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 Harm. Show all posts
Showing posts with label Harm. Show all posts

Tuesday, February 20, 2024

Understanding Liability Risk from Using Health Care Artificial Intelligence Tools

Mello, M. M., & Guha, N. (2024).
The New England journal of medicine, 390(3), 271–278. https://doi.org/10.1056/NEJMhle2308901

Optimism about the explosive potential of artificial intelligence (AI) to transform medicine is tempered by worry about what it may mean for the clinicians being "augmented." One question is especially problematic because it may chill adoption: when Al contributes to patient injury, who will be held responsible?

Some attorneys counsel health care organizations with dire warnings about liability1 and dauntingly long lists of legal concerns. Unfortunately, liability concern can lead to overly conservative decisions, including reluctance to try new things. Yet, older forms of clinical decision support provided important opportunities to prevent errors and malpractice claims. Given the slow progress in reducing diagnostic errors, not adopting new tools also has consequences and at some point may itself become malpractice. Liability uncertainty also affects Al developers' cost of capital and incentives to develop particular products, thereby influencing which Al innovations become available and at what price.

To help health care organizations and physicians weigh Al-related liability risk against the benefits of adoption, we examine the issues that courts have grappled with in cases involving software error and what makes them so challenging. Because the signals emerging from case law remain somewhat faint, we conducted further analysis of the aspects of Al tools that elevate or mitigate legal risk. Drawing on both analyses, we provide risk-management recommendations, focusing on the uses of Al in direct patient care with a "human in the loop" since the use of fully autonomous systems raises additional issues.

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The Awkward Adolescence of Software-Related Liability

Legal precedent regarding Al injuries is rare because Al models are new and few personal-injury claims result in written opinions. As this area of law matures, it will confront several challenges.

Challenges in Applying Tort Law Principles to Health Care Artificial Intelligence (AI).

Ordinarily, when a physician uses or recommends a product and an injury to the patient results, well-established rules help courts allocate liability among the physician, product maker, and patient. The liabilities of the physician and product maker are derived from different standards of care, but for both kinds of defendants, plaintiffs must show that the defendant owed them a duty, the defendant breached the applicable standard of care, and the breach caused their injury; plaintiffs must also rebut any suggestion that the injury was so unusual as to be outside the scope of liability.

The article is paywalled, which is not how this should work.

Friday, February 16, 2024

Citing Harms, Momentum Grows to Remove Race From Clinical Algorithms

B. Kuehn
JAMA
Published Online: January 17, 2024.
doi:10.1001/jama.2023.25530

Here is an excerpt:

The roots of the false idea that race is a biological construct can be traced to efforts to draw distinctions between Black and White people to justify slavery, the CMSS report notes. For example, the third US president, Thomas Jefferson, claimed that Black people had less kidney output, more heat tolerance, and poorer lung function than White individuals. Louisiana physician Samuel Cartwright, MD, subsequently rationalized hard labor as a way for slaves to fortify their lungs. Over time, the report explains, the medical literature echoed some of those ideas, which have been used in ways that cause harm.

“It is mind-blowing in some ways how deeply embedded in history some of this misinformation is,” Burstin said.

Renewed recognition of these harmful legacies and growing evidence of the potential harm caused by structural racism, bias, and discrimination in medicine have led to reconsideration of the use of race in clinical algorithms. The reckoning with racial injustice sparked by the May 2020 murder of George Floyd helped accelerate this work. A few weeks after Floyd’s death, an editorial in the New England Journal of Medicine recommended reconsidering race in 13 clinical algorithms, echoing a growing chorus of medical students and physicians arguing for change.

Congress also got involved. As a Robert Wood Johnson Foundation Health Policy Fellow, Michelle Morse, MD, MPH, raised concerns about the use of race in clinical algorithms to US Rep Richard Neal (D, MA), then chairman of the House Ways and Means Committee. Neal in September 2020 sent letters to several medical societies asking them to assess racial bias and a year later he and his colleagues issued a report on the misuse of race in clinical decision-making tools.

“We need to have more humility in medicine about the ways in which our history as a discipline has actually held back health equity and racial justice,” Morse said in an interview. “The issue of racism and clinical algorithms is one really tangible example of that.”


My summary: There's increasing worry that using race in clinical algorithms can be harmful and perpetuate racial disparities in healthcare. This concern stems from a recognition of the historical harms of racism in medicine and growing evidence of bias in algorithms.

A review commissioned by the Agency for Healthcare Research and Quality (AHRQ) found that using race in algorithms can exacerbate health disparities and reinforce the false idea that race is a biological factor.

Several medical organizations and experts have called for reevaluating the use of race in clinical algorithms. Some argue that race should be removed altogether, while others advocate for using it only in specific cases where it can be clearly shown to improve outcomes without causing harm.

Wednesday, February 14, 2024

Responding to Medical Errors—Implementing the Modern Ethical Paradigm

T. H. Gallagher &  A. Kachalia
The New England Journal of Medicine
January 13, 2024
DOI: 10.1056/NEJMp2309554

Here are some excerpts:

Traditionally, recommendations regarding responding to medical errors focused mostly on whether to disclose mistakes to patients. Over time, empirical research, ethical analyses, and stakeholder engagement began to inform expectations - which are now embodied in communication and resolution programs (CRPS) — for how health care professionals and organizations should respond not just to errors but any time patients have been harmed by medical care (adverse events). CRPs require several steps: quickly detecting adverse events, communicating openly and empathetically with patients and families about the event, apologizing and taking responsibility for errors, analyzing events and redesigning processes to prevent recurrences, supporting patients and clinicians, and proactively working with patients toward reconciliation. In this modern ethical paradigm, any time harm occurs, clinicians and health care organizations are accountable for minimizing suffering and promoting learning. However, implementing this ethical paradigm is challenging, especially when the harm was due to an error.

