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

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Bigotry. Show all posts
Showing posts with label Bigotry. Show all posts

Tuesday, August 23, 2022

Tackling Implicit Bias in Health Care

J. A. Sabin
N Engl J Med 2022; 387:105-107
DOI: 10.1056/NEJMp2201180

Implicit and explicit biases are among many factors that contribute to disparities in health and health care. Explicit biases, the attitudes and assumptions that we acknowledge as part of our personal belief systems, can be assessed directly by means of self-report. Explicit, overtly racist, sexist, and homophobic attitudes often underpin discriminatory actions. Implicit biases, by contrast, are attitudes and beliefs about race, ethnicity, age, ability, gender, or other characteristics that operate outside our conscious awareness and can be measured only indirectly. Implicit biases surreptitiously influence judgment and can, without intent, contribute to discriminatory behavior. A person can hold explicit egalitarian beliefs while harboring implicit attitudes and stereotypes that contradict their conscious beliefs.

Moreover, our individual biases operate within larger social, cultural, and economic structures whose biased policies and practices perpetuate systemic racism, sexism, and other forms of discrimination. In medicine, bias-driven discriminatory practices and policies not only negatively affect patient care and the medical training environment, but also limit the diversity of the health care workforce, lead to inequitable distribution of research funding, and can hinder career advancement.

A review of studies involving physicians, nurses, and other medical professionals found that health care providers’ implicit racial bias is associated with diagnostic uncertainty and, for Black patients, negative ratings of their clinical interactions, less patient-centeredness, poor provider communication, undertreatment of pain, views of Black patients as less medically adherent than White patients, and other ill effects.1 These biases are learned from cultural exposure and internalized over time: in one study, 48.7% of U.S. medical students surveyed reported having been exposed to negative comments about Black patients by attending or resident physicians, and those students demonstrated significantly greater implicit racial bias in year 4 than they had in year 1.

A review of the literature on reducing implicit bias, which examined evidence on many approaches and strategies, revealed that methods such as exposure to counterstereotypical exemplars, recognizing and understanding others’ perspectives, and appeals to egalitarian values have not resulted in reduction of implicit biases.2 Indeed, no interventions for reducing implicit biases have been shown to have enduring effects. Therefore, it makes sense for health care organizations to forgo bias-reduction interventions and focus instead on eliminating discriminatory behavior and other harms caused by implicit bias.

Though pervasive, implicit bias is hidden and difficult to recognize, especially in oneself. It can be assumed that we all hold implicit biases, but both individual and organizational actions can combat the harms caused by these attitudes and beliefs. Awareness of bias is one step toward behavior change. There are various ways to increase our awareness of personal biases, including taking the Harvard Implicit Association Tests, paying close attention to our own mistaken assumptions, and critically reflecting on biased behavior that we engage in or experience. Gonzalez and colleagues offer 12 tips for teaching recognition and management of implicit bias; these include creating a safe environment, presenting the science of implicit bias and evidence of its influence on clinical care, using critical reflection exercises, and engaging learners in skill-building exercises and activities in which they must embrace their discomfort.

Wednesday, July 13, 2022

Dangerous as the Plague

Samuel Huneke
The Baffler
Originally posted 23 JUN 22

Here is an excerpt:

There is not enough space here to enumerate all of the similarities and differences between National Socialism and today’s right, but the place of Christianity in each movement is instructive. The churches were always on tenuous terms at best with Hitler’s state. Many Nazi leaders were openly hostile to Christianity and to the “traditional” family. Homosexuality posed a threat to Nazism not in moral terms, but rather in social and political terms, threatening to undermine its homosocial order. In stark contrast, the American right today remains in thrall to white Christian nationalism, which openly seeks to impose its own version of morality on the nation. The threat queerness poses to this version of patriarchal Christianity, coupled with broader anxieties about loss of social status, is what appears to motivate the new right’s transphobia and homophobia.

