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

Tuesday, March 31, 2020

Pregnant and shackled: why inmates are still giving birth cuffed and bound

23 states do not have laws against shackling of incarcerated pregnant women.Lori Teresa Yearwood
Originally posted 24 Feb 20

Here is an excerpt:

To convolute matters more, the federal government does not require prisons or jails to collect data on pregnancy and childbirth among female inmates. A bill introduced in September 2018 would have required such data collection. However, no action was taken on the bill.

Even the definition of shackling varies. Some states, such as Maryland and New York, ban all restraints immediately before and after birth, though there are exceptions in extraordinary circumstances. Other states, such as Ohio, allow pregnant women to be handcuffed in the front of their bodies, as opposed to behind their bodies, which is thought to be more destabilizing.

Then there is the delineation between shackling during pregnancy, active delivery and postpartum. Individual state laws are filled with nuances. As of 2017, Rhode Island is the only state that has what is called “a private right of action”, an enforcement mechanism allowing the illegally shackled woman to sue for monetary compensation.

The one constant: the acute psychological trauma that shackling inflicts.

“Women subjected to restraint during childbirth report severe mental distress, depression, anguish, and trauma,” states a 2017 report from the American Psychological Association.

“Women who get locked up, tend on average to have suffered many more childhood traumas, says Terry Kupers, MD, a psychiatrist and the author of the book Solitary: The Inside Story of Supermax Isolation and How We Can Abolish It. He implores prison staffs “to be very careful that we do not re-traumatize them. Because re-traumatization makes conditions like post-traumatic stress disorder much worse.”

Amy Ard, executive director of Motherhood Beyond Bars, a not-for-profit in Georgia, worries that the trauma of shackling takes a toll on the self-image of new mothers. Inevitably, this question looms in the minds of the women Ard works with: if I am someone who needs to be chained, how can I expect to also see myself as someone capable of protecting my child?

The info is here.

How Should We Judge Whether and When Mission Statements Are Ethically Deployed?

K. Schuler & D. Stulberg
AMA J Ethics. 2020;22(3):E239-247.
doi: 10.1001/amajethics.2020.239.


Mission statements communicate health care organizations’ fundamental purposes and can help potential patients choose where to seek care and employees where to seek employment. They offer limited benefit, however, when patients do not have meaningful choices about where to seek care, and they can be misused. Ethical implementation of mission statements requires health care organizations to be truthful and transparent about how their mission influences patient care, to create environments that help clinicians execute their professional obligations to patients, and to amplify their obligations to communities.

Ethics, Mission, Standard of Care

Mission statements have long been used to communicate an organization’s values, priorities, and goals; serve as a moral compass for an organization; guide institutional decision making; and align efforts of employees. They can also be seen as advertising to prospective patients and employees. Although health care organizations’ mission statements serve these beneficial purposes, ethical questions (especially about business practices seen as motivating profit by rewarding underutilization) arise when mission implementation conflicts with acting in the best interests of patients. Ethical questions also arise when religiously affiliated organizations deny clinically indicated care in order to uphold their religiously based mission. For example, a Catholic organization’s mission statement might include phrases such as “faithful,” “honoring our sponsor’s spirit,” or “promoting reverence for life” and likely accords the Ethical and Religious Directives for Catholic Health Care Services, which Catholic organizations’ clinicians are required to follow as a condition of employment or privileges.

When strictly followed, these directives restrict health care service delivery, such that patients—particularly those seeking contraception, pregnancy termination, miscarriage management, end-of-life care, or other services perceived as conflicting with Catholic teaching—are not given the standard of care. Federal and state laws protect conscience rights of organizations, allowing them to refuse to provide services that conflict with the deeply held beliefs and values that drive their mission.6 Recognizing the potential for conflict between mission statements and patients’ autonomy or best interests, we maintain that health care organizations have fundamental ethical and professional obligations to patients that should not be superseded by a mission statement.

The info is here.

Monday, March 30, 2020

The Trump administration’s botched coronavirus response

PressTVGerman Lopez
Updated 25 March 20

Here is an excerpt:

It’s also something that the federal government has done well before — recently, with H1N1 and Zika. “It’s been surprising to me that the administration’s had a hard time executing on some of these things,” Ashish Jha, director of the Harvard Global Health Institute, previously told me.

But it’s the kind of thing that the Trump administration has screwed up, while instead trying to downplay the threat of Covid-19. Trump himself has tweeted comparisons of Covid-19 to the common flu — which Jha describes as “really unhelpful,” because the novel coronavirus appears to be much worse. Trump also called concerns about the virus a “hoax.” He said on national television that, based on nothing more than a self-admitted “hunch,” the death rate of the disease is much lower than public health officials projected.

And Trump has rejected any accountability for the botched testing process: “I don’t take responsibility at all,” he said this month.

Jha described the Trump administration’s messaging so far as “deeply disturbing,” adding that it’s “left the country far less prepared than it needs to be for what is a very substantial challenge ahead.”

Even as the Trump administration has tried to escalate its efforts to combat the pandemic, Trump has continued to downplay concerns. Recently, he’s suggested that social distancing measures — asking people to stay home and keep their physical distance from one another — could be lifted within weeks, instead of the months experts say is likely necessary. “What a great timeline that would be,” Trump said.

The info is here.

The race to develop coronavirus treatments pushes the ethics of clinical trials

Olivia Goldhill
Originally posted 28 March 20

Here is an excerpt:

But others are more pragmatic. Arthur Caplan, director of NYU Langone’s Division of Medical Ethics says that when doctors are faced with suffering patients, it’s ethical for them to use drugs that have been approved for other health conditions as treatments. This happened with Ebola, swine flu, Zika, and now coronavirus, he says.

