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
Showing posts with label Care. Show all posts
Showing posts with label Care. Show all posts

Thursday, May 25, 2023

Unselfish traits and social decision-making patterns characterize six populations of real-world extraordinary altruists

Rhoads, S. A., Vekaria, K. M. et al. (2023). 
Nature Communications
Published online 31 March 23

Abstract

Acts of extraordinary, costly altruism, in which significant risks or costs are assumed to benefit strangers, have long represented a motivational puzzle. But the features that consistently distinguish individuals who engage in such acts have not been identified. We assess six groups of real-world extraordinary altruists who had performed costly or risky and normatively rare (<0.00005% per capita) altruistic acts: heroic rescues, non-directed and directed kidney donations, liver donations, marrow or hematopoietic stem cell donations, and humanitarian aid work. Here, we show that the features that best distinguish altruists from controls are traits and decision-making patterns indicating unusually high valuation of others’ outcomes: high Honesty-Humility, reduced Social Discounting, and reduced Personal Distress. Two independent samples of adults who were asked what traits would characterize altruists failed to predict this pattern. These findings suggest that theories regarding self- focused motivations for altruism (e.g., self-enhancing reciprocity, reputation enhancement) alone are insufficient explanations for acts of real-world self- sacrifice.

From the Discussion Section

That extraordinary altruists are consistently distinguished by a common set of traits linked to unselfishness is particularly noteworthy given the differences in the demographics of the various altruistic groups we sampled and the differences in the forms of altruism they have engaged in—from acts of physical heroism to the decision to donate bone marrow. This finding replicates and extends findings from a previous study demonstrating that extraordinary altruists show heighted subjective valuation of socially distant others. In addition, our results are consistent with a recent meta-analysis of 770 studies finding a strong and consistent relationship between Honesty-Humility and various forms of self-reported and laboratory-measured prosociality. Coupled with findings that low levels of unselfish traits (e.g., low Honesty-Humility, high social discounting) correspond to exploitative and antisocial behaviors such as cheating and aggression, these results also lend support to the notion of a bipolar caring continuum along which individuals vary in the degree to which they subjectively value (care about) the welfare of others. They further suggest altruism—arguably the willingness to be voluntarily “exploited” by others—to be the opposite of phenotypes like psychopathy that are characterized by exploiting others. These traits may best predict behavior in novel contexts lacking strong norms, particularly when decisions are made rapidly and intuitively. Notably, people who are higher in prosociality are more likely to participate in psychological research to begin with—thus the observed differences between altruists and controls may be underestimates (i.e., population-level differences may be larger).

Friday, January 27, 2023

Moral foundations, values, and judgments in extraordinary altruists

Amormino, P., Ploe, M.L. & Marsh, A.A.
Sci Rep 12, 22111 (2022).
https://doi.org/10.1038/s41598-022-26418-1

Abstract

Donating a kidney to a stranger is a rare act of extraordinary altruism that appears to reflect a moral commitment to helping others. Yet little is known about patterns of moral cognition associated with extraordinary altruism. In this preregistered study, we compared the moral foundations, values, and patterns of utilitarian moral judgments in altruistic kidney donors (n = 61) and demographically matched controls (n = 58). Altruists expressed more concern only about the moral foundation of harm, but no other moral foundations. Consistent with this, altruists endorsed utilitarian concerns related to impartial beneficence, but not instrumental harm. Contrary to our predictions, we did not find group differences between altruists and controls in basic values. Extraordinary altruism generally reflected opposite patterns of moral cognition as those seen in individuals with psychopathy, a personality construct characterized by callousness and insensitivity to harm and suffering. Results link real-world, costly, impartial altruism primarily to moral cognitions related to alleviating harm and suffering in others rather than to basic values, fairness concerns, or strict utilitarian decision-making.

Discussion

In the first exploration of patterns of moral cognition that characterize individuals who have engaged in real-world extraordinary altruism, we found that extraordinary altruists are distinguished from other people only with respect to a narrow set of moral concerns: they are more concerned with the moral foundation of harm/care, and they more strongly endorse impartial beneficence. Together, these findings support the conclusion that extraordinary altruists are morally motivated by an impartial concern for relieving suffering, and in turn, are motivated to improve others’ welfare in a self-sacrificial manner that does not allow for the harm of others in the process. These results are also partially consistent with extraordinary altruism representing the inverse of psychopathy in terms of moral cognition: altruists score lower in psychopathy (with the strongest relationships observed for psychopathy subscales associated with socio-affective responding) and higher-psychopathy participants most reliably endorse harm/care less than lower psychopathy participants, with participants with higher scores on the socio-affective subscales of our psychopathy measures also endorsing impartial beneficence less strongly.

