Docs Decry ‘Moral Injury’ From Financial Pressures Of Health Care

Melissa Bailey
Kaiser Health News
Originally published 4 Feb 20

Here are two excerpts:

But “the real priority is speed and money and not our patients’ care,” Corl said. “That makes it tough for doctors who know they could be doing better for their patients.”

Dean said people often frame burnout as a personal failing. Doctors get the message: “If you did more yoga, if you ate more salmon salad, if you went for a longer run, it would help.” But, she argued, burnout is a symptom of deeper systemic problems beyond clinicians’ control.

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“The health system is not set up to help patients. It’s set up to make money,” he said.

The best way to approach this problem, he said, is to help future generations of doctors understand “how decisions made at the systems level impact how we care about patients” — so they can “stand up for what’s right.”

Whether these experiences amount to moral injury is open for discussion.

Cynda Rushton, a nurse and professor of clinical ethics at Johns Hopkins University, who has studied the related notion of “moral distress” for 25 years, said there isn’t a base of research, as there is for moral distress, to measure moral injury among clinicians.

But “what both of these terms signify,” Rushton said, “is a sense of suffering that clinicians are experiencing in their roles now, in ways that they haven’t in the past.”

Dean grew interested in moral injury from personal experience: After a decade of treating patients as a psychiatrist, she stopped because of financial pressures. She said she wanted to treat her patients in longer visits, offering both psychotherapy and medication management, but that became more difficult. Insurers would rather pay her for only a 15-minute session to manage medications and let a lower-paid therapist handle the therapy.

The info is here.

Autonomy, mastery, respect, and fulfillment are key to avoiding moral injury in physicians

Simon G Talbot and Wendy Dean
BMJ blogs
Originally posted 16 Jan 20

Here is an excerpt:

We believe that distress is a clinician’s response to multiple competing allegiances—when they are forced to make a choice that transgresses a long standing, deeply held commitment to healing. Doctors today are caught in a double bind between making patients’ needs the top priority (thereby upholding our Hippocratic Oath) and giving precedence to the business and financial frameworks of the healthcare system (insurance, hospital, and health system mandates).

Since our initial publication, we have come to believe that burnout is the end stage of moral injury, when clinicians are physically and emotionally exhausted with battling a broken system in their efforts to provide good care; when they feel ineffective because too often they have met with immovable barriers to good care; and when they depersonalize patients because emotional investment is intolerable when patient suffering is inevitable as a result of system dysfunction. Reconfiguring the healthcare system to focus on healing patients, rebuilding a sense of community and respect among doctors, and demonstrating the alignment of doctors’ goals with those of our patients may be the best way to address the crisis of distress and, potentially, find a way to prevent burnout. But how do we focus the restructuring this involves?

“Moral injury” has been widely adopted by doctors as a description for their distress, as evidenced by its use on social media and in non-academic publications. But what is at the heart of it? We believe that moral injury occurs when the basic elements of the medical profession are eroded. These are autonomy, mastery, respect, and fulfillment, which are all focused around the central principle of purpose.

The info is here.

American Psychological Association Calls for Immediate Halt to Sharing Immigrant Youths' Confidential Psychotherapy Notes with ICE

American Psychological Association
Press Release
Released 17 Feb 20

The American Psychological Association expressed shock and outrage that the federal Office of Refugee Resettlement has been sharing confidential psychotherapy notes with U.S. Immigration and Customs Enforcement to deny asylum to some immigrant youths.

“ORR’s sharing of confidential therapy notes of traumatized children destroys the bond of trust between patient and therapist that is vital to helping the patient,” said APA President Sandra L. Shullman, PhD. “We call on ORR to stop this practice immediately and on the Department of Health and Human Services and Congress to investigate its prevalence. We also call on ICE to release any immigrants who have had their asylum requests denied as a result.”

APA was reacting to a report in The Washington Post focused largely on the case of then-17-year-old Kevin Euceda, an asylum-seeker from Honduras whose request for asylum was granted by a judge, only to have it overturned when lawyers from ICE revealed information he had given in confidence to a therapist at a U.S. government shelter. According to the article, other unaccompanied minors have been similarly detained as a result of ICE’s use of confidential psychotherapy notes. These situations have also been confirmed by congressional testimony since 2018.