Some of the first coronavirus patients in China, for example, were experimentally given the HIV treatment lopinavir–ritonavir and the rheumatoid arthritis drug Actemra. Now, as the virus continues its rampage around the globe, doctors are eyeballing an increasing number of treatment possibilities—and dealing with the challenging ethics of testing their efficacy while making the safest choices for their patients.

Controlled trials—with caveats

When choosing to use an experimental treatment, doctors have to be as methodical as possible—taking careful note of how sick patients are when given treatment, the dose and timing of medication, and how they fared. “It’s not a study, not controlled, but you want observations to be systematic,” says Caplan.

If, after a couple of weeks and 10 or 20 patients the drug doesn’t seem to cause active harm, Caplan says scientists can quickly move to the first stage of clinical research.

Many of the current coronavirus clinical trials are based on those early experimental treatments. Early research on lopinavir–ritonavir suggests that the drug is not effective, though as the first study was small, researchers plan to investigate further. There are also ongoing trials into arthritis medication Actemra,  antimalarial chloroquine, and Japanese flu drug favipiravir.

While clinical trials typically take months to years to get started, Li believes the current coronavirus trials will set records for speed: “I don’t think they could go any faster,” she says. It helps that there are a lot of coronavirus patients, so it’s easy to quickly enroll study participants.

The info is here.

Sunday, March 29, 2020

Who gets the ventilator in the coronavirus pandemic?

A group of doctors pictured during a surgical operation, with a heart rate monitor in the foreground.Julian Savulescu & Dominic Wilkinson
Updated on 17 March 20

Here is an excerpt:

4. Flatten the curve: the 'too little, too late' approach

There are two wishful-thinking approaches that try to make the problem go away.

The first is that we need more liberty to impose restrictions on the movement of citizens in an effort to "flatten the curve", reduce the number of coronavirus cases and pressure on hospitals, and allow everyone who needs a ventilator to get one.

That may have been possible early on (Singapore and Taiwan adopted severe liberty restriction and seemed to have controlled the epidemic).

However, that horse has bolted and it is now inevitable that there will be a shortage of life-saving medical supplies, as there is in Italy.

This approach is a case of too little, too late.

5. Paternalism: the 'greater harm' myth

The second wishful-thinking approach is that some people try to argue that it is harmful to ventilate older patients, or patients with a poorer prognosis.

One intensive care consultant wrote an open letter to older patients claiming that he and his colleagues would not discriminate against them:

"But we won't use the things that won't work. We won't use machines that can cause harm."

But all medical treatments can cause harm. It is simply incorrect that intensive care "would not work" in a patient with COVID-19 who is older than 60, or who has comorbidities.

Is a 1/1,000 chance of survival worth the discomfort of a month on a ventilator? That is a complex value judgement and people may reasonably differ. I would take the chance.

The claim that intensive care doctors will only withhold treatment that is harmful is either paternalistic or it is confused.

If the doctor claims that they will withhold ventilation when it is harmful, this is a paternalistic value judgement. Where a ventilator has some chance of saving a person's life, it is largely up to that person to decide whether it is a harm or a benefit to take that chance.

Instead, this statement is obscuring the necessary resource allocation decision. It is sanitising rationing by pretending that intensive care doctors are only doing what is best for every patient. That is simply false.

The info is here.

Saturday, March 28, 2020

Hospitals consider universal do-not-resuscitate orders for coronavirus patients

Ariana Eunjung Cha
The Washington Post
Originally posted 25 March 20

Hospitals on the front lines of the pandemic are engaged in a heated private debate over a calculation few have encountered in their lifetimes — how to weigh the “save at all costs” approach to resuscitating a dying patient against the real danger of exposing doctors and nurses to the contagion of coronavirus.

The conversations are driven by the realization that the risk to staff amid dwindling stores of protective equipment — such as masks, gowns and gloves — may be too great to justify the conventional response when a patient “codes,” and their heart or breathing stops.

Northwestern Memorial Hospital in Chicago has been discussing a do-not-resuscitate policy for infected patients, regardless of the wishes of the patient or their family members — a wrenching decision to prioritize the lives of the many over the one.

Richard Wunderink, one of Northwestern’s intensive-care medical directors, said hospital administrators would have to ask Illinois Gov. J.B. Pritzker for help in clarifying state law and whether it permits the policy shift.

“It’s a major concern for everyone,” he said. “This is something about which we have had lots of communication with families, and I think they are very aware of the grave circumstances.”

Officials at George Washington University Hospital in the District say they have had similar conversations, but for now will continue to resuscitate covid-19 patients using modified procedures, such as putting plastic sheeting over the patient to create a barrier. The University of Washington Medical Center in Seattle, one of the country’s major hot spots for infections, is dealing with the problem by severely limiting the number of responders to a contagious patient in cardiac or respiratory arrest.

The info is here.

Friday, March 27, 2020

Coronavirus and ethics: 'Act so that most people survive'

Georg Marckmann
Originally posted 24 March 20

Here is an excerpt:

Triage, a word used in military medicine, means classification. What groups do you classify the patients into?

There are several categories. Critically-ill patients are treated immediately, the treatment of seriously-ill patients is delayed, and patients who are slightly ill are treated later. Patients with no chance of survival receive purely palliative care.

The crucial element of situations involving a large number of sick people that we can no longer care for adequately is that we have to switch from a patient-centered approach to a group- or population-oriented approach. In a patient-centered approach, we try to adjust treatment as best we can to ensure the well-being of the individual patient and accommodate their wishes.

In a group-centered approach, we try to ensure that the incidence of illness and death within a population group is as low as possible. This places a strain on those making these decisions, because they're not used to it.

As a basic rule, we try to act in such a way that the largest number of people survive, because that is in the public interest.

The info is here.

