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

Monday, November 30, 2020

In Japan, more people died from suicide last month than from Covid in all of 2020

S. Wang, R. Wright, & Y. Wakatsuki
Originally posted 29 Nov 20

Here is an excerpt:

In Japan, government statistics show suicide claimed more lives in October than Covid-19 has over the entire year to date. The monthly number of Japanese suicides rose to 2,153 in October, according to Japan's National Police Agency. As of Friday, Japan's total Covid-19 toll was 2,087, the health ministry said.

Japan is one of the few major economies to disclose timely suicide data -- the most recent national data for the US, for example, is from 2018. The Japanese data could give other countries insights into the impact of pandemic measures on mental health, and which groups are the most vulnerable.

"We didn't even have a lockdown, and the impact of Covid is very minimal compared to other countries ... but still we see this big increase in the number of suicides," said Michiko Ueda, an associate professor at Waseda University in Tokyo, and an expert on suicides.

"That suggests other countries might see a similar or even bigger increase in the number of suicides in the future."


Compounding those worries about income, women have been dealing with skyrocketing unpaid care burdens, according to the study. For those who keep their jobs, when children are sent home from school or childcare centers, it often falls to mothers to take on those responsibilities, as well as their normal work duties.

Increased anxiety about the health and well-being of children has also put an extra burden on mothers during the pandemic.

Sunday, November 29, 2020

Freerolls and binds: making policy when information is missing

Duke, A. & Sunstein, C.
(2020). Behavioural Public Policy, 1-22. 


When policymakers focus on costs and benefits, they often find that hard questions become easy – as, for example, when the benefits clearly exceed the costs, or when the costs clearly exceed the benefits. In some cases, however, benefits or costs are difficult to quantify, perhaps because of limitations in scientific knowledge. In extreme cases, policymakers are proceeding in circumstances of uncertainty rather than risk, in the sense that they cannot assign probabilities to various outcomes. We suggest that in difficult cases in which important information is absent, it is useful for policymakers to consider a concept from poker: ‘freerolls.’ A freeroll exists when choosers can lose nothing from selecting an option but stand to gain something (whose magnitude may itself be unknown). In some cases, people display ‘freeroll neglect.’ In terms of social justice, John Rawls’ defense of the difference principle is grounded in the idea that, behind the veil of ignorance, choosers have a freeroll. In terms of regulatory policy, one of the most promising defenses of the Precautionary Principle sees it as a kind of freeroll. Some responses to climate change, pandemics and financial crises can be seen as near-freerolls. Freerolls and near-freerolls must be distinguished from cases involving cumulatively high costs and also from faux freerolls, which can be found when the costs of an option are real and significant, but not visible. ‘Binds’ are the mirror-image of freerolls; they involve options from which people are guaranteed to lose something (of uncertain magnitude). Some regulatory options are binds, and there are faux binds as well.

From the Conclusion

In ordinary life, people may be asked whether they want a freeroll, in the form of a good or opportunity from which they will lose nothing, but from which they gain something of value, when the magnitude of the gain cannot be specified. The gain might take the form of the elimination of a risk. More commonly, people are given near-freerolls, because they have to pay something for the option. Often what they have to pay is very low, which makes the deal a good one. The central point here is an asymmetry in what people know. They know the costs, while they have large epistemic gaps with respect to the potential gains. People often fall prey to ‘freeroll neglect.’ When this is so, they do not see pure or near-freerolls; they seek missing information before choosing among options, even though they have no need to do so.

Freerolls are mirrored by binds, in which people are given an option from which they can only lose, even though they do not know how much they might lose. To know that binds are undesirable, the chooser need not have full knowledge about the range of possible downside outcomes. Nor need the chooser know anything about the shape of the distribution of those outcomes.

Saturday, November 28, 2020

Toward a Hierarchical Model of Social Cognition: A Neuroimaging Meta-Analysis and Integrative Review of Empathy and Theory of Mind

Schurz, M. et al.
Psychological Bulletin. 
Advance online publication. 


Along with the increased interest in and volume of social cognition research, there has been higher awareness of a lack of agreement on the concepts and taxonomy used to study social processes. Two central concepts in the field, empathy and Theory of Mind (ToM), have been identified as overlapping umbrella terms for different processes of limited convergence. Here, we review and integrate evidence of brain activation, brain organization, and behavior into a coherent model of social-cognitive processes. We start with a meta-analytic clustering of neuroimaging data across different social-cognitive tasks. Results show that understanding others’ mental states can be described by a multilevel model of hierarchical structure, similar to models in intelligence and personality research. A higher level describes more broad and abstract classes of functioning, whereas a lower one explains how functions are applied to concrete contexts given by particular stimulus and task formats. Specifically, the higher level of our model suggests 3 groups of neurocognitive processes: (a) predominantly cognitive processes, which are engaged when mentalizing requires self-generated cognition decoupled from the physical world; (b) more affective processes, which are engaged when we witness emotions in others based on shared emotional, motor, and somatosensory representations; (c) combined processes, which engage cognitive and affective functions in parallel. We discuss how these processes are explained by an underlying principal gradient of structural brain organization. Finally, we validate the model by a review of empathy and ToM task interrelations found in behavioral studies.

Public Significance Statement

Empathy and Theory of Mind are important human capacities for understanding others. Here, we present a meta-analysis of neuroimaging data from 4,207 participants, which shows that these abilities can be deconstructed into specific and partially shared neurocognitive subprocesses. Our findings provide systematic, large-scale support for the hypothesis that understanding others’ mental states can be described by a multilevel model of hierarchical structure, similar to models in intelligence and personality research.

Friday, November 27, 2020

Where Are The Self-Correcting Mechanisms In Science?

Vazire, S., & Holcombe, A. O. 
(2020, August 13).


It is often said that science is self-correcting, but the replication crisis suggests that, at least in some fields, self-correction mechanisms have fallen short of what we might hope for. How can we know whether a particular scientific field has effective self-correction mechanisms, that is, whether its findings are credible? The usual processes that supposedly provide mechanisms for scientific self-correction – mainly peer review and disciplinary committees – have been inadequate. We argue for more verifiable indicators of a field’s commitment to self-correction. These include transparency, which is already a target of many reform efforts, and critical appraisal, which has received less attention. Only by obtaining Measurements of Observable Self-Correction (MOSCs) can we begin to evaluate the claim that “science is self-correcting.” We expect the validity of this claim to vary across fields and subfields, and suggest that some fields, such as psychology and biomedicine, fall far short of an appropriate level of transparency and, especially, critical appraisal. Fields without robust, verifiable mechanisms for transparency and critical appraisal cannot reasonably be said to be self-correcting, and thus do not warrant the credibility often imputed to science as a whole.