Historically, the individual physician was deemed the "captain of the ship," solely accountable for patient outcomes. Bioethical analyses emphasized the fiduciary nature of the doctor-patient relationship (i.e., doctors are in a position of greater knowledge and power) and noted that telling patients...about harmful errors supported patient autonomy and facilitated informed consent for future decisions. However, under U.S. tort law, physicians and organizations can be held accountable and financially liable for damages when they make negligent errors. As a result, ethical recommendations for openness were drowned out by fears of lawsuits and payouts, leading to a "deny and defend" response. Several factors initiated a paradigm shift. In the early 2000s, reports from the Institute of Medicine transformed the way the health care profession conceptualized patient safety.1 The imperative became creating cultures of safety that encouraged everyone to report errors to enable learning and foster more reliable systems. Transparency assumed greater importance, since you cannot fix problems you don't know about. The ethical imperative for openness was further supported when rising consumerism made it clear that patients expected responses to harm to include disclosure of what happened, an apology, reconciliation, and organizational learning.

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CRP Model for Responding to Harmful Medical Errors

Research has been critical to CRP expansion. Several studies have demonstrated that CRPs can enjoy physician support and operate without increasing liability risk. Nonetheless, research also shows that physicians remain concerned about their ability to communicate with patients and families after a harmful error and worry about liability risks including being sued, having their malpractice premiums raised, and having the event reported to the National Practitioner Data Bank (NPDB).5 Successful CRPS typically deploy a formal team, prioritize clinician and leadership buy-in, and engage liability insurers in their efforts. The table details the steps associated with the CRP model, the ethical rationale for each step, barriers to implementation, and strategies for overcoming them.

The growth of CRPs also reflects collaboration among diverse stakeholder groups, including patient advocates, health care organizations, plaintiff and defense attorneys, liability insurers, state medical associations, and legislators. Sustained stakeholder engagement that respects the diverse perspectives of each group has been vital, given the often opposing views these groups have espoused.
As CRPS proliferate, it will be important to address a few key challenges and open questions in implementing this ethical paradigm.


The article provides a number of recommendations for how healthcare providers can implement these principles. These include:
  • Developing open and honest communication with patients.
  • Providing timely and accurate information about the error.
  • Offering apologies and expressing empathy for the harm that has been caused.
  • Working with patients to develop a plan to address the consequences of the error.
  • Conducting a thorough investigation of the error to identify the root causes and prevent future errors.
  • Sharing the results of the investigation with patients and the public.

Tuesday, February 13, 2024

Majority of debtors to US hospitals now people with health insurance

Jessica Glenza
The Guardian
Originally posted 11 Jan 24

People with health insurance may now represent the majority of debtors American hospitals struggle to collect from, according to medical billing analysts.

This marks a sea change from just a few years ago, when people with health insurance represented only about one in 10 bills hospitals considered “bad debt”, analysts said.

“We always used to consider bad debt, especially bad debt write-offs from a hospital perspective, those [patients] that have the ability to pay but don’t,” said Colleen Hall, senior vice-president for Kodiak Solutions, a billing, accounting and consulting firm that works closely with hospitals and performed the analysis.

“Now, it’s not as if these patients across the board are even able to pay, because [out-of-pocket costs are] such an astronomical amount related to what their general income might be.”

Although “bad debt” can be a controversial metric in its own right, those who work in the hospital billing industry say it shows how complex health insurance products with large out-of-pocket costs have proliferated.

“What we noticed was a breaking point right around the 2018-2019 timeframe,” said Matt Szaflarski, director of revenue cycle intelligence at Kodiak Solutions. The trend has since stabilized, but remains at more than half of all “bad debt”.

In 2018, just 11.1% of hospitals’ bad debt came from insured “self-pay” accounts, or from patients whose insurance required out-of-pocket payments, according to Kodiak. By 2022, the proportion who did (or could) not pay their bills soared to 57.6% of all hospitals’ bad debt.


The US Healthcare system needs to be fixed:

Not all health insurance plans are created equal. Many plans have narrow networks and limited coverage, leaving patients responsible for costs associated with out-of-network providers or specialized care. This can be particularly detrimental for people with chronic conditions or those requiring emergency care.

Medical debt can have a devastating impact on individuals and families. It can lead to financial hardship, delayed or foregone care, damage to credit scores, and even bankruptcy. This can have long-term consequences for physical and mental health, employment opportunities, and overall well-being.

Fixing the US healthcare system is a complex challenge, but it is essential to ensure that everyone has access to affordable, quality healthcare without fear of financial ruin. 

Friday, February 2, 2024

Young people turning to AI therapist bots

Joe Tidy
BBC.com
Originally posted 4 Jan 24

Here is an excerpt:

Sam has been so surprised by the success of the bot that he is working on a post-graduate research project about the emerging trend of AI therapy and why it appeals to young people. Character.ai is dominated by users aged 16 to 30.

"So many people who've messaged me say they access it when their thoughts get hard, like at 2am when they can't really talk to any friends or a real therapist,"
Sam also guesses that the text format is one with which young people are most comfortable.
"Talking by text is potentially less daunting than picking up the phone or having a face-to-face conversation," he theorises.

Theresa Plewman is a professional psychotherapist and has tried out Psychologist. She says she is not surprised this type of therapy is popular with younger generations, but questions its effectiveness.

"The bot has a lot to say and quickly makes assumptions, like giving me advice about depression when I said I was feeling sad. That's not how a human would respond," she said.

Theresa says the bot fails to gather all the information a human would and is not a competent therapist. But she says its immediate and spontaneous nature might be useful to people who need help.
She says the number of people using the bot is worrying and could point to high levels of mental ill health and a lack of public resources.


