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

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

Sunday, November 18, 2018

Bornstein claims Trump dictated the glowing health letter

Alex Marquardt and Lawrence Crook
CNN.com
Originally posted May 2, 2018

When Dr. Harold Bornstein described in hyperbolic prose then-candidate Donald Trump's health in 2015, the language he used was eerily similar to the style preferred by his patient.

It turns out the patient himself wrote it, according to Bornstein.

"He dictated that whole letter. I didn't write that letter," Bornstein told CNN on Tuesday. "I just made it up as I went along."

The admission is an about face from his answer more than two years when the letter was released and answers one of the lingering questions about the last presidential election. The letter thrust the eccentric Bornstein, with his shoulder-length hair and round eyeglasses, into public view.

"His physical strength and stamina are extraordinary," he crowed in the letter, which was released by Trump's campaign in December 2015. "If elected, Mr. Trump, I can state unequivocally, will be the healthiest individual ever elected to the presidency."

The missive didn't offer much medical evidence for those claims beyond citing a blood pressure of 110/65, described by Bornstein as "astonishingly excellent." It claimed Trump had lost 15 pounds over the preceding year. And it described his cardiovascular health as "excellent."

The info is here.

Dartmouth Allowed 3 Professors to Sexually Harass and Assault Students, Lawsuit Charges

Nell Gluckman
The Chronicle of Higher Education
Originally published November 15, 2018

Seven current and former students sued Dartmouth College on Thursday, saying it had failed to protect them from three psychology and brain-science professors who sexually harassed and assaulted them. In the lawsuit, filed in a federal court in New Hampshire, they say that when they and others reported horrific treatment, the college did nothing, allowing the professors’ behavior to continue until last spring, when one retired and the other two resigned.

The 72-page complaint, which seeks class-action status, describes an academic department where heavy drinking, misogyny, and sexual harassment were normalized. It says that the three professors — Todd F. Heatherton, William M. Kelley, and Paul J. Whalen — “leered at, groped, sexted,” and “intoxicated” students. One former student alleges she was raped by Kelley, and a current student alleges she was raped by Whalen. Dartmouth ended a Title IX investigation after the professors left, and, as far as the complainants could tell, did not attempt to examine how the abuse occurred or how it could be prevented it from happening again, according to the complaint.

In a written statement, a Dartmouth spokesman said that college officials “respectfully but strongly disagree with the characterizations of Dartmouth’s actions in the complaint and will respond through our own court filings.”

The info is here.

Saturday, November 17, 2018

The New Age of Patient Autonomy: Implications for the Patient-Physician Relationship

Madison Kilbride and Steven Joffe
JAMA. Published online October 15, 2018.

Here is an excerpt:

The New Age of Patient Autonomy

The abandonment of strong medical paternalism led scholars to explore alternative models of the patient-physician relationship that emphasize patient choice. Shared decision making gained traction in the 1980s and remains the preferred model for health care interactions. Broadly, shared decision making involves the physician and patient working together to make medical decisions that accord with the patient’s values and preferences. Ideally, for many decisions, the physician and patient engage in an informational volley—the physician provides information about the range of options, and the patient expresses his or her values and preferences. In some cases, the physician may need to help the patient identify or clarify his or her values and goals of care in light of the available treatment options.

Although there is general consensus that patients should participate in and ultimately make their own medical decisions whenever possible, most versions of shared decision making take for granted that the physician has access to knowledge, understanding, and medical resources that the patient lacks. As such, the shift from medical paternalism to patient autonomy did not wholly transform the physician’s role in the therapeutic relationship.

In recent years, however, widespread access to the internet and social media has reduced physicians’ dominion over medical information and, increasingly, over patients’ access to medical products and services. It is no longer the case that patients simply visit their physicians, describe their symptoms, and wait for the differential diagnosis. Today, some patients arrive at the physician’s office having thoroughly researched their symptoms and identified possible diagnoses. Indeed, some patients who have lived with rare diseases may even know more about their conditions than some of the physicians with whom they consult.