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Notably, and contrary to our predictions, we did not find that donating a kidney to a stranger is strongly or consistently correlated (positively or negatively) with basic values like universalism, benevolence, power, hedonism, or conformity. That suggests extraordinary altruism may not be driven by unusual values, at least as they are measured by the Schwartz inventory, but rather by specific moral concerns (such as harm/care). Our findings suggest that reported values may not in themselves predict whether one acts on those values when it comes to extraordinary altruism, much as “…a person can value being outgoing in social gatherings, independently of whether they are prone to acting in a lively or sociable manner”. Similarly, people who share a common culture may value common things but acting on those values to an extraordinarily costly and altruistic degree may require a stronger motivation––a moral motivation.

Monday, November 21, 2022

AI Isn’t Ready to Make Unsupervised Decisions

Joe McKendrick and Andy Thurai
Harvard Business Review
Originally published September 15, 2022

Artificial intelligence is designed to assist with decision-making when the data, parameters, and variables involved are beyond human comprehension. For the most part, AI systems make the right decisions given the constraints. However, AI notoriously fails in capturing or responding to intangible human factors that go into real-life decision-making — the ethical, moral, and other human considerations that guide the course of business, life, and society at large.

Consider the “trolley problem” — a hypothetical social scenario, formulated long before AI came into being, in which a decision has to be made whether to alter the route of an out-of-control streetcar heading towards a disaster zone. The decision that needs to be made — in a split second — is whether to switch from the original track where the streetcar may kill several people tied to the track, to an alternative track where, presumably, a single person would die.

While there are many other analogies that can be made about difficult decisions, the trolley problem is regarded to be the pinnacle exhibition of ethical and moral decision making. Can this be applied to AI systems to measure whether AI is ready for the real world, in which machines can think independently, and make the same ethical and moral decisions, that are justifiable, that humans would make?

Trolley problems in AI come in all shapes and sizes, and decisions don’t necessarily need to be so deadly — though the decisions AI renders could mean trouble for a business, individual, or even society at large. One of the co-authors of this article recently encountered his own AI “trolley moment,” during a stay in an Airbnb-rented house in upstate New Hampshire. Despite amazing preview pictures and positive reviews, the place was poorly maintained and a dump with condemned adjacent houses. The author was going to give the place a low one-star rating and a negative review, to warn others considering a stay.

However, on the second morning of the stay, the host of the house, a sweet and caring elderly woman, knocked on the door, inquiring if the author and his family were comfortable and if they had everything they needed. During the conversation, the host offered to pick up some fresh fruits from a nearby farmers market. She also said she doesn’t have a car, she would walk a mile to a friend’s place, who would then drive her to the market. She also described her hardships over the past two years, as rentals slumped due to Covid and that she is caring for someone sick full time.

Upon learning this, the author elected not to post the negative review. While the initial decision — to write a negative review — was based on facts, the decision not to post the review was purely a subjective human decision. In this case, the trolley problem was concern for the welfare of the elderly homeowner superseding consideration for the comfort of other potential guests.

How would an AI program have handled this situation? Likely not as sympathetically for the homeowner. It would have delivered a fact-based decision without empathy for the human lives involved.

Tuesday, September 27, 2022

Beyond individualism: Is there a place for relational autonomy in clinical practice and research?

Dove, E. S., Kelly, S. E., et al. (2017).
Clinical Ethics, 12(3), 150–165.
https://doi.org/10.1177/1477750917704156

Abstract

The dominant, individualistic understanding of autonomy that features in clinical practice and research is underpinned by the idea that people are, in their ideal form, independent, self-interested and rational gain-maximising decision-makers. In recent decades, this paradigm has been challenged from various disciplinary and intellectual directions. Proponents of ‘relational autonomy’ in particular have argued that people’s identities, needs, interests – and indeed autonomy – are always also shaped by their relations to others. Yet, despite the pronounced and nuanced critique directed at an individualistic understanding of autonomy, this critique has had very little effect on ethical and legal instruments in clinical practice and research so far. In this article, we use four case studies to explore to what extent, if at all, relational autonomy can provide solutions to ethical and practical problems in clinical practice and research. We conclude that certain forms of relational autonomy can have a tangible and positive impact on clinical practice and research. These solutions leave the ultimate decision to the person most affected, but encourage and facilitate the consideration of this person’s care and responsibility for connected others.

