How Moral Case Deliberation Supports Good Clinical Decision Making

Inguaggiato, G., et al. (2019).

The AMA Journal of Ethic, 21(10),

E913-919.

https://doi.org/10.1001/amajethics.2019.913

Abstract

In clinical decision making, facts are presented and discussed, preferably in the context of both evidence-based medicine and patients’ values. Because clinicians’ values also have a role in determining the best courses of action, we argue that reflecting on both patients’ and professionals’ values fosters good clinical decision making, particularly in situations of moral uncertainty. Moral case deliberation, a form of clinical ethics support, can help elucidate stakeholders’ values and how they influence interpretation of facts. This article demonstrates how this approach can help clarify values and contribute to good clinical decision making through a case example.

Here are some thoughts:

This article discusses how moral case deliberation (MCD) supports good clinical decision-making. It argues that while evidence-based medicine and patient values are crucial, clinicians' values also play a significant role, especially in morally uncertain situations. MCD, a form of clinical ethics support, helps clarify the values of all stakeholders and how these values influence the interpretation of facts. The article explains how MCD differs from shared decision-making, emphasizing its focus on ethical dilemmas and understanding moral uncertainty among caregivers rather than reaching a shared decision with the patient. Through dialogue and a structured approach, MCD facilitates a deeper understanding of the situation, leading to better-informed and morally sensitive clinical decisions. The article uses a case study from a neonatal intensive care unit to illustrate how MCD can help resolve disagreements and uncertainties by exploring the different values held by nurses and physicians.

Surviving and thriving in spite of hate: Burnout and resiliency in clinicians working with patients attracted by violent extremism

Rousseau, C.,  et al. (2025).

The American journal of orthopsychiatry,

10.1037/ort0000832.

Advance online publication.

https://doi.org/10.1037/ort0000832

Abstract

Violent extremism (VE) is often manifested through hate discourses, which are hurtful for their targets, shatter social cohesion, and provoke feelings of impending threat. In a clinical setting, these discourses may affect clinicians in different ways, eroding their capacity to provide care. This clinical article describes the subjective experiences and the coping strategies of clinicians engaged with individuals attracted by VE. A focus group was held with eight clinicians and complemented with individual interviews and field notes. Clinicians reported four categories of personal consequences. First, results show that the effect of massive exposure to hate discourses is associated with somatic manifestations and with the subjective impression of being dirty. Second, clinicians endorse a wide range of work-related affects, ranging from intense fear, anger, and irritation to sadness and numbing. Third, they perceive that their work has relational consequences on their families and friends. Last, clinicians also describe that their work transforms their vision of the world. In terms of coping strategies, team relations and a community of practice were identified as supportive. With time, the pervasive uncertainty, the relative lack of institutional support, and the work-related emotional burden are associated with disengagement and burnout, in particular in practitioners working full-time with this clientele. Working with clients attracted to or engaged in VE is very demanding for clinicians. To mitigate the emotional burden of being frequently confronted with hate and threats, team relations, decreasing clinical exposure, and avoiding heroic positions help prevent burnout.

A pdf is here.

Here are some thoughts:

The article explores the psychological impact on clinicians treating individuals drawn to violent extremism (VE). It documents how prolonged exposure to hate discourse can lead to somatic symptoms (e.g., nausea, headaches), emotional exhaustion, hypervigilance, and a sense of being "contaminated" by hate. Clinicians reported struggling with moral dilemmas, fearing responsibility if a patient acts violently, and experiencing disruptions in their personal relationships.

Despite these challenges, team support, supervision, humor, and structured work boundaries were identified as critical resilience factors. The study highlights the need for institutional backing and clinician training to manage moral distress, avoid burnout, and sustain ethical engagement with patients who espouse extremist views.

Reasoning and empathy are not competing but complementary features of altruism

Law, K. F., et al. (2025, February 8).

PsyArXiv

https://doi.org/10.31234/osf.io/jm8gk_v1

Abstract

Humans can care about distant strangers, an adaptive advantage that enables our species to cooperate in increasingly large-scale groups. Theoretical frameworks accounting for an expansive moral circle and altruistic behavior are often framed as a dichotomy between competing pathways of emotion-driven empathy versus logic-driven reasoning. Here, in a pre-registered investigation comparing variations in empathy and reasoning capacities across different exceptionally altruistic populations –– effective altruists (EAs) who aim to maximize welfare gains with their charitable contributions (N = 119) and extraordinary altruists (XAs) who have donated organs to strangers (N = 65) –– alongside a third sample of demographically-similar general population controls (N = 176), we assess how both capacities contribute to altruistic behaviors that transcend conventional parochial boundaries. We find that, while EAs generally manifest heightened reasoning ability and XAs heightened empathic ability, both empathy and reasoning independently predict greater engagement in equitable and effective altruism on laboratory measures and behavioral tasks. Interaction effects suggest combining empathy and reasoning often yields the strongest willingness to prioritize welfare impartially and maximize impact. These results highlight complementary roles for empathy and reasoning in overcoming biases that constrain altruism, supporting a unified framework for expansive altruism and challenging the empathy-reasoning dichotomy in existing theory.

