Consent GPT: Is It Ethical to Delegate Procedural Consent to Conversational AI?

Allen, J., Earp, B., Koplin, J. J., & Wilkinson, D.

(July 25, 2023). http://dx.doi.org/10.2139/ssrn.4520613

Abstract

Obtaining informed consent from patients prior to a medical or surgical procedure is a fundamental part of safe and ethical clinical practice. Currently, it is routine for a significant part of the consent process to be delegated to members of the clinical team not performing the procedure (e.g. junior doctors). However, it is common for consent-taking delegates to lack sufficient time and clinical knowledge to adequately promote patient autonomy and informed decision-making. Such problems might be addressed in a number of ways. One possible solution to this clinical dilemma is through the use of conversational artificial intelligence (AI) using large language models (LLMs). There is considerable interest in the potential benefits of such models in medicine. For delegated procedural consent, LLM could improve patients’ access to the relevant procedural information and therefore enhance informed decision-making.

In this paper, we first outline a hypothetical example of delegation of consent to LLMs prior to surgery. We then discuss existing clinical guidelines for consent delegation and some of the ways in which current practice may fail to meet the ethical purposes of informed consent. We outline and discuss the ethical implications of delegating consent to LLMs in medicine concluding that at least in certain clinical situations, the benefits of LLMs potentially far outweigh those of current practices.

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Here are some additional points from the article:

• The authors argue that the current system of delegating procedural consent to human consent-takers is not always effective, as consent-takers may lack sufficient time or clinical knowledge to adequately promote patient autonomy and informed decision-making.
• They suggest that LLMs could be used to provide patients with more comprehensive and accurate information about procedures, and to answer patients' questions in a way that is tailored to their individual needs.
• However, the authors also acknowledge that there are a number of ethical concerns that need to be addressed before LLMs can be used for procedural consent. These include concerns about bias, accuracy, and patient trust.

Do Obligations Follow the Mind or Body?

Protzko, J., Tobia, K., Strohminger, N.,

& Schooler, J.  (2022, February 7). 

Retrieved from psyarxiv.com/m5a6g

Abstract

Do you persist as the same person over time because you keep the same mind or because you keep the same body? Philosophers have long investigated this question of personal identity with thought experiments. Cognitive scientists have joined this tradition by assessing lay intuitions about those cases. Much of this work has focused on judgments of identity continuity. But identity also has practical significance: obligations are tagged to one’s identity over time. Understanding how someone persists as the same person over time could provide insight into how and why moral and legal obligations persist. In this paper, we investigate judgments of obligations in hypothetical cases where a person’s mind and body diverge (e.g., brain transplant cases). We find a striking pattern of results: In assigning obligations in these identity test cases, people are divided among three groups: “body-followers”, “mind-followers”, and “splitters”—people who say that the obligation is split between the mind and the body. Across studies, responses are predicted by a variety of factors, including mind/body dualism, essentialism, education, and professional training. When we give this task to professional lawyers, accountants, and bankers, we find they are more inclined to rely on bodily continuity in tracking obligations. These findings reveal not only the heterogeneity of intuitions about identity, but how these intuitions relate to the legal standing of an individual’s obligations.

From the General Discussion

Whether one is a mind-follower, body-follower, or splitter was predicted by several psychological traits, suggesting that participants’ decisions were not arbitrary. Furthermore, the use of comprehension checks did not moderate the results, so the variety of assigning obligations were not due to participants not understanding the scenarios. We found physical essentialism and mind/body dualism predict body-following; while the best educated participants are more likely mind-followers and the least educated are more likely splitters. The professional experts were more likely to be body-followers.

Essentialism predicted the belief that obligations track the body. This may seem mysterious, until we consider that much of essentialism has to do with tracking a physical (if invisible) properties. Here is a sample item from the Beliefs in Essentialism Scale: Trying on a sweater that Hitler wore, even if it was washed thoroughly beforehand, would make me very uncomfortable (Horne & Cimpian, 2019). If someone believes that essences are physically real in this way, it makes sense that they would also believe that obligations and identity go with the body. 