From the Discussion section

Together, these cases show that in our quest to enhance the practical value of the concept of relational autonomy in healthcare and research, we must be careful not to remove the patient or participant from the centre of decision-making. At the same time, we should acknowledge that the patient’s decision to consent (or refuse) to treatment or research can be augmented by facilitating and encouraging that her relations to, and responsibility for, others are considered in decision-making processes. Our case studies do not suggest that we should expand consent requirements to others per se, such as family members or community elders – that is, to add the requirement of seeking consent from further individuals who may also be seen as having a stake in the decision. Such a position would undermine the idea that the person who is centrally affected by a decision should typically have the final say in what happens with and to her, or her body, or even her data. As long as this general principle respects all legal exceptions (see below), we believe that it is a critical underpinning of fundamental respect for persons that should not done away with. Moreover, expanding consent or requiring consent to include others (however so defined) undermines the main objective of relational autonomy, which is to foreground the relational aspect of human identities and interests, and not merely to expand the range of individuals who need to give consent to a procedure. An approach that merely extends consent requirements to other people does not foreground relations but rather presumptions about who the relevant others of a person are.

Wednesday, September 21, 2022

Professional Civil Disobedience — Medical-Society Responsibilities after Dobbs

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

Here are two excerpts:

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

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

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

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

Monday, July 5, 2021

When Do Robots have Free Will? Exploring the Relationships between (Attributions of) Consciousness and Free Will

Nahmias, E., Allen, C. A., & Loveall, B.
In Free Will, Causality, & Neuroscience
Chapter 3

Imagine that, in the future, humans develop the technology to construct humanoid robots with very sophisticated computers instead of brains and with bodies made out of metal, plastic, and synthetic materials. The robots look, talk, and act just like humans and are able to integrate into human society and to interact with humans across any situation. They work in our offices and our restaurants, teach in our schools, and discuss the important matters of the day in our bars and coffeehouses. How do you suppose you’d respond to one of these robots if you were to discover them attempting to steal your wallet or insulting your friend? Would you regard them as free and morally responsible agents, genuinely deserving of blame and punishment?

If you’re like most people, you are more likely to regard these robots as having free will and being morally responsible if you believe that they are conscious rather than non-conscious. That is, if you think that the robots actually experience sensations and emotions, you are more likely to regard them as having free will and being morally responsible than if you think they simply behave like humans based on their internal programming but with no conscious experiences at all. But why do many people have this intuition? Philosophers and scientists typically assume that there is a deep connection between consciousness and free will, but few have developed theories to explain this connection. To the extent that they have, it’s typically via some cognitive capacity thought to be important for free will, such as reasoning or deliberation, that consciousness is supposed to enable or bolster, at least in humans. But this sort of connection between consciousness and free will is relatively weak. First, it’s contingent; given our particular cognitive architecture, it holds, but if robots or aliens could carry out the relevant cognitive capacities without being conscious, this would suggest that consciousness is not constitutive of, or essential for, free will. Second, this connection is derivative, since the main connection goes through some capacity other than consciousness. Finally, this connection does not seem to be focused on phenomenal consciousness (first-person experience or qualia), but instead, on access consciousness or self-awareness (more on these distinctions below).

From the Conclusion

In most fictional portrayals of artificial intelligence and robots (such as Blade Runner, A.I., and Westworld), viewers tend to think of the robots differently when they are portrayed in a way that suggests they express and feel emotions. No matter how intelligent or complex their behavior, they do not come across as free and autonomous until they seem to care about what happens to them (and perhaps others). Often this is portrayed by their showing fear of their own death or others, or expressing love, anger, or joy. Sometimes it is portrayed by the robots’ expressing reactive attitudes, such as indignation, or our feeling such attitudes towards them. Perhaps the authors of these works recognize that the robots, and their stories, become most interesting when they seem to have free will, and people will see them as free when they start to care about what happens to them, when things really matter to them, which results from their experiencing the actual (and potential) outcomes of their actions.