Human Trafficking Survivor Settles Lawsuit Against Motel Where She Was Held Captive

Todd Bookman
Originally posted 20 Feb 20

Here is an excerpt:

Legal experts and anti-trafficking groups say her 2015 case was the first filed against a hotel or motel for its role in a trafficking crime.

"It is not that any hotel is liable just because trafficking occurred on their premises," explains Cindy Vreeland, a partner at the firm WilmerHale, which handled Ricchio's case pro bono. "The question is whether the company that's been sued knew or should have known about the trafficking."

After a number of appeals and delays, the case finally settled in December 2019 with Ricchio receiving an undisclosed monetary award. Owners of the Shangri-La Motel didn't respond to a request for comment.

"I never thought it would be, like, an eight-year process," Ricchio says. "Anything in the court system seems to take forever."

That slow process isn't deterring other survivors of trafficking from bringing their own suits.

According to the Human Trafficking Institute, there were at least 25 new cases filed nationwide against hotels and motels last year under the TVPA.

Some of the named defendants include major chains such as Hilton, Marriott and Red Roof Inn.

"You can't just let anything happen on your property, turn a blind eye and say, 'Too bad, so sad, I didn't do it, so I'm not responsible,' " says Paul Pennock with the firm Weitz & Luxenberg.

The info is here.

Thursday, March 26, 2020

Respirators, our rights, right and wrong: Medical ethics in an age of coronavirus

Dan Sulmasy
Being human in helping others.nydailynews.com
Originally posted 22 March 20

The coronavirus pandemic is upon us. This novel virus has disrupted lives, killed people, and wreaked havoc with our economy. COVID-19 has also raised novel ethical questions and generated ethical duties for the public, health professionals and the government. Just as our health system has been caught off guard, so have our ethics.

The general principles that guide care for individual patients are the duty to help the sick and respect their autonomy. The general principles that guide public health ethics are concern for the common good and justice. In the current crisis, these principles all come into play. We are in this together. Even if the personal risk for an individual is not great, the risk to the common good is immense. But the measures taken to mitigate the effects of the virus must be just and fair.

The duties for the general public are not arbitrary. They might seem mundane, but they are important and ought to be considered truly ethical duties. Obey the rules: We owe this to each other. Wash your hands. Keep six feet away from strangers. Don’t shake hands with, kiss or hug strangers or acquaintances. Disinfect surfaces where the coronavirus might linger. Self-quarantine if you become sick. Call or email your doctor through an encrypted system or telemedicine connection.

Unless you are experiencing life-threatening distress, don’t rush to the emergency room where you could infect people having heart attacks or complications of cancer. Don’t hoard food, disinfectant wipes, or toilet paper. Don’t spread false and alarming rumors on social media.

Italian nurse with coronavirus dies by suicide over fear of infecting others

Daniela TrezziYaron Steinbuch
Originally published 25 March 20

A 34-year-old Italian nurse working on the front lines of the coronavirus pandemic took her own life after testing positive for the illness and was terrified that she had infected others, according to a report.

Daniela Trezzi had been suffering “heavy stress” amid fears she was spreading the deadly bug while treating patients at the San Gerardo Hospital in Monza in the hard-hit region of Lombardy, the Daily Mail reported.

She was working in the intensive care unit while under quarantine after being diagnosed with COVID-19, according to the UK news site.

The National Federation of Nurses of Italy expressed its “pain and dismay” over Trezzi’s death, which came as the country’s mounting death toll surged with 743 additional fatalities Tuesday.

“Each of us has chosen this profession for good and, unfortunately, also for bad: we are nurses,” the federation said.

The info is here.

Wednesday, March 25, 2020

COVID-19 and the Impossibility of Morality

John Danaher
philosophical disquisitions
Originally published 16 March 20

The stories coming out of Italy over the past two weeks have been chilling. With their healthcare system overwhelmed by COVID-19 cases, Italian doctors are facing tragic triage decisions on a daily basis. In severe cases of COVID-19 patients need ventilators to survive. But there are only so many ventilators to go around. What if you don’t have enough? Who should you save? The 80 year old with COPD and other medical complications or the slightly healthier 50 year old without them? The 45 year old mother of two or the 55 year old single man? The 29 year old healthcare worker or the 38 year old diabetes patient?

Questions like these might sound like thought experiments cooked up in a first year ethics class, but they are not. Indeed, decision-making of this sort is not uncommon in crisis situations. For example, infamous tales are told about what happened at the Memorial Medical Center in New Orleans during Hurricane Katrina in 2005. With rising flood waters, no electricity and several critically ill patients who could not be evacuated, medical workers at Memorial had to make some tough decisions: abandon patients and leave them die in agony or administer euthanizing drugs to end their suffering more quickly? The suspicion is that many chose the latter course of action.

And medical decisions are just the tip of the iceberg. As we are all now being asked to isolate ourselves for the common good, many of us will find ourselves confronting similar, albeit less high stakes decisions. Which is more important: my duty to care for my elderly parents or my duty to protect them (and others) from potential transmission of disease? My duty to work to ensure that other people have the essential services they need or my duty to myself and my family to protect them from illness? We may not like to ask these questions, but we cannot avoid them.

But what are the answers? What should people do in cases like this? I don't know that I have much in the way of specific guidance to offer, but I do have a point that I think is worth making. It's at times like this that the essentially tragic nature of much moral decision-making reveals itself. This tragedy lurks in the background most of the time, but it is brought into sharp relief at times like this. Once we are aware of this ineluctable tragedy we might be inclined to change some of our common moral practices. We might be less inclined to blame others for the choices they make; and we might be more conscious of the pain of moral regret.

The info is here.

What Should Health Care Organizations Do to Reduce Billing Fraud and Abuse?