The endurance of these tropes also highlights the limits of the professionalized LGBTQ political movement in this country, which has prioritized visibility and assimilation—eschewing more revolutionary strategies that would encompass the needs of the most marginalized. Groups like the Human Rights Campaign have been successful up to a point, but their strategies were always predicated on the notion that if queer people were visible and showed that they weren’t actually that different, prejudice would seep away. Because its aim was assimilation, this tactic fundamentally upheld the division between normal and abnormal on which animus rests. Instead of contesting that very division, it sought to put certain queer people on the “right” side of it. In this way, it also misunderstood hatred as a product of ignorance rather than a political strategy or an expression of sublimated anxieties.

Now animus against queer people—especially trans people—is back with a vengeance. From the conspiracy-addled world of QAnon, in which a shadowy cabal of pedophiles, juiced on the blood of children, runs the world, to the mendacity of trans-exclusionary radical feminists (or TERFs), a growing segment of the population seems willing to entertain the notion that lesbians, gay men, and trans people are “recruiting” children. The bestseller Irreversible Damage, published in 2020 and reaching audiences well beyond the fringe right, insisted that girls were being seduced by a “transgender craze” that it termed a “contagion.” Just before Pride month, U.S. Representative Marjorie Taylor Greene, who has embraced the rhetoric of “grooming,” predicted that in “four or five generations, no one will be straight anymore.”

Monday, May 2, 2022

Mormon Leader Reaffirms Faith's Stance on Same-Sex Marriage

Sam Metz
Associated Press
Originally published 3 APR 22

A top leader in The Church of Jesus Christ of Latter-day Saints reaffirmed the faith’s opposition to same-sex marriage and “changes that confuse or alter gender” as debates over gender and sexuality reemerge throughout the United States.

Dallin H. Oaks, the second-highest-ranking leader of the faith known widely as the Mormon Church, told thousands of listeners gathered at a conference center at the church’s Salt Lake City headquarters that what he called “social and legal pressures” wouldn’t compel the church to alter its stances on same-sex marriage or matters of gender identity that he did not specify.

The highest level of salvation, Oaks said, “can only be attained through faithfulness to the covenants of an eternal marriage between a man and a woman. That divine doctrine is why we teach that gender is an essential characteristic of individual pre-mortal, mortal, and eternal identity and purpose.”

Oaks also said church doctrine “opposed changes that confuse or alter gender or homogenize the differences between men and women” and warned that “confusing gender, distorting marriage, and discouraging childbearing” was the devil’s work.

He also implored members of the faith to live peacefully and respect those with beliefs different than their own.

Oaks’ remarks reaffirm the faith’s long-held position on same-sex marriage that it has held to steadfastly even as its softened its policies on other LGTBQ matters, including allowing the children of same-sex couples to be baptized.

The Latter-day Saints’ reaffirmation of their stances comes as debates rage throughout the nation over transgender youth and what kids should learn about gender and sexuality. Officials in Texas have fought to classify gender confirmation surgeries as child abuse and Florida has outlawed instruction on sexual orientation and gender identity in kindergarten through third grade.

Monday, August 31, 2020

Racism among white Christians is higher than among the nonreligious. That's no coincidence.

Robert Jones
nbcnews.com
Originally published 27 July 20

Here are two excerpts:

As a white Christian who was raised Southern Baptist and shaped by a denominational college and seminary, it pains me to see these patterns in the data. Even worse, these questions only hint at the magnitude of the problem.

To determine the breadth of these attitudes, I created a "Racism Index," a measure consisting of 15 questions designed to get beyond personal biases and include perceptions of structural injustice. These questions included the three above, as well as questions about the treatment of African Americans in the criminal justice system and general perceptions of race, racism and racial discrimination.

Even at a glance, the Racism Index reveals a clear distinction. Compared to nonreligious whites, white Christians register higher median scores on the Racism Index, and the differences among white Christian subgroups are largely differences of degree rather than kind.

Not surprisingly, given their concentration in the South, white evangelical Protestants have the highest median score (0.78) on the Racism Index. But it is a mistake to see this as merely a Southern or an evangelical problem. The median scores of white Catholics (0.72) and white mainline Protestants (0.69) — groups that are more culturally dominant in the Northeast and the Midwest — are not far behind. Notably, the median score for each white Christian subgroup is significantly above the median scores of the general population (0.57), white religiously unaffiliated Americans (0.42) and Black Protestants (0.24).

