Transformative experience and the right to revelatory autonomy

Farbod Akhlaghi

Analysis

Originally Published: 31 December 2022

Abstract

Sometimes it is not us but those to whom we stand in special relations that face transformative choices: our friends, family or beloved. A focus upon first-personal rational choice and agency has left crucial ethical questions regarding what we owe to those who face transformative choices largely unexplored. In this paper I ask: under what conditions, if any, is it morally permissible to interfere to try to prevent another from making a transformative choice? Some seemingly plausible answers to this question fail precisely because they concern transformative experiences. I argue that we have a distinctive moral right to revelatory autonomy grounded in the value of autonomous self-making. If this right is outweighed then, I argue, interfering to prevent another making a transformative choice is permissible. This conditional answer lays the groundwork for a promising ethics of transformative experience.

Conclusion

Ethical questions regarding transformative experiences are morally urgent. A complete answer to our question requires ascertaining precisely how strong the right to revelatory autonomy is and what competing considerations can outweigh it. These are questions for another time, where the moral significance of revelation and self-making, the competing weight of moral and non-moral considerations, and the sense in which some transformative choices are more significant to one’s identity and self-making than others must be further explored.

But to identify the right to revelatory autonomy and duty of revelatory non-interference is significant progress. For it provides a framework to address the ethics of transformative experience that avoids complications arising from the epistemic peculiarities of transformative experiences. It also allows us to explain cases where we are permitted to interfere in another’s transformative choice and why interference in some choices is harder to justify than others, whilst recognizing plausible grounds for the right to revelatory autonomy itself in the moral value of autonomous self-making. This framework, moreover, opens novel avenues of engagement with wider ethical issues regarding transformative experience, for example concerning social justice or surrogate transformative choice-making. It is, at the very least, a view worthy of further consideration.

The info is here.

This reasoning applies to psychologists in psychotherapy.  Unless significant danger is present, psychologists need to avoid intrusive advocacy, meaning pulling autonomy away from the patient.  Soft paternalism can occur in psychotherapy, when trying to avoid significant harm.

Physicians united: Here’s why pulling out of WHO is a big mistake

Andis Robeznieks
American Medical Association
Originally published 8 July 20

Here is an excerpt:

The joint statement builds on a previous response from the AMA made back in May after the administration announced its intention to withdraw from the WHO.

Withdrawal served “no logical purpose,” made finding a solution to the pandemic more challenging and could have harmful repercussions in worldwide efforts to develop a vaccine and effective COVID-19 treatments, then-AMA President Patrice A. Harris, MD, MA, said at the time.

Defeating COVID-19 “requires the entire world working together,” Dr. Harris added.

In April, Dr. Harris said withdrawing from the WHO would be “a dangerous step in the wrong direction, and noted that “fighting a global pandemic requires international cooperation “

“Cutting funding to the WHO—rather than focusing on solutions—is a dangerous move at a precarious moment for the world,” she added

The message regarding the need for a unified international effort was echoed in the statement from the physician leaders.

"As our nation and the rest of the world face a global health pandemic, a worldwide, coordinated response is more vital than ever,” they said. “This dangerous withdrawal not only impacts the global response against COVID-19, but also undermines efforts to address other major public health threats.”

The info is here.

How Could the CDC Make That Mistake?

Alexis C. Madrigal & Robinson Meyer
The Atlantic
Originally posted 21 May 20

The Centers for Disease Control and Prevention is conflating the results of two different types of coronavirus tests, distorting several important metrics and providing the country with an inaccurate picture of the state of the pandemic. We’ve learned that the CDC is making, at best, a debilitating mistake: combining test results that diagnose current coronavirus infections with test results that measure whether someone has ever had the virus. The upshot is that the government’s disease-fighting agency is overstating the country’s ability to test people who are sick with COVID-19. The agency confirmed to The Atlantic on Wednesday that it is mixing the results of viral and antibody tests, even though the two tests reveal different information and are used for different reasons.

This is not merely a technical error. States have set quantitative guidelines for reopening their economies based on these flawed data points.