K. Drabiak and J. Wolfson
AMA J Ethics. 2020;22(3):E221-231.
doi: 10.1001/amajethics.2020.221.


Whether physicians are being trained or encouraged to commit fraud within corporatized organizational cultures through contractual incentives (or mandates) to optimize billing and process more patients is unknown. What is known is that upcoding and misrepresentation of clinical information (fraud) costs more than $100 billion annually and can result in unnecessary procedures and prescriptions. This article proposes fraud mitigation strategies that combine organizational cultural enhancements and deployment of transparent compliance and risk management systems that rely on front-end data analytics.

Fraud in Health Care

Growth in corporatization and profitization in medicine, insurance company payment rules, and government regulation have fed natural proclivities, even among physicians, to optimize profits and reimbursements (Florida Department of Health, oral communication, September 2019). According to the most recent Health Care Fraud and Abuse Control Program Annual Report, in one case a management company “pressured and incentivized” dentists to meet specific production goals through a system that disciplined “unproductive” dentists and awarded cash bonuses tied to the revenue from procedures—including many allegedly medically unnecessary services—they performed. This has come at a price: escalating costs, fraud and abuse, medically unnecessary services, adverse effects on patient safety, and physician burnout.

Breaking the cycle of bad behaviors that are induced in part by financial incentives speaks to core ethical issues in the practice of medicine that can be addressed through a combination of organizational and cultural enhancements and more transparent practice-based compliance and risk management systems that rely on front-end data analytics designed to identify, flag, and focus investigations on fraud and abuse at the practice site. Here, we discuss types of health care fraud and their impact on health care costs and patient safety, how this behavior is incentivized and justified within current and evolving medical practice settings, and a 2-pronged strategy for mitigating this behavior.

The info is here.

Tuesday, March 24, 2020

The effectiveness of moral messages on public health behavioral intentions during the COVID-19 pandemic

J. Everett, C. Colombatta, & others
PsyArXiv PrePrints
Originally posted 20 March 20

With the COVID-19 pandemic threatening millions of lives, changing our behaviors to prevent the spread of the disease is a moral imperative. Here, we investigated the effectiveness of messages inspired by three major moral traditions on public health behavioral intentions. A sample of US participants representative for age, sex and race/ethnicity (N=1032) viewed messages from either a leader or citizen containing deontological, virtue-based, utilitarian, or non-moral justifications for adopting social distancing behaviors during the COVID-19 pandemic. We measured the messages’ effects on participants’ self-reported intentions to wash hands, avoid social gatherings, self-isolate, and share health messages, as well as their beliefs about others’ intentions, impressions of the messenger’s morality and trustworthiness, and beliefs about personal control and responsibility for preventing the spread of disease. Consistent with our pre-registered predictions, deontological messages had modest effects across several measures of behavioral intentions, second-order beliefs, and impressions of the messenger, while virtue-based messages had modest effects on personal responsibility for preventing the spread. These effects were observed for messages from leaders and citizens alike. Our findings are at odds with participants’ own beliefs about moral persuasion: a majority of participants predicted the utilitarian message would be most effective. We caution that these effects are modest in size, likely due to ceiling effects on our measures of behavioral intentions and strong heterogeneity across all dependent measures along several demographic dimensions including age, self-identified gender, self-identified race, political conservatism, and religiosity. Although the utilitarian message was the least effective among those tested, individual differences in one key dimension of utilitarianism—impartial concern for the greater good—were strongly and positively associated with public health intentions and beliefs. Overall, our preliminary results suggest that public health messaging focused on duties and responsibilities toward family, friends and fellow citizens will be most effective in slowing the spread of COVID-19 in the US. Ongoing work is investigating whether deontological persuasion generalizes across different populations, what aspects of deontological messages drive their persuasive effects, and how such messages can be most effectively delivered across global populations.

The research is here.

Sen. Kelly Loeffler Dumped Millions in Stock After Coronavirus Briefing

Image result for loeffler stock saleL. Markay, W. Bredderman, & S. Bordy
Updated 20 March 20

The Senate’s newest member sold off seven figures’ worth of stock holdings in the days and weeks after a private, all-senators meeting on the novel coronavirus that subsequently hammered U.S. equities.

Sen. Kelly Loeffler (R-GA) reported the first sale of stock jointly owned by her and her husband on Jan. 24, the very day that her committee, the Senate Health Committee, hosted a private, all-senators briefing from administration officials, including the CDC director and Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases, on the coronavirus.

“Appreciate today’s briefing from the President’s top health officials on the novel coronavirus outbreak,” she tweeted about the briefing at the time.

That first transaction was a sale of stock in the company Resideo Technologies valued at between $50,001 and $100,000. The company’s stock price has fallen by more than half since then, and the Dow Jones Industrial Average overall has shed approximately 10,000 points, dropping about a third of its value.

It was the first of 29 stock transactions that Loeffler and her husband made through mid-February, all but two of which were sales. One of Loeffler’s two purchases was stock worth between $100,000 and $250,000 in Citrix, a technology company that offers teleworking software and which has seen a small bump in its stock price since Loeffler bought in as a result of coronavirus-induced market turmoil.

The info is here.

Monday, March 23, 2020

Changes in risk perception and protective behavior during the first week of the COVID-19 pandemic in the United States

T. Wise, T. Zbozinek, & others
Originally posted 19 March 20


By mid-March 2020, the COVID-19 pandemic spread to over 100 countries and all 50 states in the US. Government efforts to minimize the spread of disease emphasized behavioral interventions, including raising awareness of the disease and encouraging protective behaviors such as social distancing and hand washing, and seeking medical attention if experiencing symptoms. However, it is unclear to what extent individuals are aware of the risks associated with the disease, how they are altering their behavior, factors which could influence the spread of the virus to vulnerable populations. We characterized risk perception and engagement in preventative measures in 1591 United States based individuals over the first week of the pandemic (March 11th-16th 2020) and examined the extent to which protective behaviors are predicted by individuals’ perception of risk. Over 5 days, subjects demonstrated growing awareness of the risk posed by the virus, and largely reported engaging in protective behaviors with increasing frequency. However, they underestimated their personal risk of infection relative to the average person in the country. We found that engagement in social distancing and hand washing was most strongly predicted by the perceived likelihood of personally being infected, rather than likelihood of transmission or severity of potential transmitted infections. However, substantial variability emerged among individuals, and using data-driven methods we found a subgroup of subjects who are largely disengaged, unaware, and not practicing protective behaviors. Our results have implications for our understanding of how risk perception and protective behaviors can facilitate early interventions during large-scale pandemics.

