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, April 30, 2016

In medical market, shoppers lack savvy

By Peter Ubel
The News and Observer
Originally posted April 6, 2016

Even before Obamacare became the law of the land, the U.S. health care system was undergoing a dramatic transformation. Millions of people were shifting from generous health insurance plans to consumer-directed ones that pair low monthly premiums with high out-of-pocket costs.

This shift has been encouraged by employers, eager to reduce the cost of employee benefits. It has also been encouraged by market enthusiasts who contend that the U.S. health care system needs to be more like the traditional consumer economy.

In theory, a family with a high deductible plan – on the hook for, say, the first $5,000 of health care expenses each year – will scrutinize the cost and quality of health care alternatives before deciding whether to receive them. In practice, health care consumerism doesn’t always play out at the bedside in ways that promote savvy medical decisions.

The article is here.


  • A shift from generous health insurance plans to consumer-directed plans has not helped people
  • Most patients, or doctors, do not know how to discuss out-of-pocket health care costs
  • Frustration with our system often distracts physicians from dealing with patients’ financial concerns

Friday, April 29, 2016

No, You Can’t Feel Sorry for Everyone

BY Adam Waytz
Originally posted April 14, 2015

Here is an excerpt:

Morality can’t be everywhere at once—we humans have trouble extending equal compassion to foreign earthquake victims and hurricane victims in our own country. Our capacity to feel and act prosocially toward another person is finite. And one moral principle can constrain another. Even political liberals who prize universalism recoil when it distracts from a targeted focus on socially disadvantaged groups. Empathy draws our attention toward particular targets, and whether that target represents the underprivileged, blood relatives, refugees from a distant country, or players on a sports team, those targets obscure our attention from other equally (or more) deserving ones.

That means we need to abandon an idealized cultural sensitivity that gives all moral values equal importance. We must instead focus our limited moral resources on a few values, and make tough choices about which ones are more important than others. Collectively, we must decide that these actions affect human happiness more than those actions, and therefore the first set must be deemed more moral than the second set.

The article is here.

How We Feel about Human Cloning

Guest post by Joshua May
BMJ Blogs
Originally posted April 7, 2016

Here is an excerpt:

How would you feel about cloning?  Take the nucleus of a cell from yourself or a loved one, then put it into an egg that will eventually develop into a baby that shares nearly all the genes of the donor cell.  The resulting baby will simply be a kind of ‘delayed twin’ of the donor.

Most people believe this is immoral.  There’s a bit more support for therapeutic uses that merely create new tissue, for example.  But, at least in the US and UK, people overwhelmingly condemn cloning for the purposes of creating new human lives.  In fact, a recent poll suggests there is little disagreement in America over this issue, where human cloning is among the most widely condemned topics (alongside polygamy and infidelity).

That’s what people think, but how do they feel?  Controversial bioethical issues often generate intense feelings.  Some bioethicists treat cloning in particular as a line in the sand that we mustn’t cross, for fear of sliding down a slippery slope to a dystopia.

The blog post is here.

Thursday, April 28, 2016

Canadian Prime Minister Seeks to Legalize Physician-Assisted Suicide

By Ian Austen
The New York Times
Originally posted April 14, 2016

The government of Prime Minister Justin Trudeau introduced legislation on Thursday to legalize physician-assisted suicide for Canadians with serious medical conditions.

The proposed law limits physician-assisted suicides to Canadians and residents, who are eligible to participate in the national health care system, preventing a surge in medical tourism among the dying from other countries. Assisted suicide is legal in only a few American states, including Oregon and Vermont.

Under Canada’s proposed law, people who want to die will be able to either commit suicide with medication provided by their doctors or have the doctors administer the dose. Family members will be allowed to assist patients with their death.

The article is here.

The Visual Guide to Morality: Vision as an Integrative Analogy for Moral Experience, Variability and Mechanism

Chelsea Schein, Neil Hester and Kurt Gray
Social and Personality Psychology Compass 10/4 (2016): 231–251


Analogies help organize, communicate and reveal scientific phenomena. Vision may be the best analogy for understanding moral judgment. Although moral psychology has long noted similarities between seeing and judging, we systematically review the “morality is like vision” analogy through
three elements: experience, variability and mechanism. Both vision and morality are experienced as automatic, durable and objective. However, despite feelings of objectivity, both vision and morality show substantial variability across biology, culture and situation. The paradox of objective experience and cultural subjectivity is best understood through constructionism, as both vision and morality involve the flexible combination of more basic ingredients. Specifically, both vision and morality involve a mechanism that demonstrates Gestalt, combination and coherence. The “morality is like vision” analogy not only provides intuitive organization and compelling communication for moral psychology but also speaks to debates in the field, such as intuition versus reason, pluralism versus universalism and modularity versus constructionism.

The article is here.

Wednesday, April 27, 2016

Are moral foundations heritable? Probably

by Jonathan Haidt
The Righteous Mind Blog
Originally posted April 11, 2016

Are moral foundation scores heritable? A new paper by Kevin Smith et al. has tested moral foundations theory in a sample of Australian twins and found that moral foundations are neither heritable nor stable over time. The authors summarized MFT fairly, and they used a research design that is appropriate for the questions they asked, but with one major flaw: They improvised an ultra-short measure of moral foundations (around 2008) that was so poor that they essentially have no measure of moral foundations at time 1. Then at time 2 (around 2010) they used a better measure, the MFQ20. As I show below, nothing can be concluded about heritability or stability from their data.

The blog post is here.

Intuitive Ethics and Political Orientations: Testing Moral Foundations as a Theory of Political Ideology

Kevin B. Smith, John R. Alford, John R. Hibbing, Nicholas G. Martin, Peter K. Hatemi
American Journal of Political Science. 