Unaccompanied minors who are detained in U.S. shelters are required to undergo therapy, ostensibly to help them deal with trauma and other issues arising from leaving their home countries. According to the Post, ORR entered into a formal memorandum of agreement with ICE in April 2018 to share details about children in its care. The then-head of ORR testified before Congress that the agency would be asking its therapists to “develop additional information” about children during “weekly counseling sessions where they may self-disclose previous gang or criminal activity to their assigned clinician,” the newspaper reported. The agency added two requirements to its public handbook: that arriving children be informed that while it was essential to be honest with staff, self-disclosures could affect their release and that if a minor mentioned anything having to do with gangs or drug dealing, therapists would file a report within four hours to be passed to ICE within one day, the Post said.

"For this administration to weaponize these therapy sessions by ordering that the psychotherapy notes be passed to ICE is appalling,” Shullman added. “These children have already experienced some unimaginable traumas. Plus, these are scared minors who may not understand that speaking truthfully to therapists about gangs and drugs – possibly the reasons they left home – would be used against them.”

23 and Baby

Tanya Lewis
nature.com
Originally posted 4 Dec 19

Here are two excerpts:

Proponents say that genetic testing of newborns can help diagnose a life-threatening childhood-onset disease in urgent cases and could dramatically increase the number of genetic conditions all babies are screened for at birth, enabling earlier diagnosis and treatment. It could also inform parents of conditions they could pass on to future children or of their own risk of adult-onset diseases. Genetic testing could detect hundreds or even thousands of diseases, an order of magnitude more than current heel-stick blood tests—which all babies born in the U.S. undergo at birth—or confirm results from such a test.

But others caution that genetic tests may do more harm than good. They could miss some diseases that heel-stick testing can detect and produce false positives for others, causing anxiety and leading to unnecessary follow-up testing. Sequencing children’s DNA also raises issues of consent and the prospect of genetic discrimination.

Regardless of these concerns, newborn genetic testing is already here, and it is likely to become only more common. But is the technology sophisticated enough to be truly useful for most babies? And are families—and society—ready for that information?

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Then there’s the issue of privacy. If the child’s genetic information is stored on file, who has access to it? If the information becomes public, it could lead to discrimination by employers or insurance companies. The Genetic Information Nondiscrimination Act (GINA), passed in 2008, prohibits such discrimination. But GINA does not apply to employers with fewer than 15 employees and does not cover insurance for long-term care, life or disability. It also does not apply to people employed and insured by the military’s Tricare system, such as Rylan Gorby. When his son’s genome was sequenced, researchers also obtained permission to sequence Rylan’s genome, to determine if he was a carrier for the rare hemoglobin condition. Because it manifests itself only in childhood, Gorby decided taking the test was worth the risk of possible discrimination.

The info is here.

Convict Trump: The Constitution is more important than abortion

Paul Miller
The Christian Post
Originally posted 22 Dec 19

Christians should advocate for President Donald J. Trump’s conviction and removal from office by the Senate. While Trump has an excellent record of appointing conservative judges and advancing a prolife agenda, his criminal conduct endangers the Constitution. The Constitution is more important than the prolife cause because without the Constitution, prolife advocacy would be meaningless.

The fact that we live in a democratic republic is what enables us to turn our prolife convictions from private opinion into public advocacy. In other systems of government, the government does not care what its citizens think or believe. Only when the government is forced to take counsel from its citizens through elections, representation, and majoritarian rule do our opinions count.

Our democratic Constitution — adopted to “secure the blessings of liberty” for all Americans — is what guarantees that our voice matters. Without it, we can talk about the evils of abortion until we are blue in the face and it will never affect abortion policy one iota. The Constitution — with its guarantees of free speech, free assembly, the right to petition the government, regular elections, and the peaceful transfer of power — is the only thing that forces the government to listen to us.

Trump’s behavior is a threat to our Constitutional order. The facts behind his impeachment show that he abused a position of public trust for private gain, the definition of corruption and abuse of power. More worryingly, he refused to comply with Congress’s power to investigate his conduct, a fundamental breach of the checks and balances that is the bedrock of our Constitutional order.

The info is here.

Where AI and ethics meet

Stephen Fleischresser
Cosmos Magazine
Originally posted 18 Nov 19

Here is an excerpt:

His first argument concerns common aims and fiduciary duties, the duties in which trusted professionals, such as doctors, place other’s interests above their own. Medicine is clearly bound together by the common aim of promoting the health and well-being of patients and Mittelstadt argues that it is a “defining quality of a profession for its practitioners to be part of a ‘moral community’ with common aims, values and training”.