From the Discussion:

One explanation for our results is the optimism bias.  This bias is associated with the belief that we are less likely to acquire a disease than others, and has been shown across a variety of diseases including lung  cancer. Indeed,  those  who  show  the  optimism  bias  are  less  likely  to  be  vaccinated  against disease. Recent evidence suggests that this may also be the case for COVID-19 and could result in a failure to engage in behaviors that contribute to the spread this highly contagious disease.  Our results extend  on  these  findings  by  showing  that behavior  changes  over  the  first  week  of  the  COVID-19 pandemic such that as individuals perceive an increase in personal risk they increasingly engage in risk-prevention  behaviors.   Notably,  we  observed  rapid  increases  in  risk  perception  over  a  5-day  period, indicating that public health messages spread through government and the media can be effective in raising awareness of the risk.

The research is here.

Burr moves to quell fallout from stock sales with request for Ethics probe

Richard BurrJack Brewster
Originally posted 20 March 20

Sen. Richard Burr (R-N.C.) on Friday asked the Senate Ethics Committee to review stock sales he made weeks before the markets began to tank in response to the coronavirus pandemic — a move designed to limit the fallout from an intensifying political crisis.

Burr, who chairs the powerful Senate Intelligence Committee, defended the sales, saying he “relied solely on public news reports to guide my decision regarding the sale of stocks" and disputed the notion he used information that he was privy to during classified briefings on the novel coronavirus. Burr specifically name-checked CNBC’s daily health and science reporting from its Asia bureau.

“Understanding the assumption many could make in hindsight however, I spoke this morning with the chairman of the Senate Ethics Committee and asked him to open a complete review of the matter with full transparency,” Burr said in a statement.

Burr, who is retiring at the end of 2022, has faced calls to resign from across the ideological spectrum since ProPublica reported Thursday that he dumped between $628,000 and $1.72 million of his holdings on Feb. 13 in 33 different transactions — a week before the stock market began plummeting amid fears of the coronavirus spreading in the U.S.

The info is here.

Sunday, March 22, 2020

Our moral instincts don’t match this crisis

Yascha Mounk
The Atlantic
Originally posted March 19, 2020

Here is an excerpt:

There are at least three straightforward explanations.

The first has to do with simple ignorance. For those of us who have spent the past weeks obsessing about every last headline regarding the evolution of the crisis, it can be easy to forget that many of our fellow citizens simply don’t follow the news with the same regularity—or that they tune into radio shows and television networks that have, shamefully, been downplaying the extent of the public-health emergency. People crowding into restaurants or hanging out in big groups, then, may simply fail to realize the severity of the pandemic. Their sin is honest ignorance.

The second explanation has to do with selfishness. Going out for trivial reasons imposes a real risk on those who will likely die if they contract the disease. Though the coronavirus does kill some young people, preliminary data from China and Italy suggest that they are, on average, less strongly affected by it. For those who are far more likely to survive, it is—from a purely selfish perspective—less obviously irrational to chance such social encounters.

The third explanation has to do with the human tendency to make sacrifices for the suffering that is right in front of our eyes, but not the suffering that is distant or difficult to see.

The philosopher Peter Singer presented a simple thought experiment in a famous paper. If you went for a walk in a park, and saw a little girl drowning in a pond, you would likely feel that you should help her, even if you might ruin your fancy shirt. Most people recognize a moral obligation to help another at relatively little cost to themselves.

Then Singer imagined a different scenario. What if a girl was in mortal danger halfway across the world, and you could save her by donating the same amount of money it would take to buy that fancy shirt? The moral obligation to help, he argued, would be the same: The life of the distant girl is just as important, and the cost to you just as small. And yet, most people would not feel the same obligation to intervene.

The same might apply in the time of COVID-19. Those refusing to stay home may not know the victims of their actions, even if they are geographically proximate, and might never find out about the terrible consequences of what they did. Distance makes them unjustifiably callous.

The info is here.

Saturday, March 21, 2020

Moral Courage in the Coronavirus: A Guide for Medical Providers and Institutions

Holly Tabor & Alyssa Burgard
Just Security
Originally published 18 March 20

Times of crisis generate extreme moral dilemmas: situations we can’t begin to imagine, unthinkable choices emerging between options that all seem bad, each with harms and negative outcomes. During the COVID-19 pandemic, these moral dilemmas are experienced across the healthcare landscape — from bedside encounters to executive suites of hospitals and health systems. Who gets put on a ventilator? Who transitions to comfort care? What does end of life care look like when high flow oxygen can’t be used because of viral spread? Who gets a hospital bed? How do we choose which sick person, with or without COVID-19, gets treated? Which patients should be enrolled in research? How do we support patients when their families cannot visit them? We will turn away people who, in any other circumstance in a U.S. medical facility, we would have been obliged to treat. We will second guess these decisions, and perhaps be haunted by them forever. We only know one thing for sure: people will suffer and die regardless of which decisions we make.