Consideration of specific items in the Mind/body Dualism Scale (Nadelhoffer et al., 2014) similarly offer insight into its relationship with the continuity of obligation in this study. Items like Human action can only be understood in terms of our souls and minds and not just in terms of our brains, indicate that for mind/body dualists, a person is not reducible to their brain. Accordingly, for mind/body dualists, though the brain may change, something else remains in the body that maintains both identity and obligations.

The pdf is here.

The Case Against Non-Moral Blame

Matheson, B., & Milam, P.E.

Forthcoming in the Oxford Studies 

in Normative Ethics 11

Abstract

Non-moral blame seems to be widespread and widely accepted in everyday life—tolerated at least, but often embraced. We blame athletes for poor performance, artists for bad or boring art, scientists for faulty research, and voters for flawed reasoning. This paper argues that non-moral blame is never justified—i.e. it’s never a morally permissible response to a non-moral failure. Having explained what blame is and how non-moral blame differs from moral blame, the paper presents the argument in four steps. First, it argues that many (perhaps most) apparent cases of non-moral blame are actually cases of moral blame. Second, it argues that even if non-moral blame is pro tanto permissible—because its target is blameworthy for their substandard performance—it often (perhaps usually) fails to meet other permissibility conditions, such as fairness or standing. Third, it goes further and challenges the claim that non-moral blame is ever even pro tanto permissible. Finally, it considers a number of arguments in support of non-moral obligations and argues that none of them succeed.

A pdf is here.

This philosophical piece highlights, in part, the Fundamental Attribution Error in context of moral judgment.

Developing judgments about peers' obligation to intervene

Marshall, J., Mermin-Bunnell, K, & Bloom, P.
Cognition
Volume 201, August 2020, 104215

Abstract

In some contexts, punishment is seen as an obligation limited to authority figures. In others, it is also a responsibility of ordinary citizens. In two studies with 4- to 7-year-olds (n = 232) and adults (n = 76), we examined developing judgments about whether certain individuals, either authority figures or peers, are obligated to intervene (Study 1) or to punish (Study 2) after witnessing an antisocial action. In both studies, children and adults judged authority figures as obligated to act, but only younger children judged ordinary individuals as also obligated to do so. Taken together, the present findings suggest that younger children, at least in the United States, start off viewing norm enforcement as a universal responsibility, entrusting even ordinary citizens with a duty to intervene in response to antisocial individuals. Older children and adults, though, see obligations as role-dependent—only authority figures are obligated to intervene.

The research is here.

Where AI and ethics meet

Stephen Fleischresser
Cosmos Magazine
Originally posted 18 Nov 19

Here is an excerpt:

His first argument concerns common aims and fiduciary duties, the duties in which trusted professionals, such as doctors, place other’s interests above their own. Medicine is clearly bound together by the common aim of promoting the health and well-being of patients and Mittelstadt argues that it is a “defining quality of a profession for its practitioners to be part of a ‘moral community’ with common aims, values and training”.

For the field of AI research, however, the same cannot be said. “AI is largely developed by the private sector for deployment in public (for example, criminal sentencing) and private (for example, insurance) contexts,” Mittelstadt writes. “The fundamental aims of developers, users and affected parties do not necessarily align.”

Similarly, the fiduciary duties of the professions and their mechanisms of governance are absent in private AI research.

“AI developers do not commit to public service, which in other professions requires practitioners to uphold public interests in the face of competing business or managerial interests,” he writes. In AI research, “public interests are not granted primacy over commercial interests”.

In a related point, Mittelstadt argues that while medicine has a professional culture that lays out the necessary moral obligations and virtues stretching back to the physicians of ancient Greece, “AI development does not have a comparable history, homogeneous professional culture and identity, or similarly developed professional ethics frameworks”.

Medicine has had a long time over which to learn from its mistakes and the shortcomings of the minimal guidance provided by the Hippocratic tradition. In response, it has codified appropriate conduct into modern principlism which provides fuller and more satisfactory ethical guidance.

The info is here.

Can Business Schools Have Ethical Cultures, Too?

