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

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

Saturday, September 24, 2022

A community response approach to mental health and substance abuse crises reduced crime

T. S. Dee and J. Pyne
Science Advances, 8 Jun 2022
Vol 8, Issue 23


Police officers often serve as first responders to mental health and substance abuse crises. Concerns over the unintended consequences and high costs associated with this approach have motivated emergency response models that augment or completely remove police involvement. However, there is little causal evidence evaluating these programs. This preregistered study presents quasi-experimental evidence on the impact of an innovative “community response” pilot in Denver that directed targeted emergency calls to health care responders instead of the police. We find robust evidence that the program reduced reports of targeted, less serious crimes (e.g., trespassing, public disorder, and resisting arrest) by 34% and had no detectable effect on more serious crimes. The sharp reduction in targeted crimes reflects the fact that health-focused first responders are less likely to report individuals they serve as criminal offenders and the spillover benefits of the program (e.g., reducing crime during hours when the program was not in operation).

From the Discussion Section

The evidence in this study indicates that the STAR community response program was effective in reducing police-reported criminal offenses (i.e., both reducing the designation of individuals in crisis as criminal offenders and reducing the actual level of crime). These results provide a compelling motivation for the continued implementation and assessment of this approach. However, successfully replicating the STAR program is likely to rely on key implementation details such as the recruitment and training of dispatchers and mental health field staff as well as the successful coordination of their activities with the police. Furthermore, the generalizability of the community response approach to a broader set of potentially preventable charges is uncertain and a design feature worthy of further study. There are also additional details about programs such as STAR that merit further investigation and clarification. For example, we are unsure of whether the existence of STAR may have increased the trust and the willingness of community members to call 911. However, we note that such an effect is likely to imply that our estimates underestimate the true effect of the STAR program. That is because increase in trust and willingness to call 911 is likely to increase measured crime in the short run as some of these calls would result in police engagement regardless of arrest status. Future studies may also consider the effects of programs like STAR on health-related outcomes, such as access to health services (e.g., counseling and therapy) and related measures of well-being.

Friday, September 23, 2022

Facial attractiveness is more associated with individual warmth than with competence: Behavioral and neural evidence

Mengxue Lan, et al. (2022) 
Social Neuroscience, 17:3, 225-235
DOI: 10.1080/17470919.2022.2069152


Individuals appear to infer others’ psychological characteristics according to facial attractiveness and these psychological characteristics can be classified into two categories in social cognition, that is, warmth and competence. However, which category of psychological characteristic is more associated with face attractiveness and its neural mechanisms have not been explored. To address this, participants were asked to judge others’ warmth and competence traits based on face attractiveness, while their brains were scanned using functional magnetic resonance imaging (fMRI). They also assessed the attractiveness of faces after scanning. Behavioral results showed that the correlation between face attractiveness and warmth ratings was significantly higher than that with competence ratings. fMRI results demonstrated that the dorsomedial prefrontal cortex (dmPFC), temporoparietal junction (TPJ), lateral prefrontal cortex, and lateral temporal lobe were more involved in the warmth task. Moreover, attractiveness ratings were negatively correlated with activation of the dmPFC and TPJ only in the warmth task. Furthermore, the attractiveness ratings were negatively correlated with the defined dmPFC, region related to attractiveness judgment, only in the warmth task. In conclusion, people are more inclined to infer others’ warmth than competence characteristics from face attractiveness, that is, face attractiveness is more associated with warmth than with competence.

Thursday, September 22, 2022

Freezing revisited: coordinated autonomic and central optimization of threat coping

Roelofs, K., Dayan, P. 
Nat Rev Neurosci 23, 568–580 (2022).


Animals have sophisticated mechanisms for coping with danger. Freezing is a unique state that, upon threat detection, allows evidence to be gathered, response possibilities to be previsioned and preparations to be made for worst-case fight or flight. We propose that — rather than reflecting a passive fear state — the particular somatic and cognitive characteristics of freezing help to conceal overt responses, while optimizing sensory processing and action preparation. Critical for these functions are the neurotransmitters noradrenaline and acetylcholine, which modulate neural information processing and also control the sympathetic and parasympathetic branches of the autonomic nervous system. However, the interactions between autonomic systems and the brain during freezing, and the way in which they jointly coordinate responses, remain incompletely explored. We review the joint actions of these systems and offer a novel computational framework to describe their temporally harmonized integration. This reconceptualization of freezing has implications for its role in decision-making under threat and for psychopathology.