Thursday, November 26, 2020

Oncologist Pays for Patient's Meds: A 'Boundary' Crossed?

Nic Mulcahy
Originally posted 4 Nov 20

It was an act of kindness: while overseeing a patient through a round of chemotherapy, an oncology fellow at Johns Hopkins University's Kimmel Comprehensive Cancer Center in Baltimore, Maryland, paid a modest amount of money (about $10) for that patient's antiemetic medication and retrieved it from the center's pharmacy.

Co-fellow Arjun Gupta, MD, witnessed the act and shared it with the world September 23 on Twitter.

"Just observed a co-fellow pay the co-pay for a patient's post-chemo nausea meds at the pharmacy, arrange them in a pill box, and deliver them to the patient in the infusion center. So that the patient could just leave after chemo."

Healthcare professionals applauded the generosity. "Phenomenal care," tweeted Carolyn Alexander, MD, a fertility physician in Los Angeles.

It's a common occurrence, said others. "Go ask a nurse how many times they've done it. I see it happen weekly," tweeted Chelsea Mitchell, PharmD, an intensive care unit pharmacist in Memphis, Tennessee.

Lack of universal healthcare brings about these moments, claimed multiple professionals who read Gupta's anecdote. "#ThisIsDoctoring. This is also a shameful indictment of our medical system," said Mary Landrigan-Ossar, MD, an anesthesiologist at Children's Hospital, Boston, Massachusetts.

However, one observer called out something no one else had ― that paying for a patient's medication is not allowed in some facilities.

Wednesday, November 25, 2020

The subjective turn

Jon Stewart
Originally posted 2 Nov 20

What is the human being? Traditionally, it was thought that human nature was something fixed, given either by nature or by God, once and for all. Humans occupy a unique place in creation by virtue of a specific combination of faculties that they alone possess, and this is what makes us who we are. This view comes from the schools of ancient philosophy such as Platonism, Aristotelianism and Stoicism, as well as the Christian tradition. More recently, it has been argued that there is actually no such thing as human nature but merely a complex set of behaviours and attitudes that can be interpreted in different ways. For this view, all talk of a fixed human nature is merely a naive and convenient way of discussing the human experience, but doesn’t ultimately correspond to any external reality. This view can be found in the traditions of existentialism, deconstruction and different schools of modern philosophy of mind.

There is, however, a third approach that occupies a place between these two. This view, which might be called historicism, claims that there is a meaningful conception of human nature, but that it changes over time as human society develops. This approach is most commonly associated with the German philosopher G W F Hegel (1770-1831). He rejects the claim of the first view, that of the essentialists, since he doesn’t think that human nature is something given or created once and for all. But he also rejects the second view since he doesn’t believe that the notion of human nature is just an outdated fiction we’ve inherited from the tradition. Instead, Hegel claims that it’s meaningful and useful to talk about the reality of some kind of human nature, and that this can be understood by an analysis of human development in history. Unfortunately, Hegel wrote in a rather inaccessible fashion, which has led many people to dismiss his views as incomprehensible or confused. His theory of philosophical anthropology, which is closely connected to his theory of historical development, has thus remained the domain of specialists. It shouldn’t.

With his astonishing wealth of knowledge about history and culture, Hegel analyses the ways in which what we today call subjectivity and individuality first arose and developed through time. He holds that, at the beginning of human history, people didn’t conceive of themselves as individuals in the same way that we do today. There was no conception of a unique and special inward sphere that we value so much in our modern self-image. Instead, the ancients conceived of themselves primarily as belonging to a larger group: the family, the tribe, the state, etc. This meant that questions of individual freedom or self-determination didn’t arise in the way that we’re used to understanding them.

Tuesday, November 24, 2020

How to know who’s trustworthy

T. Ryan Byerly
Originally posted 4 Nov 2020

Here is an excerpt:

An interesting fact about the virtues of intellectual dependability is that they are both intellectual and moral virtues. They’re ‘intellectual’ in the sense that they’re concerned with intellectual goods such as knowledge and understanding; but they’re moral virtues too, because they’re concerned with the intellectual goods of others. Indeed, the moral, other-regarding features of these virtues are especially central in a way that’s different to other intellectual virtues, such as inquisitiveness or intellectual perseverance.

It is in part because of the centrality of their other-regarding dimensions that the virtues of intellectual dependability haven’t taken on a larger role in education. The reigning paradigm of what we should aim for in education is that of the critical thinker. But being a critical thinker doesn’t necessarily mean that you possess other-regarding qualities, such as the virtues of intellectual dependability.

While we might lament this fact when it comes to formal education, we can still make efforts to become more intellectually dependable on our own. And we arguably should try to do so. After all, it’s not just us who are in need of dependable guides in our networks – we need to be intellectually dependable for the sake others, too.

If we want to grow in these virtues of intellectual dependability – to become more benevolent, transparent and so on – what can we do? The following are four strategies that researchers tend to agree can help us grow in intellectual virtue.

A first strategy is direct instruction – learning about the nature of particular intellectual virtues that we hope to cultivate. Ideally, we’ll gain an account of what the virtue involves, and we might learn about the vices that oppose it. Part of the reason why direct instruction is important is that it helps to reduce our cognitive load. It gives us a framework to think through our intellectual life. It also helps us set a target to aim for.

A second strategy is to think how intellectual virtues apply in particular situations, considering what the intellectual virtue – and perhaps also its opposing vices – looks like in action. You might select some historical, contemporary or even fictional examples of people who appear to act in accordance with the virtue or its opposing vice. By encountering exemplars, you might gain a taste or sensibility for the virtue, and a person to emulate. More generally, this exercise can help you to practise evaluating scenarios in which intellectual virtues can influence behaviour. When done well, this can help you appreciate the variety of contexts in which intellectual virtues make a difference, and the different kinds of behaviour they lead to.

Monday, November 23, 2020

Ethical & Legal Considerations of Patients Audio Recording, Videotaping, & Broadcasting Clinical Encounters

Ferguson BD, Angelos P. 
JAMA Surg. 
Published online October 21, 2020. 

