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

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

Wednesday, April 25, 2018

The Peter Principle: Promotions and Declining Productivity

Edward P. Lazear
Hoover Institution and Graduate School of Business
Revision 10/12/00


Many have observed that individuals perform worse after having received a promotion. The
most famous statement of the idea is the Peter Principle, which states that people are promoted to
their level of incompetence. There are a number of possible explanations. Two are explored. The
most traditional is that the prospect of promotion provides incentives which vanish after the
promotion has been granted; thus, tenured faculty slack off. Another is that output as a statistical
matter is expected to fall. Being promoted is evidence that a standard has been met. Regression
to the mean implies that future productivity will decline on average. Firms optimally account for the
regression bias in making promotion decisions, but the effect is never eliminated. Both explanations
are analyzed. The statistical point always holds; the slacking off story holds only under certain
compensation structures.

The paper is here.

Dear Therapist: I Google-Stalked My Therapist

Lori Gottlieb
The Atlantic
Originally published March 21, 2108

Here is an excerpt:

Most of us wonder who our therapists are outside of the therapy room, usually because we like them so much. Sometimes, of course, people Google their therapists if something feels off—to see if their credentials check out, or if other patients have posted similar concerns. More often, though, our curiosity is a reflection of how important our therapist has become to us, and in some cases, it’s a way to feel connected to the therapist between sessions. The problem is, of course, that we want therapy to be a space where we feel free to talk about absolutely anything. And no matter what we discover—a bombshell like yours, or something more mundane—the fallout of a Google binge becomes a secret that takes that freedom away.

Carl Jung called secrets “psychic poison” for good reason. When I finally confessed my Google-stalking to my therapist, all the air returned to the room. My verbal shackles were removed, and we talked about what was behind my desire to type his name into my search engine. But more important, the way I handled the situation before fessing up taught me something interesting about how I handle discomfort—something far more interesting than anything I learned about my therapist online.

And I think the same might prove true for you.

What people do in therapy is pretty much what they do in their outside lives. In other words, if a patient tends to feel dissatisfied with people in her life, it’s likely that she’ll eventually feel dissatisfied with me. If she tries to please people, she’ll probably try to please me too. And if she avoids people when she feels hurt by them, I’ll be on the lookout for signs that I’ve said something that may have hurt her, too (she cancels her next session, or clams up, or comes late).

The information is here.

Tuesday, April 24, 2018

The Next Best Version of Me: How to Live Forever

David Ewing Duncan
Originally published March 27, 2018

Here is an excerpt:

There are also the ethics of using a powerful new technology to muck around with life’s basic coding. Theoretically, scientists could one day manufacture genomes, human or otherwise, almost as easily as writing code on a computer, transforming digital DNA on someone’s laptop into living cells of, say, Homo sapiens. Mindful of the controversy, Church and his HGP-Write colleagues insist that minting people is not their goal, though the sheer audacity of making genome-scale changes to human DNA is enough to cause controversy. “People get upset if you put a gene from another species into something you eat,” says Stanford bioethicist and legal scholar Henry Greely. “Now we’re talking about a thorough rewriting of life? Hairs will stand on end. Hackles will be raised.”

Raised hackles or not, Church and his team are forging ahead. “We want to start with a human Y,” he says, referring to the male sex chromosome, which he explains has the fewest genes of a person’s 23 chromo­somes and is thus easier to build. And he doesn’t want to synthesize just any Y chromosome. He and his team want to use the Y chromosome sequence from an actual person’s genome: mine.

“Can you do that?” I stammer.

“Of course we can—with your permission,” he says, reminding me that it would be easy to tap into my genome, since it was stored digitally in his lab’s computers as part of an effort he launched in 2005 called the Personal Genome Project.

The article is here.

When therapists face discrimination

Zara Abrams
The Monitor on Psychology - April 2018

Here is an excerpt:

Be aware of your own internalized biases. 

Reflecting on their own social, cultural and political perspectives means practitioners are less likely to be caught off guard by something a client says. “It’s important for psychologists to be aware of what a client’s biases and prejudices are bringing up for them internally, so as not to project that onto the client—it’s important to really understand what’s happening,” says Kathleen Brown, PhD, a licensed clinical psychologist and APA fellow.