Monday, May 24, 2021

The evolutionary origin of human hyper-cooperation

Burkart, J., Allon, O., Amici, F. et al. 
Nat Commun 5, 4747 (2014). 
https://doi.org/10.1038/ncomms5747

Abstract

Proactive, that is, unsolicited, prosociality is a key component of our hyper-cooperation, which in turn has enabled the emergence of various uniquely human traits, including complex cognition, morality and cumulative culture and technology. However, the evolutionary foundation of the human prosocial sentiment remains poorly understood, largely because primate data from numerous, often incommensurable testing paradigms do not provide an adequate basis for formal tests of the various functional hypotheses. We therefore present the results of standardized prosociality experiments in 24 groups of 15 primate species, including humans. Extensive allomaternal care is by far the best predictor of interspecific variation in proactive prosociality. Proactive prosocial motivations therefore systematically arise whenever selection favours the evolution of cooperative breeding. Because the human data fit this general primate pattern, the adoption of cooperative breeding by our hominin ancestors also provides the most parsimonious explanation for the origin of human hyper-cooperation.

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Our results demonstrate that the extent of allomaternal care provides the best explanation for the distribution of proactive prosociality among primate species, including humans. This conclusion is not affected when using different ways of quantifying allomaternal care. Importantly, we find no support for any of the other hypotheses, even when more refined analyses of within-species, dyad-level variation are conducted. The adoption of extensive allomaternal care by our hominin ancestors thus provides the most parsimonious explanation for the origin of human hyper-cooperation.

Tuesday, April 13, 2021

Can Clinical Empathy Survive? Distress, Burnout, and Malignant Duty in the Age of Covid‐19

A. Anzaldua & J. Halpern
Hastings Report
Jan-Feb 2021 22-27.

Abstract

The Covid‐19 crisis has accelerated a trend toward burnout in health care workers, making starkly clear that burnout is especially likely when providing health care is not only stressful and sad but emotionally alienating; in such situations, there is no mental space for clinicians to experience authentic clinical empathy. Engaged curiosity toward each patient is a source of meaning and connection for health care providers, and it protects against sympathetic distress and burnout. In a prolonged crisis like Covid‐19, clinicians provide care out of a sense of duty, especially the duty of nonabandonment. We argue that when duty alone is relied on too heavily, with fear and frustration continually suppressed, the risk of burnout is dramatically increased. Even before Covid‐19, clinicians often worked under dehumanizing and unjust conditions, and rates of burnout were 50 percent for physicians and 33 percent for nurses. The Covid‐19 intensification of burnout can serve as a wake‐up call that the structure of health care needs to be improved if we are to prevent the loss of a whole generation of empathic clinicians.

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The Dynamics of Clinical Empathy

Clinical empathy, a specific form of empathy that has therapeutic impact in the medical setting and is professionally sustainable, was first conceptualized by one of us, Jodi Halpern, as emotionally engaged curiosity. Her work challenged the expectation that physicians should limit themselves to detached cognitive empathy, showing how affective resonance, when redirected into curiosity about the patient, is essential for therapeutic impact. Halpern's interactive model of affective and cognitive empathy has been supported by empirical research, including findings regarding improved diagnosis, treatment adherence, and coping as well as studies of specific diseases (for example, about improved diabetes outcomes), though more research is needed to precisely identify the specific ways that affective resonance and cognitive curiosity contribute to meeting specific clinical needs. This model is also supported by neuroscientific findings showing how affective attunement improves cognitive empathy.

Models of compassion in medical care add valuable practices of mindfulness but do not emphasize an individualized appreciation of each patient's predicament. We thus work with Halpern's model, which emphasizes using emotional resonance to inform imagining the world from each patient's perspective. Halpern defines the cognitive aim of imagining each patient's perspective as “curiosity” because the practice of clinical empathy as engaged curiosity is founded on the recognition that each patient brings their own distinct world, with a unique set of values and needs that the physician cannot presume to know. This is a subtle but vital point. 

Saturday, April 10, 2021

Ethical and Professionalism Implications of Physician Employment and Health Care Business Practices

De Camp, M, & Sulmasy, L. S.
Annals of Internal Medicine
Position Paper: 16 March 21

Abstract

The environment in which physicians practice and patients receive care continues to change. Increasing employment of physicians, changing practice models, new regulatory requirements, and market dynamics all affect medical practice; some changes may also place greater emphasis on the business of medicine. Fundamental ethical principles and professional values about the patient–physician relationship, the primacy of patient welfare over self-interest, and the role of medicine as a moral community and learned profession need to be applied to the changing environment, and physicians must consider the effect the practice environment has on their ethical and professional responsibilities. Recognizing that all health care delivery arrangements come with advantages, disadvantages, and salient questions for ethics and professionalism, this American College of Physicians policy paper examines the ethical implications of issues that are particularly relevant today, including incentives in the shift to value-based care, physician contract clauses that affect care, private equity ownership, clinical priority setting, and physician leadership. Physicians should take the lead in helping to ensure that relationships and practices are structured to explicitly recognize and support the commitments of the physician and the profession of medicine to patients and patient care.

