By David Casarett
The New York Times
November 11, 2015
Here are two excerpts:
Sheila had just received a “patient experience” survey that asked for her opinions about her recent stay in one of our hospitals. He read off some of the questions, in a voice that was tinged with a mix of anger and amusement. Those questions were about the quality of the food (“unimpressive”), the availability of parking (“O.K.”), and the cleanliness of the rooms (“perfect”).
But, he said, “You didn’t ask us about what really matters.”
What he meant, he explained, was that these questions didn’t reflect what was important to a 73-year-old woman with incurable breast cancer who knows she’s going to die in the next six months. And they didn’t assess how well we were supporting her husband, who was overwhelmed with being a caregiver and advocate, a father and grandfather. We asked for their opinions, but we didn’t ask the right questions.
(cut)
We need to be asking these questions. National surveys could easily be modified to include questions that are important to patients like Sheila. We could include questions about emotional and spiritual support, control over decisions, adequacy of information and respect for dignity. Those sorts of questions are arguably important for all of us, but they’re particularly relevant to those who are facing advanced, incurable illnesses.
The entire article is here.
Monday, November 30, 2015
Moral cleansing and moral licenses: experimental evidence
Pablo Brañas-Garzaa, Marisa Buchelia, María Paz Espinosa and Teresa García-Muñoz
Economics and Philosophy / Volume 29 / Special Issue 02 / July 2013, pp 199-212
ABSTRACT
Research on moral cleansing and moral self-licensing has introduced dynamic considerations in the theory of moral behavior. Past bad actions trigger negative feelings that make people more likely to engage in future moral behavior to offset them. Symmetrically, past good deeds favor a positive self-perception that creates licensing effects, leading people to engage in behavior that is less likely to be moral. In short, a deviation from a “normal state of being” is balanced with a subsequent action that compensates the prior behavior. We model the decision of an individual trying to reach the optimal level of moral self-worth over time and show that under certain conditions the optimal sequence of actions follows a regular pattern which combines good and bad actions. We conduct an economic experiment where subjects play a sequence of giving decisions (dictator games) to explore this phenomenon. We find that donation in the previous period affects present decisions and the sign is negative: participants’ behavior in every round is negatively correlated to what they did in the past. Hence donations over time seem to be the result of a regular pattern of self-regulation: moral licensing (being selfish after altruist) and cleansing (altruistic after selfish).
The entire article is here.
Economics and Philosophy / Volume 29 / Special Issue 02 / July 2013, pp 199-212
ABSTRACT
Research on moral cleansing and moral self-licensing has introduced dynamic considerations in the theory of moral behavior. Past bad actions trigger negative feelings that make people more likely to engage in future moral behavior to offset them. Symmetrically, past good deeds favor a positive self-perception that creates licensing effects, leading people to engage in behavior that is less likely to be moral. In short, a deviation from a “normal state of being” is balanced with a subsequent action that compensates the prior behavior. We model the decision of an individual trying to reach the optimal level of moral self-worth over time and show that under certain conditions the optimal sequence of actions follows a regular pattern which combines good and bad actions. We conduct an economic experiment where subjects play a sequence of giving decisions (dictator games) to explore this phenomenon. We find that donation in the previous period affects present decisions and the sign is negative: participants’ behavior in every round is negatively correlated to what they did in the past. Hence donations over time seem to be the result of a regular pattern of self-regulation: moral licensing (being selfish after altruist) and cleansing (altruistic after selfish).
The entire article is here.
Sunday, November 29, 2015
You’re not as virtuous as you think
By Nitin Nohria
The Washington Post
Originally published October 15, 2015
Moral overconfidence is on display in politics, in business, in sports — really, in all aspects of life. There are political candidates who say they won’t use attack ads until, late in the race, they’re behind in the polls and under pressure from donors and advisers, their ads become increasingly negative. There are chief executives who come in promising to build a business for the long-term but then condone questionable accounting gimmickry to satisfy short-term market demands. There are baseball players who shun the use of steroids until they age past their peak performance and start to look for something to slow the decline. These people may be condemned as hypocrites. But they aren’t necessarily bad actors. Often, they’ve overestimated their inherent morality and underestimated the influence of situational factors.