Originally developed to explain cultural variation in moral judgments, moral foundations theory (MFT) has become widely adopted as a theory of political ideology. MFT posits that political attitudes are rooted in instinctual evaluations generated by innate psychological modules evolved to solve social dilemmas. If this is correct, moral foundations must be relatively stable dispositional traits, changes in moral foundations should systematically predict consequent changes in political orientations, and, at least in part, moral foundations must be heritable. We test these hypotheses and find substantial variability in individual-level moral foundations across time, and little evidence that these changes account for changes in political attitudes. We also find little evidence that moral foundations are heritable. These findings raise questions about the future of MFT as a theory of ideology.

The article is here.

Tuesday, April 26, 2016

Doctors often overestimate promise of newly approved drugs

By Dennis Thompson
HealthDay News
Originally posted April 12, 2016

Here is an excerpt:

The U.S. Congress in 2012 gave FDA the power to designate a drug as a "breakthrough therapy" if preliminary clinical evidence suggests an advantage over existing medications.

But a survey of nearly 700 doctors revealed that many tended to misinterpret "breakthrough." Doctors often believed the drugs were supported by stronger evidence than the law requires to achieve that designation, said lead author Dr. Aaron Kesselheim. He is a faculty member at Brigham and Women's Hospital in Boston.

"When people hear 'breakthrough,' it gives them an inappropriately elevated sense of what the drug might do," Kesselheim said. "It may give physicians false reassurance about the outcomes they might expect to receive when they prescribe it."

The article is here.

Inference of Trustworthiness from Intuitive Moral Judgments

Jim A. C. Everett, David A. Pizarro, M. J. Crockett.
Journal of Experimental Psychology: General, 2016
DOI: 10.1037/xge0000165


Moral judgments play a critical role in motivating and enforcing human cooperation. Research on the proximate mechanisms of moral judgments highlights the importance of intuitive, automatic processes in forming such judgments. Intuitive moral judgments often share characteristics with deontological theories in normative ethics, which argue that certain acts (such as killing) are absolutely wrong, regardless of their consequences. Why do moral intuitions typically follow deontological prescriptions, as opposed to those of other ethical theories? Here we test a functional explanation for this phenomenon by investigating whether agents who express deontological moral judgments are more valued as social partners. Across five studies we show that people who make characteristically deontological judgments (as opposed to judgments that align with other ethical traditions) are preferred as social partners, perceived as more moral and trustworthy, and trusted more in economic games. These findings provide empirical support for a partner choice account for why intuitive moral judgments often align with deontological theories.

The article can be downloaded here.

Monday, April 25, 2016

Shame and Blame in the Therapeutic Relationship

Ami Schattner
JAMA Intern Med. Published online April 04, 2016.

Here is an excerpt:

[The physician-patient relationship] requires full commitment providing information, empathy, and bonding obligatory for patient-centeredness, patient satisfaction, trust, and adherence which translate into "hard" health outcomes. Because clinical care is strongly dependent on this human interaction, it is also susceptible to inherent biases (mostly unintentional) that are one major cause of variation in care. In this context, providers' reactions to certain patients may involve negative feelings adversely affecting the degree of effort invested in their care, diagnostic accuracy, treatment decisions, and level of communication, empathy and support. Stigmatized patients may get different (less than optimal) care, just as "nice" patients may be preferred and receive better care. Instead of empathy and bonding, which have a positive impact on outcomes, censure, absent compassion, diminished bonding, and poor support toward patients who caused their own wretched state are likely, as well as actual variation in care, all compromising patient outcomes. For example, poor provider's empathy and bonding on the part of the clinician was linked to low patient adherence and may be associated with actual discrimination and rationing.

The article is here.

The Strict Liability Standard and Clinical Supervision

Paul D. Polychronis & Steven G. Brown
Professional Psychology: Research and Practice, Vol 47(2), Apr 2016, 139-146.


Clinical supervision is essential to both the training of new psychologists and the viability of professional psychology. It is also a high-risk endeavor for clinical supervisors because of regulations in many states that impose a strict liability standard on supervisors for supervisees’ conduct. Applied in the context of tort law, the concept of strict liability makes supervisors responsible for supervisees’ actions without having to establish that a given supervisor was negligent or careless. Consequently, in jurisdictions where the strict liability standard is used, it is virtually inevitable that clinical supervisors will be named in civil suits over a supervisee’s actions regardless of whether a supervisor has been appropriately conscientious. In cases of supervisee misconduct, regulations in 27 of 51 jurisdictions (the 50 states plus the District of Columbia) generally hold clinical supervisors fully responsible for supervisees’ actions in a professional realm regardless of the nature of the supervisees’ misbehavior. Some examples are provided of language from these state regulations. The implications of this current reality are discussed. Altering the regulatory approach to clinical supervision is explored to reduce risk to clinical supervisors that is beyond their reasonable control. Recommendations for conducting clinical supervision and corresponding risk-management practices are suggested to assist clinicians in protecting themselves if practicing in a jurisdiction that uses the strict liability standard in regulations governing clinical supervision.

The article is here.

Sunday, April 24, 2016

Why Is It So Hard for Us to Admit Our Mistakes?

Karen Firestone
Harvard Business Review
Originally posted March 28, 2016

Advice for how to gracefully handle mistakes often emphasizes 1) taking responsibility for the error, 2) presenting a plan for the remedy, and then 3) fixing what was wrong. Although these directions sound simple, they can be extremely difficult to execute in real life. No one finds it easy to own up to a mistake — particularly a costly one.


Many people are afraid of appearing incompetent in front of our colleagues and bosses. But what we sometimes don’t realize is that it is worse to be viewed as a coward incapable of owning up to mistakes or accepting criticism. Rather than saying, “The plate dropped,” it is good practice to say, “I dropped the plate” — especially if that is exactly what happened. The best executives and investors “drop plates” all the time; without doing so, they would lack experience and a healthy understanding of risk.

The article is here.

Saturday, April 23, 2016

Computer creates high-tech Rembrandt counterfeit

Michael Franco
Originally posted April 6, 2016

In conversations about artificial intelligence and the time when machines will be able to functions as well as — or better than — human beings, it's often said that one thing computers will never be able to do is create art and music the way we do. Well, that argument just lost a bit of steam thanks to a project that's been carried out by Microsoft and ING. Working with the Technical University of Delft and two museums in the Netherlands, the project, called "Next Rembrandt," used algorithms and a 3D printer to create a brand-new Rembrandt painting that looks like it could easily have been delivered by Dutch Master's own hand about 350 years ago.