Here is an excerpt:

Employment of physicians likewise has advantages, such as financial stability, practice management assistance, and opportunities for collaboration and continuing education, but there is also the potential for dual loyalty when physicians try to be accountable to both their patients and their employers. Dual loyalty is not new; for example, mandatory reporting of communicable diseases may place societal interests in preventing disease at odds with patient privacy interests. However, the ethics of everyday business models and practices in medicine has been less explored.

Trust is the foundation of the patient–physician relationship. Trust, honesty, fairness, and respect among health care stakeholders support the delivery of high-value, patient-centered care. Trust depends on expertise, competence, honesty, transparency, and intentions or goodwill. Institutions, systems, payers, purchasers, clinicians, and patients should recognize and support “the intimacy and importance of patient–clinician relationships” and the ethical duties of physicians, including the primary obligation to act in the patient's best interests (beneficence).

Business ethics does not necessarily conflict with the ethos of medicine. Today, physician leadership of health care organizations may be vital for delivering high-quality care and building trust, including in health care institutions. Truly trustworthy institutions may be more successful (in patient care and financially) in the long term.

Blanket statements about business practices and contractual provisions are unhelpful; most have both potential positives and potential negatives. Nevertheless, it is important to raise awareness of business practices relevant to ethics and professionalism in medical practice and promote the physician's ability to advocate for arrangements that align with medicine's core values. In this paper, the American College of Physicians (ACP) highlights 6 contemporary issues and offers ethical guidance for physicians. Although the observed trends toward physician employment and organizational consolidation merit reflection, certain issues may also resonate with independent practices and in other practice settings.

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

Abstract

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.

Highlights

• 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.

Conclusion

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.

Wednesday, November 11, 2020

How social relationships shape moral judgment

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

Abstract

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.

Monday, October 12, 2020

The U.S. Has an Empathy Deficit—Here’s what we can do about it.

Judith Hall and Mark Leary
Scientific American
Originally poste 17 Sept 20

Here are two excerpts:

Fixing this empathy deficit is a challenge because it is not just a matter of having good political or corporate leaders or people treating each other with good will and respect. It is, rather, because empathy is a fundamentally squishy term. Like many broad and complicated concepts, empathy can mean many things. Even the researchers who study it do not always say what they mean, or measure empathy in the same way in their studies—and they definitely do not agree on a definition. In fact, there are stark contradictions: what one researcher calls empathy is not empathy to another.

When laypeople are surveyed on how they define empathy, the range of answers is wide as well. Some people think empathy is a feeling; others focus on what a person does or says. Some think it is being good at reading someone’s nonverbal cues, while others include the mental orientation of putting oneself in someone else’s shoes. Still others see empathy as the ability or effort to imagine others’ feelings, or as just feeling “connected” or “relating” to someone. Some think it is a moral stance to be concerned about other people’s welfare and a desire to help them out. Sometimes it seems like “empathy” is just another way of saying “being a nice and decent person.” Actions, feelings, perspectives, motives, values—all of these are “empathy” according to someone.

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Whatever people think empathy is, it’s a powerful force and human beings need it. These three things might help to remedy our collective empathy deficit:

Take the time to ask those you encounter how they are feeling, and really listen. Try to put yourself in their shoes. Remember that we all tend to underestimate other people’s emotional distress, and we’re most likely to do so when those people are different from us.

Remind yourself that almost everyone is at the end of their rope these days. Many people barely have enough energy to handle their own problems, so they don’t have their normal ability to think about yours.

Tuesday, June 30, 2020

Want To See Your Therapist In-Person Mid-Pandemic? Think Again

Todd Essig
Forbes.com
Originally posted 27 June 20

Here is an excerpt:

Psychotherapy is built on a promise; you bring your suffering to this private place and I will work with you to keep you safe and help you heal. That promise is changed by necessary viral precautions. First, the possibility of contact tracing weakens the promise of confidentiality. I promise to keep this private changes to a promise to keep it private unless someone gets sick and I need to contact the local health department.

