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

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

Sunday, October 22, 2017

A Car Crash And A Mistrial Cast Doubts On Court-Ordered Mental Health Exams

Steve Burger
Side Effect Media: Public Health/Personal Stories
Originally posted September 26, 2017

Here is an excerpt:

Investigating a lie

Fink was often hired by the courts in Indiana, and over the last ten years had performed dozens of these competency evaluations. His scene-of-the-crash confession called into question not only the Loving trial, but every one he ever worked on.

Courts rely on psychologists to assess the mental fitness of defendants, but Fink’s story raises serious questions about how courts determine mental competency in Indiana and what system of oversight is in place to ensure defendants get a valid examination.

The judge declared a mistrial in Caleb Loving’s case, but Fink’s confession prompted a massive months-long investigation in Vanderburgh County.

Hermann led the investigation, working to untangle a mess of nearly 70 cases for which Fink performed exams or testing, determined to discover the extent of the damage he had done.

“A lot of different agencies participated in that investigation,” Herman said. “It was a troubling case, in that someone who was literally hired by the court to come in and testify about something … [was] lying.”

The county auditor’s office provided payment histories of psychologists hired by the courts, and the Evansville Police Department spent hundreds of hours looking through records. The courts helped Hermann get access to the cases that Albert Fink had worked on.

Trump's ethics critics get their day in court

Julia Horowitz 
Originally published October 17, 2017

Ethics experts have been pressing President Trump in the media for months. On Wednesday, they'll finally get their day in court.

At the center of a federal lawsuit in New York is the U.S. Constitution's Foreign Emoluments Clause, which bars the president from accepting gifts from foreign governments without permission from Congress.

Citizens for Responsibility and Ethics in Washington, a watchdog group, will lay out its case before Judge George Daniels. Lawyers for the Justice Department have asked the judge to dismiss the case.

The obscure provision of the Constitution is an issue because Trump refused to sell his business holdings before the inauguration. Instead, he placed his assets in a trust and handed the reins of the Trump Organization to his two oldest sons, Don Jr. and Eric.

The terms of the trust make it so Trump can technically withdraw cash payments from his businesses any time he wants. He can also dissolve the trust when he leaves office -- so if his businesses do well, he'll ultimately profit.

CREW claims that because government leaders and entities frequent his hotels, clubs and restaurants, Trump is in breach of the Emoluments Clause. The fear is that international officials will try to curry favor with Trump by patronizing his properties.

The article is here.

Saturday, October 21, 2017

Thinking about the social cost of technology

Natasha Lomas
Tech Crunch
Originally posted September 30, 2017

Here is an excerpt:

Meanwhile, ‘users’ like my mum are left with another cryptic puzzle of unfamiliar pieces to try to slot back together and — they hope — return the tool to the state of utility it was in before everything changed on them again.

These people will increasingly feel left behind and unplugged from a society where technology is playing an ever greater day-to-day role, and also playing an ever greater, yet largely unseen role in shaping day to day society by controlling so many things we see and do. AI is the silent decision maker that really scales.

The frustration and stress caused by complex technologies that can seem unknowable — not to mention the time and mindshare that gets wasted trying to make systems work as people want them to work — doesn’t tend to get talked about in the slick presentations of tech firms with their laser pointers fixed on the future and their intent locked on winning the game of the next big thing.

All too often the fact that human lives are increasingly enmeshed with and dependent on ever more complex, and ever more inscrutable, technologies is considered a good thing. Negatives don’t generally get dwelled on. And for the most part people are expected to move along, or be moved along by the tech.

That’s the price of progress, goes the short sharp shrug. Users are expected to use the tool — and take responsibility for not being confused by the tool.

But what if the user can’t properly use the system because they don’t know how to? Are they at fault? Or is it the designers failing to properly articulate what they’ve built and pushed out at such scale? And failing to layer complexity in a way that does not alienate and exclude?

And what happens when the tool becomes so all consuming of people’s attention and so capable of pushing individual buttons it becomes a mainstream source of public opinion? And does so without showing its workings. Without making it clear it’s actually presenting a filtered, algorithmically controlled view.