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The results point to a stark conclusion: While most white Christians think of themselves as people who hold warm feelings toward African Americans, holding racist views is nonetheless positively and independently associated with white Christian identity. Again, this troubling relationship holds not just for white evangelical Protestants, but also for white mainline Protestants and white Catholics.

The info is here.

Wednesday, June 17, 2020

13th is now free on YouTube



Combining archival footage with testimony from activists and scholars, director Ava DuVernay's examination of the U.S. prison system looks at how the country's history of racial inequality drives the high rate of incarceration in America.

This piercing, Oscar-nominated film won Best Documentary at the Emmys, the BAFTAs and the NAACP Image Awards.

 US Rating: TV-MA For mature audiences. May not be suitable for ages 17 and under.

Wednesday, February 19, 2020

How to talk someone out of bigotry

Brian Resnick
vox.com
Originally published 29 Jan 20

Here is an excerpt:

Topping and dozens of other canvassers were a part of that 2016 effort. It was an important study: Not only has social science found very few strategies that work, in experiments, to change minds on issues of prejudice, but even fewer tests of those strategies have occurred in the real world.

Typically, the conversations begin with the canvasser asking the voter for their opinion on a topic, like abortion access, immigration, or LGBTQ rights. Canvassers (who may or may not be members of the impacted community) listen nonjudgmentally. They don’t say if they are pleased or hurt by the response. They are supposed “to appear genuinely interested in hearing the subject ruminate on the question,” as Broockman and Kalla’s latest study instructions read.

The canvassers then ask if the voters know anyone in the affected community, and ask if they relate to the person’s story. If they don’t, and even if they do, they’re asked a question like, “When was a time someone showed you compassion when you really needed it?” to get them to reflect on their experience when they might have felt something similar to the people in the marginalized community.

The canvassers also share their own stories: about being an immigrant, about being a member of the LGBTQ community, or about just knowing people who are.

It’s a type of conversation that’s closer to what a psychotherapist might have with a patient than a typical political argument. (One clinical therapist I showed it to said it sounded a bit like “motivational interviewing,” a technique used to help clients work through ambivalent feelings.) It’s not about listing facts or calling people out on their prejudicial views. It’s about sharing and listening, all the while nudging people to be analytical and think about their shared humanity with marginalized groups.

The info is here.

Friday, April 8, 2016

Tennessee Lawmakers Pass Bill Permitting Mental Health Professionals to Discriminate

By Eric Levitz
New York Magazine
Originally posted April 6, 2016

Tennessee's House of Representatives just passed a bill that would allow therapists who believe homosexuality is the mark of Satan to refuse to treat gay clients. More precisely, the bill allows mental-health counselors to deny treatment to anyone who seeks help with "goals, outcomes, or behaviors that conflict with the sincerely held principles of the counselors or therapist." If the bill makes it into law, Tennessee would be the first state to allow therapists to pick what kind of clients they're willing to serve.

From a certain angle, the law may appear more significant on a symbolic level than a practical one: If you're a gay teenager looking for someone to counsel you through your first same-sex relationship, it's probably in your interest to see someone who doesn't think that relationship will bring you eternal hellfire. But what's really at stake in the legislation is what the ethical code for licensed mental-health professionals in the United States will entail. The bill was drafted in reaction to the American Counseling Association's 2014 code of ethics, which warned counselors not to impose their personal values onto their clients. Tennessee's bill would allow the state's mental-health professionals to reject clients — for failing to conform to their beliefs — without losing their licenses.

The article is here.

Saturday, November 23, 2013

Swastikas, Slurs and Torment in Town’s Schools

By Benjamin Weiser
The New York Times
Originally published November 7, 2013

Here is an excerpt:

“There are anti-Semitic incidents that have occurred that we need to address,” John Boyle, Crispell Middle School’s principal, said in a deposition in April.

In 2011, when one parent complained about continued harassment of her daughter and another Jewish girl, Pine Bush’s superintendent from 2008 to 2013, Philip G. Steinberg, wrote in an email, “I have said I will meet with your daughters and I will, but your expectations for changing inbred prejudice may be a bit unrealistic.”

Mr. Steinberg, who, along with two other administrators named as defendants, is Jewish, described the lawsuit in recent interviews as a “money grab.” He contended that the plaintiffs had “embellished” some allegations.

The entire story is here.