Moral overconfidence is in line with what studies find to be our generally inflated view of ourselves. We rate ourselves as above-average drivers, investors and employees, even though math dictates that can’t be true for all of us. We also tend to believe we are less likely than the typical person to exhibit negative qualities and to experience negative life events: to get divorced, become depressed or have a heart attack.
The entire article is here.
The Washington Post
Originally published October 15, 2015
Moral overconfidence is on display in politics, in business, in sports — really, in all aspects of life. There are political candidates who say they won’t use attack ads until, late in the race, they’re behind in the polls and under pressure from donors and advisers, their ads become increasingly negative. There are chief executives who come in promising to build a business for the long-term but then condone questionable accounting gimmickry to satisfy short-term market demands. There are baseball players who shun the use of steroids until they age past their peak performance and start to look for something to slow the decline. These people may be condemned as hypocrites. But they aren’t necessarily bad actors. Often, they’ve overestimated their inherent morality and underestimated the influence of situational factors.
Moral overconfidence is in line with what studies find to be our generally inflated view of ourselves. We rate ourselves as above-average drivers, investors and employees, even though math dictates that can’t be true for all of us. We also tend to believe we are less likely than the typical person to exhibit negative qualities and to experience negative life events: to get divorced, become depressed or have a heart attack.
The entire article is here.
Saturday, November 28, 2015
Penn study: Pay patients to take their pills
By Tom Avril
Philly.com
Originally posted November 8, 2015
Here are two excerpt:
While the field of medicine has moved increasingly toward paying doctors for performance, there has been little controlled research on whether it works. Studies of patients, meanwhile, have found that incentives can encourage healthy behaviors such as giving up cigarettes.
But in a study of 1,503 patients announced Sunday, the Penn team reported that the most effective approach, at least where statins are concerned, may be to reward both patient and physician.
"In some respects, it takes two to tango," said lead author David A. Asch, a professor at Penn's Perelman School of Medicine.
(cut)
Even if money helps, the notion of paying people to do the right thing may rub some the wrong way.
"We shouldn't have to," said Bobbi Cecco, president of the Hackensack, N.J., chapter of the Mended Hearts patient support group. "But if that's what it comes down to . . ."
Wei, the Michigan physician, said she already is motivated to help her patients stick with their medicine.
"Financial incentives wouldn't change my values or patient care," she said. "I am also an idealist."
The entire article is here.
Philly.com
Originally posted November 8, 2015
Here are two excerpt:
While the field of medicine has moved increasingly toward paying doctors for performance, there has been little controlled research on whether it works. Studies of patients, meanwhile, have found that incentives can encourage healthy behaviors such as giving up cigarettes.
But in a study of 1,503 patients announced Sunday, the Penn team reported that the most effective approach, at least where statins are concerned, may be to reward both patient and physician.
"In some respects, it takes two to tango," said lead author David A. Asch, a professor at Penn's Perelman School of Medicine.
(cut)
Even if money helps, the notion of paying people to do the right thing may rub some the wrong way.
"We shouldn't have to," said Bobbi Cecco, president of the Hackensack, N.J., chapter of the Mended Hearts patient support group. "But if that's what it comes down to . . ."
Wei, the Michigan physician, said she already is motivated to help her patients stick with their medicine.
"Financial incentives wouldn't change my values or patient care," she said. "I am also an idealist."
The entire article is here.
Friday, November 27, 2015
Neuroscience: Tortured reasoning
Lasana T. Harris
Nature 527, 35–36 (05 November 2015) doi:10.1038/527035a
Published online 04 November 2015
In 2009, following the abuse of prisoners at its Guantanamo Bay detention camp, the US government made a significant decision. It moved the responsibility for 'enhanced interrogation techniques' from the CIA to a new government organization: the High-Value Detainee Interrogation Group (HIG). The move upset many CIA insiders; torture had been in their toolkit since the early days of the cold war. The remarks of one official at a HIG-organized conference on torture in Washington DC can be summed up as: how could a new agency, created to both conduct and study torture, replace the decades of practice and perfection attained by the CIA? By adding a scientific component, responded the newly appointed head of the HIG.
This exchange highlights the theme of neuroscientist Shane O'Mara's Why Torture Doesn't Work. Rightly, O'Mara takes a moral stand against torture (forced retrieval of information from the memories of the unwilling). However, instead of simply providing utilitarian arguments, he argues that there is no evidence from psychology or neuroscience for many of the specious justifications of torture as an information-gathering tool. Providing an abundance of gruesome detail, O'Mara marshals vast, useful information about the effects of such practices on the brain and the body.