There’s no newspaper style masthead or TV news captions to signify the existence of Facebook’s algorithmic editors. But increasingly people are tuning in to social media to consume news.

This signifies a major, major shift.

The article is here.

Stunner On Birth Control: Trump’s Moral Exemption Is Geared To Just 2 Groups

Julie Rovner
Kaiser Health News
Originally posted October 16, 2017

Here is an excerpt:

So what’s the difference between religious beliefs and moral convictions?

“Theoretically, it would be someone who says ‘I don’t have a belief in God,’ but ‘I oppose contraception for reasons that have nothing to do with religion or God,’ ” said Mark Rienzi, a senior counsel for the Becket Fund for Religious Liberty, which represented many of the organizations that sued the Obama administration over the contraceptive mandate.

Nicholas Bagley, a law professor at the University of Michigan, said it would apply to “an organization that has strong moral convictions but does not associate itself with any particular religion.”

What kind of an organization would that be? It turns out not to be such a mystery, Rienzi and Bagley agreed.

Among the hundreds of organizations that sued over the mandate, two — the Washington, D.C.-based March for Life and the Pennsylvania-based Real Alternatives — are anti-abortion groups that do not qualify for religious exemptions. While their employees may be religious, the groups themselves are not.

The article is here.

Friday, October 20, 2017

A virtue ethics approach to moral dilemmas in medicine

P Gardiner
J Med Ethics. 2003 Oct; 29(5): 297–302.


Most moral dilemmas in medicine are analysed using the four principles with some consideration of consequentialism but these frameworks have limitations. It is not always clear how to judge which consequences are best. When principles conflict it is not always easy to decide which should dominate. They also do not take account of the importance of the emotional element of human experience. Virtue ethics is a framework that focuses on the character of the moral agent rather than the rightness of an action. In considering the relationships, emotional sensitivities, and motivations that are unique to human society it provides a fuller ethical analysis and encourages more flexible and creative solutions than principlism or consequentialism alone. Two different moral dilemmas are analysed using virtue ethics in order to illustrate how it can enhance our approach to ethics in medicine.

A pdf download of the article can be found here.

Note from John: This article is interesting for a myriad of reasons. For me, we ethics educators have come a long way in 14 years.

The American Psychological Association and torture: How could it happen?

Bryan Welch
International Journal of Applied Psychoanalytic Studies
Volume 14 (2)

Here is an excerpt:

This same grandiosity was ubiquitous in the governance's rhetoric at the heart of the association's discussions on torture. Banning psychologists' participation in reputed torture mills was clearly unnecessary, proponents of the APA policy argued. To do so would be an “insult” to military psychologists everywhere. No psychologist would ever engage in torture. Insisting on a change in APA policy reflected a mean-spirited attitude toward the military psychologists. The supporters of the APA policy managed to transform the military into the victims in the interrogation issue.

In the end, however, it was psychologists' self-assumed importance that carried the day on the torture issue. Psychologists' participation in these detention centers, it was asserted, was an antidote to torture, since psychologists' very presence could protect the potential torture victims (presumably from Rumsfeld and Cheney, no less!). The debates on the APA Council floor, year after year, concluded with the general consensus that, indeed, psychology was very, very important to our nation's security. In fact the APA Ethics Director repeatedly advised members of the APA governance that psychologists' presence was necessary to make sure the interrogations were “safe, legal, ethical, and effective.”

We psychologists were both too good and too important to join our professional colleagues in other professions who were taking an absolutist moral position against one of the most shameful eras in our country's history. While the matter was clearly orchestrated by others, it was this self-reinforcing grandiosity that led the traditionally liberal APA governance down the slippery slope to the Bush administration's torture program.

During this period I had numerous personal communications with members of the APA governance structure in an attempt to dissuade them from ignoring the rank-and-file psychologists who abhorred the APA's position. I have been involved in many policy disagreements over the course of my career, but the smugness and illogic that characterized the response to these efforts were astonishing and went far beyond normal, even heated, give and take. Most dramatically, the intelligence that I have always found to characterize the profession of psychology was sorely lacking.