How should we confront these intense challenges? Many institutions are doing what they can to provide guidance. But “guidelines” by design are intended to provide broad parameters to aid in decision making, and therefore rarely address the exact situations clinicians face. Certainly no guidelines can reduce the pain of having to actually carry out recommendations that affect an individual patient.  For other decisions, front line providers will have no guidance at all, or will have ill-informed, or even potentially harmful guidance. In perhaps the worst case scenario, they may even be encouraged to keep quiet about their concerns or observations rather than raise them to others’ attention.

As bioethicists, we know that moral dilemmas require personal moral courage, that is, the ability to take action for moral reasons, despite the risk of adverse consequences. We have already seen several stark examples of moral courage from doctors, nurses, and researchers in this outbreak. In late December in Wuhan, China, a 34 year-old ophthalmologist, Dr. Li Wenliang, raised the alarm in a chat group of doctors about a new virus he was seeing. He was subsequently punished by the Chinese government. He continued to share his story via social media, even from his hospital bed, and was repeatedly censored. Dr. Wenliang died of the virus on February 7.

The info is here.

Friday, March 20, 2020

Oceanside council approves its first ethics code

Oceanside Civic CenterPhil Diehl
San Diego Union Tribune
Originally posted 1 March 20

Facing a public backlash over infighting, campaign contributions and alleged conflicts of interest, the Oceanside City Council unanimously approved its first code of ethics.

“This is a start,” said Councilwoman Esther Sanchez before Wednesday’s vote. The need for a policy is evident from the efforts underway to recall two council members (including herself) and for a referendum to overturn the council’s recent approval of a controversial Morro Hills development project, she said.

“We need to respect each other, and we need to respect the public,” Sanchez said, noting that she too at times has been critical of her fellow council members. “Sometimes it gets personal ... we need to do better.”

Residents said the policy should go further to include more specifics and penalties. Some suggested the city should limit campaign contributions, or not allow council members to vote on projects proposed by developers who contribute to their election campaigns.

The info is here.

Flawed science? Two efforts launched to improve scientific validity of psychological test evidence in court

Karen Franklin
forensicpsychologist Blog
Originally posted 15 Feb 20

Here is an excerpt:

New report slams "junk science” psychological assessments

In one of two significant developments, a group of researchers today released evidence of systematic problems with the state of psychological test admissibility in court. The researchers' comprehensive survey found that only about two-thirds of the tools used by clinicians in forensic settings were generally accepted in the field, while even fewer -- only about four in ten -- were favorably reviewed in authoritative sources such as the Mental Measurements Yearbook.

Despite this, psychological tests are rarely challenged when they are introduced in court, Tess M.S. Neal and her colleagues found. Even when they are, the challenges fail about two-thirds of the time. Worse yet, there is little relationship between a tool’s psychometric quality and the likelihood of it being challenged.

“Some of the weakest tools tend to get a pass from the courts,” write the authors of the newly issued report, "Psychological Assessments in Legal Contexts: Are Courts Keeping 'Junk Science' Out of the Courtroom?”

The report, currently in press in the journal Psychological Science in the Public Interest, proposes that standard batteries be developed for forensic use, based on the consensus of experts in the field as to which tests are the most reliable and valid for assessing a given psycho-legal issue. It further cautions against forensic deployment of newly developed tests that are being marketed by for-profit corporations before adequate research or review by independent professionals.

The info is here.

Thursday, March 19, 2020

Responding to Unprofessional Behavior by Trainees — A “Just Culture” Framework

J. A. Wasserman, M. Redinger, and T. Gibb
New England Journal of Medicine
February 20, 2020
doi: 10.1056/NEJMms1912591

Professionalism lapses by trainees can be addressed productively if viewed through a lens of medical error, drawing on “just culture” principles. With this approach, educators can promote a formative learning environment while fairly addressing problematic behaviors.

Addressing lapses in professionalism is critical to professional development. Yet characterizing the ways in which the behavior of emerging professionals may fall short and responding to those behaviors remain difficult.

Catherine Lucey suggests that we “consider professionalism lapses to be either analogous to or a form of medical error,” in order to create “a ‘just environment’ in which people are encouraged to report professionalism challenges, lapses, and near misses.” Applying a framework of medical error promotes an understanding of professionalism as a set of skills whose acquisition requires a psychologically safe learning environment.

 Lucey and Souba also note that professionalism sometimes requires one to act counter to one’s other interests and motivations (e.g., to subordinate one’s own interests to those of others); the skills required to navigate such dilemmas must be acquired over time, and therefore trainees’ behavior will inevitably sometimes fall short.

We believe that lapses in professional behavior can be addressed productively if we view them through this lens of medical error, drawing on “just culture” principles and related procedural approaches.


The Just Culture Approach

Thanks to a movement catalyzed by an Institute of Medicine report, error reduction has become a priority of health systems over the past two decades. Their efforts have involved creating a “culture of psychological safety” that allows for open dialogue, dissent, and transparent reporting. Early iterations involved “blame free” approaches, which have increasingly given way to an emphasis on balancing individual and system accountability.

Drawing on these just culture principles, a popular approach for defining and responding to medical error recognizes the qualitative differences among inadvertent human error, at-risk behavior, and reckless behavior (the Institute for Safe Medication Practices also provides an excellent elaboration of these categories).

“Inadvertent human errors” result from suboptimal individual functioning, but without intention or the knowledge that a behavior is wrong or error-prone (e.g., an anesthesiologist inadvertently grabbing a paralyzing agent instead of a reversal agent). These errors are not considered blameworthy, and proper response involves consolation and assessment of systemic changes to prevent them in the future.

Does virtue lead to status? Testing the moral virtue theory of status attainment.

Bai, F., Ho, G. C. C., & Yan, J. (2020).
Journal of Personality and 
Social Psychology, 118(3), 501–531.