Given the increased availability of smartphones and other devices capable of capturing audio and video, it has become increasingly easy for patients to record medical encounters. This behavior can occur overtly, with or without the physician’s express consent, or covertly, without the physician’s knowledge or consent. The following hypothetical cases demonstrate specific scenarios in which physicians have been recorded during patient care.

A patient has come to your clinic seeking a second opinion. She was recently treated for cholangiocarcinoma at another hospital. During her postoperative course, major complications occurred that required a prolonged index admission and several interventional procedures. She is frustrated with the protracted management of her complications. In your review of her records, it becomes evident that her operation may not have been indicated; moreover, it appears that gross disease was left in situ owing to the difficulty of the operation. You eventually recognize that she was never informed of the intraoperative findings and final pathology report. During your conversation, you notice that her husband opens an audio recording app on his phone and places it face up on the desk to document your conversation.


From the Discussion

Each of these cases differs, yet each reflects the general issue of patients recording interactions with their physicians. In the following discussion, we explore a number of ethical and legal considerations raised by such cases and offer suggestions for ways physicians might best navigate these complex situations.

These cases illustrate potentially difficult patient interactions—the first, a delicate conversation involving surgical error; the second, ongoing management of a life-threatening postoperative complication; and the third, a straightforward bedside procedure involving unintended bystanders. When audio or video recording is introduced in clinical encounters, the complexity of these situations can be magnified. It is sometimes challenging to balance a patient’s need to document a physician encounter with the desire for the physician to maintain the patient-physician relationship. Patient autonomy depends on the fidelity with which information is transferred from physician to patient. 

In many cases, patients record encounters to ensure well-informed decision making and therefore to preserve autonomy. In others, patients may have ulterior motives for recording an encounter.

Sunday, November 22, 2020

The logic of universalization guides moral judgment

Levine, S., et al.
PNAS October 20, 2020 
117 (42) 26158-26169; 
first published October 2, 2020; 


To explain why an action is wrong, we sometimes say, “What if everybody did that?” In other words, even if a single person’s behavior is harmless, that behavior may be wrong if it would be harmful once universalized. We formalize the process of universalization in a computational model, test its quantitative predictions in studies of human moral judgment, and distinguish it from alternative models. We show that adults spontaneously make moral judgments consistent with the logic of universalization, and report comparable patterns of judgment in children. We conclude that, alongside other well-characterized mechanisms of moral judgment, such as outcome-based and rule-based thinking, the logic of universalizing holds an important place in our moral minds.


Humans have several different ways to decide whether an action is wrong: We might ask whether it causes harm or whether it breaks a rule. Moral psychology attempts to understand the mechanisms that underlie moral judgments. Inspired by theories of “universalization” in moral philosophy, we describe a mechanism that is complementary to existing approaches, demonstrate it in both adults and children, and formalize a precise account of its cognitive mechanisms. Specifically, we show that, when making judgments in novel circumstances, people adopt moral rules that would lead to better consequences if (hypothetically) universalized. Universalization may play a key role in allowing people to construct new moral rules when confronting social dilemmas such as voting and environmental stewardship.

Saturday, November 21, 2020

Unethical amnesia responds more to instrumental than to hedonic motives

Galeotti, F, Saucet, C., & Villeval, M. C.
PNAS, October 13, 2020 117 (41) 25423-25428; 
first published September 28, 2020; 


Humans care about morality. Yet, they often engage in actions that contradict their moral self. Unethical amnesia is observed when people do not remember or remember less vividly these actions. This paper explores two reasons why individuals may experience unethical amnesia. Forgetting past unethical behavior may be motivated by purely hedonic or affective reasons, such as the willingness to maintain one’s moral self-image, but also by instrumental or strategic motives, in anticipation of future misbehavior. In a large-scale incentivized online experiment (n = 1,322) using a variant of a mind game, we find that hedonic considerations are not sufficient to motivate the forgetting of past cheating behavior. This is confirmed in a follow-up experiment (n = 1,005) in which recalls are elicited the same day instead of 3 wk apart. However, when unethical amnesia can serve as a justification for a future action, such as deciding on whether to keep undeserved money, motivated forgetting is more likely. Thereby, we show that motivated forgetting occurs as a self-excuse to justify future immoral decisions.


Using large-scale incentivized online experiments, we tested two possible origins of individuals’ forgetting about their past cheating behavior in a mind game. We found that purely hedonic considerations, such as the maintenance of a positive self-image, are not sufficient to motivate unethical amnesia, but the addition of an instrumental value to forgetting triggers such amnesia. Individuals forget their past lies more when amnesia can serve as an excuse not to engage in future morally responsible behavior. These findings shed light on the interplay between dishonesty and memory and suggest further investigations of the cost function of unethical amnesia. A policy implication is that improving ethics requires making unethical amnesia more difficult for individuals.

Friday, November 20, 2020

When Did We Become Fully Human? What Fossils and DNA Tell Us About the Evolution of Modern Intelligence

Nick Longrich
Originally posted 18 OCT 2020 

Here are two excerpts:

Because the fossil record is so patchy, fossils provide only minimum dates. Human DNA suggests even earlier origins for modernity. Comparing genetic differences between DNA in modern people and ancient Africans, it’s estimated that our ancestors lived 260,000 to 350,000 years ago. All living humans descend from those people, suggesting that we inherited the fundamental commonalities of our species, our humanity, from them.

All their descendants—Bantu, Berber, Aztec, Aboriginal, Tamil, San, Han, Maori, Inuit, Irish—share certain peculiar behaviors absent in other great apes. All human cultures form long-term pair bonds between men and women to care for children. We sing and dance. We make art. We preen our hair, adorn our bodies with ornaments, tattoos and makeup.

We craft shelters. We wield fire and complex tools. We form large, multigenerational social groups with dozens to thousands of people. We cooperate to wage war and help each other. We teach, tell stories, trade. We have morals, laws. We contemplate the stars, our place in the cosmos, life’s meaning, what follows death.


First, we journeyed out of Africa, occupying more of the planet. There were then simply more humans to invent, increasing the odds of a prehistoric Steve Jobs or Leonardo da Vinci. We also faced new environments in the Middle East, the Arctic, India, Indonesia, with unique climates, foods and dangers, including other human species. Survival demanded innovation.

Many of these new lands were far more habitable than the Kalahari or the Congo. Climates were milder, but Homo sapiens also left behind African diseases and parasites. That let tribes grow larger, and larger tribes meant more heads to innovate and remember ideas, more manpower, and better ability to specialize. Population drove innovation.