(Underline provided by me.)
The entire book review is here.
Nature 527, 35–36 (05 November 2015) doi:10.1038/527035a
Published online 04 November 2015
In 2009, following the abuse of prisoners at its Guantanamo Bay detention camp, the US government made a significant decision. It moved the responsibility for 'enhanced interrogation techniques' from the CIA to a new government organization: the High-Value Detainee Interrogation Group (HIG). The move upset many CIA insiders; torture had been in their toolkit since the early days of the cold war. The remarks of one official at a HIG-organized conference on torture in Washington DC can be summed up as: how could a new agency, created to both conduct and study torture, replace the decades of practice and perfection attained by the CIA? By adding a scientific component, responded the newly appointed head of the HIG.
This exchange highlights the theme of neuroscientist Shane O'Mara's Why Torture Doesn't Work. Rightly, O'Mara takes a moral stand against torture (forced retrieval of information from the memories of the unwilling). However, instead of simply providing utilitarian arguments, he argues that there is no evidence from psychology or neuroscience for many of the specious justifications of torture as an information-gathering tool. Providing an abundance of gruesome detail, O'Mara marshals vast, useful information about the effects of such practices on the brain and the body.
(Underline provided by me.)
The entire book review is here.
Thursday, November 26, 2015
Inability and Obligation in Moral Judgment
Wesley Buckwalter and John Turri
PLOS
Published: August 21, 2015
DOI: 10.1371/journal.pone.0136589
Introduction
Morality is central to human social life [1–3]. Fulfilling moral obligations often requires us to put other people’s interests before our own. Sometimes this is easy, but other times it is hard. For example, it is plausible we are obligated to alleviate terrible suffering if we can do so at very little cost to ourselves, as happens when we donate money to famine relief or vaccination programs. But how far does this obligation extend? Some argue that it extends to the point where we would be making ourselves worse off than the people receiving charitable aid [4]. Many have found this suggestion implausible, sometimes on the grounds that the requirements for morality are limited by our psychology [5–7]. Given the way we are constituted, perhaps we are simply incapable of donating that much. This raises an important question: how demanding is morality and what are the limits of moral requirements?
According to a longstanding principle of moral philosophy, moral requirements are limited by ability. This is often glossed by the slogan that “ought implies can” (hereafter “OIC” for short). The principle says that one is obliged to perform an action only if one can perform the action. Support for OIC can be traced back to at least Cicero [8]. A more explicit articulation comes from Immanuel Kant, who writes, “Duty commands nothing but what we can do,” and that, “If the moral law commands that we ought to be better human beings now, it inescapably follows that we must be capable of being better human beings”.
The entire article is here.
PLOS
Published: August 21, 2015
DOI: 10.1371/journal.pone.0136589
Introduction
Morality is central to human social life [1–3]. Fulfilling moral obligations often requires us to put other people’s interests before our own. Sometimes this is easy, but other times it is hard. For example, it is plausible we are obligated to alleviate terrible suffering if we can do so at very little cost to ourselves, as happens when we donate money to famine relief or vaccination programs. But how far does this obligation extend? Some argue that it extends to the point where we would be making ourselves worse off than the people receiving charitable aid [4]. Many have found this suggestion implausible, sometimes on the grounds that the requirements for morality are limited by our psychology [5–7]. Given the way we are constituted, perhaps we are simply incapable of donating that much. This raises an important question: how demanding is morality and what are the limits of moral requirements?
According to a longstanding principle of moral philosophy, moral requirements are limited by ability. This is often glossed by the slogan that “ought implies can” (hereafter “OIC” for short). The principle says that one is obliged to perform an action only if one can perform the action. Support for OIC can be traced back to at least Cicero [8]. A more explicit articulation comes from Immanuel Kant, who writes, “Duty commands nothing but what we can do,” and that, “If the moral law commands that we ought to be better human beings now, it inescapably follows that we must be capable of being better human beings”.
The entire article is here.