Brian Gallagher
www.ethicalsystems.org
Originally posted 18 Nov 19

Here is an excerpt:

The informal aspects of an ethical culture are pretty intuitive. These include role models and heroes, norms, rituals, stories, and language. “The systems can be aligned to support ethical behavior (or unethical behavior),” Eury and Treviño write, “and the systems can be misaligned in a way that sends mixed messages, for instance, the organization’s code of conduct promotes one set of behaviors, but the organization’s norms encourage another set of behaviors.” Although Smeal hasn’t completely rid itself of unethical norms, it has fostered new ethical ones, like encouraging teachers to discuss the school’s honor code on the first day of class. Rituals can also serve as friendly reminders about the community’s values—during finals week, for example, the honor and integrity program organizes complimentary coffee breaks, and corporate sponsors support ethics case competitions. Eury and Treviño also write how one powerful story has taken hold at Smeal, about a time when the college’s MBA program, after it implemented the honor code, rejected nearly 50 applicants for plagiarism, and on the leadership integrity essay, no less. (Smeal was one of the first business schools to use plagiarism-detection software in its admissions program.)

Given the inherently high turnover rate at a school—and a diverse student population—it’s a constant challenge to get the community’s newcomers to aspire to meet Smeal’s honor and integrity standards. Since there’s no stopping students from graduating, Eury and Treviño stress the importance of having someone like Smeal’s honor and integrity director—someone who, at least part-time, focuses on fostering an ethical culture. “After the first leadership integrity director stepped down from her role, the college did not fill her position for a few years in part because of a coming change in deans,” Eury and Treviño write. The new Dean eventually hired an honor and integrity director who served in her role for 3-and-a-half years, but, after she accepted a new role in the college, the business school took close to 8 months to fill the role again. “In between each of these leadership changes, the community continued to change and grow, and without someone constantly ‘tending to the ethical culture garden,’ as we like to say, the ‘weeds’ will begin to grow,” Eury and Treviño write. Having an honor and integrity director makes an “important symbolic statement about the college’s commitment to tending the culture but it also makes a more substantive contribution to doing so.”

The info is here.

Why not common morality?

Rhodes R 

Journal of Medical Ethics 

Published Online First: 11 September 2019. 

doi: 10.1136/medethics-2019-105621

Abstract

This paper challenges the leading common morality accounts of medical ethics which hold that medical ethics is nothing but the ethics of everyday life applied to today’s high-tech medicine. Using illustrative examples, the paper shows that neither the Beauchamp and Childress four-principle account of medical ethics nor the Gert et al 10-rule version is an adequate and appropriate guide for physicians’ actions. By demonstrating that medical ethics is distinctly different from the ethics of everyday life and cannot be derived from it, the paper argues that medical professionals need a touchstone other than common morality for guiding their professional decisions. That conclusion implies that a new theory of medical ethics is needed to replace common morality as the standard for understanding how medical professionals should behave and what medical professionalism entails. En route to making this argument, the paper addresses fundamental issues that require clarification: what is a profession? how is a profession different from a role? how is medical ethics related to medical professionalism? The paper concludes with a preliminary sketch for a theory of medical ethics.

The info is here.

Study: College Presidents Prioritizing Student Mental Health

Jeremy Bauer-Wolf
InsideHigherEd.com
Originally posted August 12, 2019

With college students reporting problems with anxiety and depression more than ever before, and suicides now a big problem on campuses, university presidents are responding accordingly.

More than 80 percent of top university executives say that mental health is more of a priority on campus than it was three years ago, according to a new report released today by the American Council on Education.

"Student mental health concerns have escalated over the last 10 years," the report states. "We wanted to know how presidents were responding to this increase. To assess short-term changes, we asked presidents to reflect on the last three years on their campus and whether they have observed an increase, decrease, or no change in how they prioritize mental health."

ACE, which represents more than 1,700 college and university presidents, surveyed more than 400 college and university leaders from two- and four-year public and private institutions. About 78 percent of those surveyed were at four-year universities, and the remainder led two-year institutions.