Thursday, November 19, 2020

The Psychology of Moral Conviction

Skitka, L., Hanson, B. and others
Annual Review of Psychology
(2021). 72:1.


This review covers theory and research on the psychological characteristics and consequences of attitudes that are experienced as moral convictions, that is, attitudes that people perceive as grounded in a fundamental distinction between right and wrong. Morally convicted attitudes represent something psychologically distinct from other constructs (e.g., strong but nonmoral attitudes or religious beliefs), are perceived as universally and objectively true, and are comparatively immune to authority or peer influence. Variance in moral conviction also predicts important social and political consequences. Stronger moral conviction about a given attitude object, for example, is associated with greater intolerance of attitude dissimilarity, resistance to procedural solutions for conflict about that issue, and increased political engagement and volunteerism in that attitude domain. Finally, we review recent research that explores the processes that lead to attitude moralization; we integrate these efforts and conclude with a new domain theory of attitude moralization.

From the Conclusion

As this review has revealed, attitudes held with moral conviction have a psychological profile that corresponds well with the domain theory of attitudes. Moral convictions differ from otherwise strong but non-moral attitudes by being perceived as more objectively and universally true, authority independent, and obligatory. In addition to these distinctions, moral convictions predicts the degree to which people perceive that the ends justify the means in achieving morally preferred outcomes, their unwillingness to compromise on morally convicted issues, and increased political engagement and willingness to engage in volunteerism on the one hand, and acceptance of lying, violence, and cheating to achieve preferred ends on the other.

Wednesday, November 18, 2020

Virtuous Victims

Jordan, J., & Kouchaki, M. (2020, April 11).


Humans ubiquitously encounter narratives about immoral acts and their victims. Here, we demonstrate that these narratives can influence perceptions of victims’ moral character. Specifically, across a wide range of contexts, victims are seen as more moral than non-victims who have behaved identically. Using 13 experiments (total n = 8,358), we explore this Virtuous Victim effect. We show that it is specific to victims of immorality (i.e., it does not extend equally to victims of accidental misfortune) and to moral virtue (i.e., it does not extend equally to positive nonmoral traits). We also show that the Virtuous Victim effect can occur online and in the lab, when subjects have other morally relevant information about the victim, when subjects have a direct opportunity to condemn the perpetrator, and in the context of both third- and first-person victim narratives. Finally, we provide support for the Justice Restoration Hypothesis, which posits that people see victims as moral in order to motivate adaptive justice-restorative action (i.e., punishment of perpetrators and helping of victims). We show that people see victims as having elevated moral character, but do not expect them to behave more morally or less immorally—a pattern that is consistent with the Justice Restoration Hypothesis, but not readily explained by alternative explanations for the Virtuous Victim effect. And we provide both correlational and causal evidence for a key prediction of the Justice Restoration Hypothesis: when people do not perceive incentives to help victims and punish perpetrators, the Virtuous Victim effect disappears.

From the Discussion

Our theory and results negate the hypothesis that people see victims as morally deserving of mistreatment in order to maintain just world beliefs. We suggest that, when exposed to apparent injustice, the default reaction is not to justify what has occurred, but rather to seek to restore justice (by punishing the perpetrator and/or helping the victim)  .It has been proposed that restoring justice is another route through which people can maintain just world beliefs(25, 26). And we have argued it is typically a more adaptive response to wrongdoing, because people frequently face incentives for justice-restorative action.  Our experiments are consistent with the hypothesis that in order to adaptively motivate such action, people see victims as morally good. Future research should investigate whether people also see victims as possessing other traits (e.g., helpless, neediness, or innocence) that might motivate justice-restorative action.

Tuesday, November 17, 2020

Violent CRED s toward Out-Groups Increase Trustworthiness: Preliminary Experimental Evidence

Řezníček, D., & Kundt, R. (2020).
Journal of Cognition and Culture, 20(3-4), 262-281. 
doi: https://doi.org/10.1163/15685373-12340084


In the process of cultural learning, people tend to acquire mental representations and behavior from prestigious individuals over dominant ones, as prestigious individuals generously share their expertise and know-how to gain admiration, whereas dominant ones use violence, manipulation, and intimidation to enforce obedience. However, in the context of intergroup conflict, violent thoughts and behavior that are otherwise associated with dominance can hypothetically become prestigious because parochial altruists, who engage in violence against out-groups, act in the interest of their group members, therefore prosocially. This shift would imply that for other in-groups, individuals behaving violently toward out-groups during intergroup conflicts become simultaneously prestigious, making them desirable cultural models to learn from. Using the mechanism of credibility enhancing displays (CRED s), this article presents preliminary vignette-based evidence that violent CRED s toward out-groups during intergroup conflict increase the perceived trustworthiness of a violent cultural model.

From the Discussion section

We found support for hypotheses H1–3 regarding the seemingly paradoxical relationship between trustworthiness, prestige, dominance, and violence during an intergroup conflict (see Figures 1 and 2). Violent cultural model’s trustworthiness was positively predicted by CREDs and prestige, while it was negatively predicted by dominance. This suggests that in-groups violent toward out-groups during an intergroup conflict are not perceived as dominant manipulators who are better to be avoided and not learned from but rather as prestigious heroes who deserve to be venerated. Thus, it appears that a positive perception of violence toward out-groups, as modeled or tested by various researchers (Bowles, 2008; Castano & Leidner, 2012; Choi & Bowles, 2007;Cohen, Montoya, & Insko, 2006; Roccas, Klar, & Liviatan, 2006), is an eligible notion. Our study offers preliminary evidence for the suggestion that fighting violently for one’s group may increase the social status of fighters via prestige, not dominance.

Monday, November 16, 2020

Religious moral righteousness over care: a review and a meta-analysis

Current Opinion in Psychology
Volume 40, August 2021, Pages 79-85


Does religion enhance an ‘extended’ morality? We review research on religiousness and Schwartz’s values, Haidt’s moral foundations (through a meta-analysis of 45 studies), and deontology versus consequentialism (a review of 27 studies). Instead of equally encompassing prosocial (care for others) and other values (duties to the self, the community, and the sacred), religiosity implies a restrictive morality: endorsement of values denoting social order (conservation, loyalty, and authority), self-control (low autonomy and self-expansion), and purity more strongly than care; and, furthermore, a deontological, non-consequentialist, righteous orientation, that could result in harm to (significant) others. Religious moral righteousness is highest in fundamentalism and weakens in secular countries. Only spirituality reflects an extended morality (care, fairness, and the binding foundations). Evolutionarily, religious morality seems to be more coalitional and ‘hygienic’ than caring.