Wednesday, November 25, 2015
The ‘blame and shame society’
Jean Knox
Psychoanalytic Psychotherapy
Volume 28, Issue 3, 2014
Abstract
In this opinion piece, I explore some of the social and cultural factors that contribute to the creation of feelings of shame in those members of society who are vulnerable or disadvantaged in various ways. I suggest that a ‘blame and shame’ attitude has become pervasive in today's political culture, reassuring the comfortable and privileged that they deserve their own success and allowing them to blame the disadvantaged for their own misfortune. Those who feel that they must become invulnerable in order to succeed therefore project their own vulnerable child onto the vulnerable in our society and attack and condemn in others what they most fear in themselves.
Introduction
One of the most intractable problems all therapists encounter is shame – the persistent negative sense of self that is evident when patients persist in describing themselves as disgusting, bad, dirty and all the other words of self-loathing which reflect a deeply painful self-hatred that the person clings to in spite of all attempts to shift it. These feelings are often accompanied by self-harm of various kinds – repeated cutting or overdosing, alcohol or drug abuse, eating disorders and by difficulty in affect regulation, mentalisation, attachment and sexuality.
An understanding of the unique personal relationships that have contributed to this kind of self-disgust and shame is vital if psychotherapists are to help their patients as effectively as possible. Herman (1992) first identified this as one key part of complex PTSD, suggesting that it arises from chronic developmental trauma.
The entire article is here.
Psychoanalytic Psychotherapy
Volume 28, Issue 3, 2014
Abstract
In this opinion piece, I explore some of the social and cultural factors that contribute to the creation of feelings of shame in those members of society who are vulnerable or disadvantaged in various ways. I suggest that a ‘blame and shame’ attitude has become pervasive in today's political culture, reassuring the comfortable and privileged that they deserve their own success and allowing them to blame the disadvantaged for their own misfortune. Those who feel that they must become invulnerable in order to succeed therefore project their own vulnerable child onto the vulnerable in our society and attack and condemn in others what they most fear in themselves.
Introduction
One of the most intractable problems all therapists encounter is shame – the persistent negative sense of self that is evident when patients persist in describing themselves as disgusting, bad, dirty and all the other words of self-loathing which reflect a deeply painful self-hatred that the person clings to in spite of all attempts to shift it. These feelings are often accompanied by self-harm of various kinds – repeated cutting or overdosing, alcohol or drug abuse, eating disorders and by difficulty in affect regulation, mentalisation, attachment and sexuality.
An understanding of the unique personal relationships that have contributed to this kind of self-disgust and shame is vital if psychotherapists are to help their patients as effectively as possible. Herman (1992) first identified this as one key part of complex PTSD, suggesting that it arises from chronic developmental trauma.
The entire article is here.
Americans With Government Health Plans Most Satisfied
by Rebecca Riffkin
Gallup
Originally published November 6, 2015
Americans' satisfaction with the way the healthcare system works for them varies by the type of insurance they have. Satisfaction is highest among those with veterans or military health insurance, Medicare and Medicaid, and is lower among those with employer-paid and self-paid insurance. Americans with no health insurance are least satisfied of all.
STORY HIGHLIGHTS
Gallup
Originally published November 6, 2015
Americans' satisfaction with the way the healthcare system works for them varies by the type of insurance they have. Satisfaction is highest among those with veterans or military health insurance, Medicare and Medicaid, and is lower among those with employer-paid and self-paid insurance. Americans with no health insurance are least satisfied of all.
STORY HIGHLIGHTS
- Uninsured Americans least satisfied with health system
- Those with veterans or military insurance most satisfied
- Self-insured less satisfied than others who have insurance
Tuesday, November 24, 2015
Genetically enhance humanity or face extinction - PART 2
Julian Savulescu presents at Sydney's Festival of Dangerous Ideas
In his talk at the Festival of Dangerous Ideas (Sydney Opera House), philosopher and bioethicist Julian Savulescu examines the nature of human beings as products of evolution, in particular their limited altruism, limited cooperative instincts and limited ability to take account of the future consequences of actions. He argues that humans' biology and psychology are unfit for the kind of society we live in and we must either alter our political institutions, severely restrain our technology or change our nature. Or face annihilation by our own design.
In his talk at the Festival of Dangerous Ideas (Sydney Opera House), philosopher and bioethicist Julian Savulescu examines the nature of human beings as products of evolution, in particular their limited altruism, limited cooperative instincts and limited ability to take account of the future consequences of actions. He argues that humans' biology and psychology are unfit for the kind of society we live in and we must either alter our political institutions, severely restrain our technology or change our nature. Or face annihilation by our own design.
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