The article is linked above.

Here are some thoughts:

This research challenges the traditional dichotomy between empathy and reasoning in altruistic behavior. Rather than viewing them as opposing forces, the study argues that both cognitive and emotional capacities contribute independently to altruistic actions that transcend parochial biases. To explore this, the researchers examined three groups: Effective Altruists (EAs), who emphasize reasoned decision-making to maximize the welfare impact of their charitable actions; Extraordinary Altruists (XAs), who have demonstrated extreme altruism by donating organs to strangers; and a demographically similar general population control group.

The findings reveal that EAs tend to exhibit stronger reasoning abilities, while XAs demonstrate heightened empathy. However, both cognitive and emotional capacities play crucial roles in fostering altruism that prioritizes impartial welfare and maximizes impact. This challenges the prevailing notion that empathy is inherently biased and ineffective in promoting broad, equitable altruism. Instead, the study suggests that empathy, when cultivated, can complement reasoning to enhance prosocial motivation. Furthermore, while XAs engage in altruistic behavior primarily driven by emotional responses, EAs rely more on deliberative reasoning. Despite these differences, both groups demonstrate a commitment to helping distant others, suggesting that there are distinct but overlapping pathways to altruism.

For psychologists and other mental health professionals, these findings have significant implications. Understanding the cognitive and emotional foundations of altruism can inform therapeutic interventions aimed at fostering prosocial behavior in individuals who struggle with social engagement, such as those with psychopathy or social anhedonia. Additionally, the research challenges assumptions about empathy, showing that it can be expanded beyond parochial biases, which is particularly relevant for training programs that aim to develop empathy in clinicians, social workers, and caregivers. The study also contributes to broader ethical and moral discussions about how to encourage compassionate and rational decision-making in fields such as healthcare, philanthropy, and policymaking. Ultimately, this research highlights the importance of integrating both empathy and reasoning in efforts to promote altruism, offering valuable insights for psychology, psychotherapy, and social work.

Relational Norms for Human-AI Cooperation

Earp, B.D, et al. (2025).

arXiv.com

https://doi.org/10.48550/arXiv.2502.12102

Abstract

How we should design and interact with so-called “social” artificial intelligence (AI) depends, in part, on the socio-relational role the AI serves to emulate or occupy. In human society, different types of social relationship exist (e.g., teacher-student, parent-child, neighbors, siblings, and so on) and are associated with distinct sets of prescribed (or proscribed) cooperative functions, including hierarchy, care, transaction, and mating. These relationship-specific patterns of prescription and proscription (i.e., “relational norms”) shape our judgments of what is appropriate or inappropriate for each partner within that relationship. Thus, what is considered ethical, trustworthy, or cooperative within one relational context, such as between friends or romantic partners, may not be considered as such within another relational context, such as between strangers, housemates, or work colleagues. Moreover, what is appropriate for one partner within a relationship, such as a boss giving orders to their employee, may not be appropriate for the other relationship partner (i.e., the employee giving orders to their boss) due to the relational norm(s) associated with that dyad in the relevant context (here, hierarchy and transaction in a workplace context). Now that artificially intelligent “agents” and chatbots powered by large language models (LLMs), are increasingly being designed and used to fill certain social roles and relationships that are analogous to those found in human societies (e.g., AI assistant, AI mental health provider, AI tutor, AI “girlfriend” or “boyfriend”), it is imperative to determine whether or how human-human relational norms will, or should, be applied to human-AI relationships. Here, we systematically examine how AI systems' characteristics that differ from those of humans, such as their likely lack of conscious experience and immunity to fatigue, may affect their ability to fulfill relationship-specific cooperative functions, as well as their ability to (appear to) adhere to corresponding relational norms. We also highlight the "layered" nature of human-AI relationships, wherein a third party (the AI provider) mediates and shapes the interaction. This analysis, which is a collaborative effort by philosophers, psychologists, relationship scientists, ethicists, legal experts, and AI researchers, carries important implications for AI systems design, user behavior, and regulation. While we accept that AI systems can offer significant benefits such as increased availability and consistency in certain socio-relational roles, they also risk fostering unhealthy dependencies or unrealistic expectations that could spill over into human-human relationships. We propose that understanding and thoughtfully shaping (or implementing) suitable human-AI relational norms—for a wide range of relationship types—will be crucial for ensuring that human-AI interactions are ethical, trustworthy, and favorable to human well-being.

