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

Welcome to the nexus of ethics, psychology, morality, philosophy and health care

Thursday, December 13, 2018

Does deciding among morally relevant options feel like making a choice? How morality constrains people’s sense of choice

Kouchaki, M., Smith, I. H., & Savani, K. (2018).
Journal of Personality and Social Psychology, 115(5), 788-804.


We demonstrate that a difference exists between objectively having and psychologically perceiving multiple-choice options of a given decision, showing that morality serves as a constraint on people’s perceptions of choice. Across 8 studies (N = 2,217), using both experimental and correlational methods, we find that people deciding among options they view as moral in nature experience a lower sense of choice than people deciding among the same options but who do not view them as morally relevant. Moreover, this lower sense of choice is evident in people’s attentional patterns. When deciding among morally relevant options displayed on a computer screen, people devote less visual attention to the option that they ultimately reject, suggesting that when they perceive that there is a morally correct option, they are less likely to even consider immoral options as viable alternatives in their decision-making process. Furthermore, we find that experiencing a lower sense of choice because of moral considerations can have downstream behavioral consequences: after deciding among moral (but not nonmoral) options, people (in Western cultures) tend to choose more variety in an unrelated task, likely because choosing more variety helps them reassert their sense of choice. Taken together, our findings suggest that morality is an important factor that constrains people’s perceptions of choice, creating a disjunction between objectively having a choice and subjectively perceiving that one has a choice.

A pdf can be found here.

A choice may not feel like a choice when morality is at play

Susan Kelley
Cornell Chronicle
Originally posted November 15, 2018

Here is an excerpt:

People who viewed the issues as moral – regardless of which side of the debate they stood on – felt less of a sense of choice when faced with the decisions. “In contrast, people who made a decision that was not imbued with morality were more likely to view it as a choice,” Smith said.

The researchers saw this weaker sense of choice play out in the participants’ attention patterns. When deciding among morally relevant options displayed on a computer screen, they devoted less visual attention to the option that they ultimately rejected, suggesting they were less likely to even consider immoral options as viable alternatives in their decision-making, the study said.

Moreover, participants who felt they had fewer options tended to choose more variety later on. After deciding among moral options, the participants tended to opt for more variety when given the choice of seven different types of chocolate in an unrelated task. “It’s a very subtle effect but it’s indicative that people are trying to reassert their sense of autonomy,” Smith said.

Understanding the way that people make morally relevant decisions has implications for business ethics, he said: “If we can figure out what influences people to behave ethically or not, we can better empower managers with tools that might help them reduce unethical behavior in the workplace.”

The info is here.

The original research is here.

Wednesday, December 12, 2018

Social relationships more important than hard evidence in partisan politics

Dartmouth College
Originally posted November 13, 2018

Here is an excerpt:

Three factors drive the formation of social and political groups according to the research: social pressure to have stronger opinions, the relationship of an individual's opinions to those of their social neighbors, and the benefits of having social connections.

A key idea studied in the paper is that people choose their opinions and their connections to avoid differences of opinion with their social neighbors. By joining like-minded groups, individuals also prevent the psychological stress, or "cognitive dissonance," of considering opinions that do not match their own.

"Human social tendencies are what form the foundation of that political behavior," said Tucker Evans, a senior at Dartmouth who led the study. "Ultimately, strong relationships can have more value than hard evidence, even for things that some would take as proven fact."

The information is here.

The original research is here.

Why Are Doctors Killing Themselves?

The Practical Professional in Healthcare
October/November 2018

Here is an excerpt:

The nation loses 300 to 400 physicians each year, the equivalent of two large medical school classes, and more than a million patients lose their doctor.  According to a new research study encompassing data from the past ten years, physicians are committing suicide at a rate that’s more than twice as high as the average population—higher even than for veterans.

With a critical shortage of physicians looming and advocates like Pamela Wible calling attention to the problem, the increasingly urgent question remains: Why are doctors killing themselves? And what can be done to help?  In response, researchers are ramping up their efforts to understand the causes of
physician suicide; leading hospitals, medical schools and professional organizations are pioneering new programs and interventions; and regulators are reconsidering how they might revise the licensing/renewal process to support their efforts.

The info is here.

There are several other articles on physician self-care, which applies to other helping professions.

Tuesday, December 11, 2018

Beyond the Boundaries: Ethical Issues in the Practice of Indirect Personality Assessment in Non-Health-Service Psychology

Marvin W. Acklin
Journal of Personality Assessment


This article focuses on ethical quandaries in the practice of indirect personality assessment in non-health-service psychology. Indirect personality assessment methods do not involve face-to-face interaction. Personality assessment at a distance is a methodological development of personality and social psychology, psychobiography, and psychohistory. Indirect personality methods are used in clinical, forensic, law enforcement, public safety, and national security settings. Psychology practice in non-health-service settings creates tensions between principles of beneficence and duty to society. This article defines methods of indirect personality assessment and some ethical ramifications. Their application in non-health-service settings occurs in the context of intense controversy over the ethics of psychologists’ participation in work settings where there are third-party loyalties, absence of voluntary informed consent, presence of nonstipulated harms, and absence of legal and ethical accountability. A hypothetical case example illustrates typical quandaries encountered in a national security assessment. This article provides a framework for critically examining ethical quandaries, a contemporary conceptual and process model for integrative moral cognition, and parameters for ethical reasoning by the individual practitioner under the exigencies of real-world practice.