• We meta-analyzed 45 studies on religion and Haidt’s five moral foundations.

• Religiosity implies high purity, authority, and loyalty; care is involved only weakly.

• Only spirituality reflects extended morality: care, fairness, and the binding values.

• Results parallel findings on religion and Schwartz’s values across the world.

• Religious morality is primarily deontological, non-consequentialist, and righteous.


On the basis of the findings of the various research areas examined in this article, we think it is reasonable to infer that the role of religious (ingroup) prosociality in forming and consolidating large coalitions involving reciprocal interpersonal helping may have been overestimated in the contemporary evolutionary psychology of religion.  This role may not reflect the very center of religious morality. Rather, the results of the present review suggest that the evolutionary perspectives of religion focusing on the importance of hygienic and righteous/coalitional morality (avoidance of pathogens, loyalty, group conformity, as well as preservation of personal and social order) may be more central in explaining, from a moral perspective, religions’ origin and maintenance.

Sunday, November 15, 2020

Determined to Be Humble? Exploring the Relationship Between Belief in Free Will and Humility

Earp, B. D., et al.


In recent years, diminished belief in free will or increased belief in determinism have been associated with a range of antisocial or otherwise negative outcomes: unjustified aggression, cheating, prejudice, less helping behavior, and so on. Only a few studies have entertained the possibility of prosocial or otherwise positive outcomes, such as greater willingness to forgive and less motivation to punish retributively. Here, five studies (open data, materials, and pre-print at https://osf.io/hmy39/) explore the relationship between belief in determinism and another positive outcome or attribute, namely, humility. The reported findings suggest that relative disbelief in free will is reliably associated in our samples with at least one type of humility—what we call ‘Einsteinian’ humility—but is not associated with, or even negatively associated with, other types of humility described in the literature.

From the Conclusion

At the same time, in our final study, we found a positive relationship between belief in free will and several other measures of humility: ethical/epistemic humility, Landrum humility, and modesty, with the last of these remaining significant even with a conservative alpha criterion. Although this is contrary to what we expected, it is consistent with the dominant narrative in the literature according to which belief in free will is associated with pro-social traits and behaviors. We believe we are the first to show a relationship of any kind between belief in free will and this particular trait—modesty—and we hope to explore this relationship in more detail in future work.

Saturday, November 14, 2020

Do ethics classes influence student behavior? Case study: Teaching the ethics of eating meat

Schwitzgebel, E. et al.
Volume 203, October 2020


Do university ethics classes influence students' real-world moral choices? We aimed to conduct the first controlled study of the effects of ordinary philosophical ethics classes on real-world moral choices, using non-self-report, non-laboratory behavior as the dependent measure. We assigned 1332 students in four large philosophy classes to either an experimental group on the ethics of eating meat or a control group on the ethics of charitable giving. Students in each group read a philosophy article on their assigned topic and optionally viewed a related video, then met with teaching assistants for 50-minute group discussion sections. They expressed their opinions about meat ethics and charitable giving in a follow-up questionnaire (1032 respondents after exclusions). We obtained 13,642 food purchase receipts from campus restaurants for 495 of the students, before and after the intervention. Purchase of meat products declined in the experimental group (52% of purchases of at least $4.99 contained meat before the intervention, compared to 45% after) but remained the same in the control group (52% both before and after). Ethical opinion also differed, with 43% of students in the experimental group agreeing that eating the meat of factory farmed animals is unethical compared to 29% in the control group. We also attempted to measure food choice using vouchers, but voucher redemption rates were low and no effect was statistically detectable. It remains unclear what aspect of instruction influenced behavior.

Friday, November 13, 2020

Cracking the Code of Sustained Collaboration

Francesca Gino
Harvard Business Review
Originally published Nov 2019

Ask any leader whether his or her organization values collaboration, and you’ll get a resounding yes. Ask whether the firm’s strategies to increase collaboration have been successful, and you’ll probably receive a different answer.

“No change seems to stick or to produce what we expected,” an executive at a large pharmaceutical company recently told me. Most of the dozens of leaders I’ve interviewed on the subject report similar feelings of frustration: So much hope and effort, so little to show for it.

One problem is that leaders think about collaboration too narrowly: as a value to cultivate but not a skill to teach. Businesses have tried increasing it through various methods, from open offices to naming it an official corporate goal. While many of these approaches yield progress—mainly by creating opportunities for collaboration or demonstrating institutional support for it—they all try to influence employees through superficial or heavy-handed means, and research has shown that none of them reliably delivers truly robust collaboration.

What’s needed is a psychological approach. When I analyzed sustained collaborations in a wide range of industries, I found that they were marked by common mental attitudes: widespread respect for colleagues’ contributions, openness to experimenting with others’ ideas, and sensitivity to how one’s actions may affect both colleagues’ work and the mission’s outcome. Yet these attitudes are rare. Instead, most people display the opposite mentality, distrusting others and obsessing about their own status. The task for leaders is to encourage an outward focus in everyone, challenging the tendency we all have to fixate on ourselves—what we’d like to say and achieve—instead of what we can learn from others.

Thursday, November 12, 2020

Deinstitutionalization of People with Mental Illness: Causes and Consequences

Daniel Yohanna, MD
Virtual Mentor. 2013;15(10):886-891.

Here is an excerpt:

State hospitals must return to their traditional role of the hospital of last resort. They must function as entry points to the mental health system for most people with severe mental illness who otherwise will wind up in a jail or prison. State hospitals are also necessary for involuntary commitment. As a nation, we are working through a series of tragedies involving weapons in the hands of people with severe mental illness—in Colorado, where James Holmes killed or wounded 70 people, Arizona, where Jared Loughner killed or wounded 19 people, and Connecticut, where Adam Lanza killed 28 including children as young as 6 years old. All are thought to have had severe mental illness at the time of their crimes. After we finish the debate about the availability of guns, particularly to those with mental illness, we will certainly have to address the mental health system and lack of services, especially for those in need of treatment but unwilling or unable to seek it. With proper services, including involuntary commitment, many who have the potential for violence can be treated. Just where will those services be initiated, and what will be needed?