Here are some thoughts:

This article details the intricate dynamics of how artificial intelligence (AI) systems, particularly those designed to mimic social roles, should interact with humans in a manner that is both ethically sound and socially beneficial. Authored by a diverse team of experts from various disciplines, the paper posits that understanding and applying human-human relational norms to human-AI interactions is essential for fostering ethical, trustworthy, and advantageous outcomes. The authors draw upon the Relational Norms model, which identifies four primary cooperative functions in human relationships—care, transaction, hierarchy, and mating—that guide behavior and expectations within different types of relationships, such as parent-child, teacher-student, or romantic partnerships.

As AI systems increasingly occupy social roles traditionally held by humans, such as assistants, tutors, and companions, the paper examines how AI's unique characteristics, such as the lack of consciousness and immunity to fatigue, influence their ability to fulfill these roles and adhere to relational norms. A significant aspect of human-AI relationships highlighted in the document is their "layered" nature, where a third party—the AI provider—mediates and shapes the interaction. This structure can introduce risks, such as changes in AI behavior or the monetization of user interactions, which may not align with the user's best interests.

The authors emphasize the importance of transparency in AI design, urging developers to clearly communicate the capabilities, limitations, and data practices of their systems to prevent exploitation and build trust. They also call for adaptive regulatory frameworks that consider the specific relational contexts of AI systems, ensuring user protection and ethical alignment. Users, too, are encouraged to educate themselves about AI and relational norms to engage more effectively and safely with these technologies. The paper concludes by advocating for ongoing interdisciplinary research and collaboration to address the evolving challenges posed by AI in social roles, ensuring that AI systems are developed and governed in ways that respect human values and contribute positively to society.

What We Do When We Define Morality (and Why We Need to Do It)

Dahl, A. (2023).

Psychological Inquiry, 34(2), 53–79.

https://doi.org/10.1080/1047840x.2023.2248854

Abstract

Psychological research on morality relies on definitions of morality. Yet the various definitions often go unstated. When unstated definitions diverge, theoretical disagreements become intractable, as theories that purport to explain “morality” actually talk about very different things. This article argues that we need to define morality and considers four common ways of doing so: The linguistic, the functionalist, the evaluating, and the normative. Each has encountered difficulties. To surmount those difficulties, I propose a technical, psychological, empirical, and distinctive definition of morality: obligatory concerns with others’ welfare, rights, fairness, and justice, as well plus the reasoning, judgment, emotions, and actions that spring from those concerns. By articulating workable definitions of morality, psychologists can communicate more clearly across paradigms, separate definitional from empirical disagreements, and jointly advance the field of moral psychology.

A pre-print is here.

Here are some thoughts:

The article discusses the importance of defining morality in psychological research and the challenges associated with this task. Dahl argues that all psychological research on morality relies on definitions, but these definitions often go unstated, leading to communication problems and intractable disagreements when researchers use different unstated definitions.

The article examines four common approaches to defining morality: linguistic (whatever people call "moral"), functionalist (defined by social function), evaluating (collection of right actions), and normative (all judgments about right and wrong). After discussing the difficulties with each approach, Dahl proposes an alternative definition of morality: "obligatory concerns with others' welfare, rights, fairness, and justice, as well as the reasoning, judgment, emotions, and actions that spring from those concerns." This definition is described as technical, psychological, empirical, and distinctive.

The article emphasizes the need for clear definitions to communicate across paradigms, separate definitional from empirical disagreements, and advance the field of moral psychology. Dahl provides examples of debates in moral psychology (e.g., about obedience to authority, harm-based morality) that are complicated by lack of clear definitions. In conclusion, while defining morality is challenging due to its many meanings in ordinary language, Dahl argues that a workable scientific definition is both possible and necessary for progress in the field of moral psychology.

Advancing Transgender Health amid Rising Policy Threats

Coelho, D. R., Chen, A. L., &

Keuroghlian, A. S. (2025).

New England Journal of Medicine.

https://doi.org/10.1056/nejmp2416382

Abstract

The current U.S. political landscape poses escalating challenges for transgender health. Clinicians, researchers, policymakers, and advocates can act to counteract regressive policies.