Is It Ethical to Use Prognostic Estimates from Machine Learning to Treat Psychosis?

Nicole Martinez-Martin, Laura B. Dunn, and Laura Weiss Roberts
AMA J Ethics. 2018;20(9):E804-811.
doi: 10.1001/amajethics.2018.804.


Machine learning is a method for predicting clinically relevant variables, such as opportunities for early intervention, potential treatment response, prognosis, and health outcomes. This commentary examines the following ethical questions about machine learning in a case of a patient with new onset psychosis: (1) When is clinical innovation ethically acceptable? (2) How should clinicians communicate with patients about the ethical issues raised by a machine learning predictive model?



In order to implement the predictive tool in an ethical manner, Dr K will need to carefully consider how to give appropriate information—in an understandable manner—to patients and families regarding use of the predictive model. In order to maximize benefits from the predictive model and minimize risks, Dr K and the institution as a whole will need to formulate ethically appropriate procedures and protocols surrounding the instrument. For example, implementation of the predictive tool should consider the ability of a physician to override the predictive model in support of ethically or clinically important variables or values, such as beneficence. Such measures could help realize the clinical application potential of machine learning tools, such as this psychosis prediction model, to improve the lives of patients.

Monday, December 10, 2018

What makes a ‘good’ clinical ethicist?

Trevor Bibler
Baylor College of Medicine Blog
Originally posted October 12, 2018

Here is an excerpt:

Some hold that the complexity of clinical ethics consultations couldn’t be reduced to multiple-choice questions based on a few sources, arguing that creating multiple-choice questions that reflect the challenges of doing clinical ethics is nearly impossible. Most of the time, the HEC-C Program is careful to emphasize that they are testing knowledge of issues in clinical ethics, not the ethicist’s ability to apply this knowledge to the practice of clinical ethics.

This is a nuanced distinction that may be lost on those outside the field. For example, an administrator might view the HEC-C Program as separating a good ethicist from an inadequate ethicist simply because they have 400 hours of experience and can pass a multiple-choice exam.

Others disagree with the source material (called “core references”) that serves as the basis for exam questions. I believe the core references, if repetitious, are important works in the field. My concern is that these works do not pay sufficient attention to some of the most pressing and challenging issues in clinical ethics today: income inequality, care for non-citizens, drug abuse, race, religion, sex and gender, to name a few areas.

Also, it’s feasible that inadequate ethicists will become certified. I can imagine an ethicist might meet the requirements, but fall short of being a good ethicist because in practice they are poor communicators, lack empathy, are authoritarian when analyzing ethics issues, or have an off-putting presence.

On the other hand, I know some ethicists I would consider experts in the field who are not going to undergo the certification process because they disagree with it. Both of these scenarios show that HEC certification should not be the single requirement that separates a good ethicist from an inadequate ethicist.

The info is here.

Somers Point therapist charged with hiring hitman to 'permanently disfigure' victim

Lauren Carroll
The Press of Atlantic City
Originally posted November 6, 2018

A Somers Point therapist told an undercover FBI agent posing as a hitman she wanted her Massachusetts colleague’s “face bashed-in” and arm broken, according to a criminal complaint filed with the U.S Attorney’s Office.

Diane Sylvia, 58, has been charged with solicitation to commit a crime of violence and appeared in Camden federal court Monday.

According to the criminal complaint filed Friday, a person contacted the FBI to report a murder-for-hire scheme on Sept. 24.

The informant is a former member of an organization criminal gang and was in therapy with Sylvia, a licensed clinical social worker. Sylvia allegedly asked the informant to help kill a North Attleboro, Massachusetts, man, the complaint said.

Sylvia’s lawyer Michael Paulhus of Toms River could not be reached for comment. Sylvia could not be reached for comment.

According to the court documents, Sylvia targeted the man after he threatened to report her to a licensing board. She wanted the man assaulted to “make (her) feel better,” according to court documents.

The info is here.

Sunday, December 9, 2018

The Vulnerable World Hypothesis

Nick Bostrom
Working Paper (2018)


Scientific and technological progress might change people’s capabilities or incentives in ways that would destabilize civilization. For example, advances in DIY biohacking tools might make it easy for anybody with basic training in biology to kill millions; novel military technologies could trigger arms races in which whoever strikes first has a decisive advantage; or some economically advantageous process may be invented that produces disastrous negative global externalities that are hard to regulate. This paper introduces the concept of a vulnerable world: roughly, one in which there is some level of technological development at which civilization almost certainly gets devastated by default, i.e. unless it has exited the “semi-anarchic default condition”. Several counterfactual historical and speculative future vulnerabilities are analyzed and arranged into a typology. A general ability to stabilize a vulnerable world would require greatly amplified capacities for preventive policing and global governance. The vulnerable world hypothesis thus offers a new perspective from which to evaluate the risk-benefit balance of developments towards ubiquitous surveillance or a unipolar world order.

The working paper is here.

Vulnerable World Hypothesis: If technological development continues then a set of capabilities will at some point be attained that make the devastation of civilization extremely likely, unless civilization
sufficiently exits the semi-anarchic default condition.