Nearly 30 years ago, Gudeman and Shore published an estimate of the number of people who would need long-term care—defined as secure, supportive, indefinite care in specialized facilities—in Massachusetts. Although a rather small study, it is still instructive today. They estimated that 15 persons out of 100,000 in the general population would need long-term care. Trudel and colleagues confirmed this approximation with a study of the long-term need for care among people with the most severe and persistent mental illness in a semi-rural area in Canada, where they estimated a need of 12.4 beds per 100,000. A consensus of other experts estimates that the total number of state beds required for acute and long-term care would be more like 50 beds per 100,000 in the population. At the peak of availability in 1955, there were 340 beds per 100,000. In 2010, the number of state beds was 43,318 or 14.1 beds per 100,000.

Wednesday, November 11, 2020

How social relationships shape moral judgment

Earp, B. D.,  et al. (2020, September 18).


Our judgments of whether an action is morally wrong depend on who is involved and their relationship to one another. But how, when, and why do social relationships shape such judgments? Here we provide new theory and evidence to address this question. In a pre- registered study of U.S. participants (n = 423, nationally representative for age, race and gender), we show that particular social relationships (like those between romantic partners, housemates, or siblings) are normatively expected to serve distinct cooperative functions – including care, reciprocity, hierarchy, and mating – to different degrees. In a second pre- registered study (n = 1,320) we show that these relationship-specific norms, in turn, influence the severity of moral judgments concerning the wrongness of actions that violate cooperative expectations. These data provide evidence for a unifying theory of relational morality that makes highly precise out-of-sample predictions about specific patterns of moral judgments across relationships. Our findings show how the perceived morality of actions depends not only on the actions themselves, but also on the relational context in which those actions occur.

From the Discussion

In other relationships, by contrast, such as those between friends, family members, or romantic partners --so-called “communal” relationships --reciprocity takes a different form: that of mutually expected responsiveness to one another’s needs. In this form of reciprocity, each party tracks the other’s needs (rather than specific benefits provided) and strives to meet these needs to the best of their respective abilities, in proportion to the degree of responsibility each has assumed for the other’s welfare. Future work should distinguish between these two types of reciprocity: that is, mutual care-based reciprocity in communal relationships (when both partners have similar needs and abilities) and tit-for-tat reciprocity between “transactional” cooperation partners who have equal standing or claim on a resource.

Tuesday, November 10, 2020

Why Good Ethics Are Now Big Business—And How To Embrace Them

Phil Lewis
Originally published 14 Oct 20

Here is an excerpt:

“I think ethics cascading through the business, through the teams and managers, is very much about cascading the culture, but a culture that everyone understands. It’s about hiring the right people. People who share our values,” he explains. 

“And this wouldn’t work if you were just thinking about today or tomorrow as a business. But if you think about five years, or 10 years, or 50 years, the way Japanese businesses operate, looking after people, giving them a sense of purpose, making sure that the growth path of the business is also thinking about the growth path of the individual… If you really look after people, that intrinsic motivation will follow.”

It’s almost a karmic approach to business, then: do good things and good things will come to you. That’s an approach Pawlik has taken through the pandemic too—and it seems to be proving its worth. 

“When this happened, we were very much, ‘What do you need? Can I help you with strategy? Can I help you reach a new market and diversify? Whatever it is, let's put some time together, and you can ask questions, and I'll just help.’ I offered to do loads of free training to organizations, to support them. The approach was: let's just give them more value and see if we can help people. 

“And that came back tenfold. People were so happy with how we've supported them, that when they got stronger legs, they came back to us and said, ‘You know what? You really helped us through that difficult time period. You didn't need to, you didn't ask for anything back. And now we want to reciprocate.’ It's perfectly logical. Help people, and good things will come back.”

Monday, November 9, 2020

Betrayal vs. Nonbetrayal Trauma: Different Effects of Social Support & Emotion Regulation on PTSD Symptom Severity

N. Kline & K.M. Palm Read
Psychological Trauma: 
Theory, Research, Practice, and Policy. 


Objective: Betrayal Trauma Theory posits that interpersonal traumas are particularly injurious when the perpetrator is a person that the victim previously trusted and was close to. A relevant protective factor to examine is social support, which may influence PTSD symptomology through its influence on emotion regulation. The aim of the current study was to examine differences in the associations between social support, emotion regulation, and PTSD symptom severity for survivors of betrayal trauma and nonbetrayal trauma. 

Method: Two hundred and 73 trauma survivors (age: M = 25.96 years, SD = 9.42 years; 80.2% female; 63.7% White) completed the anonymous, online survey. Results: Across both groups, emotion regulation mediated the relationship between social support and PTSD symptom severity. A multiple-samples SEM analysis showed that the betrayal group evidenced a weaker relationship between social support and emotion regulation. 

Conclusions: Findings suggest that survivors of high betrayal trauma may not engage with their social support in ways that foster emotion regulation skills. Therefore, for high betrayal trauma survivors specifically, group interventions that involve the survivor and close contact(s), may be particularly beneficial in enhancing emotion regulation and decreasing PTSD symptomology.

Impact Statement

Findings suggest social support may influence the impact of trauma through improving survivors’ ability to regulate emotions. Survivors of betrayal trauma may not seek out social support to the same extent or manner as nonbetrayal trauma survivors, limiting opportunities for beneficial emotional regulation practices and support. Clinicians should consider focusing on how interpersonal processes can facilitate greater understanding, acceptance, and regulation of emotions following betrayal trauma. 

Sunday, November 8, 2020

Where loneliness can lead

Samantha Rose Hill
Originally published 16 Oct 20

Here is an excerpt:

Why loneliness is not obvious.

Arendt’s answer was: because loneliness radically cuts people off from human connection. She defined loneliness as a kind of wilderness where a person feels deserted by all worldliness and human companionship, even when surrounded by others. The word she used in her mother tongue for loneliness was Verlassenheit – a state of being abandoned, or abandon-ness. Loneliness, she argued, is ‘among the most radical and desperate experiences of man’, because in loneliness we are unable to realise our full capacity for action as human beings. When we experience loneliness, we lose the ability to experience anything else; and, in loneliness, we are unable to make new beginnings.

In order to illustrate why loneliness is the essence of totalitarianism and the common ground of terror, Arendt distinguished isolation from loneliness, and loneliness from solitude. Isolation, she argued, is sometimes necessary for creative activity. Even the mere reading of a book, she says requires some degree of isolation. One must intentionally turn away from the world to make space for the experience of solitude but, once alone, one is always able to turn back.