The association found 29 percent of all the presidents surveyed received reports of students with mental health issues once a week or more. About 42 percent of the presidents reported hearing about these problems at least a few times every month. As a result, presidents have allocated more funding to addressing student mental health problems -- 72 percent of the presidents indicated they had spent more money on mental health initiatives than they did three years ago. One unnamed president even reported spending $15 million on a new “comprehensive student well-being building.”

The info is here.

Who Is Experiencing What Kind of Moral Distress?

Carina Fourie
AMA J Ethics. 2017;19(6):578-584.

Abstract

Moral distress, according to Andrew Jameton’s highly influential definition, occurs when a nurse knows the morally correct action to take but is constrained in some way from taking this action. The definition of moral distress has been broadened, first, to include morally challenging situations that give rise to distress but which are not necessarily linked to nurses feeling constrained, such as those associated with moral uncertainty. Second, moral distress has been broadened so that it is not confined to the experiences of nurses. However, such a broadening of the concept does not mean that the kind of moral distress being experienced, or the role of the person experiencing it, is morally irrelevant. I argue that differentiating between categories of distress—e.g., constraint and uncertainty—and between groups of health professionals who might experience moral distress is potentially morally relevant and should influence the analysis, measurement, and amelioration of moral distress in the clinic.

The info is here.

‘My death is not my own’: the limits of legal euthanasia

Henk Blanken
The Guardian
Originally posted August 10, 2018

Here is an excerpt:

Of the 10,000 Dutch patients with dementia who die each year, roughly half of them will have had an advance euthanasia directive. They believed a doctor would “help” them. After all, this was permitted by law, and it was their express wish. Their naive confidence is shared by four out of 10 Dutch adults, who are convinced that a doctor is bound by an advance directive. In fact, doctors are not obliged to do anything. Euthanasia may be legal, but it is not a right.

As doctors have a monopoly on merciful killing, their ethical standard, and not the law, ultimately determines whether a man like Joop can die. An advance directive is just one factor, among many, that a doctor will consider when deciding on a euthanasia case. And even though the law says it’s legal, almost no doctors are willing to perform euthanasia on patients with severe dementia, since such patients are no longer mentally capable of making a “well-considered request” to die.

This is the catch-22. If your dementia is at such an early stage that you are mentally fit enough to decide that you want to die, then it is probably “too early” to want to die. You still have good years left. And yet, by the time your dementia has deteriorated to the point at which you wished (when your mind was intact) to die, you will no longer be allowed to die, as you are not mentally fit to make that decision. It is now “too late” to die.

The info is here.

What is the ethics of ageing?

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

Abstract

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

The article is here.

Don’t look to the president for moral leadership

Julia Azari
vox.com
Originally posted February 19, 2018

President Trump’s reaction to last week’s school shooting in Parkland, Florida, has drawn heavy criticism.

His initial round of tweets, reminding the country that the Florida shooter had been known to display “bad and erratic behavior,” and that such behavior should be “reported to the authorities” were not well-received. Critics called the response “victim-blaming.” Survivors of the shooting were neither comforted nor inspired.

Of course, we live in a time of partisan polarization, and it’s easy to suggest that there are many Americans who are unlikely to respond positively to any message from President Trump. That’s probably true. But none other than liberal snowflake Ari Fleischer — press secretary to George W. Bush — offered a broader indictment: “Some of the biggest errors Pres. Trump has made are what he did NOT say. He did not immediately condemn the KKK after Charlottesville. He did not immediately condemn domestic violence or offer sympathy for Rob Porter’s ex-wives. He should speak today about the school shooting.” Trump did address the incident in a speech on Thursday.

(cut)

Anti-Trump Republican Rick Wilson tweeted on Sunday that Trump isn’t a president but a “moral stress test.” His speech on Thursday and his visit to Florida over the weekend appeared to impress very few people. At the time of this writing, the president’s response appears to have culminated in a series of tweets chastising the FBI for not pursuing reports about the Florida shooter and linking the FBI’s failure to its Russia investigation.

The article is here.