Here are some important points-

Reasons for appeal:
  • Cost: Traditional therapy's expense and limited availability drive some towards bots, seen as cheaper and readily accessible.
  • Stigma: Stigma associated with mental health might make bots a less intimidating first step compared to human therapists.
  • Technology familiarity: Young people, comfortable with technology, find text-based interaction with bots familiar and less daunting than face-to-face sessions.
Concerns and considerations:
  • Bias: Bots trained on potentially biased data might offer inaccurate or harmful advice, reinforcing existing prejudices.
  • Qualifications: Lack of professional mental health credentials and oversight raises concerns about the quality of support provided.
  • Limitations: Bots aren't replacements for human therapists. Complex issues or severe cases require professional intervention.

Friday, December 29, 2023

A Hybrid Account of Harm

Unruh, C. F. (2022).
Australasian Journal of Philosophy, 1–14.
https://doi.org/10.1080/00048402.2022.2048401

Abstract

When does a state of affairs constitute a harm to someone? Comparative accounts say that being worse off constitutes harm. The temporal version of the comparative account is seldom taken seriously, due to apparently fatal counterexamples. I defend the temporal version against these counterexamples, and show that it is in fact more plausible than the prominent counterfactual version of the account. Non-comparative accounts say that being badly off constitutes harm. However, neither the temporal comparative account nor the non-comparative account can correctly classify all harms. I argue that we should combine them into a hybrid account of harm. The hybrid account is extensionally adequate and presents a unified view on the nature of harm.


Here's my take:

Charlotte Unruh proposes a new way of thinking about harm. Unruh argues that neither the traditional comparative account nor the non-comparative account of harm can adequately explain all cases of harm. The comparative account says that harm consists in being worse off than one would have been had some event not occurred. The non-comparative account says that harm consists in being in a bad state, regardless of how one would have fared otherwise.

Unruh proposes a hybrid account of harm that combines elements of both the comparative and non-comparative accounts. She says that an agent suffers harm if and only if either (i) the agent suffers ill-being or (ii) the agent's well-being is lower than it was before. This hybrid account is able to explain cases of harm that cannot be explained by either the comparative or non-comparative account alone. For example, the hybrid account explains why it is harmful to prevent someone from achieving a good that they would have otherwise achieved, even if the person is still in a good state overall.

Unruh's hybrid account of harm has a number of advantages over other accounts of harm. It is extensionally adequate, meaning that it correctly classifies all cases of harm as harmful and all cases of non-harm as non-harmful. It is also normatively plausible, meaning that it accords with our intuitions about what counts as harm. Additionally, the hybrid account is able to explain a number of different phenomena related to harm, such as the severity of harm, the distribution of harm, and the compensation for harm.

Wednesday, November 8, 2023

Everything you need to know about artificial wombs

Cassandra Willyard
MIT Technology Review
Originally posted 29 SEPT 23

Here is an excerpt:

What is an artificial womb?

An artificial womb is an experimental medical device intended to provide a womblike environment for extremely premature infants. In most of the technologies, the infant would float in a clear “biobag,” surrounded by fluid. The idea is that preemies could spend a few weeks continuing to develop in this device after birth, so that “when they’re transitioned from the device, they’re more capable of surviving and having fewer complications with conventional treatment,” says George Mychaliska, a pediatric surgeon at the University of Michigan.

One of the main limiting factors for survival in extremely premature babies is lung development. Rather than breathing air, babies in an artificial womb would have their lungs filled with lab-made amniotic fluid, that mimics the amniotic fluid they would have hadjust like they would in utero. Neonatologists would insert tubes into blood vessels in the umbilical cord so that the infant’s blood could cycle through an artificial lung to pick up oxygen. 

The device closest to being ready to be tested in humans, called the EXTrauterine Environment for Newborn Development, or EXTEND, encases the baby in a container filled with lab-made amniotic fluid. It was invented by Alan Flake and Marcus Davey at the Children’s Hospital of Philadelphia and is being developed by Vitara Biomedical.


Here is my take:

Artificial wombs are experimental medical devices that aim to provide a womb-like environment for extremely premature infants. The technology is still in its early stages of development, but it has the potential to save the lives of many babies who would otherwise not survive.

Overall, artificial wombs are a promising new technology with the potential to revolutionize the care of premature infants. However, more research is needed to fully understand the risks and benefits of the technology before it can be widely used.

Here are some additional ethical concerns that have been raised about artificial wombs:
  • The potential for artificial wombs to be used to create designer babies or to prolong the lives of fetuses with severe disabilities.
  • The potential for artificial wombs to be used to exploit or traffick babies.
  • The potential for artificial wombs to exacerbate existing social and economic inequalities.
It is important to have a public conversation about these ethical concerns before artificial wombs become widely available. We need to develop clear guidelines for how the technology should be used and ensure that it is used in a way that benefits all of society.

Tuesday, October 10, 2023

The Moral Case for No Longer Engaging With Elon Musk’s X

David Lee
Bloomberg.com
Originally published 5 October 23

Here is an excerpt:

Social networks are molded by the incentives presented to users. In the same way we can encourage people to buy greener cars with subsidies or promote healthy living by giving out smartwatches, so, too, can levers be pulled to improve the health of online life. Online, people can’t be told what to post, but sites can try to nudge them toward behaving in a certain manner, whether through design choices or reward mechanisms.

Under the previous management, Twitter at least paid lip service to this. In 2020, it introduced a feature that encouraged people to actually read articles before retweeting them, for instance, to promote “informed discussion.” Jack Dorsey, the co-founder and former chief executive officer, claimed to be thinking deeply about improving the quality of conversations on the platform — seeking ways to better measure and improve good discourse online. Another experiment was hiding the “likes” count in an attempt to train away our brain’s yearn for the dopamine hit we get from social engagement.