For the field of AI research, however, the same cannot be said. “AI is largely developed by the private sector for deployment in public (for example, criminal sentencing) and private (for example, insurance) contexts,” Mittelstadt writes. “The fundamental aims of developers, users and affected parties do not necessarily align.”

Similarly, the fiduciary duties of the professions and their mechanisms of governance are absent in private AI research.

“AI developers do not commit to public service, which in other professions requires practitioners to uphold public interests in the face of competing business or managerial interests,” he writes. In AI research, “public interests are not granted primacy over commercial interests”.

In a related point, Mittelstadt argues that while medicine has a professional culture that lays out the necessary moral obligations and virtues stretching back to the physicians of ancient Greece, “AI development does not have a comparable history, homogeneous professional culture and identity, or similarly developed professional ethics frameworks”.

Medicine has had a long time over which to learn from its mistakes and the shortcomings of the minimal guidance provided by the Hippocratic tradition. In response, it has codified appropriate conduct into modern principlism which provides fuller and more satisfactory ethical guidance.

The info is here.

A.I. Systems Echo Biases They’re Fed, Putting Scientists on Guard

Cade Metz
The New York Times
Originally published Nov 11, 2019

Here is the conclusion:

“This is hard. You need a lot of time and care,” he said. “We found an obvious bias. But how many others are in there?”

Dr. Bohannon said computer scientists must develop the skills of a biologist. Much as a biologist strives to understand how a cell works, software engineers must find ways of understanding systems like BERT.

In unveiling the new version of its search engine last month, Google executives acknowledged this phenomenon. And they said they tested their systems extensively with an eye toward removing any bias.

Researchers are only beginning to understand the effects of bias in systems like BERT. But as Dr. Munro showed, companies are already slow to notice even obvious bias in their systems. After Dr. Munro pointed out the problem, Amazon corrected it. Google said it was working to fix the issue.

Primer’s chief executive, Sean Gourley, said vetting the behavior of this new technology would become so important, it will spawn a whole new industry, where companies pay specialists to audit their algorithms for all kinds of bias and other unexpected behavior.

“This is probably a billion-dollar industry,” he said.

The whole article is here.

This Researcher Exploited Prisoners, Children, and the Elderly. Why Does Penn Honor Him?

Albert Kligman

Alexander Kafka
The Chronicle of Higher Education
Originally published Nov 8, 2019

Here is an excerpt:

What the university sites don’t mention is how Retin-A and Renova, an anti-wrinkle variation of the retinoic acid compound, were derived from substances first experimentally applied by Kligman’s research team to the skin of inmates at Holmesburg Prison, then a large facility in Philadelphia.

From the 1950s into the 1970s, the prison served as Kligman’s “Kmart of human experimentation,” in the words of Allen M. Hornblum, an author who exhaustively documented the Penn researcher’s projects at Holmesburg in his books Acres of Skin (1998) and Sentenced to Science: One Black Man’s Story of Imprisonment in America (2007).

Colleges are questioning the morality of accepting research funds from Jeffrey Epstein, who was accused of sexually molesting young girls, and the Sacklers, makers of OxyContin.

They are searching their souls over institutional ties to slavery and Jim Crow-era exploitation.

Hornblum and others have asked for decades whether Penn should be honoring Kligman, and Hornblum and Yusef Anthony, the former inmate whose story Hornblum tells in Sentenced to Science, will ask again in a lecture at Princeton next month. The current ethical climate amplifies their question.

The university’s president, Amy Gutmann, and a Penn colleague, the bioethicist Jonathan D. Moreno, recently published a book on bioethics and health care. “They are advising the world on all of these different issues,” Hornblum says, “but they don’t know what’s going on on their own campus? They don’t know it’s wrong?”

Penn says it “regrets the manner in which this research was conducted” and emphasizes the university’s commitment to research ethics. But it has given no indication that it plans to take any action regarding the lectureship or the university’s portrayal of Kligman.

Kligman, who died in 2010, defended his work by saying that experiments on prisoners were common at the time, and he was right. But, Hornblum says, the scale and duration of the Holmesburg experiments stood out even then.

The info is here.

Is biohacking ethical? It’s complicated. A new Netflix series explains why.