The article and video are here.

Friday, April 22, 2016

The Ethics of Sexual Objectification: Autonomy and Consent

Patricia Marino
Inquiry: An Interdisciplinary Journal of Philosophy
Volume 51, Issue 4, 2008


It is now a platitude that sexual objectification is wrong. As is often pointed out, however, some objectification seems morally permissible and even quite appealing—as when lovers are so inflamed by passion that they temporarily fail to attend to the complexity and humanity of their partners. Some, such as Nussbaum, have argued that what renders objectification benign is the right sort of relationship between the participants; symmetry, mutuality, and intimacy render objectification less troubling. On this line of thought, pornography, prostitution, and some kinds of casual sex are inherently morally suspect. I argue against this view: what matters is simply respect for autonomy, and whether the objectification is consensual. Intimacy, I explain, can make objectification more morally worrisome rather than less, and symmetry and mutuality are not relevant. The proper political and social context, however, is crucial, since only in its presence can consent be genuine. I defend the consent account against the objection that there is something paradoxical in consenting to objectification, and I conclude that given the right background conditions, there is nothing wrong with anonymous, one‐sided, or just‐for‐pleasure kinds of sexual objectification.

The article is here.

Review: Eric Fair’s ‘Consequence,’ a Memoir by a Former Abu Ghraib Interrogator

By Michiko Kakutani
New York Times Book Review
Originally published April 4, 2016

Here is an excerpt:

Of the Abu Ghraib torture photos broadcast by “60 Minutes” in April 2004, Mr. Fair writes: “Some of the activities in the photographs are familiar to me. Others are not. But I am not shocked. Neither is anyone else who served at Abu Ghraib. Instead, we are shocked by the performance of the men who stand behind microphones and say things like ‘bad apples’ and ‘Animal House’ on night shift.’”

In 2007, Mr. Fair says, he confessed everything to a lawyer from the Department of Justice and two agents from the Army’s Criminal Investigation Command, providing pictures, letters, names, firsthand accounts, locations and techniques. He was not prosecuted. “We tortured people the right way,” he writes, “following the right procedures, and used the approved techniques.”

Mr. Fair, however, became increasingly racked by guilt. He begins having nightmares. Nightmares in which “someone I know begins to shrink,” becoming so small “they slip through my fingers and disappear onto the floor.” Nightmares in which “there’s a large pool of blood on the floor” that moves as if it’s alive, nipping at his feet.

The book review is here.

Thursday, April 21, 2016

A question of basic morality on legal defense for juveniles

By The Los Angeles Times Editorial Board
Originally published April 4, 2016

Here are two excerpts:

But the public defender often has a conflict of interest. Consider, for example, when two people are accused of stealing a bike. Each might blame the other for the crime, so they can't have the same lawyer. One gets the public defender. For many years, the second one got a private lawyer from a county-approved panel, who was paid by the hour and — county officials argued — had too little incentive to keep costs down.


The fee, which has inched up over the years, has yielded results that should have been predictable. More juvenile defendants represented by those flat-fee panel lawyers get sentenced to “camps” — juvenile jails — than their counterparts represented by the public defender. That means a higher cost to taxpayers, who foot the bill for each of those jailed teenagers, even though the outcomes (criminal recidivism, homelessness, employment) are far better for those whose sentences are served in community and school settings.

The full text is here.

The Science of Choosing Wisely — Overcoming the Therapeutic Illusion

David Casarett
New England Journal of Medicine 2016; 374:1203-1205
March 31, 2016
DOI: 10.1056/NEJMp1516803

Here are two excerpts:

The success of such efforts, however, may be limited by the tendency of human beings to overestimate the effects of their actions. Psychologists call this phenomenon, which is based on our tendency to infer causality where none exists, the “illusion of control.” In medicine, it may be called the “therapeutic illusion” (a label first applied in 1978 to “the unjustified enthusiasm for treatment on the part of both patients and doctors”). When physicians believe that their actions or tools are more effective than they actually are, the results can be unnecessary and costly care. Therefore, I think that efforts to promote more rational decision making will need to address this illusion directly.


The outcome of virtually all medical decisions is at least partly outside the physician’s control, and random chance can encourage physicians to embrace mistaken beliefs about causality. For instance, joint lavage is overused for relief of osteoarthritis-related knee pain, despite a recommendation against it from the American Academy of Orthopedic Surgery. Knee pain tends to wax and wane, so many patients report improvement in symptoms after lavage, and it’s natural to conclude that the intervention was effective.

The article is here.

Wednesday, April 20, 2016

Is health profiling morally permissible?

Kasper Lippert-Rasmussen
J Med Ethics doi:10.1136/medethics-2015-103360

R. Scott Braithwaite, Elizabeth R. Stevens and Arthur Caplan argue that some risk stratifications—that is, “employing patient characteristics to reduce the uncertainty that a future event will occur”—amount to profiling and, thus, invidious discrimination. These are forms of risk stratification “in which there is concern that ethical harms exceed likely or proven benefits for a group, and in the case of health care, involves any differential treatment in response to a personal characteristic that may cause an unwanted consequence for that person or for other persons with that characteristic”. Braithwaite et al recognise the potential benefits of (increasingly fine-grained) risk stratification: “It can make the provision of therapies safer…[and] improve diagnostic accuracy… Additionally, it can promote the efficient utilization of resources”. However, risk stratification also involves ‘ethical harms’, which must be weighed against the benefits, that is, it can (1) stigmatise groups; (2) violate privacy; (3) increase distributive injustice, for example, by making an already unjustly disadvantaged group suffer further disadvantages relative to a ‘counterfactual situation of no risk stratification’; and (4) imperil autonomy.

The article is here.

Evolution makes scientific sense. So why do many people reject it?

