels violates law

Javier David
Originally published March 11, 2018

A $130,000 payment made by President Donald Trump's attorney to an adult film star should be probed as a financial obligation that the president "knowingly and willfully" failed to report, a watchdog has argued.

In a legal complaint filed late last week with the Department of Justice and the Office of Government Ethics, the Citizens for Responsibility and Ethics in Washington (CREW) argued that Trump lawyer Michael Cohen's payment to Stormy Daniels "constituted a loan to President Trump that he should have reported as a liability on his public financial disclosure."

The filing raised the question of whether, as a general election candidate, Trump deliberately failed to disclose it.

CREW's argument has been raised with increasing regularity by some legal experts, who say Cohen's surreptitious payment could be viewed as an illicit campaign contribution. The attorney disclosed recently that he used a home equity loan to arrange a payment to Daniels, buying her silence for an alleged affair she had with Trump more than a decade ago.

In CREW's judgement, Trump "seemingly violated a federal law by failing to disclose it" on his campaign filings. Experts have said that had Trump paid Daniels with his own money, the payment wouldn't be an issue since candidates can contribute to their own campaigns. Yet since a disclosure wasn't made, there could be a violation.

The information is here.

How Russia Hacked the American Mind

Maya Kosoff
Vanity Fair
Originally posted February 19, 2018

Here is an excerpt:

Social media certainly facilitated the Russian campaign. As part of Facebook’s charm offensive, Zuckerberg has since offered tangible fixes, including a plan to verify election advertisements and an effort to emphasize friends, family, and Groups. But Americans’ lack of news literacy transcends Facebook, and was created in part by the Internet itself. As news has shifted from print and television outlets to digital versions of those same outlets to information shared on social-media platforms (still the primary source of news for an overwhelming majority of Americans) audiences failed to keep pace; they never learned to vet the news they consume online.

It’s also a problem we’ve created ourselves. As we’ve become increasingly polarized, news outlets have correspondingly adjusted to cater to our tastes, resulting in a media landscape that’s split into separate, non-overlapping universes of conflicting facts—a world in which Fox News and CNN spout theories about the school shooting in Parkland, Florida, that are diametrically opposed. It was this atmosphere that made the U.S. fertile ground for foreign manipulation. As political scientists Jay J. Van Bavel and Andrea Pereira noted in a recent paper, “Partisanship can even alter memory, implicit evaluation, and even perceptual judgment,” fueling an “human attraction to fake and untrustworthy news” that “poses a serious problem for healthy democratic functioning.”

The article is here.

Thursday, March 15, 2018

Apple’s Move to Share Health Care Records Is a Game-Changer

Aneesh Chopra and Safiq Rab
Originally posted February 19, 2018

Here is an excerpt:

Naysayers point out the fact that Apple is currently displaying only a sliver of a consumer’s entire electronic health record. That is true, but it's largely on account of the limited information available via the open API standard. As with all standards efforts, the FHIR API will add more content, like scheduling slots and clinical notes, over time. Some of that work will be motivated by proposed federal government voluntary framework to expand the types of data that must be shared over time by certified systems, as noted in this draft approach out for public comment.

Imagine if Apple further opens up Apple Health so it no longer serves as the destination, but a conduit for a patient's longitudinal health record to a growing marketplace of applications that can help guide consumers through decisions to better manage their health.

Thankfully, the consumer data-sharing movement—placing the longitudinal health record in the hands of the patient and the applications they trust—is taking hold, albeit quietly. In just the past few weeks, a number of health systems that were initially slow to turn on the required APIs suddenly found the motivation to meet Apple's requirement.

The article is here.