One thing the prior Twitter management didn’t do is actively make things worse. When Musk introduced creator payments in July, he splashed rocket fuel over the darkest elements of the platform. These kinds of posts always existed, in no small number, but are now the despicable main event. There’s money to be made. X’s new incentive structure has turned the site into a hive of so-called engagement farming — posts designed with the sole intent to elicit literally any kind of response: laughter, sadness, fear. Or the best one: hate. Hate is what truly juices the numbers.

The user who shared the video of Carson’s attack wasn’t the only one to do it. But his track record on these kinds of posts, and the inflammatory language, primed it to be boosted by the algorithm. By Tuesday, the user was still at it, making jokes about Carson’s girlfriend. All content monetized by advertising, which X desperately needs. It’s no mistake, and the user’s no fringe figure. In July, he posted that the site had paid him more than $16,000. Musk interacts with him often.


Here's my take: 

Lee pointed out that social networks can shape user behavior through incentives, and the previous management of Twitter had made some efforts to promote healthier online interactions. However, under Elon Musk's management, the platform has taken a different direction, actively encouraging provocative and hateful content to boost engagement.

Lee criticized the new incentive structure on X, where users are financially rewarded for producing controversial content. They argued that as the competition for attention intensifies, the content will likely become more violent and divisive.

Lee also mentioned an incident involving former executive Yoel Roth, who raised concerns about hate speech on the platform, and Musk's dismissive response to those concerns.  Musk is not a business genius and does not understand how to promote a healthy social media site.

Monday, October 2, 2023

Research: How One Bad Employee Can Corrupt a Whole Team

Stephen Dimmock & William Gerken
Harvard Business Review
Originally posted 5 March 2018

Here is an excerpt:

In our research, we wanted to understand just how contagious bad behavior is. To do so, we examined peer effects in misconduct by financial advisors, focusing on mergers between financial advisory firms that each have multiple branches. In these mergers, financial advisors meet new co-workers from one of the branches of the other firm, exposing them to new ideas and behaviors.

We collected an extensive data set using the detailed regulatory filings available for financial advisors. We defined misconduct as customer complaints for which the financial advisor either paid a settlement of at least $10,000 or lost an arbitration decision. We observed when complaints occurred for each financial advisor, as well as for the advisor’s co-workers.

We found that financial advisors are 37% more likely to commit misconduct if they encounter a new co-worker with a history of misconduct. This result implies that misconduct has a social multiplier of 1.59 — meaning that, on average, each case of misconduct results in an additional 0.59 cases of misconduct through peer effects.

However, observing similar behavior among co-workers does not explain why this similarity occurs. Co-workers could behave similarly because of peer effects – in which workers learn behaviors or social norms from each other — but similar behavior could arise because co-workers face the same incentives or because individuals prone to making similar choices naturally choose to work together.

In our research, we wanted to understand how peer effects contribute to the spread of misconduct. We compared financial advisors across different branches of the same firm, because this allowed us to control for the effect of the incentive structure faced by all advisors in the firm. We also focused on changes in co-workers caused by mergers, because this allowed us to remove the effect of advisors choosing their co-workers. As a result, we were able to isolate peer effects.


Here is my summary: 

The article discusses a study that found that even the most honest employees are more likely to commit misconduct if they work alongside a dishonest individual. The study, which was conducted by researchers at the University of California, Irvine, found that financial advisors were 37% more likely to commit misconduct if they encountered a new co-worker with a history of misconduct.

The researchers believe that this is because people are more likely to learn bad behavior than good behavior. When we see someone else getting away with misconduct, it can make us think that it's okay to do the same thing. Additionally, when we're surrounded by people who are behaving badly, it can create a culture of acceptance for misconduct.

Thursday, September 28, 2023

US prison labor is cruel and pointless legalized slavery.

Dyjuan Tatro
The Guardian
Originally posted 22 Sept 23

Here is an excerpt:

It costs New York around $70,000 a year in taxpayer money to imprison someone. It costs the BPI about $10,000 a year to educate an incarcerated student. New York’s recidivism rate is 40%, while graduates of the BPI and similar programs recidivate at only 4%, a tenfold decrease. Yet, despite its clear positive record, only 300 of New York’s 30,000 incarcerated people are enrolled at the BPI in any given semester. I was one of a lucky few.

Prisons are designed to warehouse, traumatize and exploit people, then send them back home in worse shape than when they entered the system. Despite having worked every day, the vast majority of people are released with no job experience, no references and no hope. Some would take this to mean that the system is failing. And it is with regard to public safety, rehabilitation and justice, but it’s horrifyingly successful at two things: guaranteeing jobs for some and perpetuating slavery for others.

Over the years, I learned that prison officials were not interested in giving us fruitful educational and job opportunities that allowed us to go home and stay home. The reality is much more sinister. Prisons are a job program for officers that requires us to keep coming back.


Here is my summary:

The article is a personal account of the author's experience working in prison. Tatro argues that prison labor is a form of legalized slavery, and that it is cruel and pointless. He writes that his work in prison was meaningless and dehumanizing, and that it did not teach him any skills or prepare him for life outside of prison. He also argues that prison labor undermines the living standards of workers outside of prison, as businesses that use prison labor are able to pay their workers less.

Tatro's article is a powerful indictment of the US prison system, and it raises important questions about the role of labor in the rehabilitation of prisoners.