Several states—including Pennsylvania, the site of one of the country’s largest outbreaks, as well as Texas, Georgia, and Vermont—are blending the data in the same way. Virginia likewise mixed viral and antibody test results until last week, but it reversed course and the governor apologized for the practice after it was covered by the Richmond Times-Dispatch and The Atlantic. Maine similarly separated its data on Wednesday; Vermont authorities claimed they didn’t even know they were doing this.

The widespread use of the practice means that it remains difficult to know exactly how much the country’s ability to test people who are actively sick with COVID-19 has improved.

The info is here.

Why Google thinks we need to regulate AI

Sundar Pichai
ft.com
Originally posted 19 Jan 20

Here are two excerpts:

Yet history is full of examples of how technology’s virtues aren’t guaranteed. Internal combustion engines allowed people to travel beyond their own areas but also caused more accidents. The internet made it possible to connect with anyone and get information from anywhere, but also easier for misinformation to spread.

These lessons teach us that we need to be clear-eyed about what could go wrong. There are real concerns about the potential negative consequences of AI, from deepfakes to nefarious uses of facial recognition. While there is already some work being done to address these concerns, there will inevitably be more challenges ahead that no one company or industry can solve alone.

(cut)

But principles that remain on paper are meaningless. So we’ve also developed tools to put them into action, such as testing AI decisions for fairness and conducting independent human-rights assessments of new products. We have gone even further and made these tools and related open-source code widely available, which will empower others to use AI for good. We believe that any company developing new AI tools should also adopt guiding principles and rigorous review processes.

Government regulation will also play an important role. We don’t have to start from scratch. Existing rules such as Europe’s General Data Protection Regulation can serve as a strong foundation. Good regulatory frameworks will consider safety, explainability, fairness and accountability to ensure we develop the right tools in the right ways. Sensible regulation must also take a proportionate approach, balancing potential harms, especially in high-risk areas, with social opportunities.

Regulation can provide broad guidance while allowing for tailored implementation in different sectors. For some AI uses, such as regulated medical devices including AI-assisted heart monitors, existing frameworks are good starting points. For newer areas such as self-driving vehicles, governments will need to establish appropriate new rules that consider all relevant costs and benefits.

The info is here.

Vatican, Catholic colleges weigh-in on emerging AI ethics debate

Jack Jenkins
National Catholic Reporter
Originally posted May 25, 2019

Here is an excerpt:

Mastrofini also noted that the partnership emerged after Pope Francis asked the academy to study the topic of ethics and AI.

"The technologies are advancing but they are not neutral," he told Religion News Service via email. "The Church, expert in humanity, can show the way for a development that makes the world more human and fair."

Microsoft officials declined to comment on the meeting.

The conversation between the Pope and Smith is one of several recent attempts by religious groups to wade into Silicon Valley's ongoing debate over the ethics of artificial intelligence.

Not long after Microsoft announced its partnership with the Vatican, Francis addressed the issue directly during a speech to a plenary meeting of the Pontifical Academy for Life. The pontiff noted that he had previously spoken to the seriousness of artificial intelligence during his January 2018 address to the World Economic Forum in Davos, Switzerland, but doubled-down on the potential dangers of misusing technology.

"It should be noted that the designation of 'artificial intelligence,' although certainly effective, may risk being misleading," Francis told the Pontifical Academy. "The terms conceal the fact that — in spite of the useful fulfillment of servile tasks (this is the original meaning of the term 'robot'), functional automatisms remain qualitatively distant from the human prerogatives of knowledge and action. And therefore they can become socially dangerous."

The info is here.

The Fake Sex Doctor Who Conned the Media Into Publicizing His Bizarre Research on Suicide, Butt-Fisting, and Bestiality

Jennings Brown
www.gizmodo.com
Originally published March 1, 2019

Here is an excerpt:

Despite Sendler’s claims that he is a doctor, and despite the stethoscope in his headshot, he is not a licensed doctor of medicine in the U.S. Two employees of the Harvard Medical School registrar confirmed to me that Sendler was never enrolled and never received a MD from the medical school. A Harvard spokesperson told me Sendler never received a PhD or any degree from Harvard University.