Sigal Samuel
www.vox.com
Originally posted October 22, 2019

Here is an excerpt:

Biohacking raises a lot of questions with huge ethical implications. Should biohacking yourself be a human right or should your control over your own body be curtailed — possibly even criminalized — if it’s risky to you or others? (Many biohacking pursuits exist in a legal gray zone but are not yet outright illegal, or not enforced as such. Some new gene therapies profiled in Unnatural Selection, like Jackson Kennedy’s, are approved by the Food and Drug Administration.) Will biohacking enhance life for all of us equally or will it widen the gap between haves and have-nots?

Perhaps we’d do best to strictly limit the use of new technologies like CRISPR. But then again, given that people are dying and these technologies might help, can we morally afford to not use them?

Ethical objections to biohacking

While some people who engage with biohacking view themselves as part of the scientific establishment and often voice ethical concerns about technologies like CRISPR, others have a strong anti-establishment streak.

Unnatural Selection assigns uneven weight to different camps — proponents of the new technologies get more airtime than their critics, perhaps because it’s more visually interesting to watch people inject themselves with new DNA than it is to watch finger-wagging bioethicists warn about risks.

The info is here.

Super-precise new CRISPR tool could tackle a plethora of genetic diseases

Heidi Ledford
nature.com
Originally posted October 21, 2019

For all the ease with which the wildly popular CRISPR–Cas9 gene-editing tool alters genomes, it’s still somewhat clunky and prone to errors and unintended effects. Now, a recently developed alternative offers greater control over genome edits — an advance that could be particularly important for developing gene therapies.

The alternative method, called prime editing, improves the chances that researchers will end up with only the edits they want, instead of a mix of changes that they can’t predict. The tool, described in a study published on 21 October in Nature1, also reduces the ‘off-target’ effects that are a key challenge for some applications of the standard CRISPR–Cas9 system. That could make prime-editing-based gene therapies safer for use in people.

The tool also seems capable of making a wider variety of edits, which might one day allow it to be used to treat the many genetic diseases that have so far stymied gene-editors. David Liu, a chemical biologist at the Broad Institute of MIT and Harvard in Cambridge, Massachusetts and lead study author, estimates that prime editing might help researchers tackle nearly 90% of the more than 75,000 disease-associated DNA variants listed in ClinVar, a public database developed by the US National Institutes of Health.

The specificity of the changes that this latest tool is capable of could also make it easier for researchers to develop models of disease in the laboratory, or to study the function of specific genes, says Liu.

The info is here.

Moral Enhancement: A Realistic Approach

Greg Conan
British Medical Journal Blogs
Originally published August 29, 2019

Here is an excerpt:

If you could take a pill to make yourself a better person, would you do it? Could you justifiably make someone else do it, even if they do not want to?

When presented so simplistically, the idea might seem unrealistic or even impossible. The concepts of “taking a pill” and “becoming a better person” seem to belong to different categories. But many of the traits commonly considered to make one a “good person”—such as treating others fairly and kindly without violence—are psychological traits strongly influenced by neurobiology, and neurobiology c
an be changed using medicine. So when and how, if ever, should medicine be used to improve moral character?

Moral bioenhancement (MBE), the concept of improving moral character using biomedical technology, has fascinated me for years—especially once I learned that it has been hotly debated in the bioethics literature since 2008. I have greatly enjoyed diving into the literature to learn about how the concept has been analyzed and presented. Much of the debate has focused on its most abstract topics, like defining its terms and relating MBE to freedom. Although my fondness for analytic philosophy means that I cannot condemn anyone for working to examine ideas with maximum clarity and specificity, any MBE proponent who actually wants MBE to be implemented must focus on realistic methods.

The info is here.

The Sex Premium in Religiously Motivated Moral Judgment

Liana Hone, Thomas McCauley, Eric Pedersen,
Evan Carter, and Michael McCullough
PsyArXiv Preprints

Abstract

Religion encourages people to reason about moral issues deontologically rather than on the basis of the perceived consequences of specific actions. However, recent theorizing suggests that religious people’s moral convictions are actually quite strategic (albeit unconsciously so), designed to make their worlds more amenable to their favored approaches to solving life’s basic challenges. In six experiments, we find that religious cognition places a “sex premium” on moral judgments, causing people to judge violations of conventional sexual morality as particularly objectionable. The sex premium is especially strong among highly religious people, and applies to both legal and illegal acts. Religion’s influence on moral reasoning, even if deontological, emphasizes conventional sexual norms, and may reflect the strategic projects to which religion has been applied throughout history.