Totalitarianism uses isolation to deprive people of human companionship, making action in the world impossible, while destroying the space of solitude. The iron-band of totalitarianism, as Arendt calls it, destroys man’s ability to move, to act, and to think, while turning each individual in his lonely isolation against all others, and himself. The world becomes a wilderness, where neither experience nor thinking are possible.

Saturday, November 7, 2020

Psychopathy as moral blindness: a qualifying exploration of the blindness-analogy in psychopathy theory and research

Rasmus Rosenberg Larsen (2020) 
Philosophical Explorations, 23:3, 214-233
DOI: 10.1080/13869795.2020.1799662


The term psychopathy refers to a personality disorder associated with callous personality traits and antisocial behaviors. Throughout its research history, psychopathy has frequently been described as a peculiar form of moral blindness, engendering a narrative about a patient stereotype incapable of taking a genuine moral perspective, similar to a blind person who is deprived of proper visual perceptions. However, recent empirical research has shown that clinically diagnosed psychopaths are morally more fit than initially thought, and the blindness-analogy now comes across as largely misleading. In this contribution, the moral-blindness analogy is explored in an attempt to qualify anew its relevance in psychopathy theory and research. It is demonstrated that there are indeed theoretically relevant parallels to be drawn between blindness and psychopathy, parallels that are especially illuminating when accounting for the potential symptomatology, dimensionality, and etiological nature of the disorder.

Concluding remarks

In summary, what has been proposed throughout this paper is a perspective in terms of how to interpret and improve psychopathy research, an approach which lends itself to theorize psychopathy as a peculiar form of moral blindness. Following leading research, it was posited that psychopathy must, first of all, be understood as an emotional disorder, that is, a disorder of substantial emotional attenuation. Building on Prinz’s constructivist sentimentalism, it was demonstrated how said emotional incapacity could manifest in moral psychological impairments, as an inability to perceive the degrees of moral rightness and wrongness. Prinz’s theory was then expanded by adding (or amending) that psychopaths are not necessarily impaired in terms of perceiving the categorical value of a given moral situation, i.e. judging whether something is either right or wrong. Indeed, psychopaths must perceive this basic information by the mere fact that they do have some levels of valanced emotional experience. Instead, what is predicted is that globally low emotion attenuation (i.e. psychopathy) leads to observable differences in terms of
judging the degree of rightness and wrongness of a situation.

Friday, November 6, 2020

Deluded, with reason

Huw Green
Originally published 31 Aug 20

Here is an excerpt:

Of course, beliefs don’t exist only in a private mental context, but can also be held in place by our relationships and social commitments. Consider how political identities often involve a cluster of commitments to various beliefs, even where there is no logical connection between them – for instance, how a person who advocates for say, trans rights, is also more likely to endorse Left-wing economic policies. As the British clinical psychologist Vaughan Bell and his colleagues note in their preprint, ‘De-rationalising Delusions’ (2019), beliefs facilitate affiliation and intragroup trust. They cite earlier philosophical work by others that suggests ‘reasoning is not for the refinement of personal knowledge … but for argumentation, social communication and persuasion’. Indeed, our relationships usually ground our beliefs in a beneficial way, preventing us from developing ideas too disparate from those of our peers, and helping us to maintain a set of ‘healthy’ beliefs that promote our basic wellbeing and continuity in our sense of self.

Given the social function of beliefs, it’s little surprise that delusions usually contain social themes. Might delusion then be a problem of social affiliation, rather than a purely cognitive issue? Bell’s team make just this claim, proposing that there is a broader dysfunction to what they call ‘coalitional cognition’ (important for handling social relationships) involved in the generation of delusions. Harmful social relationships and experiences could play a role here. It is now widely acknowledged that there is a connection between traumatic experiences and symptoms of psychosis. It’s easy to see how trauma could have a pervasive impact on a person’s sense of how safe and trustworthy the world feels, in turn affecting their belief systems.

The British philosopher Matthew Ratcliffe and his colleagues made this point in their 2014 paper, observing how ‘traumatic events are often said to “shatter” a way of experiencing the world and other people that was previously taken for granted’. They add that a ‘loss of trust in the world involves a pronounced and widespread sense of unpredictability’ that could make people liable to delusions because the ideas we entertain are likely to be shaped by what feels plausible in the context of our subjective experience. Loss of trust is not the same as the absence of a grounding belief, but I would argue that it bears an important similarity. When we lose trust in something, we might say that we find it hard to believe in it. Perhaps loss of certain forms of ordinary belief, especially around close social relationships, makes it possible to acquire beliefs of a different sort altogether.

Thursday, November 5, 2020

Are psychopaths moral‐psychologically impaired? Reassessing emotion‐theoretical explanations

Rasmus Rosenberg Larsen
Mind & Language. 2020; 1– 17. 


Psychopathy has been theorized as a disorder of emotion, which impairs moral judgments. However, these theories are increasingly being abandoned as empirical studies show that psychopaths seem to make proper moral judgments. In this contribution, these findings are reassessed, and it is argued that prevalent emotion‐theories of psychopathy appear to operate with the unjustified assumption that psychopaths have no emotions, which leads to the hypothesis that psychopaths are completely unable to make moral judgments. An alternative and novel explanation is proposed, theorizing psychopathy as a degree‐specific emotional deficiency, which causes degree‐specific differences in moral judgments.

From the Conclusion Section

Motivated by a suite of ostensibly undermining empirical studies, this paper sought to defend and qualify emotion-theories of psychopathy by explicating in detail the philosophical and psychological commitments these theories appear to be implicitly endorsing, namely, a (constructivist) sentimentalist framework. This explication demonstrated, above all, that psychopathy studies appear to operate with an inconsistent set of hypotheses when trying to capture the differences between diagnosed psychopaths and controls in terms of their moral judgments and values. This led to a consideration of alternative research designs particularly aimed at capturing the potential moral psychological differences that follows from having diminished emotional dispositions, namely, degree-specific differences related to the two-dimensional value spectrum, as opposed to differences related to answers on moral categorical issues.

Wednesday, November 4, 2020

The psychology and neuroscience of partisanship

Harris, E. A., Pärnamets, et al.