The authors perform one of the first empirical tests of the moral virtue theory of status attainment (MVT), a conceptual framework for showing that morality leads to status. Studies 1a to 1d are devoted to developing and validating a 15-item status attainment scale (SAS) to measure how virtue leads to admiration (virtue–admiration), how dominance leads to fear (dominance–fear), and how competence leads to respect (competence–respect). Studies 2a and 2b are an exploration of the nomological network and discriminant validity to show that peer-reported virtue–admiration is positively related to moral character and perceptions such as perceived warmth and unrelated to amoral constructs such as neuroticism. In addition, virtue–admiration mediates the positive effect of several self-reported moral character traits, such as moral identity-internalization, on status conferral. Study 3 supports the external validity of the virtue route to status in a sample of full-time managers from China. In Study 4, a preregistered experiment, virtue evokes superior status while selfishness evokes inferior status. Perceivers who are high in moral character show stronger perceptions of superior status. Finally, Study 5, another preregistered experiment, shows that virtue leads to higher status through inducing virtue–admiration rather than competence–respect, even for incompetent actors. The findings provide initial support for MVT arguing that virtue is a distinct, third route to status.

The research is here.

Wednesday, March 18, 2020

‘Hunters’: explores justice, morality of revenge

Gabe Friedman
Originally posted 27 Feb 20

Here is an excerpt:

“The center of the series really revolves around the moral, ethical question, ‘Does it take evil to fight evil? Do you have to be a bad guy in order to effectively combat the bad guys?’” Logan Lerman, who plays the show’s protagonist Jonah Heidelbaum, says in a phone interview from Los Angeles. “I’m really curious to see what people’s responses are.”

The show, which was co-produced by Jordan Peele — the writer and director behind the horror blockbusters “Get Out” and “Us” — whirls into motion after Jonah’s grandmother is murdered in her Brooklyn apartment.

Jonah’s quest to discover the perpetrator brings him into contact with Meyer, who has assembled an “Ocean’s 11”-style team with members whose specialties range from combat to disguise. Jonah fits in immediately as a code-breaker because of his ability to recognize written patterns.

Meyer informs Jonah — one of multiple Jewish members of the squad — that there are many Nazis hiding in plain sight throughout the country.

In fact, in the show’s world, there is a large Nazi network that plans to establish a “Fourth Reich.” The hunters set to work to dismantle it, and they aren’t afraid to get their hands dirty (and very bloody) along the way.

The show imagines an alternate history in which some of the thousands of Nazis and Nazi collaborators who made their way to the US after WW II maintained their Nazi identities rather than hiding them.

The info is here.

How Salesforce Makes Decisions on Ethics and Social Issues

Kristin Broughton
The Wall Street Journal
Originally published 17 Feb 20

After facing public backlash in 2018 for doing business with U.S. immigration authorities amid the separation of migrant families at the southern U.S. border, Salesforce.com Inc., a company known for speaking up on social issues, hired a resident ethicist.

Paula Goldman joined the business software company early last year as chief ethical and humane use officer, a new role tasked with developing a framework for making decisions on complicated political issues.

Although the company’s contract with U.S. Customs and Border Protection remains in place, Salesforce has tackled other controversial issues. In her first year on the job, Ms. Goldman supervised the development of a corporate policy that prohibits customers from using Salesforce’s software to sell military-style firearms to private citizens.

She also is responsible for ensuring Salesforce’s products are developed with ethics in mind, particularly those involving artificial intelligence. One way she has done that is by introducing a process known as “consequence scanning,” an exercise that requires employees to document the potential unintended outcomes of releasing a new function, she said.

“We’re in this moment of correction where it’s like, ‘Oh yeah, this is our responsibility to integrate this question into the way we do business,’” Ms. Goldman said.

The info is here.

Tuesday, March 17, 2020

Trump's separation of families constitutes torture, doctors find

David Xol-Cholom of Guatemala hugs his son Byron at Los Angeles international airport last month as they reunite after being separated about one and half years ago.Amanda Holpuch
Originally posted 25 Feb 20

Here is an excerpt:

Legal experts have argued family separation constituted torture, but this is the first time a medical group has reached the determination.

PHR volunteer psychiatrists evaluated 17 adults and nine children who had been separated between 30 to 90 days. Most met the criteria for at least one mental health condition, including post-traumatic stress disorder, major depressive disorder or generalized anxiety disorder “consistent with, and likely linked to, the trauma of family separation”, according to the report.

Not only did the brutal family separation policy create trauma, it was intensified by the families’ previous exposure to violence on their journey to the US and in their home countries of Honduras, Guatemala and El Salvador.

All but two of the adults evaluated by PHR said they had received death threats in their home countries and 14 out of the 17 adults said they were targeted by drug cartels. All were fearful their child would be harmed or killed if they remained at home.

Almost all the children had been drugged, kidnapped, poisoned or threatened by gangs before they left. One mother told investigators she moved her daughter to different schools in El Salvador several times so gang members couldn’t find her and kill her.

The info is here.

Some Researchers Wear Yellow Pants, but Even Fewer Participants Read Consent Forms

B, Douglas, E. McGorray, & P. Ewell
Originally published 5 Feb 20


Though consent forms include important information, those experienced with behavioral research often observe that participants do not carefully read consent forms. Three studies examined participants’ reading of consent forms for in-person experiments. In each study, we inserted the phrase “some researchers wear yellow pants” into sections of the consent form and measured participants’ reading of the form by testing their recall of the color yellow. In Study 1, we found that the majority of participants did not read consent forms thoroughly. This suggests that overall, participants sign consent forms that they have not read, confirming what has been observed anecdotally and documented in other research domains. Study 2 examined which sections of consent forms participants read and found that participants were more likely to read the first two sections of a consent form (procedure and risks) than later sections (benefits and anonymity and confidentiality). Given that rates of recall of the target phrase were under 70% even when the sentence was inserted into earlier sections of the form, we explored ways to improve participant reading in Study 3. Theorizing that the presence of a researcher may influence participants’ retention of the form, we assigned participants to read the form with or without a researcher present. Results indicated that removing the researcher from the room while participants read the consent form decreased recall of the target phrase. Implications of these results and suggestions for future researchers are discussed.