Nathalia Gjersoe
The Guardian
Originally published March 31, 2016

Evolution is poorly understood by students and, disturbingly, by many of their science teachers. Although it is part of the compulsory science curriculum in most schools in the UK and the USA, more than a third of people in both countries reject the theory of evolution outright or believe that it is guided by a supreme being.

It is critical that the voting public have a clear understanding of evolution. Adaptation by natural selection, the primary mechanism of evolution, underpins a raft of current social concerns such as antibiotic resistance, the impact of climate change and the relationship between genes and environment. So why, despite formal scientific education, does intelligent design remain so intuitively plausible and evolution so intuitively opaque? And what can we do about it?

Developmental psychologists have identified two cognitive biases in very young children that help to explain the popularity of intelligent design. The first is a belief that species are defined by an internal quality that cannot be changed (psychological essentialism). The second is that all things are designed for a purpose (promiscuous teleology). These biases interact with cultural beliefs such as religion but are just as prevalent in children raised in secular societies. Importantly, these beliefs become increasingly entrenched, making formal scientific instruction more and more difficult as children get older.

Tuesday, April 19, 2016

Good News! You're Not an Automaton

By Cass R. Sunstein
Bloomberg View
Originally published March 30, 2016

A good nudge is like a GPS device: A small, low-cost intervention that tells you how to get where you want to go -- and if you don’t like what it says, you're free to ignore it. But when, exactly, will people do that? A new study sheds important light on that question, by showing the clear limits of nudging. Improbably, this research is also good news: It shows that when people feel strongly, it’s not easy to influence them to make choices that they won’t like.

The focus of this new research, as with much recent work on behavioral science, is on what people eat. Numerous studies suggest that if healthy foods are made more visible or convenient to find, more people will choose them. We tend to make purchasing decisions quickly and automatically; if certain foods or drinks -- snickers bars, apples, orange juice -- are easy to see and grab, consumption will jump.

The article is here.

Note: The podcast on nudge theory and how it applies to psychotherapy can be found here.

Divergent roles of autistic and alexithymic traits in utilitarian moral judgments in adults with autism

Indrajeet Patil, Jens Melsbach, Kristina Hennig-Fast & Giorgia Silani
Scientific Reports 6, Article number: 23637 (2016)


This study investigated hypothetical moral choices in adults with high-functioning autism and the role of empathy and alexithymia in such choices. We used a highly emotionally salient moral dilemma task to investigate autistics’ hypothetical moral evaluations about personally carrying out harmful utilitarian behaviours aimed at maximizing welfare. Results showed that they exhibited a normal pattern of moral judgments despite the deficits in social cognition and emotional processing. Further analyses revealed that this was due to mutually conflicting biases associated with autistic and alexithymic traits after accounting for shared variance: (a) autistic traits were associated with reduced utilitarian bias due to elevated personal distress of demanding social situations, while (b) alexithymic traits were associated with increased utilitarian bias on account of reduced empathic concern for the victim. Additionally, autistics relied on their non-verbal reasoning skills to rigidly abide by harm-norms. Thus, utilitarian moral judgments in autism were spared due to opposite influences of autistic and alexithymic traits and compensatory intellectual strategies. These findings demonstrate the importance of empathy and alexithymia in autistic moral cognition and have methodological implications for studying moral judgments in several other clinical populations.

The article is here.

Monday, April 18, 2016

The Benjamin Franklin Effect

David McRaney
You Are Not So Smart Blog: A Celebration of Self Delusion
October 5, 2011

The Misconception: You do nice things for the people you like and bad things to the people you hate.

The Truth: You grow to like people for whom you do nice things and hate people you harm.


Sometimes you can’t find a logical, moral or socially acceptable explanation for your actions. Sometimes your behavior runs counter to the expectations of your culture, your social group, your family or even the person you believe yourself to be. In those moments you ask, “Why did I do that?” and if the answer damages your self-esteem, a justification is required. You feel like a bag of sand has ruptured in your head, and you want relief. You can see the proof in an MRI scan of someone presented with political opinions which conflict with their own. The brain scans of a person shown statements which oppose their political stance show the highest areas of the cortex, the portions responsible for providing rational thought, get less blood until another statement is presented which confirms their beliefs. Your brain literally begins to shut down when you feel your ideology is threatened. Try it yourself. Watch a pundit you hate for 15 minutes. Resist the urge to change the channel. Don’t complain to the person next to you. Don’t get online and rant. Try and let it go. You will find this is excruciatingly difficult.

The blog post is here.

Note: How do you perceive complex patients or those who do not respond well to psychotherapy?

Bathroom Bills, Bigotry, and Bioethics

Elizabeth Dietz
The Hastings Center Bioethics Forum blog
March 31, 2016

Here is an excerpt:

HB 2 should incite the worry, and the anger, of bioethicists on several fronts. It is unclear how transgender people could even comply with the letter of the law, let alone its spirit. When transgender men who are read as men – but whose birth certificates say “female”–- are compelled to use the women’s restroom, this creates precisely the “problem,”- i.e., the idea of men invading a women’s only space, that the law purports to protect against. The law’s defenders have invented an imaginary threat to shore up support for the legislation, insisting that women are endangered if transgender women, who are routinely misgendered as “men” in this rhetoric, are allowed to share these spaces. While a 2013 survey by the Williams Institute of UCLA School of Law found that “roughly 70% of trans people have reported being denied entrance, assaulted or harassed while trying to use a restroom,” there is no evidence of violence perpetrated by transgender people in restrooms.

The article is here.

Sunday, April 17, 2016

Are Religion and Spirituality of Relevance in Psychotherapy?

By Jeffrey E. Barnett
Spirituality in Clinical Practice, Vol 3(1), Mar 2016, 5-9.


Are religion and spirituality of relevance in psychotherapy? Reasons why they are are addressed and information is shared to illustrate their great importance in many clients’ lives and why they are relevant to the psychotherapy process. Recommendations regarding how psychotherapists advertise their services, informed consent, clinical competence, cultural competence, and boundaries and multiple relationships are provided so that psychotherapists may fulfill their ethical obligations to provide clients with the most relevant and efficacious treatment possible.