Tuesday, September 26, 2023

I Have a Question for the Famous People Who Have Tried to Apologize

Elizabeth Spiers
The New York Times - Guest Opinion
Originally posted 22 September 23

Here is an excerpt:

As a talk show host, Ms. Barrymore has been lauded in part for her empathy. She is vulnerable, and that makes her guests feel like they can be, too. But even nice people can be self-centered when they’re on the defensive. That’s what happened when people objected to the news that her show would return to production despite the writers’ strike. In a teary, rambling video on Instagram, which was later deleted, she spoke about how hard the situation had been — for her. “I didn’t want to hide behind people. So I won’t. I won’t polish this with bells and whistles and publicists and corporate rhetoric. I’ll just stand out there and accept and be responsible.” (Ms. Barrymore’s awkward, jumbled sentences unwittingly demonstrated how dearly she needs those writers.) Finally, she included a staple of the public figure apology genre: “My intentions have never been in a place to upset or hurt anyone,” she said. “It’s not who I am.”

“This is not who I am” is a frequent refrain from people who are worried that they’re going to be defined by their worst moments. It’s an understandable concern, given the human tendency to pay more attention to negative events. People are always more than the worst thing they’ve done. But it’s also true that the worst things they’ve done are part of who they are.

Somehow, Mila Kunis’s scripted apology was even worse. She and Mr. Kutcher had weathered criticism for writing letters in support of their former “That ’70s Show” co-star Danny Masterson after he was convicted of rape. Facing her public, she spoke in the awkward cadence people have when they haven’t memorized their lines and don’t know where the emphasis should fall. “The letters were not written to question the legitimacy” — pause — “of the judicial system,” she said, “or the validity” — pause — “of the jury’s ruling.” For an actress, it was not a very convincing performance. Mr. Kutcher, who is her husband, was less awkward in his delivery, but his defense was no more convincing. The letters, he explained, were only “intended for the judge to read,” as if the fact that the couple operated behind the scenes made it OK.


Here are my observations about the main theme of this article:

Miller argues that many celebrity apologies fall short because they are not sincere. She says that they often lack the essential elements of a good apology: acknowledging the offense, providing an explanation, expressing remorse, and making amends. Instead, many celebrity apologies are self-serving and aimed at salvaging their public image.

Miller concludes by saying that if celebrities want their apologies to be meaningful, they need to be honest, take responsibility for their actions, and show that they are truly sorry for the harm they have caused.

I would also add that celebrity apologies can be difficult to believe because they often follow a predictable pattern. The celebrity typically issues a statement expressing their regret and apologizing to the people they have hurt. They may also offer a brief explanation for their behavior, but they often avoid taking full responsibility for their actions. And while some celebrities may make amends in some way, such as donating to charity or volunteering their time, many do not.

As a result, many people are skeptical of celebrity apologies. They see them as nothing more than a way for celebrities to save face and get back to their normal lives. This is why it is so important for celebrities to be sincere and genuine when they apologize.

Friday, September 8, 2023

He was a top church official who criticized Trump. He says Christianity is in crisis

S. Detrow, G. J. Sanchez, & S. Handel
npr.org
Originally poste 8 Aug 23

Here is an excerpt:

What's the big deal? 

According to Moore, Christianity is in crisis in the United States today.
  • Moore is now the editor-in-chief of the Christianity Today magazine and has written a new book, Losing Our Religion: An Altar Call For Evangelical America, which is his attempt at finding a path forward for the religion he loves.
  • Moore believes part of the problem is that "almost every part of American life is tribalized and factionalized," and that has extended to the church.
  • "I think if we're going to get past the blood and soil sorts of nationalism or all of the other kinds of totalizing cultural identities, it's going to require rethinking what the church is," he told NPR.
  • During his time in office, Trump embraced a Christian nationalist stance — the idea that the U.S. is a Christian country and should enforce those beliefs. In the run-up to the 2024 presidential election, Republican candidates are again vying for the influential evangelical Christian vote, demonstrating its continued influence in politics.
  • In Aug. 2022, church leaders confirmed the Department of Justice was investigating Southern Baptists following a sexual abuse crisis. In a statement, SBC leaders said: "Current leaders across the SBC have demonstrated a firm conviction to address those issues of the past and are implementing measures to ensure they are never repeated in the future."
  • In 2017, the church voted to formally "denounce and repudiate" white nationalism at its annual meeting.

What is he saying? 

Moore spoke to All Things Considered's Scott Detrow about what he thinks the path forward is for evangelicalism in America.

On why he thinks Christianity is in crisis:
It was the result of having multiple pastors tell me, essentially, the same story about quoting the Sermon on the Mount, parenthetically, in their preaching — "turn the other cheek" — [and] to have someone come up after to say, "Where did you get those liberal talking points?" And what was alarming to me is that in most of these scenarios, when the pastor would say, "I'm literally quoting Jesus Christ," the response would not be, "I apologize." The response would be, "Yes, but that doesn't work anymore. That's weak." And when we get to the point where the teachings of Jesus himself are seen as subversive to us, then we're in a crisis.

The information is here. 

Thursday, August 31, 2023

It’s not only political conservatives who worry about moral purity

K. Gray, W. Blakey, & N. DiMaggio
psychce.co
Originally posted 13 July 23

Here are two excerpts:

What does this have to do with differences in moral psychology? Well, moral psychologists have suggested that politically charged arguments about sexuality, spirituality and other subjects reflect deep differences in the moral values of liberals and conservatives. Research involving scenarios like this one has seemed to indicate that conservatives, unlike liberals, think that maintaining ‘purity’ is a moral good in itself – which for them might mean supporting what they construe as the ‘sanctity of marriage’, for example.