Conclusions and future directions

Considering the post encounter threat state from neural, psychological and computational perspectives has shown how the most obvious external characteristic of this state — a particular form of active freezing arising from co-activation of the normally opposed sympathetic and parasympathetic branches of the ANS — could have various advantages from the viewpoints of both information processing and fast Pavlovian or instrumental action. Descending control of this state is quite well understood, and the potential benefits of expending effort on enhancing unbiased, bottom-up, sensory processing and engaging in planning are easy to observe. However, the roles of ascending neuromodulators in engaging these forms of appropriate information processing are less clear.  Certainly, various of the modes of action of ACh and NA in the CNS are in a position to achieve some of this; but much remains to be discovered by precisely recording and manipulating the candidate circuits within the timeframes of the detection, evaluation and action stages.

One important source of ideas is evolutionary theory. For instance, the polyvagal theory of the phylogeny of the ANS suggests that it progressed in three stages. The first, associated with an unmyelinated vagus nerve, allowed metabolic activity to be depressed in response to threat and also controlled aspects of digestion. The second stage was associated with the sympathetic nervous system, which organized energized behaviour for fight or flight. The third stage was associated with a myelinated vagus nerve and allowed for more flexible and sophisticated responding. It has been suggested that the last stage is particularly involved in the evolution of somatic regulation in a social context; but the evolutionary layering of the competition and cooperation between the inhibitory and activating aspects of the different branches of the ANS is notable. It would be interesting to understand the parallel evolution of cholinergic and noradrenergic neuromodulation in the CNS. 

Note: We are primates subject to the principles of biology and evolution.

Wednesday, September 21, 2022

Professional Civil Disobedience — Medical-Society Responsibilities after Dobbs

Matthew K. Wynia
The New England Journal of Medicine
September 15, 2022, 387:959-961

Here are two excerpts:

The AMA called Dobbs “an egregious allowance of government intrusion into the medical examination room, a direct attack on the practice of medicine and the patient–physician relationship, and a brazen violation of patients’ rights to evidence-based reproductive health services.” The American Academy of Family Physicians wrote that the decision “negatively impacts our practices and our patients by undermining the patient–physician relationship and potentially criminalizing evidence-based medical care.” The American College of Physicians stated, “A patient’s decision about whether to continue a pregnancy should be a private decision made in consultation with a physician or other health care professional, without interference from the government.” And the CEO of the American College of Obstetricians and Gynecologists called Dobbs “tragic” for patients, “the boldest act of legislative interference that we have seen in this country,” and “an affront to all that drew my colleagues and me into medicine.”

Medical organizations are rarely so united. Yet even many physicians who oppose abortion recognize that medically nuanced decisions are best left in the hands of individual patients and their physicians — not state lawmakers. Abortion bans are already pushing physicians in some states to wait until patients become critically ill before intervening in cases of ectopic pregnancy or septic miscarriage, among other problems.

Beyond issuing strongly worded statements, what actions should medical organizations take in the face of laws that threaten patients’ well-being? Should they support establishing committees to decide when a pregnant person’s life is in sufficient danger to warrant an abortion? Should they advocate for allowing patients to travel elsewhere for care? Or should they encourage their members to provide evidence-based medical care, even if doing so means accepting — en masse — fines, suspensions of licensure, and potential imprisonment? How long could a dangerous state law survive if the medical profession, as a whole, refused to be intimidated into harming patients, even if such a refusal meant that many physicians might go to jail?


Proposing professional civil disobedience of state laws prohibiting abortion might seem naive. Historically, physicians have rarely been radical, and most have conformed with bad laws and policies, even horrific ones — such as those authorizing forced-sterilization programs in the United States and Nazi Germany, the use of psychiatric hospitals as political prisons in the Soviet Union, and police brutality under apartheid in South Africa. Too often, organized medicine has failed to fulfill its duty to protect patients when doing so required acting against state authority. Although there are many examples of courageous individual physicians defying unjust laws or regulations, examples of open support for these physicians by their professional associations — such as the AMA’s offer to support physicians who refused to be involved in “enhanced” interrogations (i.e., torture) during the Iraq War — are uncommon. And profession-wide civil disobedience — such as Dutch physicians choosing to collectively turn in their licenses rather than practice under Nazi rule — is rare.