Even more powerful is the fact that a mid-pandemic in-person psychotherapy promise has to include all the ways we will protect each other from very real dangers, hardly the experience of psychological safety. There will even be a promise to pretend we are safe together even when we are doing so many things to remind us we are each the source of a potentially life-altering infection.

When I imagine how my caseload would react were I to begin mid-pandemic in-person work, like I did for a recent webinar for the NYS Psychological Association, I anticipate as many people welcoming the chance to work together on a shared project of viral safety as I do imagining those who would feel devastated or burdened. But even for the first group of willing co-participants, it is important to see that such a joint project of mutual safety is not psychotherapy. No anticipated reaction included the experience of psychological safety on which effective psychotherapy rests.

Rather than feeling safe enough to address the private and dark, patients/clients will each in their own way labor under the burden of keeping themselves, their families, their therapist, other patients, and office staff safe. The vigilance required to remain safe will inevitably reduce the therapeutic benefits one might hope would develop from being back in the office.

The article is here.

Friday, June 26, 2020

Debunking the Secular Case for Religion

Gurwinder Bhogal
rabbitholemag.com
Originally published 28 April 20

Here is an excerpt:

Could we, perhaps, identify the religious traditions that protect civilizations by looking at our history and finding the practices common to all long-lived civilizations? After all, Taleb has claimed that religion is “Lindy;” that is to say it has endured for a long time and therefore must be robust. But the main reason religious teachings have been robust is not that they’ve stood the test of time, but that those who tried to change them tended to be killed. Taleb also doesn’t explain what happens when religious practices differ or clash. Should people follow the precepts of the hardline Wahhabi brand of Islam, or those of a more moderate one? If the Abrahamic religions agree that usury leads to recessions, which of them do we consult on eating pork? Do we follow the Old Testament’s no or the New Testament’s yes, the green light of Christianity or the red light of Islam and Judaism?

Neither Taleb nor Peterson appear to answer these questions. But many evolutionary psychologists have: they say we should not blindly accept any religious edict, because none contain any inherent wisdom. The dominant view among evolutionary psychologists is that religion is not an evolutionary adaptation but a “spandrel,” a by-product of other adaptations. Richard Dawkins has compared religion to the tendency of moths to fly into flames: the moth did not evolve to fly into flames; it evolved to navigate by the light of the moon. Since it’s unable to distinguish between moonlight and candlelight, its attempt to keep a candle-flame in a fixed ommatidium (unit of a compound eye) causes it to keep veering around the flame, until it spirals into it. Dawkins argues that religion didn’t evolve for a purpose; it merely exploits the actual systems we evolved to navigate the world. An example of such a system might be what psychologist Justin Barrett calls the Hyperactive Agent Detection Device, the propensity to see natural phenomena as products of design. Basically, in our evolutionary history, mistaking a natural phenomenon for an artifact was far less risky than mistaking an artifact for a natural phenomenon, so our brains erred toward the former.

The info is here.

Friday, June 19, 2020

My Bedside Manner Got Worse During The Pandemic. Here's How I Improved

Shahdabul Faraz
npr.org
Health Shots
Originally published 16 May 20

Here is an excerpt:

These gestures can be as simple as sitting in a veteran's room for an extra five minutes to listen to World War II stories. Or listening with a young cancer patient to a song by our shared favorite band. Or clutching a sick patient's shoulder and reassuring him that he will see his three daughters again.

These gestures acknowledge a patient's humanity. It gives them some semblance of normalcy in an otherwise difficult period in their lives. Selfishly, that human connection also helps us — the doctors, nurses and other health care providers — deal with the often frustrating nature of our stressful jobs.

Since the start of the pandemic, our bedside interactions have had to be radically different. Against our instincts, and in order to protect our patients and colleagues, we tend to spend only the necessary amount of time in our patients' rooms. And once inside, we try to keep some distance. I have stopped holding my patients' hands. I now try to minimize small talk. No more whimsical conversational detours.

Our interactions now are more direct and short. I have, more than once, felt guilty for how quickly I've left a patient's room. This guilt is worsened, knowing that patients in hospitals don't have family and friends with them now either. Doctors are supposed to be there for our patients, but it's become harder than ever in recent months.