The article is here.

Here are two excerpts:

Scholars and clinicians in the mental health fields have long considered the relevance of religion and spirituality as issues to consider and address in mental health treatment. While many mental health professionals in general, and psychologists in particular, had exhibited significant resistance to, and lack of respect for, religion and spirituality and their role in the psychotherapy process over the years, in recent years there has been much greater acceptance. Much of this acceptance is based on research findings on the great value of religion and spirituality for so many individuals and how addressing them in psychotherapy can be so meaningful and impactful for so many clients. Thus, it is now safe to say that the evidence is in; religion and spirituality are important issues to consider and address in psychotherapy.


For those of us who are not comfortable addressing our clients' religious and spiritual needs and issues in our psychotherapeutic work with them, referrals to appropriately trained colleagues is recommended. But, it is important to consider the viability of not addressing these issues at all with our clients as for so many individuals who seek out mental health treatment these are important and salient issues in their lives. Preparing ourselves to provide needed treatment services to those who are likely to seek our help is consistent with our ethical obligations as professionals. Failure to do so falls below minimally accepted ethics standards. So, in response to the question asked in the beginning of this commentary, the answer is most definitely yes, religion and spirituality are of relevance in psychotherapy, and as has been shared, they should be addressed in a thoughtful and respectful manner with each and every client we work with in psychotherapy.

Saturday, April 16, 2016

Legal and ethical aspects of organ donation after euthanasia in Belgium and the Netherlands

Jan Bollen, Rankie ten Hoopen, Dirk Ysebaert, Walther van Mook, & Ernst van Heurn
J Med Ethics doi:10.1136/medethics-2015-102898


Organ donation after euthanasia has been performed more than 40 times in Belgium and the Netherlands together. Preliminary results of procedures that have been performed until now demonstrate that this leads to good medical results in the recipient of the organs. Several legal aspects could be changed to further facilitate the combination of organ donation and euthanasia. On the ethical side, several controversies remain, giving rise to an ongoing, but necessary and useful debate. Further experiences will clarify whether both procedures should be strictly separated and whether the dead donor rule should be strictly applied. Opinions still differ on whether the patient's physician should address the possibility of organ donation after euthanasia, which laws should be adapted and which preparatory acts should be performed. These and other procedural issues potentially conflict with the patient's request for organ donation or the circumstances in which euthanasia (without subsequent organ donation) traditionally occurs.

The article is here.

Friday, April 15, 2016

Brain stimulation in sport: is it fair?

By Nick Davis
The Conversation
Originally published March 16, 2016

If I tried to sell you a drink or a tablet, claiming it would make you run faster or improve your tennis serve, you would be suspicious. Taking a supplement to boost performance in sport feels like cheating, and it generally is.

However, new advances in neuroscience have pointed the way to performance enhancement by stimulating the activity of the brain. Mild electrical stimulation using electrodes placed on the head – called transcranial direct current stimulation, or tDCS, makes the brain more or less active, and may lead to long-lasting changes in brain processing.

The article is here.

An Experimental Autism Treatment Cost Me My Marriage

By John Elder Robison
The New York Times
Originally published March 16, 2016

Here is an excerpt:

Several T.M.S. devices have been approved by the Food and Drug Administration for the treatment of severe depression, and others are under study for different conditions. (It’s still in the experimental phase for autism.) The doctors wondered if changing activity in a particular part of the autistic brain could change the way we sense emotions. That sounded exciting. I hoped it would help me read people a little better.

They say, be careful what you wish for. The intervention succeeded beyond my wildest dreams — and it turned my life upside down. After one of my first T.M.S. sessions, in 2008, I thought nothing had happened. But when I got home and closed my eyes, I felt as if I were on a ship at sea. And there were dreams — so real they felt like hallucinations. It sounds like a fairy tale, but the next morning when I went to work, everything was different. Emotions came at me from all directions, so fast that I didn’t have a moment to process them.

The article is here.

Thursday, April 14, 2016

The Ethics of Doing Ethics

Sven Ove Hansson
Sci Eng Ethics
DOI 10.1007/s11948-016-9772-3


Ethicists have investigated ethical problems in other disciplines, but there has not been much discussion of the ethics of their own activities. Research in ethics has many ethical problems in common with other areas of research, and it also has problems of its own. The researcher’s integrity is more precarious than in most other disciplines, and therefore even stronger procedural checks are needed to protect it. The promotion of some standpoints in ethical issues may be socially harmful, and even our decisions as to which issues we label as ‘‘ethical’’ may have unintended and potentially harmful social consequences. It can be argued that ethicists have an obligation to make positive contributions to society, but the practical implications of such an obligation are not easily identified. This article provides an overview of ethical issues that arise in research into ethics and in the application of such research. It ends with a list of ten practical proposals for how these issues should be dealt with.

The article is here.

Neuroscientist pleads guilty in court to fraud, gets two-year suspended sentence

Retraction Watch
Originally published March 31, 2016

Here is an except:

It’s not often that we see stories of researchers getting sentenced by courts for fraud (even though more scientists are bringing misconduct disputes to the courthouse). Last year, a researcher who confessed to spiking blood samples to boost the findings of an HIV vaccine experiment was sentenced to almost five years in prison, and ordered to pay back millions in grant funding; only a handful of other scientists — such as Eric Poehlman and Scott Reuben — have also been sentenced to jail time for their deeds.

The article is here.

Wednesday, April 13, 2016

Who is on ethics board that Google set up after buying DeepMind?

Sam Shead
Business Insider
Originally published March 26, 2016

Google's artificial intelligence (AI) ethics board, established when Google acquired London AI startup DeepMind in 2014, remains one of the biggest mysteries in tech, with both Google and DeepMind refusing to reveal who sits on it.

Google set up the board at DeepMind's request after the cofounders of the £400 million research-intensive AI lab said they would only agree to the acquisition if Google promised to look into the ethics of the technology it was buying into.

The article is here.