It may seem strange to think about ‘purity’ as a core driver of political differences. But purity, in the moral sense, is an old concept. It pops up in the Hebrew Bible a lot, in taboos around food, menstruation, and divine encounters. When Moses meets God at the Burning Bush, God says to Moses: ‘Do not come any closer, take off your sandals, for the place where you are standing is holy ground.’ Why does God tell Moses to take off his shoes? Not because his shoes magically hurt God, but because shoes are dirty, and it’s disrespectful to wear your shoes in the presence of the creator of the universe. Similarly, in ancient Greece, worshippers were often required to endure long purification rituals before looking at sacred religious idols or engaging in different spiritual rites. These ancient moral practices seem to reflect an intuition that ‘cleanliness is next to Godliness’.

In the modern era, purity has repeatedly appeared at the centre of political battlegrounds, as in clashes between US conservatives and liberals over sexual education and mores in the 1990s. It was around this time that the psychologist Jonathan Haidt began formulating a theory to help explain the moral divide. Moral foundations theory argues that liberals and conservatives are divided because they rely on distinct moral values, including purity, to different degrees.

(cut)

A harm-focused perspective on moral judgments related to ‘purity’ could help us better understand and communicate with moral opponents. We all grasp the importance of protecting ourselves and our loved ones from harm. Learning that people on the ‘other side’ of a political divide care about questions of purity because they connect these to their understanding of harm can help us empathise with different moral opinions. It is easy for a liberal to dismiss a conservative’s condemnation of dead-chicken sex when it is merely said to be ‘impure’; it is harder to be dismissive if it’s suggested that someone who makes a habit of that behaviour might end up harming people.

Explicitly grounding discussions of morality in perceptions of harm could help us all to be better citizens of a ‘small-L liberal’ society – one in which the right to swing our fists ends where others’ noses begin. If something seems disgusting, impure and immoral to you, take some time to try to articulate the harms you intuitively perceive. Talking about these potential harms may help other people understand where you are coming from. Of course, someone might not share your judgment that harm is being done. But identifying perceived harms at least puts the conversation in terms that everyone understands.


Here is my summary:

The authors define purity as "the state of being free from contamination or pollution."  They argue that people on both the left and the right care about purity because they associate it with safety and well-being.
They provide examples of how liberals and conservatives can both use purity-related language, such as "desecrate" and "toxic." They propose a new explanation of moral judgments that suggests that people care about purity when they perceive that 'impure' acts can lead to harm.

Sunday, August 27, 2023

Ontario court rules against Jordan Peterson, upholds social media training order

Canadian Broadcasting Company
Originally posted 23 August 23

An Ontario court ruled against psychologist and media personality Jordan Peterson Wednesday, and upheld a regulatory body's order that he take social media training in the wake of complaints about his controversial online posts and statements.

Last November, Peterson, a professor emeritus with the University of Toronto psychology department who is also an author and media commentator, was ordered by the College of Psychologists of Ontario to undergo a coaching program on professionalism in public statements.

That followed numerous complaints to the governing body of Ontario psychologists, of which Peterson is a member, regarding his online commentary directed at politicians, a plus-sized model, and transgender actor Elliot Page, among other issues. You can read more about those social media posts here.

The college's complaints committee concluded his controversial public statements could amount to professional misconduct and ordered Peterson to pay for a media coaching program — noting failure to comply could mean the loss of his licence to practice psychology in the province.

Peterson filed for a judicial review, arguing his political commentary is not under the college's purview.

Three Ontario Divisional Court judges unanimously dismissed Peterson's application, ruling that the college's decision falls within its mandate to regulate the profession in the public interest and does not affect his freedom of expression.

"The order is not disciplinary and does not prevent Dr. Peterson from expressing himself on controversial topics; it has a minimal impact on his right to freedom of expression," the decision written by Justice Paul Schabas reads, in part.



My take:

Peterson has argued that the order violates his right to free speech. He has also said that the complaints against him were politically motivated. However, the court ruled that the college's order was justified in order to protect the public from harm.

The case of Jordan Peterson is a reminder that psychologists, like other human beings, are not infallible. They are capable of making mistakes and of expressing harmful views. It is important to hold psychologists accountable for their actions, and to ensure that they are held to the highest ethical standards.

In addition to the steps outlined above, there are a number of other things that can be done to mitigate bias in psychology. These include:
  • Increasing diversity in the field of psychology
  • Promoting critical thinking and self-reflection among psychologists
  • Developing more specific ethical guidelines for psychologists' use of social media
  • Holding psychologists accountable for their online behavior

Tuesday, August 15, 2023

Twitter Exec Defends Restoring Account That Shared Child Sex Abuse Material

Matt Novak
Forbes Magazine
Originally published 9 AUG 23

Executives at X, the company formerly known as Twitter, testified in front of an Australian Parliament hearing late Wednesday, and defended the restoration of an X account after it shared child sexual abuse material in late July. The incident attracted widespread attention because X owner Elon Musk personally intervened to reinstate the account after a violation that would normally result in a permanent ban from the social media platform.

Nick Pickles, the head of global government affairs at X, was asked about the incident by an Australian senator late Wednesday ET, early Thursday Australian local time, after Pickles first suggested there was a zero tolerance policy for child sex abuse material before seeming to contradict himself. Pickles said the offending account in question may have been sharing the content “out of outrage.”

“One of the challenges we see is, for example, people sharing this content out of outrage because they want to raise awareness of an issue and see something in the media,” Pickles testified, according to an audio livestream.

“So if there are circumstances where someone shares content but, under review, we decide the appropriate remediation is to remove the content but not the user,” Pickles continued.

There’s nothing in the X terms of service that says it’s okay to share child sexual abuse material if a user is doing it because they’re outraged over the images or looking to “raise awareness.” It’s generally understood that sharing child sex abuse materials, regardless of intent, is not only a federal crime in the U.S. and Australia, but re-victimizes the child.