From the Discussion

How does the sex premium in religiously motivated moral judgment arise during development? We see three plausible pathways. First, society’s vectors for religious cultural learning may simply devote more attention to sex and reproduction than to prosociality when they seek to influence others’ moral stances. Conservative preachers, for instance, devote more time to issues of sexual purity than do liberal preachers, and religious parents discuss the morality of sex with their children more frequently than do less religious parents, even though they discuss sex with their children less frequently overall. Second, strong emotions facilitate cultural learning by improving attention, memory, and motivation, and few human experiences generate stronger emotions than do sex and reproduction. If the emotions that regulate sexual attraction, arousal, and avoidance (e.g., sexual disgust) are stronger than those that regulate prosocial behavior (e.g., empathy; moralistic anger), then the sex premium documented here may emerge from the fact that religiously motivated sexual moralists can create more powerful cultural learning experiences than prosocial moralists can.  Finally, given the extreme importance of sex and reproduction to fitness, the children of religiously adherent adults may observe that violations of local sexual standards to evoke greater moral outrage and condemnation from third parties than do violations of local standards for prosocial behavior.

The research is here.

The Koch-backed right-to-try law has been a bust, but still threatens our health

Michael Hiltzik
The Los Angeles Times
Originally posted September 17, 2019

The federal right-to-try law, signed by President Trump in May 2018 as a sop to right-wing interests, including the Koch brothers network, always was a cruel sham perpetrated on sufferers of intractably fatal diseases.

As we’ve reported, the law was promoted as a compassionate path to experimental treatments for those patients — but in fact was a cynical ploy aimed at emasculating the Food and Drug Administration in a way that would undermine public health and harm all patients.

Now that a year has passed since the law’s enactment, the assessments of how it has functioned are beginning to flow in. As NYU bioethicist Arthur Caplan observed to Ed Silverman’s Pharmalot blog, “the right to try remains a bust.”

His judgment is seconded by the veteran pseudoscience debunker David Gorski, who writes: “Right-to-try has been a spectacular failure thus far at getting terminally ill patients access to experimental drugs.”

That should come as no surprise, Gorski adds, because “right-to-try was never about helping terminally ill patients. ... It was always about ideology more than anything else. It was always about weakening the FDA’s ability to regulate drug approval.”

The info is here.

Is there a right to die?

Eric Mathison
Baylor Medical College of Medicine Blog
Originally posted May 31, 2019

How people think about death is undergoing a major transformation in the United States. In the past decade, there has been a significant rise in assisted dying legalization, and more states are likely to legalize it soon.

People are adapting to a healthcare system that is adept at keeping people alive, but struggles when aggressive treatment is no longer best for the patient. Many people have concluded, after witnessing a loved one suffer through a prolonged dying process, that they don’t want that kind of death for themselves.

Public support for assisted dying is high. Gallup has tracked Americans’ support for it since 1951. The most recent survey, from 2017, found that 73% of Americans support legalization. Eighty-one percent of Democrats and 67% of Republicans support it, making this a popular policy regardless of political affiliation.

The effect has been a recent surge of states passing assisted dying legislation. New Jersey passed legislation in April, meaning seven states (plus the District of Columbia) now allow it. In addition to New Jersey, California, Colorado, Hawaii, and D.C. all passed legislation in the past three years, and seventeen states are considering legislation this year. Currently, around 20% of Americans live in states where assisted dying is legal.

The info is here.

Ethics a distant second to profits in Silicon Valley

Gabriel Fairman
www.sdtimes.com
Originally published September 9, 2019

Here is an excerpt:

For ethics to become a part of the value system that drives behavior in Silicon Valley, it would have to be incentivized as such. I have a hard time envisioning a world were ethics can offer shareholders huge returns. Ethics is about doing the right thing, and the right thing and the lucrative thing typically don’t necessarily go hand in hand.

Everyone can understand ethics. Basic questions such as “Will this be good for the world in a year, 10 years or 20 years?”, “Would I want this for my kids?” are easy litmus tests to differentiate between ethical and unethical conduct. The challenge is that considerations on ethics slow down development by raising challenges and concerns early on.  Ethics are about amplifying potential problems that can be foreseen down the road.

