Living a fully ethical life involves doing the most good we can.
- Peter Singer

Wednesday, August 24, 2016

The Controversial Issue of Euthanasia in Patients With Psychiatric Illness

Emilie Olie & Philippe Courtet
JAMA. 2016;316(6):656-657

A main objective of legalization of euthanasia or physician-assisted suicide (EAS) is to ease suffering (ie, physical pain and loss of autonomy elicited by an irreversible serious disease), when a terminally ill patient's pain is overwhelming despite palliative care. It implies that there is no reasonable alternative in the patient's situation, with no prospect of improvement of a painful condition or global functioning. Because mental disorders are among the most disabling illnesses, requests for EAS based on unbearable mental suffering caused by severe psychiatric disease may possibly increase. EAS may be differentiated from suicide because EAS results in death without self-inflicted behavior, yet both are driven by a desire to end life. This raises the question: Should the management of patients with psychiatric disorders requesting EAS be considered for suicide prevention?

Mental illness increases suicidal risk and requires treatment. Nevertheless, evidence-based medical and psychosocial treatments currently are not provided to the majority of patients with psychiatric diseases who would benefit. Even if these therapies were prescribed, about 30% of depressed patients are treatment resistant. Patients may have undergone treatments destined to fail or they may have refused potential effective therapeutics. Nevertheless, the probability of disease remission increases with number of different treatments attempted. Given these uncertainties and that there are no valid indicators to predict the response to treatment, there is no reliable mechanism to define incurable disease and determine medical futility for psychiatric care. Considering euthanasia for psychiatric patients may reinforce poor expectations of the medical community for mental illness treatment and contribute to a relative lack of progress in developing more effective therapeutic strategies.

The article is here.

I feel therefore I am

How exactly did consciousness become a problem? And why, after years off the table, is it a hot research subject now?

Margaret Wertheim
Originally published December 1, 2015

Here is an excerpt:

Here again we meet the subject of pain, both physical and emotional. Can misery be ‘explained’ by synaptic firing? Can happiness? Some years ago, I discussed this issue with Father George Coyne, a Jesuit priest and astronomer who was then Director of the Vatican Observatory. I asked him what he thought of the notion that when the 12th‑century Hildegard of Bingen was having her visions of God, perhaps she was having epileptic fits. He had no problem with the fits. Indeed, he thought that when something so powerful was going on in a mind, there would necessarily be neurological correlates. Hildegard might well have been an epileptic, Father Coyne opined; that didn’t mean God wasn’t also talking to her.

Pain is surely like this too: it must have neurological correlates otherwise we wouldn’t be able to react to withdraw a hand from a flame and save our bodies from damage. (People who lose the ability to feel pain quickly succumb to injuries.) At the same time, pain transcends its physical dimensions, as do the many species of misery catalogued in Dante’s Hell, and represented to us in daily news accounts of the effects of war on millions of people today.

Tuesday, August 23, 2016

Administration Paints Rosy Future For Obamacare Marketplaces

By Phil Galewitz
Kaiser Health News
Originally published August 11, 2016

Despite dire warnings from Republicans and some large insurers about the stability of the Affordable Care Act exchanges, an Obama administration report released Thursday indicated the individual health insurance market has steadily added healthier and lower-risk consumers.

Medical costs per enrollee in the exchanges in 2015 were unchanged compared with 2014, according to the Centers for Medicare & Medicaid Services. In contrast, per-member health costs rose between 3 percent and 6 percent in the broader U.S. insurance market, which includes 154 million people who get coverage through their employer and the 55 million people on Medicare, the report said.

Aviva Aron-Dine, senior counselor to U.S. Health and Human Services Secretary Sylvia Burwell, said the data was encouraging when many insurers have announced double-digit rate increases for 2017 and others have pulled back in some states to curtail financial losses.

The article is here.

Patients on social media cause ethics headache for doctors

BY Lisa Rapaport
Originally published August 5, 2016

As more and more sick patients are going online and using social media to search for answers about their health, it’s raising a lot of thorny ethical questions for doctors.

“The internet and ready access to vast amounts of information are now permanent aspects of how we live our lives, including how we think about and deal with our health problems,” Dr. Chris Feudtner, director of medical ethics at the Children's Hospital of Philadelphia, said by email.

Social media in particular can affect how patients interact with doctors and what type of care they expect, Feudtner and colleagues write in an article about ethics in the journal Pediatrics.

“Clinicians should ask about what patients and families have read on the Internet, and then work through that information thoughtfully, as sometimes Internet information is not helpful and sometimes it is helpful,” Feudtner said. “Doing this takes time and effort, yet trust is built with time and effort.”

The article is here.