Stereotype Threat, Epistemic Injustice, and Rationality

Stacey Goguen
Draft, forthcoming (2016) in Brownstein and Saul (eds), Implicit Bias and Philosophy, Vol I,
Oxford University Press.

Stereotype threat is most well-known for its ability to hinder performance. However, it actually has a  wide range of effects. For instance, it can also cause stress, anxiety, and self-doubt. These additional effects are as important and as central to the phenomenon as its effects on performance are. As a result, stereotype threat has more far-reaching implications than many philosophers have realized. In particular, the phenomenon has a number of unexplored “epistemic effects.

These are effects on our epistemic lives — i.e., the ways we engage with the world as actual and potential knowers. In this paper I flesh out the implications of a specific epistemic effect: self-doubt. Certain kinds of self-doubt can deeply affect our epistemic lives by exacerbating moments of epistemic injustice and by perniciously interacting with ideals of rationality. In both cases, self-doubt can lead to one questioning one’s own humanity or full personhood. Because stereotype threat can trigger this kind of self-doubt, it can affect various aspects of ourselves besides our ability to perform to our potential. It can also affect our very sense of self. In this paper, I argue that we should adopt a more comprehensive account of stereotype threat that explicitly acknowledges all of the known effects of the phenomenon. Doing so will allow us to better investigate the epistemological implications of stereotype threat, as well as the full extent of its reach into our lives. I focus on fleshing out stereotype threat’s effect of self-doubt, and how this effect can influence the very foundations of our epistemic lives. I do this by arguing that self-doubt from stereotype threat can constitute an epistemic injustice, and that this sort of self-doubt can be exacerbated by stereotypes of irrationality. As a result, self-doubt from stereotype threat can erode our faith in ourselves as full human persons and as rational, reliable knowers.

The full text is here.

Tuesday, April 12, 2016

Most People Think Watching Porn Is Morally Wrong

By Emma Green
The Atlantic
Originally posted March 6, 2016

Here is an excerpt:

Recent debates about the porn industry haven't seemed to take this ambivalence into account. A Duke University freshman starred in hardcore porn videos and took to the blogs to defend her right to do so. Editorials about Britain's new Internet porn filter have focused on the government's right to regulate the web. Both of these are compelling and understandable points of concern, but they hinge on this issue of rights: The right to voluntarily work in the erotica industry without harassment, the right to enjoy sex work, the right to watch porn without interrogation from your government.

These are all valid issues. But even if 18-year-olds are free to make sex tapes and middle-aged men are free to watch them without Big Brother's scrutiny, there is a lingering moral question: Is watching porn a good thing to do?

The article is here.

Note: Some of these statistics in this article are fascinating.

Rationalization in Moral and Philosophical Thought

Eric Schwitzgebel and Jonathan Ellis


Rationalization, in our intended sense of the term, occurs when a person favors a particular conclusion as a result of some factor (such as self-interest) that is of little justificatory epistemic relevance, if that factor then biases the person’s subsequent search for, and assessment of, potential justifications for the conclusion.  Empirical evidence suggests that rationalization is common in ordinary people’s moral and philosophical thought.  We argue that it is likely that the moral and philosophical thought of philosophers and moral psychologists is also pervaded by rationalization.  Moreover, although rationalization has some benefits, overall it would be epistemically better if the moral and philosophical reasoning of both ordinary people and professional academics were not as heavily influenced by rationalization as it likely is.  We discuss the significance of our arguments for cognitive management and epistemic responsibility.

The paper is here.

Monday, April 11, 2016

The Sunk Cost Fallacy

David McRaney
You are Not So Smart Blog: The Celebration of Self-Delusion
Originally published March 25, 2011 (and still relevant)

The Misconception: You make rational decisions based on the future value of objects, investments and experiences.

The Truth: Your decisions are tainted by the emotional investments you accumulate, and the more you invest in something the harder it becomes to abandon it.

The blog post is here.

Note: This heuristic may be one reason psychologists hang onto patients longer than required.

New Technologies as Social Experiments: An Ethical Framework

By John Danaher
Philosophical Disquisitions 
Posted: Mar 19, 2016

What was Apple thinking when it launched the iPhone? It was an impressive bit of technology, poised to revolutionise the smartphone industry, and set to become nearly ubiquitous within a decade. The social consequences have been dramatic. Many of those consequences have been positive: increased connectivity, increased knowledge and increased day-to-day convenience.

A considerable number have been quite negative: the assault on privacy; increased distractability, endless social noise. But were any of them weighing on the mind of Steve Jobs when he stepped onstage to deliver his keynote on January 9th 2007?

Some probably were, but more than likely they leaned toward the positive end of the spectrum. Jobs was famous for his ‘reality distortion field’; it’s unlikely he allowed the negative to hold him back for more than a few milliseconds. It was a cool product and it was bound to be a big seller. That’s all that mattered. But when you think about it this attitude is pretty odd. The success of the iPhone and subsequent smartphones has given rise to one of the biggest social experiments in human history. The consequences of near-ubiquitous smartphone use were uncertain at the time.

The article is here.

Sunday, April 10, 2016

The Paradox of Nonlethal Weapons

Fritz Allhoff
Law and Bioethics Blog
Originally published March 10, 2016

Here are two excerpts:

These are all examples of lethal weapons. Importantly, though, there are myriad restrictions on the use of nonlethal weapons as well. And this gives rise to what I’ll call the “paradox of nonlethal weapons.” The paradox is simply that, sometimes, international law allows soldiers to kill, but not to disable. Or, in other words, some nonlethal weapons may be prohibited, while, at the same time, some lethal weaponry is not. As Donald Rumsfeld put it, “in many instances, our forces are allowed to shoot somebody and kill them, but they’re not allowed to use a nonlethal riot control agent.”


Regardless of the specific technologies, though, the general question is this: why should there be limits on nonlethal weapons at the same time that lethal weapons are allowed? This leads to the curious—and perhaps perverse—outcome that enemy combatants can be killed, but not even temporarily disabled.

The article is here.