On the other hand, venture-funded start-ups are about minimizing the ramifications of these problems as they move on quickly. How can ethics compete with billion-dollar exits? It can’t. Ethics are just this thing that we read about in articles or hear about in lectures. It is not driving day-to-day decision-making. You listen to people in boardrooms asking, “How will this impact our valuation?,” or “What is the ROI of this initiative?” but you don’t hear top-level execs brainstorming about how their product or company could be more ethical because there is no compensation tied to that. The way we have built our world, ethics are just fluff.

We are also extraordinary at differentiating private vs. public lives. Many people working at tech companies don’t allow their kids to use electronic devices ubiquitously or would not want their kids bossed around by an algorithm as they let go of full-time employee benefits. But they promote these things and further them because these things are highly profitable, not because they are fundamentally good. This key distinction between private and public behavior allows people to behave in wildly hypocritical ways, by helping advance the very things they do not want in their own homes.

The info is here.

Brain-reading tech is coming. The law is not ready to protect us.

Sigal Samuel
vox.com
Originally posted August 30, 2019

Here is an excerpt:

2. The right to mental privacy

You should have the right to seclude your brain data or to publicly share it.

Ienca emphasized that neurotechnology has huge implications for law enforcement and government surveillance. “If brain-reading devices have the ability to read the content of thoughts,” he said, “in the years to come governments will be interested in using this tech for interrogations and investigations.”

The right to remain silent and the principle against self-incrimination — enshrined in the US Constitution — could become meaningless in a world where the authorities are empowered to eavesdrop on your mental state without your consent.

It’s a scenario reminiscent of the sci-fi movie Minority Report, in which a special police unit called the PreCrime Division identifies and arrests murderers before they commit their crimes.

3. The right to mental integrity

You should have the right not to be harmed physically or psychologically by neurotechnology.

BCIs equipped with a “write” function can enable new forms of brainwashing, theoretically enabling all sorts of people to exert control over our minds: religious authorities who want to indoctrinate people, political regimes that want to quash dissent, terrorist groups seeking new recruits.

What’s more, devices like those being built by Facebook and Neuralink may be vulnerable to hacking. What happens if you’re using one of them and a malicious actor intercepts the Bluetooth signal, increasing or decreasing the voltage of the current that goes to your brain — thus making you more depressed, say, or more compliant?

Neuroethicists refer to that as brainjacking. “This is still hypothetical, but the possibility has been demonstrated in proof-of-concept studies,” Ienca said, adding, “A hack like this wouldn’t require that much technological sophistication.”

The info is here.

Three things digital ethics can learn from medical ethics

Carissa Véliz
Nature Electronics 2:316-318 (2019)

Here is an excerpt:

Similarly, technological decisions are not only about facts (for example, about what is more efficient), but also about the kind of life we want and the kind of society we strive to build. The beginning of the digital age has been plagued by impositions, with technology companies often including a disclaimer in their terms and conditions that “they can unilaterally change their terms of service agreement without any notice of changes to the users”. Changes towards more respect for autonomy, however, can already be seen. With the implementation of the GDPR in Europe, for instance, tech
companies are being urged to accept that people may prefer services that are less efficient or possess less functionality if that means they get to keep their privacy.

One of the ways in which technology has failed to respect autonomy is through the use of persuasive technologies. Digital technologies that are designed to chronically distract us not only jeopardize our attention, but also our will, both individually and collectively. Technologies that constantly hijack our attention threaten the resources we need to exercise our autonomy.  If one were to ask people about their goals in life, most people would likely mention things such as “spending more time with family” — not many people would suggest “spending more time on Facebook”.  Yet most people do not accomplish their goals — we get distracted.

The info is here.

The Ethics Of Hiding Your Data From the Machines

Molly Wood
wired.com
Originally posted August 22, 2019

Here is an excerpt:

There’s also a real and reasonable fear that companies or individuals will take ethical liberties in the name of pushing hard toward a good solution, like curing a disease or saving lives. This is not an abstract problem: The co-founder of Google’s artificial intelligence lab, DeepMind, was placed on leave earlier this week after some controversial decisions—one of which involved the illegal use of over 1.5 million hospital patient records in 2017.