“I got into Harvard Medical School for MD, PhD, and Masters degree combined,” Sendler told me. I asked if he was able to get a PhD in sexual behavior from Harvard Medical School (Harvard Medical School does not provide any sexual health focuses) and he said “Yes. Yes,” without hesitation, then doubled-down: “I assume that there’s still some kind of sense of wonder on campus [about me]. Because I can see it when I go and visit [Harvard], that people are like, ‘Wow you had the balls, because no one else did that,’” presumably referring to his academic path.

Sendler told me one of his mentors when he was at Harvard Medical School was Yi Zhang, a professor of genetics at the school. Sendler said Zhang didn’t believe in him when he was studying at Harvard. But, Sendler said, he met with Zhang in Boston just a month prior to our interview. And Zhang was now impressed by Sendler’s accomplishments.

Sendler said Zhang told him in January, “Congrats. You did what you felt was right... Turns out, wow, you have way more power in research now than I do. And I’m just very proud of you, because I have people that I really put a lot of effort, after you left, into making them the best and they didn’t turn out that well.”

The info is here.

This is a fairly bizarre story and worth the long read.

Drug Companies’ Liability for the Opioid Epidemic

Rebecca L. Haffajee and Michelle M. Mello
N Engl J Med 2017; 377:2301-2305
December 14, 2017
DOI: 10.1056/NEJMp1710756

Here is an excerpt:

Opioid products, they alleged, were defectively designed because companies failed to include safety mechanisms, such as an antagonist agent or tamper-resistant formulation. Manufacturers also purportedly failed to adequately warn about addiction risks on drug packaging and in promotional activities. Some claims alleged that opioid manufacturers deliberately withheld information about their products’ dangers, misrepresenting them as safer than alternatives.

These suits faced formidable barriers that persist today. As with other prescription drugs, persuading a jury that an opioid is defectively designed if the Food and Drug Administration approved it is challenging. Furthermore, in most states, a drug manufacturer’s duty to warn about risks is limited to issuing an adequate warning to prescribers, who are responsible for communicating with patients. Finally, juries may resist laying legal responsibility at the manufacturer’s feet when the prescriber’s decisions and the patient’s behavior contributed to the harm. Some individuals do not take opioids as prescribed or purchase them illegally. Companies may argue that such conduct precludes holding manufacturers liable, or at least should reduce damages awards.

One procedural strategy adopted in opioid litigation that can help overcome defenses based on users’ conduct is the class action suit, brought by a large group of similarly situated individuals. In such suits, the causal relationship between the companies’ business practices and the harm is assessed at the group level, with the focus on statistical associations between product use and injury. The use of class actions was instrumental in overcoming tobacco companies’ defenses based on smokers’ conduct. But early attempts to bring class actions against opioid manufacturers encountered procedural barriers. Because of different factual circumstances surrounding individuals’ opioid use and clinical conditions, judges often deemed proposed class members to lack sufficiently common claims.

The article is here.

The dawn of artificial intelligence

Powerful computers will reshape humanity’s future. How to ensure the promise outweighs the perils

The Economist
Originally published May 9, 2015

“The development of full artificial intelligence could spell the end of the human race,” Stephen Hawking warns. Elon Musk fears that the development of artificial intelligence, or AI, may be the biggest existential threat humanity faces. Bill Gates urges people to beware of it.

Dread that the abominations people create will become their masters, or their executioners, is hardly new. But voiced by a renowned cosmologist, a Silicon Valley entrepreneur and the founder of Microsoft—hardly Luddites—and set against the vast investment in AI by big firms like Google and Microsoft, such fears have taken on new weight. With supercomputers in every pocket and robots looking down on every battlefield, just dismissing them as science fiction seems like self-deception. The question is how to worry wisely.

The entire article is here.