Saturday, April 9, 2016

Machines That Will Think and Feel

By David Gelernter
The Wall Street Journal
Originally published March 18, 2016

Here is an excerpt:

AI prophets envision humanlike intelligence within a few decades: not expertise at a single, specified task only but the flexible, wide-ranging intelligence that Alan Turing foresaw in a 1950 paper proposing the test for machine intelligence that still bears his name. Once we have figured out how to build artificial minds with the average human IQ of 100, before long we will build machines with IQs of 500 and 5,000. The potential good and bad consequences are staggering. Humanity’s future is at stake.

Suppose you had a fleet of AI software apps with IQs of 150 (and eventually 500 or 5,000) to help you manage life. You download them like other apps, and they spread out into your phones and computers—and walls, clothes, office, car, luggage—traveling within the dense computer network of the near future that is laid in by the yard, like thin cloth, everywhere.

AI apps will read your email and write responses, awaiting your nod to send them. They will escort your tax return to the IRS, monitor what is done and report back. They will murmur (from your collar, maybe) that the sidewalk is icier than it looks, a friend is approaching across the street, your gait is slightly odd—have you hurt your back?

The article  is here.

Friday, April 8, 2016

Why Therapist Should Talk Politics

By Richard Brouillettee
The New York Times
Originally published March 15, 2016

Here is an except:

Typically, therapists avoid discussing social and political issues in sessions. If the patient raises them, the therapist will direct the conversation toward a discussion of symptoms, coping skills, the relevant issues in a patient’s childhood and family life. But I am growing more and more convinced that this is inadequate. Psychotherapy, as a field, is not prepared to respond to the major social issues affecting our patients’ lives.

When people can’t live up to the increasingly taxing demands of the economy, they often blame themselves and then struggle to live with the guilt. You see this same tendency, of course, in a variety of contexts, from children of divorce who feel responsible for their parents’ separation to the “survivor guilt” of those who live through disasters. In situations that may seem impossible or unacceptable, guilt becomes a shield for the anger you otherwise would feel: The child may be angry with her parents for divorcing, the survivor may be angry with those who perished.

The article is here.

Tennessee Lawmakers Pass Bill Permitting Mental Health Professionals to Discriminate

By Eric Levitz
New York Magazine
Originally posted April 6, 2016

Tennessee's House of Representatives just passed a bill that would allow therapists who believe homosexuality is the mark of Satan to refuse to treat gay clients. More precisely, the bill allows mental-health counselors to deny treatment to anyone who seeks help with "goals, outcomes, or behaviors that conflict with the sincerely held principles of the counselors or therapist." If the bill makes it into law, Tennessee would be the first state to allow therapists to pick what kind of clients they're willing to serve.

From a certain angle, the law may appear more significant on a symbolic level than a practical one: If you're a gay teenager looking for someone to counsel you through your first same-sex relationship, it's probably in your interest to see someone who doesn't think that relationship will bring you eternal hellfire. But what's really at stake in the legislation is what the ethical code for licensed mental-health professionals in the United States will entail. The bill was drafted in reaction to the American Counseling Association's 2014 code of ethics, which warned counselors not to impose their personal values onto their clients. Tennessee's bill would allow the state's mental-health professionals to reject clients — for failing to conform to their beliefs — without losing their licenses.

The article is here.

Thursday, April 7, 2016

Apple’s Engineers, if Defiant, Would be in Sync With Ethics Code

By John Markoff
The New York Times
Originally published March 18, 2016

If Apple employees refused to perform the software engineering tasks that would be necessary to provide the F.B.I. with access to the contents of an iPhone used by one of the shooters in the December mass killing in San Bernardino, Calif., their decision would be explicitly supported by the code of ethics of a professional organization called the Association for Computing Machinery.

The group urges computer professionals to obey existing laws unless they raise ethical issues that come into play around privacy and technological systems that have the ability to harm the public.

The article is here.

The Curious Case of Informed Consent for Egg Donation

by Alana Rose Cattapan
BMJ Blogs
Originally posted March 17, 2016

As Michael Dunn writes in a recent editorial for the JME, “no medical ethicist worth their salt would deny that consent is a foundational concept in contemporary medical ethics,” and it is an extraordinary understatement to say that much ink has been spilled on the topic. The spaces between consent in theory and in practice is the subject of Dunn’s editorial, where he describes the ways that scholarship about consent fails, at times, to account for the messiness of the real-life process.

Obtaining consent for egg donation is a particularly messy endeavour. We still know relatively little about the long term effects of egg donation, and donors are sometimes seen as secondary players while the recipient of the eggs – the woman carrying a pregnancy and having a child – is viewed as the primary patient. Like other corporeal donations – blood, organ, bone marrow – egg donation presents a curious case of medical treatment in which there are no physiological benefits to the donor.

The blog post is here.

Wednesday, April 6, 2016

Ethical ways for psychologists to counteract negative reviews online

Pauline Wallin
The National Psychologist
Originally published March 9, 2016

If you Google your name, the first page of search results may show ratings from Healthgrades, Yelp and similar sites. Sometimes these ratings are less than kind. And sometimes they’re not even posted by real clients.

Upon seeing a negative review, your first thought might be, “How do I get this removed?” Check the website’s Terms of Service. Many rating sites stipulate that reviews must be based on facts and must not include inflammatory, racist, sexist or other prejudicial content.

Thus, if someone posts a scathing review, calling you “scum of the earth,” that would likely violate the rating site’s terms of service and your request for removal of that review will be granted.

If the review is obviously factually inaccurate and does not reflect your mode of practice – e.g., a complaint that you didn’t clean your stethoscope – you can probably get it removed.

Social Media & Ethics: Psychologists self-reflect when engaging through technology

John Gavazzi
The National Psychologist
Originally published March 9,, 2016

Many times, psychologists experience fear, dread and anxiety when the concept of ethics is introduced. Simultaneously, many psychologists use social media for both professional and personal reasons. Since social media comes in various forms, psychologists may think they are not sufficiently learned or practiced in social media, which may add to feelings of apprehension.