The research is here.

Monday, March 16, 2020

Video Games Need More Complex Morality Systems

Hayes Madsen
Originally published 26 Feb 20

Hereis an excerpt:

Perhaps a bigger issue is the simple fact that games separate decisions into these two opposed ideas. There's a growing idea that games need to represent morality as shades of grey, rather than black and white. Titles like The Witcher 3 further this effort by trying to make each conflict not have a right or wrong answer, as well as consequences, but all too often the neutral path is ignored. Even with multiple moral options, games generally reward players for being good or evil. Take inFamous for example, as making moral choices rewards you with good or bad karma, which in turn unlocks new abilities and powers. The problem here is that great powers are locked away for players on either end, cordoning off gameplay based on your moral choices.

Video games need to make more of an effort to make any choice matter for players, and if they decide to go back and forth between good and evil, that should be represented, not discouraged. Things are seldom black and white, and for games to represent that properly there needs to be incentive across the board, whether the player wants to be good, evil, or anything in between.

Moral choices can shape the landscape of game worlds, even killing characters or entire races. Yet, choices don't always need to be so dramatic or earth-shattering. Characterization is important for making huge decisions, but the smaller day-to-day decisions often have a bigger impact on fleshing out characters.

The info is here.

U.S. Indian Health Service Doctor Indicted on Charges of Sexual Abuse

Christopher Weaver and Dan Frosch
The Wall Street Journal
Originally published 13 Feb 20

Here is an excerpt:

The new allegations aren’t the first about Dr. Ibarra-Perocier, some of the people familiar with the matter said. At least two nurses accused him internally of workplace sexual harassment in past years, the people said. Dr. Ibarra-Perocier’s wife, who left her job due to illness in 2017 and died the next year, was his supervisor during that time, they said.

In December, the HHS inspector general found the agency’s patient-protection policies don’t go far enough.

The inspectors concluded the agency had focused so narrowly on medical providers who commit child sexual abuse that it didn’t adequately direct employees on how to respond to other kinds of perpetrators, victims or types of abuse.

A separate White House task force convened to examine the widening scandal is expected to release additional recommendations for improving safety at the agency’s facilities next week.

The IHS also commissioned a review of its own handling of the Weber case that is expected to lead to additional changes. The private contractor the agency retained to do that work completed its report, but the agency has withheld the document, arguing that it is a record of quality assurance program that by law is confidential.

“IHS is committed to transparency, accountability and continuous improvement,” an agency spokeswoman said in a January statement. “We also respect and protect patient privacy.”

The info is here.

Sunday, March 15, 2020

Will Past Criminals Reoffend? (Humans are Terrible at Predicting; Algorithms Worse)

Sophie Bushwick
Scientific American
Originally published 14 Feb 2020

Here is an excerpt:

Based on the wider variety of experimental conditions, the new study concluded that algorithms such as COMPAS and LSI-R are indeed better than humans at predicting risk. This finding makes sense to Monahan, who emphasizes how difficult it is for people to make educated guesses about recidivism. “It’s not clear to me how, in real life situations—when actual judges are confronted with many, many things that could be risk factors and when they’re not given feedback—how the human judges could be as good as the statistical algorithms,” he says. But Goel cautions that his conclusion does not mean algorithms should be adopted unreservedly. “There are lots of open questions about the proper use of risk assessment in the criminal justice system,” he says. “I would hate for people to come away thinking, ‘Algorithms are better than humans. And so now we can all go home.’”

Goel points out that researchers are still studying how risk-assessment algorithms can encode racial biases. For instance, COMPAS can say whether a person might be arrested again—but one can be arrested without having committed an offense. “Rearrest for low-level crime is going to be dictated by where policing is occurring,” Goel says, “which itself is intensely concentrated in minority neighborhoods.” Researchers have been exploring the extent of bias in algorithms for years. Dressel and Farid also examined such issues in their 2018 paper. “Part of the problem with this idea that you're going to take the human out of [the] loop and remove the bias is: it’s ignoring the big, fat, whopping problem, which is the historical data is riddled with bias—against women, against people of color, against LGBTQ,” Farid says.

The info is here.

Saturday, March 14, 2020

You’re Not Going to Kill Them With Kindness. You’ll Do Just the Opposite.

Judith Newman
The New York Times
Originally posted 8 Jan 20

It was New Year’s Eve, and my friends had just adopted a little girl, 4 years old, from China. The family was going around the table, suggesting what each thought the New Year’s resolution should be for the other. Fei Fei’s English was still shaky. When her turn came, though, she didn’t hesitate. She pointed at her new father, mother and sister in turn. “Be nice, be nice, be nice,” she said.

Fifteen years later, in this dark age for civility, a toddler’s cri de coeur resonates more than ever. In his recent remarks at the memorial service for Congressman Elijah Cummings, President Obama said, “Being a strong man includes being kind, and there’s nothing weak about kindness and compassion; nothing weak about looking out for others.” On a more pedestrian level, yesterday I walked into the Phluid Project, the NoHo gender-neutral shop where T-shirts have slogans like “Hatephobic” and “Be Your Self.” I asked the salesperson, “What is your current best seller?” She pointed to a shirt in the window imprinted with the slogan: “Be kind.”

So I’m not surprised that there’s been a little flurry of self-help books on basic human decency and what it will do for you.

Kindness is doing small acts for others without expecting anything in return. It’s the opposite of transactional, and therefore the opposite of what we’re seeing in our body politic today.

The info is here.