A fault in our design

We tend to think that technological progress is making us more resilient, but it might be making us more vulnerable

By Colin Dickey
Aeon Magazine
Originally published January 23, 2015

Here is an excerpt:

Freed from the constant worry of danger, we tend to forget that there ever was a danger in the first place. We’ve immunised ourselves from the fear of diseases that once plagued us, to the point where they’re now killing us once more. Fuelled by the viral spread of misinformation and paranoia, vaccine use has plummeted in parts of the Western world, leading to a resurgence in viruses. In the US, mortality rates for pertussis (whooping cough) dropped from 1,100 in 1950 to six in 1995, yet in the past decade outbreaks have once again spiked – more than 48,000 cases were reported in 2013, significantly outnumbering the 5137 cases that were reported back in 1995.

The entire article is here.

Sick in the head? Pathogen concerns bias implicit perceptions of mental illness

By Erick M. Lund and Ian A. Boggero
Evolutionary Psychology 12(4): 706-718

ABSTRACT

Biases against the mentally ill are historically and cross-culturally pervasive, suggesting they may have an evolutionary basis. The prevailing view is that people seek to distance themselves from the mentally ill because they are perceived as dangerous, violent, and incompetent. However, because of similarities between sickness behaviors and symptoms of some mental disorders, it was hypothesized that mental illness stigma could be partially explained as a function of behavioral immune system biases designed to avoid potential sources of contagion. In two experiments, it was found that mental illness was implicitly associated more with disease than danger. In Experiment 1, this implicit association was exacerbated among people who have had their biological immune system activated by a recent illness. In Experiment 2, experimentally priming disease salience increased implicit association between mental illness and disease. Implications for the evolutionary origins of prejudice and the prevention of mental illness stigma are discussed.

The article is here.

Episode 18: Critical Incidents and Psychologist Safety

If you have missed AM radio, then you will appreciate this episode.  John experiments with conference call software with his guests to discuss ethics and safety from a psychologist's point of view.  I apologize about the squeaks (Shannon's phone), scratches and other recording imperfections.

John's guests include Dr. Don McAleer, psychologist, gun owner, firearms instructor, firearm collector; Massad Ayoob, an international firearms and self-defense instructor, expert in lethal force encounters and shooting cases, and author; and, Dr. Shannon Clark, psychologist, FBI agent, active shooter and response instructor, and lifelong martial artist.

We discuss the ethics of nonmaleficence (do no harm) versus personal safety.  It is no secret that psychologists are vulnerable to threat, assault, and stalking from patients and family members of patients.  The overarching goal is to start a discussion for psychologists and mental health professionals about potential dangers for mental health professionals and some options to help keep them safe.

Click here to earn 1 APA-approved CE credit

At the end of this podcast, the listener will be able to:

1. Outline your personal values related to safety in your professional life.
2. List the options to enhance personal safety in your office.
3. Describe several responsible steps to take if you decide to carry a firearm or house one in your office.

Click here to find on iTunes

Reading Material

Ken Pope: Therapists' Resources for Threats, Stalking, or Assaults by Patients

Robert B. Young: When a Psychiatrist Shoots to Kill 

Dave Grossman: On Killing: The Psychological Cost of Learning to Kill in War and Society

Massad Ayoob: In the Gravest Extreme: The Role of the Firearm in Personal Protection

Massad Ayoob: Deadly Force: Understanding Your Right to Self Defense

Massad Ayoob Information

Massad's Training Institute

Contact information for Shannon Clark

Shannon Clark

Oxford professor thinks artificial intelligence will destroy us all

By Dylan Matthews
Interview on Vox
Updated August 19, 2014

Here is an excerpt:

The basic argument is simple. At some point, many experts believe that artificial intelligence will advance to a point where it not only exceeds human intelligence, but is capable of expanding its own intelligence, setting off an exponential "intelligence explosion." In theory, these hyper-intelligent machines could be used to serve human ends. They could cure diseases and resolve intractable scientific quandaries. In an extreme case, they could wholly replace human workers, enabling humankind to quit working and live comfortably off the robots' labor.