The article highlights how this decision contradicts ethical principles and moral standards, as sharing such harmful content not only violates the law but also goes against the norms of safeguarding vulnerable individuals, especially children, from harm. Twitter's move to restore the account in question raises concerns about their commitment to combatting online exploitation and maintaining a safe platform for users.

By reinstating an account associated with child sexual abuse material, Twitter appears to have disregarded the severity of the content and its implications. This decision not only undermines trust in the platform but also reflects poorly on the company's dedication to maintaining a responsible and accountable online environment. Critics argue that Twitter's actions in this case highlight a lack of proper content moderation and an insufficient understanding of the gravity of such unethical behavior.

The article sheds light on the potential consequences of platforms not taking immediate and decisive action against users who engage in illegal and immoral activities. This situation serves as a reminder of the broader challenges social media platforms face in balancing issues of free expression with the responsibility to prevent harm and protect users, particularly those who are most vulnerable.

This article points out the company's total and complete failure to uphold ethical and moral standards.

Monday, August 7, 2023

Shake-up at top psychiatric institute following suicide in clinical trial

Brendan Borrell
Spectrum News
Originally posted 31 July 23

Here are two excerpts:

The audit and turnover in leadership comes after the halting of a series of clinical trials conducted by Columbia psychiatrist Bret Rutherford, which tested whether the drug levodopa — typically used to treat Parkinson’s disease — could improve mood and mobility in adults with depression.

During a double-blind study that began in 2019, a participant in the placebo group died by suicide. That study was suspended prior to completion, according to an update posted on ClinicalTrials.gov in 2022.

Two published reports based on Rutherford’s pilot studies have since been retracted, as Spectrum has previously reported. The National Institute of Mental Health has terminated Rutherford’s trials and did not renew funding of his research grant or K24 Midcareer Award.

Former members of Rutherford’s laboratory describe it as a high-pressure environment that often put publications ahead of study participants. “Research is important, but not more so than the lives of those who participate in it,” says Kaleigh O’Boyle, who served as clinical research coordinator there from 2018 to 2020.

Although Rutherford’s faculty page is still active, he is no longer listed in the directory at Columbia University, where he was associate professor, and the voicemail at his former number says he is no longer checking it. He did not respond to voicemails and text messages sent to his personal phone or to emails sent to his Columbia email address, and Cantor would not comment on his employment status.

The circumstances around the suicide remain unclear, and the institute has previously declined to comment on Rutherford’s retractions. Veenstra-VanderWeele confirmed that he is the new director but did not respond to further questions about the situation.

(cut)

In January 2022, the study was temporarily suspended by the U.S. National Institute of Mental Health, following the suicide. It is unknown whether that participant had been taking any antidepressant medication prior to the study.

Four of Rutherford’s published studies were subsequently retracted or corrected for issues related to how participants taking antidepressants at enrollment were handled.

One retraction notice published in February indicates tapering could be challenging and that the researchers did not always stick to the protocol. One-third of the participants taking antidepressants were unable to successfully taper off of them.


Note: The article serves as a cautionary tale about the risks of clinical trials. While clinical trials can be a valuable way to test new drugs and treatments, they also carry risks. Participants in clinical trials may be exposed to experimental drugs that have not been fully tested, and they may experience side effects that are not well-understood.  Ethical researchers must follow guidelines and report accurate results.

Monday, July 31, 2023

Top Arkansas psychiatrist accused of falsely imprisoning patients and Medicaid fraud

Laura Strickler & Stephanie Gosk
NBCnews.com
Originally posted July 23, 2023

Here is an excerpt:

The man who led the unit at the time, Dr. Brian Hyatt, was one of the most prominent psychiatrists in Arkansas and the chairman of the board that disciplines physicians. But he’s now under investigation by state and federal authorities who are probing allegations ranging from Medicaid fraud to false imprisonment.

VanWhy’s release marked the second time in two months that a patient was released from Hyatt’s unit only after a sheriff’s deputy showed up with a court order, according to court records.

“I think that they were running a scheme to hold people as long as possible, to bill their insurance as long as possible before kicking them out the door, and then filling the bed with someone else,” said Aaron Cash, a lawyer who represents VanWhy.

VanWhy and at least 25 other former patients have sued Hyatt, alleging that they were held against their will in his unit for days and sometimes weeks. And Arkansas Attorney General Tim Griffin’s office has accused Hyatt of running an insurance scam, claiming to treat patients he rarely saw and then billing Medicaid at “the highest severity code on every patient,” according to a search warrant affidavit.

As the lawsuits piled up, Hyatt remained chairman of the Arkansas State Medical Board. But he resigned from the board in late May after Drug Enforcement Administration agents executed a search warrant at his private practice. 

“I am not resigning because of any wrongdoing on my part but so that the Board may continue its important work without delay or distraction,” he wrote in a letter. “I will continue to defend myself in the proper forum against the false allegations being made against me.”

Northwest Medical Center in Springdale “abruptly terminated” Hyatt’s contract in May 2022, according to the attorney general’s search warrant affidavit. 

In April, the hospital agreed to pay $1.1 million in a settlement with the Arkansas Attorney General’s Office. Northwest Medical Center could not provide sufficient documentation that justified the hospitalization of 246 patients who were held in Hyatt’s unit, according to the attorney general’s office. 

As part of the settlement, the hospital denied any wrongdoing.

Thursday, July 27, 2023

Supervisees’ Perspectives of Inadequate, Harmful, and Exceptional Clinical Supervision: Are We Listening?

Hutman, H., Ellis, M. V., et al (2023).
The Counseling Psychologist, 001100002311725.