For Kelly, the Atlanta-based clinical psychologist, this means she’s careful not to assume that resistant clients are treating her disrespectfully because she’s African American. Sometimes her clients, who are referred for pre-surgical evaluation and treatment, are difficult or even hostile
because their psychological intervention was mandated.

Foster an open dialogue about diversity and identity issues.

“The benefit of having that conversation, even though it can be scary or uncomfortable to bring it up in the room, is that it prevents it from festering or interfering with your ability to provide high-quality care to the client,” says Illinois-based clinical psychologist Robyn Gobin, PhD, who has experienced ageism from patients. She responds to ageist remarks by exploring what specific concerns the client has regarding her age (like Turner, she looks young). If she’s met with criticism, she tries to remain receptive, understanding that the client is vulnerable and any hostility the client expresses reflects concern for his or her own well-being. By being open and frank from the start, she shows her clients the appropriate way to confront their biases in therapy.

Of course, practitioners approach these conversations differently. If a client makes a prejudiced remark about another group, Buckman says labeling the comment as “offensive” shifts the attention from the client onto her. “It doesn’t get to the core of what’s going on with them. In the long run, exploring a way to shift how the client interacts with the ‘other’ is probably more valuable than standing up for a group in the moment.”

The information is here.

Monday, April 23, 2018

Shared Decision-making for PTSD

Juliette Harik, PhD
PTSD Research Quarterly (2018) Volume 29 (1)

Here is an excerpt:

Although several different shared decision-making models exist (for a review see Lin & Fagerlin, 2014), one useful approach conceptualizes shared decision-making as consisting of three phases
(Elwyn et al., 2012): choice talk, option talk, and decision talk. Choice talk involves communicating
to patients that there is a decision to make and that they can be involved in this decision to the extent
that they are comfortable. Option talk consists of sharing accurate and comprehensive information
about treatment options. Ideally, this involves the use of a decision aid, which is an educational tool
such as a website, brochure, or video designed to help patients understand and compare various
options (for a review, see Stacey et al., 2017). The third and final step, decision talk, consists of an
exploration of the patient’s preferences and what matters most to him or her. The process of shared
decision-making is intended to help the patient develop informed preferences, and ultimately arrive
at the decision that is best for him or her. Importantly, patients with the same clinical condition may arrive at very different treatment decisions on the basis of unique values and preferences.

Shared decision-making has been evaluated most often among patients facing care decisions for chronic medical conditions, especially cancer. In medical patients, shared decision-making has been linked with greater confidence in the treatment decision, improved satisfaction with decision-making and with treatment, greater self-efficacy, and increased trust in the provider (Joosten et al., 2008; Shay & Lafata, 2015). In mental health, shared decision-making has been most often evaluated in the context of depression, yielding mixed results on both satisfaction and treatment outcomes (Duncan, Best, & Hagen, 2010). Fewer studies have evaluated the effectiveness of shared decision-making for other mental health conditions such as PTSD.

The information is here.

Bad science puts innocent people in jail — and keeps them there

Radley Balko and Tucker Carrington
The Washington Post
Originally posted March 21, 2018

Here is an excerpt:

At the trial level, juries hear far too much dubious science, whether it’s an unproven field like bite mark matching or blood splatter analysis, exaggerated claims in a field like hair fiber analysis, or analysts testifying outside their area of expertise.  It’s difficult to say how many convictions have involved faulty or suspect forensics, but the FBI estimated in 2015 that its hair fiber analysts had testified in about 3,000 cases — and that’s merely one subspecialty of forensics, and only at the federal level.    Extrapolating from the database of DNA exonerations, the Innocence Project estimates that bad forensics contributes to about 45 percent of wrongful convictions.

But flawed evidence presented at trial is only part of the problem.  Even once a field of forensics or a particular expert has been discredited, the courts have made it extremely difficult for those convicted by bad science to get a new trial.