Tuesday, September 20, 2022

The Look Over Your Shoulder: Unethical Behaviour Decreases in the Physical Presence of Observers

Köbis, N., van der Lingen, S., et al., (2019, February 5).


Research in behavioural ethics repeatedly emphasizes the importance of others for people’s decisions to break ethical rules. Yet, in most lab experiments participants faced ethical dilemmas in full privacy settings. We conducted three experiments in which we compare such private set-ups to situations in which a second person is co-present in the lab. Study 1 manipulated whether that second person was a mere observer or co-benefitted from the participants’ unethical behaviour. Study 2 investigated social proximity between participant and observer –being a friend versus a stranger. Study 3 tested whether the mere presence of another person who cannot observe the participant’s behaviour suffices to decrease unethical behaviour. By using different behavioural paradigms of unethical behaviour, we obtain three main results: first, the presence of an observing other curbs unethical behaviour. Second, neither the payoff structure (Study 1) nor the social proximity towards the observing other (Study 2) qualifies this effect. Third, the mere presence of others does not reduce unethical behaviour if they do not observe the participant (Study 3). Implications, limitations and avenues for future research are discussed.

General Discussion

Taken together, the results of three experiments suggest that the physical presence of others reduces unethical behaviour, yet only if that other person can actually observe the behaviour. Even though the second person had no means to formally sanction wrong-doing, onlookers’ presence curtailed unethical behaviour while the local social utility (co-beneficiary or observer, Study 1) and the level of proximity (friend vs. stranger,Study 2) played a less important role. When others are merely present without being able to observe, no such attenuating effect on unethical behaviour occurs(Study 3).  Introducing the physical presence of another person to the rapidly growing stream of behavioural ethics research, our experiments provide some of the first empirical insights into the actual social aspects of unethical behaviour.

Humans are social animals who spend a substantial proportion of their time in company. Many decisions are made while being in the presence or in the gaze of others. At the same time, the overwhelming majority of lab experiments in behavioural ethics consists of individuals making decisions in isolation(for a meta-analysis, see Abeler et al., 2016). Also field experiments have sparsely looked at the impact of the tangible social elements of unethical behaviour (for a review, see Pierce & Balasubramanian, 2015). Nevertheless, the behavioural ethics literature emphasizes that appearing moral towards others is one of the main explanatory factor to explain when and how people break ethical rules (Mazar, Amir, & Ariely, 2008; Pillutla & Murnighan, 1995). Yet, so far behavioural research on the presence and observability of actual others remains sparse. Providing some of the first insights into how the physical presence of others shape our moral compass can contribute to the advancement of behavioural ethics and potentially inform the design of practical interventions. 

Direct application to those who practice independently.

Monday, September 19, 2022

The impact of economic inequality on conspiracy beliefs

Salvador Casara, B. G., Suitner, C., & Jetten, J.
(2022). Journal of Experimental Social 
Psychology, 98, 104245.


Previous literature highlights the crucial role of economic inequality in triggering a range of negative societal outcomes. However, the relationship between economic inequality and the proliferation of conspiracy beliefs remains unexplored. Here, we explore the endorsement of conspiracy beliefs as an outcome of objective country-level (Study 1a, 1b, 1c), perceived (Study 2), and manipulated economic inequality (Studies 3a, 3b, 4a, 4b). In the correlational studies, both objective and perceived economic inequality were associated with greater conspiracy beliefs. In the experiments, participants in the high (compared to the low) inequality condition were more likely to endorse conspiratorial narratives. This effect was fully mediated by anomie (Studies 3a, 3b) suggesting that inequality enhances the perception that society is breaking down (anomie), which in turn increases conspiratorial thinking, possibly in an attempt to regain some sense of order and control. Furthermore, the link between economic inequality and conspiracy beliefs was stronger when participants endorsed a conspiracy worldview (Studies 4a, 4b). Moreover, conspiracy beliefs mediated the effect of the economic inequality manipulation on willingness to engage in collective action aimed at addressing economic inequality. The results show that economic inequality and conspiracy beliefs go hand in hand: economic inequality can cause conspiratorial thinking and conspiracy beliefs can motivate collective action against economic inequality.