Why have citizens become increasingly polarized? The answer is that there is increasing identification with political parties —a process known as partisanship (Mason, 2018). This chapter will focus on the role that social identity plays in contemporary politics (Greene, 2002). These party identities influence political preferences, such that partisans are more likely to agree with policies that were endorsed by their political party, regardless of the policy content, and, in some cases, their own ideological beliefs (Cohen, 2003; Samuels & Zucco Jr, 2014). There are many social and structural factors that are related to partisanship, including polarization (Lupu, 2015), intergroup threat (e.g., Craig & Richeson, 2014), and media exposure (Tucker et al., 2018; Barberá, 2015). Our chapter will focus on the psychology and neuroscience of partisanship within these broader socio-political contexts. This will help reveal the roots of partisanship across political contexts.


A burgeoning literature suggests that partisanship is a form of social identity with interesting and wide-reaching implications for our brains and behavior. In some ways, the effects of partisanship mirror those of other forms of group identity, both behaviorally and in the brain. However, partisanship also has interesting biological antecedents and effects in political domains such as belief in fake news and conspiracy theories, as well as voting behavior. As political polarization rises in many nations across the world, partisanship will become an increasingly divisive and influential form of social identity in those countries, thus highlighting the urgency to understand its psychological and neural underpinnings.

Tuesday, November 3, 2020

Americans hate political opponents more than they love their own party, study finds

Sandee LaMotte
Updated 29 Oct 2020

Americans now hate people in the opposite political party more than they love their own party, with disrupting implications about behavior, a new study finds.

"Compared to a few decades ago, Americans today are much more opposed to dating or marrying an opposing partisan; they are also wary of living near or working for one," according to the study published Thursday in the journal Science.

"They tend to discriminate, as when paying an opposing partisan less than a copartisan for identical job performance or recommending that an opposing partisan be denied a scholarship despite being the more qualified applicant," the study said.

Leveraging data from 1975 through 2017 in nine Western democracies -- Australia, Britain, Canada, Germany, New Zealand, Norway, Sweden, Switzerland and the United States -- the researchers found that by 2017 what they call "out-party hate" was stronger in the United States than in any other nation.

"The current state of political sectarianism produces prejudice, discrimination and cognitive distortion, undermining the ability of government to serve its core functions of representing the people and solving the nation's problems," said lead author Eli Finkel, a professor of social psychology at both Northwestern University's Weinberg College of Arts and Sciences and Kellogg School of Management, in a statement.

The Political is Personal: Daily Politics as a Chronic Stressor

Feinberg, M., Ford, et al.
(2020, September 19).


Politics and its controversies have permeated everyday life, but the daily impact of politics is largely unknown. Here, we conceptualize politics as a chronic stressor with important consequences for people’s daily lives. We used longitudinal, daily-diary methods to track U.S. participants as they experienced daily political events across two weeks (Study 1: N=198, observations=2,167) and, separately, across three weeks (Study 2: N=811, observations=12,790) to explore how daily political events permeate people’s lives and how they cope with this influence of politics. In both studies, daily political events consistently evoked negative emotions, which corresponded to worse psychological and physical well-being, but also increased motivation to take political action (e.g., volunteer, protest) aimed at changing the political system that evoked these emotions in the first place. Understandably, people frequently tried to regulate their politics-induced emotions; and successfully regulating these emotions using cognitive strategies (reappraisal and distraction) predicted greater well-being, but also weaker motivation to take action. Although people can protect themselves from the emotional impact of politics, frequently-used regulation strategies appear to come with a trade-off between well being and action. To examine whether an alternative approach to one’s emotions could avoid this trade-off, we measured emotional acceptance in Study 2 (i.e., accepting one’s emotions without trying to change them) and found that successful acceptance predicted greater daily well-being but no impairment to political action. Overall, this research highlights how politics can be a chronic stressor in people’s daily lives, underscoring the far-reaching influence politicians have beyond the formal powers endowed unto them.


In all, our research bridges political psychology and affective science theory and methods, and highlights how these distinct literatures can intersect to answer important, unexplored questions. Our findings show that the political is very much personal–a pattern with powerful consequences for people’s daily lives. More generally, by demonstrating how political events personally impact the average citizen, including their psychological and physical health, our study reveals the far-reaching impact politicians have, beyond the formal powers endowed unto them.

Monday, November 2, 2020

What We’re Not Talking about When We Talk about Addiction

Hanna Pickard
The Hastings Center
Originally posted 28 Aug 20


The landscape of addiction is dominated by two rival models: a moral model and a model that characterizes addiction as a neurobiological disease of compulsion. Against both, I offer a scientifically and clinically informed alternative. Addiction is a highly heterogeneous condition that is ill-characterized as involving compulsive use. On the whole, drug consumption in addiction remains goal directed: people take drugs because drugs have tremendous value. This view has potential implications for the claim that addiction is, in all cases, a brain disease. But more importantly, it has implications for clinical and policy interventions. To help someone overcome addiction, you need to understand and address why they persist in using drugs despite negative consequences. If they are not compelled, then the explanation must advert to the value of drugs for them as an individual. What blocks us from acknowledging this reality is not science but fear: that it will ignite moralism about drugs and condemnation of drug users. The solution is not to cleave to the concept of compulsion but to fight moralism directly.

Sunday, November 1, 2020

Believing in Overcoming Cognitive Biases

T. S. Doherty & A. E. Carroll
AMA J Ethics. 2020;22(9):E773-778. 
doi: 10.1001/amajethics.2020.773.


Like all humans, health professionals are subject to cognitive biases that can render diagnoses and treatment decisions vulnerable to error. Learning effective debiasing strategies and cultivating awareness of confirmation, anchoring, and outcomes biases and the affect heuristic, among others, and their effects on clinical decision making should be prioritized in all stages of education.

Here is an excerpt:

The practice of reflection reinforces behaviors that reduce bias in complex situations. A 2016 systematic review of cognitive intervention studies found that guided reflection interventions were associated with the most consistent success in improving diagnostic reasoning. A guided reflection intervention involves searching for and being open to alternative diagnoses and willingness to engage in thoughtful and effortful reasoning and reflection on one’s own conclusions, all with supportive feedback or challenge from a mentor.

The same review suggests that cognitive forcing strategies may also have some success in improving diagnostic outcomes. These strategies involve conscious consideration of alternative diagnoses other than those that come intuitively. One example involves reading radiographs in the emergency department. According to studies, a common pitfall among inexperienced clinicians in such a situation is to call off the search once a positive finding has been noticed, which often leads to other abnormalities (eg, second fractures) being overlooked. Thus, the forcing strategy in this situation would be to continue a search even after an initial fracture has been detected.