Finally, social media is expanding quickly, so practicing psychologists may feel overwhelmed with the diversity of options. The purpose of this article is to help psychologists engage in meaningful reflection prior to engaging in social media. Thoughtful contemplation may prevent ethical breaches when engaging with social media.

Tuesday, April 5, 2016

The momentous advance in artificial intelligence demands a new set of ethics

Jason Millar
The Guardian
March 12, 2016

Here is an excerpt:

AI is also increasingly able to manage complex, data intensive tasks, such as monitoring credit card systems for fraudulent behaviour, high-frequency stock trading and detecting cyber security threats. Embodied as robots, deep-learning AI is poised to begin to move and work among us – in the form of service, transportation, medical and military robots.

Deep learning represents a paradigm shift in the relationship humans have with their technological creations. It results in AI that displays genuinely surprising and unpredictable behaviour. Commenting after his first loss, Lee described being stunned by an unconventional move he claimed no human would ever have made. Demis Hassabis, one of DeepMind’s founders, echoed the sentiment: “We’re very pleased that AlphaGo played some quite surprising and beautiful moves.”

Alan Turing, the visionary computer scientist, predicted we would someday speak of machines that think. He never predicted this.

The article is here.

Monday, April 4, 2016

Can we trust robots to make moral decisions?

By Olivia Goldhill
Originally published April 3, 2016

Last week, Microsoft inadvertently revealed the difficulty of creating moral robots. Chatbot Tay, designed to speak like a teenage girl, turned into a Nazi-loving racist after less than 24 hours on Twitter. “Repeat after me, Hitler did nothing wrong,” she said, after interacting with various trolls. “Bush did 9/11 and Hitler would have done a better job than the monkey we have got now.”

Of course, Tay wasn’t designed to be explicitly moral. But plenty of other machines are involved in work that has clear ethical implications.

The article is here.

Are volunteer study patients making a free choice?

Michael Kirsch
Originally published March 13, 2016

There was a tragedy in France recently: Innocent French citizens were taken down by a profession whose mission is to heal and comfort.  A medical clinical trial careened off the rails and crashed.  Were these volunteer study patients properly informed?  Are medical study patients here in the U.S. truly making a free choice?

From time to time, friends, patients, and relatives ask my advice if they should participate in a medical experiment.  While I am a doctor, I usually say no.  And, once I explain to them the realities of medical research, they usually say no also.

The article is here.

Sunday, April 3, 2016

When Self-Report Trumps Science: Confessions, DNA, & Prosecutorial Theories on Perceptions of Guilt

Sara Appleby and Saul Kassin
Psychology, Public Policy, and Law, Mar 10 , 2016


For many wrongfully convicted individuals, DNA testing presents a new and invaluable
means of exoneration. In several recently documented cases, however, innocent confessors were
tried and convicted despite DNA evidence that excluded them. In each of these cases, the
prosecutor proposed a speculative theory to explain away the mismatched confession and
exculpatory DNA. Three studies were conducted that pitted confessions against DNA test
results. Study 1 showed that people in general trust DNA evidence far more than self-report,
including a defendant’s confession. Using student and adult community samples, Studies 2 and 3
showed that in cases in which the defendant had confessed to police but was later exculpated by
DNA, prosecutorial theories spun to reconcile the contradiction attenuated the power of
exculpatory DNA, significantly increasing perceptions of the defendant's culpability, the rate of
conviction, and the self-reported influence of the confession. Implications and suggestions for
reform are discussed.

The cited article is here.

Access to the article is here.

Saturday, April 2, 2016

Why so many scientists are so ignorant

By Pascal-Emmanuel Gobry
The Week
Originally published March 8, 2016

Here is an excerpt:

Nye fell into the same trap that Neil DeGrasse Tyson and Stephen Hawking have been caught up in. Philosophy, these men of science opine, is largely useless, because it can't give us the sort of certain answers that science can, and amounts to little more than speculation.

There's obviously a grain of truth in this. Philosophy does not give us the certainty that math or experimental science can (but even then — as many philosophers would point out — these fields do not give us as much certainty as is sometimes claimed). But that doesn't mean that philosophy is worthless, or that it doesn't have rigor. Indeed, in a sense, philosophy is inescapable. To argue that philosophy is useless is to do philosophy. Moreover, some existential questions simply can't be escaped, and philosophy is one of the best, or at least least bad, ways we've come up with to address those questions.

The article is here.

Friday, April 1, 2016

Restrict the Recruitment of Involuntarily Committed Patients for Psychiatric Research

Carl Elliott and Matt Lamkin
JAMA Psychiatry
Published online February 10, 2016. doi:10.1001/jamapsychiatry.2015.3117

Can an involuntarily committed psychiatric patient give truly voluntary consent for medical research? This question has been fiercely debated in Minnesota since 2008, when the St Paul Pioneer Press reported the death of Dan Markingson, a mentally ill young man who had been recruited into an antipsychotic study at the University of Minnesota while under a civil commitment order. Along with many others, we have argued that the circumstances of Markingson’s commitment order compromised the voluntariness of his consent to the study. Although federal guidelines are silent on the issue, we believe the Markingson case serves as a powerful argument for serious restrictions on the recruitment of involuntarily committed patients into psychiatric research studies.

The article is here.

Assisted Outpatient Treatment: APA’s Position Statement

Renée Binder
Psychiatric News
Originally posted February 29, 2016

Here is an excerpt:

  • Is AOT ethical? Some opponents of AOT feel that it is unethical to force patients into treatment except for emergency treatment, that is, when a patient is a danger to self, a danger to others, or unable to care for basic needs. They argue that AOT goes against the principles of autonomy and right to self-determination.

Opponents contend that even if someone has a chronic mental illness and has a history of hospitalization or incarceration, they still have the right to decide if they want to comply with treatment, barring an emergency. AOT supporters argue that AOT is consistent with the principle of beneficence and tries to intervene before someone meets the criteria for involuntary hospitalization to prevent deterioration based on past history. After reviewing the arguments on both sides, the APA position statement supports the use of AOT and opines that it is ethical when used appropriately.

The article is here.