But the problem is that, Bostrom argues, superintelligent machines will be so much more intelligent than humans that they most likely won't remain tools. They'll become goal-driven actors in their own right, and their goals may not be compatible with those of humans. Indeed, they might not be compatible with the continued existence of humans. Please consult the Terminator franchise for more on how that situation plays out.

The entire article and interview is here.

When Doctors ‘Google’ Their Patients

By Haider Javed Warraich
The New York Times - Well Blog
Originally published January 6, 2013

Here is an excerpt:

I am tempted to prescribe that physicians should never look online for information about their patients, though I think the practice will become only more common, given doctors’ — and all of our — growing dependence on technology. The more important question health care providers need to ask themselves is why we would like to.

To me, the only legitimate reason to search for a patient’s online footprint is if there is a safety issue. If, for example, a patient appears to be manic or psychotic, it might be useful to investigate whether certain claims the patient makes are true. Or, if a doctor suspects a pediatric patient is being abused, it might make sense to look for evidence online. Physicians have also investigated patients on the web if they were concerned about suicide risk, or needed to contact the family of an unresponsive patient.

The entire article is here.

Internet forums can have a positive influence on self-harmers, say researchers

By Jochan Embley
The Independent
Originally published October 31, 2013

Internet forums and chatrooms can have a positive influence on young people at risk from self-harm or suicide, researchers have found.

The review, which comes from researchers at Oxford University, does admit that there are also negative, potentially dangerous aspects to forums, however.

The entire story is here.

Physician Guilty of Medicare Fraud Put Patients at Risk

By Robert Lowes

Medscape Medical News

Published January 18, 2012

A stiff prison sentence handed down to a physician in Los Angeles, California, last week for his role in a massive Medicare scam highlights how a seeming burlesque of medicine posed a danger to patients.

Alexander Popov, MD, was sentenced to 8 years and 1 month in prison in a federal court in Sacramento, California, after a jury last year found him guilty of conspiring to — and committing — healthcare fraud. An indictment issued in 2010 stated that Dr. Popov and 4 other physicians allowed a man named Vardges Egiazarian, who owned 3 clinics in the California cities of Carmichael, Richmond, and Sacramento, to submit Medicare claims in their names. Dr. Popov took on the role of co-owner and practitioner at the Sacramento clinic but never saw a patient there, according to federal prosecutors.

Over the course of 2 and a half years, Dr. Popov and the other physicians submitted more than $5 million worth of bogus claims to Medicare for nonexistent or unnecessary services, of which they received $1.7 million. The physicians' share of the take was 20% of what was paid out under their Medicare provider number.

In a sentencing memo filed in the case, federal prosecutors credit Dr. Popov and the other conspirators with doing "everything necessary to establish and operate a health clinic, with the exception of actual healthcare." As part of their hustle, they paid "cappers" to recruit and transport patients to the clinics, and the patients themselves received $100 each for showing up — a kind of reverse copay.

The patients, who were predominantly elderly immigrants who did not speak English, received little if any medical care during their visits. Clinic employees nevertheless recorded in their charts that they had received a comprehensive exam and a broad array of diagnostic tests. Staff would plug in off-the-shelf test results or would run tests on themselves and use those numbers. Dr. Popov, who lived in Los Angeles, saw none of these patients in person, but signed the charts anyway, according to prosecutors.

The entire story can be found here.

danger + opportunity ≠ crisis

How a misunderstanding about Chinese characters has led many astray

by Victor H. Mair

There is a widespread public misperception, particularly among the New Age sector, that the Chinese word for “crisis” is composed of elements that signify “danger” and “opportunity.” I first encountered this curious specimen of alleged oriental wisdom about ten years ago at an altitude of 35,000 feet sitting next to an American executive. He was intently studying a bound volume that had adopted this notorious formulation as the basic premise of its method for making increased profits even when the market is falling. At that moment, I didn't have the heart to disappoint my gullible neighbor who was blissfully imbibing what he assumed were the gems of Far Eastern sagacity enshrined within the pages of his workbook. Now, however, the damage from this kind of pseudo-profundity has reached such gross proportions that I feel obliged, as a responsible Sinologist, to take counteraction.