Monday, August 22, 2016

Autonomous Vehicles Might Develop Superior Moral Judgment

John Martellaro
The Mac Observer
Originally published August 10, 2016

Here is an excerpt:

One of the virtues (or drawbacks, depending on one’s point of view) of a morality engine is that the decisions an autonomous vehicle makes can only be traced back only to software. That helps to absolve a car maker’s employees from direct liability when it comes life and death decisions by machine. That certainly seems to be an emerging trend in technology. The benefit is obvious. If a morality engine makes the right decision, by human standards, 99,995 times out of 100,000, the case for extreme damages due to systematic failure causing death is weak. Technology and society can move forward.

The article is here.

Rationalizing our Way into Moral Progress

Jesse S. Summers
Ethical Theory and Moral Practice:1-12 (forthcoming)

Research suggests that the explicit reasoning we offer to ourselves and to others is often rationalization, that we act instead on instincts, inclinations, stereotypes, emotions, neurobiology, habits, reactions, evolutionary pressures, unexamined principles, or justifications other than the ones we think we’re acting on, then we tell a post hoc story to justify our actions. This is troubling for views of moral progress according to which moral progress proceeds from our engagement with our own and others’ reasons. I consider an account of rationalization, based on Robert Audi’s, to make clear that rationalization, unlike simple lying, can be sincere. Because it can be sincere, and because we also have a desire to be consistent with ourselves, I argue that rationalization sets us up for becoming better people over time, and that a similar case can be made to explain how moral progress among groups of people can proceed via rationalization.

Sunday, August 21, 2016

Professing the Values of Medicine The Modernized AMA Code of Medical Ethics

Brotherton S, Kao A, Crigger BJ.
JAMA. Published online July 14, 2016.

The word profession is derived from the Latin word that means “to declare openly.” On June 13, 2016, the first comprehensive update of the AMA Code of Medical Ethics in more than 50 years was adopted at the annual meeting of the American Medical Association (AMA). By so doing, physician delegates attending the meeting, who represent every state and nearly every specialty, publicly professed to uphold the values that are the underpinning of the ethical practice of medicine in service to patients and the public.

The AMA Code was created in 1847 as a national code of ethics for physicians, the first of its kind for any profession anywhere in the world.1 Since its inception, the AMA Code has been a living document that has evolved and expanded as medicine and its social environment have changed. By the time the AMA Council on Ethical and Judicial Affairs embarked on a systematic review of the AMA Code in 2008, it had come to encompass 220 separate opinions or ethics guidance for physicians on topics ranging from abortion to xenotransplantation. The AMA Code, over the years, became more fragmented and unwieldy. Opinions on individual topics were difficult to find; lacked a common narrative structure, which meant the underlying value motivating the guidance was not readily apparent; and were not always consistent in the guidance they offered or language they used.

The article is here.

Saturday, August 20, 2016

The Selective Laziness of Reasoning

Emmanuel Trouche, Petter Johansson, Lars Hall, Hugo Mercier
Cognitive Science
First published: 9 October 2015


Reasoning research suggests that people use more stringent criteria when they evaluate others' arguments than when they produce arguments themselves. To demonstrate this “selective laziness,” we used a choice blindness manipulation. In two experiments, participants had to produce a series of arguments in response to reasoning problems, and they were then asked to evaluate other people's arguments about the same problems. Unknown to the participants, in one of the trials, they were presented with their own argument as if it was someone else's. Among those participants who accepted the manipulation and thus thought they were evaluating someone else's argument, more than half (56% and 58%) rejected the arguments that were in fact their own. Moreover, participants were more likely to reject their own arguments for invalid than for valid answers. This demonstrates that people are more critical of other people's arguments than of their own, without being overly critical: They are better able to tell valid from invalid arguments when the arguments are someone else's rather than their own.

The article is here.

Friday, August 19, 2016

Why Are So Many Millennials Having Zero Sex?

By Jesse Singal
The Science of Us
Originally posted August 2, 2016

When it comes to millennials and sex, there are two narratives going on at the moment, and they clash pretty severely. One, expressed in the form of panicky think pieces about Kids These Days, argues that because of the rise of dating apps, a reduced emphasis on commitment, and various other factors, young people are having casual sex at a higher rate than ever before, and this may be causing psychological problems, particularly for young women, who — so the story usually goes — don’t get as much out of casual sex as the guys they are hooking up with.

The other narrative is that, well, the kids are all right. Even assuming there is something wrong with safe, consensual casual sex (and the proper answer to that question is it’s complicated), some researchers who track generational differences in behavior have found something that might surprise the panickers: if anything, today’s young people are hooking up less than members of past recent generations did when they were the same age. In an article published last year in the Archives of Sexual Behavior, for example, Jean Twenge of San Diego State University and Ryne Sherman of Florida Atlantic University wrote that, among adults, the “[n]umber of sexual partners increased steadily between the G.I.s and 1960s-born Gen X’ers [with Boomers in the middle] and then dipped among Millennials to return to Boomer levels.” That is, millennials, on average, appear to be having sex with fewer people than Gen-Xers did when they were at the same age, and about the same amount of sex as the boomers did when they were in their younger years.

The article is here.