The Supreme Court makes judges responsible for determining what is good science.  They already decide what evidence is allowed at trial, so asking them to do the same for expert testimony may seem intuitive.  But judges are trained to do legal analyses, not scientific ones.  They generally deal with challenges to expert testimony by looking at what other judges have said.  If a previous court has allowed a field of forensic evidence, subsequent courts will, too.

The article is here.

Note: These issues also apply to psychologists in the courtroom.

Sunday, April 22, 2018

What is the ethics of ageing?

Christopher Simon Wareham
Journal of Medical Ethics 2018;44:128-132.


Applied ethics is home to numerous productive subfields such as procreative ethics, intergenerational ethics and environmental ethics. By contrast, there is far less ethical work on ageing, and there is no boundary work that attempts to set the scope for ‘ageing ethics’ or the ‘ethics of ageing’. Yet ageing is a fundamental aspect of life; arguably even more fundamental and ubiquitous than procreation. To remedy this situation, I examine conceptions of what the ethics of ageing might mean and argue that these conceptions fail to capture the requirements of the desired subfield. The key reasons for this are, first, that they view ageing as something that happens only when one is old, thereby ignoring the fact that ageing is a process to which we are all subject, and second that the ageing person is treated as an object in ethical discourse rather than as its subject. In response to these shortcomings I put forward a better conception, one which places the ageing person at the centre of ethical analysis, has relevance not just for the elderly and provides a rich yet workable scope. While clarifying and justifying the conceptual boundaries of the subfield, the proposed scope pleasingly broadens the ethics of ageing beyond common negative associations with ageing.

The article is here.

Saturday, April 21, 2018

A Systematic Review and Meta‐Synthesis of Qualitative Research Into Mandatory Personal Psychotherapy During Training

David Murphy, Nisha Irfan, Harriet Barnett, Emma Castledine, & Lily Enescu
Counseling and Psychotherapy Research
First published February 23, 2018


This study addresses the thorny issue of mandatory personal psychotherapy within counselling and psychotherapy training. It is expensive, emotionally demanding and time‐consuming. Nevertheless, proponents argue that it is essential in protecting the public and keeping clients safe; to ensure psychotherapists develop high levels of self‐awareness and gain knowledge of interpersonal dynamics; and that it enhances therapist effectiveness. Existing evidence about these potential benefits is equivocal and is largely reliant on small‐scale qualitative studies.

We carried out a systematic review of literature searched within five major databases. The search identified 16 published qualitative research studies on the topic of mandatory personal psychotherapy that matched the inclusion criteria. All studies were rated for quality. The findings from individual studies were thematically analysed through a process of meta‐synthesis.

Meta‐synthesis showed studies on mandatory psychotherapy had reported both positive and hindering factors in almost equal number. Six main themes were identified: three positive and three negative. Positive findings were related to personal and professional development, experiential learning and therapeutic benefits. Negative findings related to ethical imperatives do no harm, justice and integrity.

When mandatory personal psychotherapy is used within a training programme, courses must consider carefully and put ethical issues at the forefront of decision‐making. Additionally, the requirement of mandatory psychotherapy should be positioned and identified as an experiential pedagogical device rather than fulfilling a curative function. Recommendations for further research are made.

The research is here.

Friday, April 20, 2018

Making a Thinking Machine

Leah Winerman
The Monitor on Psychology - April 2018

Here is an excerpt:

A 'Top Down' Approach

Now, psychologists and AI researchers are looking to insights from cognitive and developmental psychology to address these limitations and to capture aspects of human thinking that deep neural networks can’t yet simulate, such as curiosity and creativity.

This more “top-down” approach to AI relies less on identifying patterns in data, and instead on figuring out mathematical ways to describe the rules that govern human cognition. Researchers can then write those rules into the learning algorithms that power the AI system. One promising avenue for this method is called Bayesian modeling, which uses probability to model how people reason and learn about the world. Brenden Lake, PhD, a psychologist and AI researcher at New York University, and his colleagues, for example, have developed a Bayesian AI system that can accomplish a form of one-shot learning. Humans, even children, are very good at this—a child only has to see a pineapple once or twice to understand what the fruit is, pick it out of a basket and maybe draw an example.

Likewise, adults can learn a new character in an unfamiliar language almost immediately.

The article is here.