So sticking with the medical kick I’m on here, I propose that companies work a little harder to imagine the worst-case scenario surrounding the data they’re collecting. Study the side effects like you would a drug for restless leg syndrome or acne or hepatitis, and offer us consumers a nice, long, terrifying list of potential outcomes so we actually know what we’re getting into.

And for we consumers, well, a blanket refusal to offer up our data to the AI gods isn’t necessarily the good choice either. I don’t want to be the person who refuses to contribute my genetic data via 23andMe to a massive research study that could, and I actually believe this is possible, lead to cures and treatments for diseases like Parkinson’s and Alzheimer’s and who knows what else.

I also think I deserve a realistic assessment of the potential for harm to find its way back to me, because I didn’t think through or wasn’t told all the potential implications of that choice—like how, let’s be honest, we all felt a little stung when we realized the 23andMe research would be through a partnership with drugmaker (and reliable drug price-hiker) GlaxoSmithKline. Drug companies, like targeted ads, are easy villains—even though this partnership actually could produce a Parkinson’s drug. But do we know what GSK’s privacy policy looks like? That deal was a level of sharing we didn’t necessarily expect.

The info is here.

The crossroads between ethics and technology

Tehilla Shwartz Altshuler
Techcrunch.com
Originally posted August 6, 2019

Here is an excerpt:

The first relates to ethics. If anything is clear today in the world of technology, it is the need to include ethical concerns when developing, distributing, implementing and using technology. This is all the more important because in many domains there is no regulation or legislation to provide a clear definition of what may and may not be done. There is nothing intrinsic to technology that requires that it pursue only good ends. The mission of our generation is to ensure that technology works for our benefit and that it can help realize social ideals. The goal of these new technologies should not be to replicate power structures or other evils of the past. 

Startup nation should focus on fighting crime and improving autonomous vehicles and healthcare advancements. It shouldn’t be running extremist groups on Facebook, setting up “bot farms” and fakes, selling attackware and spyware, infringing on privacy and producing deepfake videos.

The second issue is the lack of transparency. The combination of individuals and companies that have worked for, and sometimes still work with, the security establishment frequently takes place behind a thick screen of concealment. These entities often evade answering challenging questions that result from the Israeli Freedom of Information law and even recourse to the military censor — a unique Israeli institution — to avoid such inquires.

The info is here.

Can Physicians Work in US Immigration Detention Facilities While Upholding Their Hippocratic Oath?

Spiegel P, Kass N, Rubenstein L.
JAMA. Published online August 30, 2019.
doi:10.1001/jama.2019.12567

The modern successor to the Hippocratic oath, called the Declaration of Geneva, was updated and approved by the World Medical Association in 2017. The pledge states that “The health and well-being of my patient will be my first consideration” and “I will not use my medical knowledge to violate human rights and civil liberties, even under threat.” Can a physician work in US immigration detention facilities while upholding this pledge?

There is a humanitarian emergency at the US-Mexico border where migrants, including families, adults, or unaccompanied children, are detained and processed by the Department of Homeland Security’s (DHS) Customs and Border Patrol and are held in overcrowded and unsanitary conditions with insufficient medical care.2 Children (persons <18 years), without their parents or guardians, are often being detained in these detention facilities beyond the 72 hours allowed under federal law. Adults and children with a parent or legal guardian are then transferred from Customs and Border Patrol facilities to DHS’ Immigration and Customs Enforcement facilities, which are also overcrowded and where existing standards for conditions of confinement are often not met. Unaccompanied minors are transferred from Customs and Border Patrol detention facilities to Health and Human Services (HHS) facilities run by the Office of Refugee Resettlement (ORR). The majority of these unaccompanied children are then released to the care of community sponsors, while others stay, sometimes for months.

Children should not be detained for immigration reasons at all, according to numerous professional associations, including the American Academy of Pediatrics.3 Detention of children has been associated with increased physical and psychological illness, including posttraumatic stress disorder, as well as developmental delay and subsequent problems in school.

Given the psychological and physical harm to children who are detained, the United Nations Committee on the Rights of the Child stated that the detention of a child “cannot be justified solely on the basis of the child being unaccompanied or separated, or on their migratory or residence status, or lack thereof,” and should in any event only be used “…as a measure of last resort and for the shortest appropriate period of time.”6 The United States is the only country not to have ratified the convention on the Rights of the Child, but the international standard is so widely recognized that it should still apply. Children held in immigration detention should be released into settings where they are safe, protected, and can thrive.

The info is here.