Here is my summary:

The evolving political landscape under the Trump-Vance administration presents significant challenges to transgender health in the United States. Executive orders redefining sex and restricting gender-affirming care, coupled with state-level legislative efforts, are systematically dismantling protections for transgender and nonbinary individuals. These policies, often based on misinformation and discriminatory intent, are resulting in clinic closures, increased geographic barriers to care, and the denial of essential, evidence-based medical interventions. The denial of gender-affirming care, widely recognized as lifesaving and crucial for mental health, is having devastating consequences, including heightened risks of depression, anxiety, and suicidal ideation. Legal challenges, such as the United States v. Skrmetti case, highlight the constitutional implications of these restrictions, potentially setting precedents that could further limit access to care across numerous states. Moreover, broader policy initiatives, like Project 2025, aim to redefine sex at the federal level, threatening to institutionalize discrimination in healthcare, education, and employment. To counteract these regressive measures, a multi-faceted approach is necessary, encompassing strengthened federal nondiscrimination protections, robust legal advocacy, and the reinforcement of community-based healthcare networks. Professional medical associations need to reaffirm their commitment to transgender health, while integrating legal and medical expertise to combat disinformation. Ultimately, prioritizing the lived experiences of transgender and nonbinary individuals and advocating for equitable policies are critical to safeguarding their health and well-being.

Should the Mental Health of Psychotherapists Be One of the Transtheoretical Principles of Change?

Knapp, S., Sternlieb, J., & Kornblith, S. 

(2025, February).

Psychotherapy Bulletin, 60(2).

Often, psychotherapy researchers find that their contributions to psychotherapy get lost in the discussions of complex methodological issues that appear far removed from the real-life work of psychotherapists. Consequently, few psychotherapists regularly read research-based studies, and researchers communicate primarily with each other and less with psychotherapists. Fortunately, the pioneering work of Castonguay et al. (2019) has identified evidence-supported principles of change that improve patient outcomes, regardless of the psychotherapist’s theoretical orientation. They help bridge the researcher/practitioner gap by identifying, in succinct terms, evidence-supported findings related to improved patient outcomes. Psychotherapy scholars identified these principles after exhaustingly reviewing thousands of studies on psychotherapy.

Of course, none of the principles of change should be implemented in isolation. Nevertheless, together, they can guide psychotherapists on how to improve and personalize their treatment plans. Examples have been given of how psychotherapists can apply these change principles to improve the treatment of patients with suicidal thoughts (Knapp, 2022) and anxiety, depression, and other disorders (Castonguay et al., 2019).

Some of the principles appeared to support the conventional wisdom on what is effective in psychotherapy. For example, Principle 3 states, “Clients with more secure attachment may benefit more from psychotherapy than clients with less secure attachment” (McAleavey et al., 2019, p. 16). However, other principles conflict with some popular beliefs about the effectiveness of psychotherapy. For example, Principle 20 states, “Clients with substance use problems may be equally likely to benefit from psychotherapy delivered by a therapist with or without his or her own history of substance use problems” (McAleavey et al., 2019, p. 17).

The information is here.

Here are some thoughts:

The article argues for recognizing the mental health of psychotherapists as a transtheoretical principle of change, emphasizing its impact on patient outcomes. Building on the work of Castonguay et al. (2019), which identified principles that enhance patient outcomes across theoretical orientations, the authors propose that a psychotherapist's emotional well-being should be considered a key factor in effective treatment. They suggest that clients benefit more when their therapist experiences fewer symptoms of mental distress, highlighting the need for psychotherapists to prioritize self-care and emotional health.

Psychotherapists face numerous stressors, including administrative burdens, exposure to patient traumas, and the emotional demands of their work, all of which have intensified during the COVID-19 pandemic. Research indicates that higher levels of therapist burnout and distress correlate with poorer patient outcomes, underscoring the importance of addressing these issues. To enhance patient care, the article recommends integrating self-care practices into psychotherapy training and fostering supportive environments within institutions. By promoting self-awareness, self-compassion, and social connections, psychotherapists can better manage their emotional well-being and provide more effective treatment. The authors emphasize the need for ongoing research and open discussions to destigmatize mental health issues within the profession, ensuring that psychotherapists feel supported in seeking help when needed. Ultimately, prioritizing the mental health of psychotherapists is essential for improving both patient outcomes and the well-being of mental health professionals.

As AI nurses reshape hospital care, human nurses are pushing back

Perrone, M. (2025, March 16).

AP News.

The article is here.