Abstract

Supervisees’ experiences in supervision vary remarkably. To capture such variability, Ellis and colleagues offered a framework for understanding and assessing inadequate, harmful, and exceptional supervision. Although their framework was supported, it did not offer a nuanced understanding of these supervision experiences. Using consensual qualitative research–modified, this study sought to obtain a rich description of inadequate, harmful, and exceptional supervision. Participants (N = 135) were presented with definitions and provided responses (n = 156) to open-ended questions describing their inadequate (n = 63), harmful (n = 30), and/or exceptional (n = 63) supervision experiences. Supervisees reporting harmful experiences described supervisors as neglectful and callous, whereas inadequate supervision reflected inappropriate feedback, unavailability, and unresponsiveness. Conversely, exceptional supervision involved safety, clinical paradigm shifts, and modeling specific techniques or theories. Implications for supervision research, theory, and practice are discussed.

 Significance of the Scholarship to the Public

We identified themes from trainees’ descriptions of their inadequate, harmful, and exceptional experiences in clinical supervision. The findings offer a nuanced understanding of supervisees’ lived experiences,
illustrating how clinical supervisors went awry or went above and beyond, and suggesting strategies for promoting exceptional supervision and preventing harmful and inadequate supervision.

Here is a summary

Background: Clinical supervision is a critical component of professional development for mental health professionals. However, not all supervision is created equal. Some supervision can be inadequate, harmful, or exceptional.

Research question: The authors of this article investigated supervisees' perspectives of inadequate, harmful, and exceptional clinical supervision.

Methods: The authors conducted a qualitative study with 135 supervisees. They asked supervisees to describe their experiences of inadequate, harmful, and exceptional supervision.

Results: The authors found that supervisees' experiences of inadequate, harmful, and exceptional supervision varied widely. However, there were some common themes that emerged. For example, supervisees who experienced inadequate supervision often felt unsupported, neglected, and judged. Supervisees who experienced harmful supervision often felt traumatized, humiliated, and disempowered. Supervisees who experienced exceptional supervision often felt supported, challenged, and empowered.

Conclusions: The authors concluded that supervisees' experiences of clinical supervision can have a profound impact on their professional development. They suggest that we need to listen to supervisees' experiences of supervision and to take steps to ensure that all supervisees receive high-quality supervision.

Tuesday, July 18, 2023

How AI is learning to read the human mind

Nicola Smith
The Telegraph
Originally posted 23 May 2023

Here is an excerpt:

‘Brain rights’

But he warned that it could also be weaponised and used for military applications or for nefarious purposes to extract information from people.

“We are on the brink of a crisis from the point of view of mental privacy,” he said. “Humans are defined by their thoughts and their mental processes and if you can access them then that should be the sanctuary.”

Prof Yuste has become so concerned about the ethical implications of advanced neurotechnology that he co-founded the NeuroRights Foundation to promote “brain rights” as a new form of human rights.

The group advocates for safeguards to prevent the decoding of a person’s brain activity without consent, for protection of a person’s identity and free will, and for the right to fair access to mental augmentation technology.

They are currently working with the United Nations to study how human rights treaties can be brought up to speed with rapid progress in neurosciences, and raising awareness of the issues in national parliaments.

In August, the Human Rights Council in Geneva will debate whether the issues around mental privacy should be covered by the International Covenant on Civil and Political Rights, one of the most significant human rights treaties in the world.

The gravity of the task was comparable to the development of the atomic bomb, when scientists working on atomic energy warned the UN of the need for regulation and an international control system of nuclear material to prevent the risk of a catastrophic war, said Prof Yuste.

As a result, the International Atomic Energy Agency (IAEA) was created and is now based in Vienna.

Monday, July 10, 2023

Santa Monica’s Headspace Health laid off dozens of therapists. Their patients don’t know where they went

Jaimie Ding
The Los Angeles Times
Originally posted 7 July 23

When Headspace Health laid off 33 of its therapists June 29, patients were told their providers had left the platform.

What they didn’t know was their therapists had lost their jobs. And they suddenly had no way to contact them.

Several therapists who were let go from Headspace, the Santa Monica meditation app and remote mental health care company, have raised alarm over their treatment and that of their patients after the companywide layoff of 181 total employees, which amounts to 15% of the workforce.

After the layoffs were announced in the morning without warning, these therapists said they immediately lost access to their patient care systems. Appointments, they said, were canceled without explanation, potentially causing irreparable harm to their patients and forcing them to violate the ethical guidelines of their profession.

One former therapist, who specializes in working with the LGBTQ+ community, said one of his clients had just come out in a session the day before he lost his job. The therapist requested anonymity because he was still awaiting severance from Headspace and feared retribution.

“I’m the first person they’ve ever talked to about it,” he said. “They’re never going back to therapy. They just had the first person she talked to about it abandon them.”

He didn’t know he had been laid off until 10 minutes after his first appointment was supposed to start and he had been unable to log into the system.


Some thoughts and analysis from me.  There are clear ethical and legal concerns here.

Abandoning patients: Headspace Health did not provide patients with any notice or information about where their therapists had gone. This is a violation of the ethical principle of fidelity, which requires healthcare providers to act in the best interests of their patients. It also leaves patients feeling abandoned and without a source of care.

Potential for harm to patients: The sudden loss of a therapist can be disruptive and stressful for patients, especially those who are in the middle of treatment. This could lead to relapses, increased anxiety, or other negative consequences. In more extreme, but realistic cases, it could even lead to suicide.

In addition to the ethical and legal problems outlined above, the article also raises questions about the quality of care that patients can expect from Headspace Health. If the company is willing to abruptly lay off therapists without providing any notice or information to patients, it raises concerns about how they value the well-being of their patients. It also raises questions about the company's commitment to providing quality care.  Headspace may believe itself to be a tech company, but it is a healthcare company subject to many rules, regulations, and standards.