From the General Discussion

It is also important to consider whether economic inequality triggers the endorsement of general or more specific conspiracy beliefs. Data from Studies 3a and 3b showed that the manipulation of economic inequality affects the endorsement of a wide range of conspiracy beliefs— general conspiracy beliefs as well as conspiracies that relate to the specific fictional society. In Studies 4a and 4b, we found that inequality enhanced the belief in conspiracies perpetrated by different groups in the specific fictional society (i.e., politicians, scientists, multinational companies, and pharmaceutical industries) while it did not affect participants’ conspiracy worldview. Future research should focus on the impact of economic inequality on the endorsement of specific versus more general conspiracy theories. It may well be the case that the relation between economic inequality and conspiracy belief endorsement is stronger when participants consider specific conspiracy beliefs that blame an outgroup for heightened anomie that results from economic inequality. Such conspiracy beliefs best serve the function of mobilizing collective ingroup action that might hold the promise of providing people with a sense of collective agency (or control; see Bukowski et al., 2017).

These results have important implications. First, those who are prone to believe in conspiracy theories are sometimes viewed as driven by irrationality — a vision that is indeed supported by a vast literature about the negative consequences of conspiracy beliefs (e.g., Jolley & Douglas, 2014; Lewandowsky et al., 2013; Van der Linden, 2015). Other findings show that conspiracy beliefs are associated with dispositional constructs that are prodromal of mental disease, such as schizotypy and delusional thinking (Barron et al., 2018; Darwin et al., 2011). However, factors that trigger conspiracy beliefs are not always irrational and they may be driven by anomie-prompted socio-structural perceptions about societies, such as economic inequality. 

Sunday, September 18, 2022

Seven years of sex abuse: How Mormon officials let it happen

Michael Rezendes
The Associated Press
Originally posted 4 AUG 22

Here is an excerpt:

When it comes to child sexual abuse, the Mormon church says “the first responsibility of the church in abuse cases is to help those who have been abused and protect those who may be vulnerable to future abuse,” according to its 2010 handbook for church leaders. The handbook also says, “Abuse cannot be tolerated in any form.”

But church officials, from the bishops in the Bisbee ward to officials in Salt Lake City, tolerated abuse in the Adams family for years.

“They just let it keep happening,” said MJ, in her AP interview. “They just said, ‘Hey, let’s excommunicate her father.’ It didn’t stop. ‘Let’s have them do therapy.’ It didn’t stop. ‘Hey, let’s forgive and forget and all this will go away.’ It didn’t go away.”

A similar dynamic played out in West Virginia, where church leaders were accused of covering up the crimes committed by a young abuser from a prominent Mormon family even after he’d been convicted on child sex abuse charges in Utah. The abuser, Michael Jensen, today is serving a 35- to 75-year prison sentence for abusing two children in West Virginia. Their family, along with others, sued the church and settled out of court for an undisclosed sum.

“Child abuse festers and grows in secrecy,” said Lynne Cadigan, a lawyer for the Adams children who filed suit. “That is why the mandatory reporting came into effect. It’s the most important thing in the world to immediately report to the police.”

The lawsuit filed by the three Adams children accuses The Church of Jesus Christ of Latter-day Saints and several members, including Bishops Herrod and Mauzy, of negligence and conspiring to cover up child sex abuse to avoid “costly lawsuits” and protect the reputation of the church, which relies on proselytizing and tithing to attract new members and raise money. In 2020, the church claimed approximately 16 million members worldwide, most of them living outside the United States.

“The failure to prevent or report abuse was part of the policy of the defendants, which was to block public disclosure to avoid scandals, to avoid the disclosure of their tolerance of child sexual molestation and assault, to preserve a false appearance of propriety, and to avoid investigation and action by public authority, including law enforcement,” the suit alleges. “Plaintiffs are informed and believe that such actions were motivated by a desire to protect the reputation of the defendants.”

Very few of the scores of lawsuits against The Church of Jesus Christ of Latter-day Saints mention the help line, in part because details of its operations have been a closely guarded secret. The documents in the sealed court records show how it works.

“The help line is certainly there to help — to help the church keep its secrets and to cover up abuse,” said Craig Vernon, an Idaho attorney who has filed several sex abuse lawsuits against the church.

Vernon, a former member, routinely demands that the church require bishops to report sex abuse to police or state authorities rather than the help line.

The sealed records say calls to the help line are answered by social workers or professional counselors who determine whether the information they receive is serious enough to be referred to an attorney with Kirton McConkie, a Salt Lake City firm that represents the church.