The info is here.

Friday, November 16, 2018

Re-thinking Data Protection Law in the Age of Big Data and AI

Sandra Wachter and Brent Mittelstadt
Oxford Internet Institute
Originally published October 11, 2018

Numerous applications of ‘Big Data analytics’ drawing potentially troubling inferences about individuals and groups have emerged in recent years.  Major internet platforms are behind many of the highest profile examples: Facebook may be able to infer protected attributes such as sexual orientation, race, as well as political opinions and imminent suicide attempts, while third parties have used Facebook data to decide on the eligibility for loans and infer political stances on abortion. Susceptibility to depression can similarly be inferred via usage data from Facebook and Twitter. Google has attempted to predict flu outbreaks as well as other diseases and their outcomes. Microsoft can likewise predict Parkinson’s disease and Alzheimer’s disease from search engine interactions. Other recent invasive applications include prediction of pregnancy by Target, assessment of users’ satisfaction based on mouse tracking, and China’s far reaching Social Credit Scoring system.

Inferences in the form of assumptions or predictions about future behaviour are often privacy-invasive, sometimes counterintuitive and, in any case, cannot be verified at the time of decision-making. While we are often unable to predict, understand or refute these inferences, they nonetheless impact on our private lives, identity, reputation, and self-determination.

These facts suggest that the greatest risks of Big Data analytics do not stem solely from how input data (name, age, email address) is used. Rather, it is the inferences that are drawn about us from the collected data, which determine how we, as data subjects, are being viewed and evaluated by third parties, that pose the greatest risk. It follows that protections designed to provide oversight and control over how data is collected and processed are not enough; rather, individuals require meaningful protection against not only the inputs, but the outputs of data processing.

The information is here.

Motivated misremembering: Selfish decisions are more generous in hindsight

Ryan Carlson, Michel Marechal, Bastiaan Oud, Ernst Fehr, & Molly Crockett
PsyArXiv
Created on: July 22, 2018 | Last edited: July 22, 2018

Abstract

People often prioritize their own interests, but also like to see themselves as moral. How do individuals resolve this tension? One way to both maximize self-interest and maintain a moral self-image is to misremember the extent of one’s selfishness. Here, we tested this possibility. Across three experiments, participants decided how to split money with anonymous partners, and were later asked to recall their decisions. Participants systematically recalled being more generous in the past than they actually were, even when they were incentivized to recall accurately. Crucially, this effect was driven by individuals who gave less than what they personally believed was fair, independent of how objectively selfish they were. Our findings suggest that when people’s actions fall short of their own personal standards, they may misremember the extent of their selfishness, thereby warding off negative emotions and threats to their moral self-image.

Significance statement

Fairness is widely endorsed in human societies, but less often practiced. Here we demonstrate how memory distortions may contribute to this discrepancy. Across three experiments (N = 1005), we find that people consistently remember being more generous in the past than they actually were. We show that this effect occurs specifically for individuals whose decisions fell below their own fairness standards, irrespective of how high or low those standards were. These findings suggest that when people perceive their own actions as selfish, they can remember having acted more equitably, thus minimizing guilt and preserving their self-image.

The research is here.

Thursday, November 15, 2018

The Impact of Leader Moral Humility on Follower Moral Self-Efficacy and Behavior

Owens, B. P., Yam, K. C., Bednar, J. S., Mao, J., & Hart, D. W.
Journal of Applied Psychology. (2018)

Abstract

This study utilizes social–cognitive theory, humble leadership theory, and the behavioral ethics literature to theoretically develop the concept of leader moral humility and its effects on followers. Specifically, we propose a theoretical model wherein leader moral humility and follower implicit theories about morality interact to predict follower moral efficacy, which in turn increases follower prosocial behavior and decreases follower unethical behavior. We furthermore suggest that these effects are strongest when followers hold an incremental implicit theory of morality (i.e., believing that one’s morality is malleable). We test and find support for our theoretical model using two multiwave studies with Eastern (Study 1) and Western (Study 2) samples. Furthermore, we demonstrate that leader moral humility predicts follower moral efficacy and moral behaviors above and beyond the effects of ethical leadership and leader general humility.