A whole industry of pundits and therapists has grown up around this one grossly inaccurate statement. A casual search of the Web turns up more than a million references to this spurious proverb. It appears, often complete with Chinese characters, on the covers of books, on advertisements for seminars, on expensive courses for “thinking outside of the box,” and practically everywhere one turns in the world of quick-buck business, pop psychology, and orientalist hocus-pocus. This catchy expression (Crisis = Danger + Opportunity) has rapidly become nearly as ubiquitous as The Tao of Pooh and Sun Zi's Art of War for the Board / Bed / Bath / Whichever Room.

The explication of the Chinese word for crisis as made up of two components signifying danger and opportunity is due partly to wishful thinking, but mainly to a fundamental misunderstanding about how terms are formed in Mandarin and other Sinitic languages. For example, one of the most popular websites centered on this mistaken notion about the Chinese word for crisis explains: “The top part of the Chinese Ideogram for 'Crisis' is the symbol for 'Danger': The bottom symbol represents 'Opportunity'.” Among the most egregious of the radical errors in this statement is the use of the exotic term “Ideogram” to refer to Chinese characters. Linguists and writing theorists avoid “ideogram” as a descriptive referent for hanzi (Mandarin) / kanji (Japanese) / hanja (Korean) because only an exceedingly small proportion of them actually convey ideas directly through their shapes. (For similar reasons, the same caveat holds for another frequently encountered label, pictogram.) It is far better to refer to the hanzi / kanji / hanja as logographs, sinographs, hanograms, tetragraphs (from their square shapes [i.e., as fangkuaizi]), morphosyllabographs, etc., or — since most of those renditions may strike the average reader as unduly arcane or clunky — simply as characters.

The second misconception in this formulation is that the author seems to take the Chinese word for crisis as a single graph, referring to it as “the Chinese Ideogram for 'crisis'.” Like most Mandarin words, that for “crisis” (wēijī) consists of two syllables that are written with two separate characters, wēi (危) and jī (機/机).

The third, and fatal, misapprehension is the author's definition of jī as “opportunity.” While it is true that wēijī does indeed mean “crisis” and that the wēi syllable of wēijī does convey the notion of “danger,” the jī syllable of wēijī most definitely does not signify “opportunity.” Webster's Ninth New Collegiate Dictionary defines “opportunity” as:

1. a favorable juncture of circumstances;
2. a good chance for advancement or progress.

While that may be what our Pollyanaish advocates of “crisis” as “danger” plus “opportunity” desire jī to signify, it means something altogether different.

The jī of wēijī, in fact, means something like “incipient moment; crucial point (when something begins or changes).” Thus, a wēijī is indeed a genuine crisis, a dangerous moment, a time when things start to go awry. A wēijī indicates a perilous situation when one should be especially wary. It is not a juncture when one goes looking for advantages and benefits. In a crisis, one wants above all to save one's skin and neck! Any would-be guru who advocates opportunism in the face of crisis should be run out of town on a rail, for his / her advice will only compound the danger of the crisis.

For those who have staked their hopes and careers on the CRISIS = DANGER + OPPORTUNITY formula and are loath to abandon their fervent belief in jī as signifying “opportunity,” it is essential to list some of the primary meanings of the graph in question. Aside from the notion of “incipient moment” or “crucial point” discussed above, the graph for jī by itself indicates “quick-witted(ness); resourceful(ness)” and “machine; device.” In combination with other graphs, however, jī can acquire hundreds of secondary meanings. It is absolutely crucial to observe that jī possesses these secondary meanings only in the multisyllabic terms into which it enters. To be specific in the matter under investigation, jī added to huì (“occasion”) creates the Mandarin word for “opportunity” (jīhuì), but by itself jī does not mean “opportunity.”

The rest can be read at Pinyin.info