Saturday, September 17, 2022

Ethical knowledge, dilemmas and resolutions in professional coaching

Hannah K. Heitz & Mark M. Leach (2022) 
Coaching: An International Journal of Theory, 
Research and Practice
DOI: 10.1080/17521882.2022.2112247


There is little understanding of coaches’ ethical knowledge, means to resolve ethical dilemmas, and how these dilemmas might align with those experienced in other helping professions. Using purposive convenience sampling, 260 coaches were asked about their training, the ethical dilemmas they have experienced, and how they have resolved their ethical dilemmas. The qualitative and quantitative results indicated that coaches reported a variety of dilemmas, with the three most common types being dilemmas related to conflicts of interest, confidentiality, and boundaries between therapy and coaching. The most reported methods of resolving dilemmas included informal resolution, referral to therapy, seeking supervision, seeking consultation and referring to the ICF Ethics Code. The results highlight common ethical issues that arise in coaching and their relationship to other helping professions.

Types of ethical dilemmas

Almost half of the participants reported having experienced an ethical dilemma as a coach. There were multiple types of ethical dilemmas reported by coaches, although the most prominently reported included conflicts of interest (36%), confidentiality (32%) and boundaries between therapy and coaching (20%). The remaining ethical dilemmas (12%) included a range of themes (e.g., misuse of services, criminality, compensation). Approximately 19% of coaches who reported experiencing an ethical dilemma reported more than one type. See Table 3 for themes and sample responses.

Ethical dilemmas

Approximately half of respondents indicated that they had encountered an ethical dilemma, and those most reported parallel the most common dilemmas reported by psychologists and counsellors. Coach responses most frequently acknowledged ethical dilemmas around conflicts of interest, confidentiality and boundaries of competence, similar to those of a multinational study by Pettifor and Sawchuk (2006) who indicated that practicing psychologists reported confidentiality, multiple relationships and competence as most common. Coaches did not report ethical dilemmas related to multiple relationships as frequently as psychologists in the Pettifor and Sawchuk study; instead, coaches reported a higher percentage of dilemmas related to conflicts of interest. At the time of data collection, multiple relationships were not explicitly mentioned in the ICF Ethics Code, except within the specific context of romantic relationships with clients, so other forms of multiple relationships may not naturally come to mind for coaches. Given that broader multiple relationships were not included within the ICF Ethics Code and the code emphasised conflicts of interest, it was difficult to discern whether coach dilemmas that were described as conflicts of interest were similar to what could be described as multiple relationships. After data was collected, the ICF Ethics Code was updated to include a broader definition of multiple relationships.

Friday, September 16, 2022

Talking with strangers is surprisingly informative

Atir, S., Wald, K. A., & Epley, N. (2022).
PNAS, 119(34). 


A meaningful amount of people’s knowledge comes from their conversations with others. The amount people expect to learn predicts their interest in having a conversation (pretests 1 and 2), suggesting that the presumed information value of conversations guides decisions of whom to talk with. The results of seven experiments, however, suggest that people may systematically underestimate the informational benefit of conversation, creating a barrier to talking with—and hence learning from—others in daily life. Participants who were asked to talk with another person expected to learn significantly less from the conversation than they actually reported learning afterward, regardless of whether they had conversation prompts and whether they had the goal to learn (experiments 1 and 2). Undervaluing conversation does not stem from having systematically poor opinions of how much others know (experiment 3) but is instead related to the inherent uncertainty involved in conversation itself. Consequently, people underestimate learning to a lesser extent when uncertainty is reduced, as in a nonsocial context (surfing the web, experiment 4); when talking to an acquainted conversation partner (experiment 5); and after knowing the content of the conversation (experiment 6). Underestimating learning in conversation is distinct from underestimating other positive qualities in conversation, such as enjoyment (experiment 7). Misunderstanding how much can be learned in conversation could keep people from learning from others in daily life.


Conversation can be a useful source of learning about practically any topic. Information exchanged through conversation is central to culture and society, as talking with others communicates norms, creates shared understanding, conveys morality, shares knowledge, provides different perspectives, and more. Yet we find that people systematically undervalue what they might learn in conversation, anticipating that they will learn less than they actually do. This miscalibration stems from the inherent uncertainty of conversations, where it can be difficult to even conceive of what one might learn before one learns it. Holding miscalibrated expectations about the information value of conversation may discourage people from engaging in them more often, creating a potentially misplaced barrier to learning more from others.

Direct applications to psychotherapy.