Here is the conclusion:

We introduced the construct of leader moral humility and theorized its effects on followers. Two studies with samples from both Eastern and Western cultures provided empirical support that leader moral humility enhances followers’ moral self-efficacy, which in turn leads to increased prosocial behavior and decreased unethical behavior. We further demonstrated that these effects depend on followers’ implicit theories of the malleability of morality. More important, we found that these effects were above and beyond the influences of general humility, ethical leadership, LMX, and ethical norms of conduct, providing support for the theoretical and practical importance of this new leadership construct. Our model is based on the general proposal that we need followers who believe in and leaders who model ongoing moral development. We hope that the current research inspires further exploration regarding how leaders and followers interact to shape and facilitate a more ethical workplace.

The article is here.

Expectations Bias Moral Evaluations

Derek Powell & Zachary Horne
PsyArXiv
Originally posted September 13, 2018

Abstract

People’s expectations play an important role in their reactions to events. There is often disappointment when events fail to meet expectations and a special thrill to having one’s expectations exceeded. We propose that expectations influence evaluations through information-theoretic principles: less expected events do more to inform us about the state of the world than do more expected events. An implication of this proposal is that people may have inappropriately muted responses to morally significant but expected events. In two preregistered experiments, we found that people’s judgments of morally-significant events were affected by the likelihood of that event. People were more upset about events that were unexpected (e.g., a robbery at a clothing store) than events that were more expected (e.g., a robbery at a convenience store). We argue that this bias has pernicious moral consequences, including leading to reduced concern for victims in most need of help.

The research/preprint is here.

Wednesday, November 14, 2018

Moral resilience: how to navigate ethical complexity in clinical practice

Cynda Rushton
Oxford University Press
Originally posted October 12, 2018

Clinicians are constantly confronted with ethical questions. Recent examples of healthcare workers caught up in high-profile best-interest cases are on the rise, but decisions regarding the allocation of the clinician’s time and skills, or scare resources such as organs and medication, are everyday occurrences. The increasing pressure of “doing more with less” is one that can take its toll.

Dr Cynda Rushton is a professor of clinical ethics, and a proponent of ‘moral resilience’ as a pathway through which clinicians can lessen their experience of moral distress, and navigate the contentious issues they may face with a greater sense of integrity. In the video series below, she provides the guiding principles of moral resilience, and explores how they can be put into practice.



The videos are here.

Keeping Human Stories at the Center of Health Care

M. Bridget Duffy
Harvard Business Review
Originally published October 8, 2018

Here is an excerpt:

A mentor told me early in my career that only 20% of healing involves the high-tech stuff. The remaining 80%, he said, is about the relationships we build with patients, the physical environments we create, and the resources we provide that enable patients to tap into whatever they need for spiritual sustenance. The longer I work in health care, the more I realize just how right he was.

How do we get back to the 80-20 rule? By placing the well-being of patients and care teams at the top of the list for every initiative we undertake and every technology we introduce. Rather than just introducing technology with no thought as to its impact on clinicians — as happened with many rollouts of electronic medical records (EMRs) — we need to establish a way to quantifiably measure whether a new technology actually improves a clinician’s workday and ability to deliver care or simply creates hassles and inefficiency. Let’s develop an up-front “technology ROI” that measures workflow impact, inefficiency, hassle and impact on physician and nurse well-being.

The National Taskforce for Humanity in Healthcare, of which I am a founding member, is piloting a system of metrics for well-being developed by J. Bryan Sexton of Duke University Medical Center. Instead of measuring burnout or how broken health care people are, Dr. Sexton’s metrics focus on emotional thriving and emotional resilience. (The former are how strongly people agree or disagree to these statements: “I have a chance to use my strengths every day at work,” “I feel like I am thriving at my job,” “I feel like I am making a meaningful difference at my job,” and “I often have something that I am very looking forward to at my job.”

The info is here.