Thursday, October 19, 2017

‘But you can’t do that!’ Why immoral actions seem impossible

Jonathan Phillips
Originally posted September 29, 2017

Suppose that you’re on the way to the airport to catch a flight, but your car breaks down. Some of the actions you immediately consider are obvious: you might try to call a friend, look for a taxi, or book a later flight. If those don’t work out, you might consider something more far-fetched, such as finding public transportation or getting the tow-truck driver to tow you to the airport. But here’s a possibility that would likely never come to mind: you could take a taxi but not pay for it when you get to the airport. Why wouldn’t you think of this? After all, it’s a pretty sure-fire way to get to the airport on time, and it’s definitely cheaper than having your car towed.

One natural answer is that you don’t consider this possibility because you’re a morally good person who wouldn’t actually do that. But there are at least two reasons why this doesn’t seem like a compelling answer to the question, even if you are morally good. The first is that, though being a good person would explain why you wouldn’t actually do this, it doesn’t seem to explain why you wouldn’t have been able to come up with this as a solution in the first place. After all, your good moral character doesn’t stop you from admitting that it is a way of getting to the airport, even if you wouldn’t go through with it. And the second reason is that it seems equally likely that you wouldn’t have come up with this possibility for someone else in the same situation – even someone whom you didn’t know was morally good.

So what does explain why we don’t consider the possibility of taking a taxi but not paying? Here’s a radically different suggestion: before I mentioned it, you didn’t think it was even possible to do that. This explanation probably strikes you as too strong, but the key to it is that I’m not arguing that you think it’s impossible now, I’m arguing that you didn’t think it was possible before I proposed it.

Is There an Ideal Amount of Income Inequality?

Brian Gallagher
Originally published September 28, 2017

Here is an excerpt:

Is extreme inequality a serious problem?

Extreme inequality in the United States, and elsewhere, is deeply troubling on a number of fronts. First, there is the moral issue. For a country explicitly founded on the principles of liberty, equality, and the pursuit of happiness, protected by the “government of the people, by the people, for the people,” extreme inequality raises troubling questions of social justice that get at the very foundations of our society. We seem to have a “government of the 1 percent by the 1 percent for the 1 percent,” as the economics Nobel laureate Joseph Stiglitz wrote in his Vanity Fair essay. The Harvard philosopher Tim Scanlon argues that extreme inequality is bad for the following reasons: (1) economic inequality can give wealthier people an unacceptable degree of control over the lives of others; (2) economic inequality can undermine the fairness of political institutions; (3) economic inequality undermines the fairness of the economic system itself; and (4) workers, as participants in a scheme of cooperation that produces national income, have a claim to a fair share of what they have helped to produce.

You’re an engineer. How did you get interested in inequality?

I do design, control, optimization, and risk management for a living. I’m used to designing large systems, like chemical plants. I have a pretty good intuition for how systems will operate, how  they can run efficiently, and how they may fail. When I started thinking about the free market and society as systems, I already had an intuitive grasp about their function. Clearly there are differences between a system of inanimate entities, like chemical plants, and human society. But they’re both systems, so there’s a lot of commonalities as well. My experience as a systems engineer helped me as I was groping in the darkness to get my hand around these issues, and to ask the right questions.

The article is here.

Wednesday, October 18, 2017

When Doing Some Good Is Evaluated as Worse Than Doing No Good at All

George E. Newman and Daylian M. Cain
Psychological Science published online 8 January 2014


In four experiments, we found that the presence of self-interest in the charitable domain was seen as tainting: People evaluated efforts that realized both charitable and personal benefits as worse than analogous behaviors that produced no charitable benefit. This tainted-altruism effect was observed in a variety of contexts and extended to both moral evaluations of other agents and participants’ own behavioral intentions (e.g., reported willingness to hire someone or purchase a company’s products). This effect did not seem to be driven by expectations that profits would be realized at the direct cost of charitable benefits, or the explicit use of charity as a means to an end. Rather, we found that it was related to the accessibility of different counterfactuals: When someone was charitable for self-interested reasons, people considered his or her behavior in the absence of self-interest, ultimately concluding that the person did not behave as altruistically as he or she could have. However, when someone was only selfish, people did not spontaneously consider whether the person could have been more altruistic.

The article is here.