The next time you’re due for a medical exam you may get a call from someone like Ana: a friendly voice that can help you prepare for your appointment and answer any pressing questions you might have.

With her calm, warm demeanor, Ana has been trained to put patients at ease — like many nurses across the U.S. But unlike them, she is also available to chat 24-7, in multiple languages, from Hindi to Haitian Creole.

That’s because Ana isn’t human, but an artificial intelligence program created by Hippocratic AI, one of a number of new companies offering ways to automate time-consuming tasks usually performed by nurses and medical assistants.

It’s the most visible sign of AI’s inroads into health care, where hundreds of hospitals are using increasingly sophisticated computer programs to monitor patients’ vital signs, flag emergency situations and trigger step-by-step action plans for care — jobs that were all previously handled by nurses and other health professionals.

Hospitals say AI is helping their nurses work more efficiently while addressing burnout and understaffing. But nursing unions argue that this poorly understood technology is overriding nurses’ expertise and degrading the quality of care patients receive.

The info is linked above.

Here are some thoughts:

The article details the increasing use of AI in healthcare to automate nursing tasks, sparking union concerns about patient safety and the risk of AI overriding human expertise. Licensing boards cannot license AI products because licensing is fundamentally designed for individuals, not tools. It establishes accountability based on demonstrated competence, which is difficult to apply to AI due to complex liability issues and the challenge of tracing AI outputs to specific actions. AI lacks the inherent personhood and professional responsibility that licensing demands, making it unaccountable for harm.

More patient-centered care, better healthcare: the association between patient-centered care and healthcare outcomes in inpatients.

Yu, C., Xian, Y., et al. (2023).

Frontiers in public health, 11, 1148277.

https://doi.org/10.3389/fpubh.2023.1148277

Abstract

Objective

The objective of this study is to explore the association between patient-centered care (PCC) and inpatient healthcare outcomes, including self-reported physical and mental health status, subjective necessity of hospitalization, and physician-induced demand behaviors.

Methods

A cross-sectional survey was conducted to assess patient-centered care among inpatients in comprehensive hospitals through QR codes after discharge from September 2021 to December 2021 and had 5,222 respondents in Jiayuguan, Gansu. The questionnaire included a translated 6-item version of the PCC questionnaire, physician-induced behaviors, and patients' sociodemographic characteristics including gender, household registration, age, and income. Logistic regression analyses were conducted to assess whether PCC promoted self-reported health, the subjective necessity of hospitalization, and decreased physician-induced demand. The interactions between PCC and household registration were implemented to assess the effect of the difference between adequate and inadequate healthcare resources.

Results

PCC promoted the patient's self-reported physical (OR = 4.154, p < 0.001) and mental health (OR = 5.642, p < 0.001) and subjective necessity of hospitalization (OR = 6.160, p < 0.001). Meanwhile, PCC reduced physician-induced demand in advising to buy medicines outside (OR = 0.415, p < 0.001), paying at the outpatient clinic (OR =0.349, p < 0.001), issuing unnecessary or repeated prescriptions and medical tests (OR = 0.320, p < 0.001), and requiring discharge and readmitting (OR = 0.389, p < 0.001).

Conclusion

By improving health outcomes for inpatients and reducing the risk of physician-induced demand, PCC can benefit both patients and health insurance systems. Therefore, PCC should be implemented in healthcare settings.

Here is a link the article.

Here are some thoughts:

The article explores how patient-centered care (PCC) influences healthcare outcomes, particularly self-reported physical and mental health, perceived necessity of hospitalization, and physician-induced demand behaviors.

For psychologists, this study offers key insights into the psychological impact of PCC. It highlights how involving patients in decision-making not only improves their perceived health but also enhances their sense of agency and engagement in treatment. Patients who experience higher PCC report better physical and mental health, suggesting that feeling heard and respected plays a crucial role in recovery. This aligns with psychological theories on autonomy and self-efficacy, which emphasize the importance of perceived control in well-being.

Another important finding is that PCC reduces physician-induced demand, such as unnecessary prescriptions or medical tests. This suggests that clear, transparent communication between healthcare providers and patients can mitigate over-treatment and enhance trust. For psychologists working in healthcare settings, this underscores the importance of training providers in effective patient communication and shared decision-making to improve adherence and outcomes.

However, the study also notes variations in PCC effectiveness based on socioeconomic status. Urban patients with greater access to healthcare resources reported less benefit from PCC, possibly due to higher expectations. This suggests that tailoring PCC interventions to different populations is essential. Psychologists can contribute by assessing patient expectations and designing interventions that enhance patient engagement while managing unrealistic healthcare beliefs.