When Therapists Make Mistakes

Keely Kolmes
drkolmes.com
Originally published August 10, 2009

We don’t often talk about therapeutic blunders, although they happen all the time. There are so many ways for therapists to fail clients. There is probably the most common: a mismatch of styles, or a therapist who is not really helping her client. Then there are those moments when perhaps we fail our clients by not responding in the moment in the way the client might desire. Maybe we sometimes challenge when we should nurture. Or we nurture when we should challenge. Or we may do any number of subtle things, perhaps below the threshold of consciousness, not even fully acknowledged by our clients, but which create distance, disappointment, or detachment. Some examples of this are the stifling of yawns, spacing out for a moment, or failing to remember an important name or detail and the client feels we are not really fully present or engaged with them. This lack of connection may trigger feelings of disappointment, loss, or abandonment. For clients with relational traumas, events such as vacations, emergencies, or even adjustments in session times may also cause feelings of loss and abandonment.

Recently, I was having one of those weeks. The details aren’t important, but I’ll acknowledge that I had taken on a few too many things. Top it off with having a few people needing to meet at different times. Add to that one way I manage client confidentiality: putting client names into my hard calendar (which I do not carry about with me) and then transcribing the sessions later to my iPhone calender simply as “client,” to preserve confidentiality in the event that my phone is lost or stolen.

The result?

The blog post is here.

When is diminishment a form of enhancement? Another twist to the “enhancement” debate in biomedical ethics

By Brian Earp
Psychiatric Ethics.com
Originally posted May 13, 2014

There is a big debate going on about “enhancement.” For many years now, people have realized that new technologies, along with discoveries in neuroscience and pharmacology, could be used in ways that seem to go beyond mere “medicine” – the treating of deformity or disease. Instead, to use a phrase popularized by Carl Elliot, they could make us “better than well.” Faster, stronger, smarter, happier. Quicker to learn, slower to forget. It has even been suggested that we could use these new technologies to “enhance” our love and relationships, or make ourselves more moral.

These kinds of prospects are exciting to some. To others, they are frightening, or at least a cause for concern. As a result, there has been a stream of academic papers—alongside more popular discussions—trying to get a handle on some of the ethics. Is it permissible to take “medicine” even if we aren’t “sick”? Should we be worried about “Playing God”? Do some people have an obligation to enhance themselves? And so on.

The entire blog post is here.

Can We Talk?

Eric H. Affsprung, PhD

Colleague Assistance Committee

Civic Virtue: Behavior that promotes the good of the community
Pro-Social Behavior: Caring about and acting on behalf of others

Why are these things important for psychologists? Are they important? How can such behavior improve our profession and our professional lives?

The members of PPA’s Colleague Assistance Committee work to promote self-care among the mem­bership. Last fall we found ourselves talking about what our obligations might be, as psychologists, to one another and our profession — and how such pro-social behavior is really an extension of good self-care (and vice versa). As we care for one another, we also support and nur­ture ourselves and our profession. We found ourselves wondering…

• Do we, as psychologists, have an obligation to support one another, to reach out to one another?
• As psychologists, have we made a commitment to one another?
• How can we support our fellow psychologists?
• How can we promote a culture of professional collegiality and support?
• How can we demonstrate care for one another in our places of employment?
• Do we promote transparency, trust and open communication at work and when working with other members of PPA? Or do we engage in split­ting, triangulation, one-upmanship, and gossip?
• When we need to correct a colleague, do we do so in a manner which is affirming of his or her value as a fellow human being? Do we take the oppor­tunity to teach, or do we belittle and punish?
• Do we have an obligation to mentor younger psychologists and those new to the profession?*
• Do we ask for help when we need to?

Are there things that we, as psychologists, don’t talk about with our colleagues? Are there things that you wish that you could talk about? Why don’t we talk about these things?

What do you think?

* Did someone act as a mentor to you? If not, what kind of mentor do you wish you’d had? Whom can you mentor? Please consider serving as a mentor for one of PPA’s early career psychologists. If you are interested, contact Dr. Michelle Herrigel, chair of the ECP committee.