I understand why these changes are needed. As I move through several hospital floors, I could unwittingly transmit the virus if I'm infected and don't know it. I'm relatively young and healthy, so if I get the disease, I will likely recover. But what about my patients? Some have compromised immune systems. Most are elderly and have more than one high-risk medical condition. I could never forgive myself if I gave one of my patients COVID-19.

The info is here.

Friday, September 27, 2019

Empathy choice in physicians and non-physicians

Daryl Cameron and Michael Inzlicht
PsyArXiv
Originally created on September 11, 2019

Abstract

Empathy in medical care has been one of the focal points in the debate over the bright and dark sides of empathy. Whereas physician empathy is sometimes considered necessary for better physician-patient interactions, and is often desired by patients, it also has been described as a potential risk for exhaustion among physicians who must cope with their professional demands of confronting acute and chronic suffering. The present study compared physicians against demographically matched non-physicians on a novel behavioral assessment of empathy, in which they choose between empathizing or remaining detached from suffering targets over a series of trials. Results revealed no statistical differences between physicians and non-physicians in their empathy avoidance, though physicians were descriptively more likely to choose empathy. Additionally, both groups were likely to perceive empathy as cognitively challenging, and perceived cognitive costs of empathy associated with empathy avoidance. Across groups, there were also no statistically significant differences in self-reported trait empathy measures and empathy-related motivations and beliefs. Overall, these results suggest that physicians and non-physicians were more similar than different in terms of their empathic choices and in their assessments of the costs and benefits of empathy for others.

Conclusion:

In summary, do physicians choose empathy, and should they do so?  We find that physicians do not how a clear preference to approach or avoid empathy.  Nevertheless, they do perceive empathy to be cognitively taxing, entailing effort, aversiveness, and feelings of inefficacy, and these perceptions associated with reduced empathy choice.  Physicians who derived more satisfaction and less burnout from helping were more likely to choose empathy, and so too if they believed that empathy is good, and useful, for medical practice.  More generally, in the current work, physicians did not show statistically meaningful differences from demographically matched controls in trait empathy, empathy regulation behavior, motivations to approach or avoid empathy, or beliefs about empathy’s use for medicine.  Although it has often been suggested that physicians exhibit different levels of empathy due to the demands of medical care, the current results suggest that physicians are much like everyone else, sensitive to the relevant costs and benefits of empathizing.

The research is here.

Thursday, August 22, 2019

New Jersey will allow terminally ill patients to end their lives

Taylor Romine
CNN.com
Originally posted July 1, 2019

Terminally ill adults in New Jersey will now be able to ask for medical help to end their lives.

In April, Gov. Phil Murphy signed the Medical Aid in Dying for the Terminally Ill Act. It goes into effect Thursday.

It allows adults with a prognosis of six months or less to live to get a prescription for life-ending medication.

Other jurisdictions that allow physician-assisted suicide are: California, Colorado, Oregon, Vermont, Washington, Hawaii, Montana and the District of Columbia.

The law requires either a psychiatrist or psychologist determine that the patient has the mental capacity to make the decision. The prescription is a series of self-administered pills that can be taken at home.

"Allowing residents with terminal illnesses to make end-of-life choices for themselves is the right thing to do," Murphy said in a statement.

The info is here.

Saturday, August 3, 2019

When Do Robots Have Free Will? Exploring the Relationships between (Attributions of) Consciousness and Free Will

Eddy Nahmias, Corey Allen, & Bradley Loveall
Georgia State University

From the Conclusion:

If future research bolsters our initial findings, then it would appear that when people consider whether agents are free and responsible, they are considering whether the agents have capacities to feel emotions more than whether they have conscious sensations or even capacities to deliberate or reason. It’s difficult to know whether people assume that phenomenal consciousness is required for or enhances capacities to deliberate and reason. And of course, we do not deny that cognitive capacities for self-reflection, imagination, and reasoning are crucial for free and responsible agency (see, e.g., Nahmias 2018). For instance, once considering agents that are assumed to have phenomenal consciousness, such as humans, it is likely that people’s attributions of free will and responsibility decrease in response to information that an agent has severely diminished reasoning capacities. But people seem to have intuitions that support the idea that an essential condition for free will is the capacity to experience conscious emotions.  And we find it plausible that these intuitions indicate that people take it to be essential to being a free agent that one can feel the emotions involved in reactive attitudes and in genuinely caring about one’s choices and their outcomes.

(cut)

Perhaps, fiction points us towards the truth here. In most fictional portrayals of artificial intelligence and robots (such as Blade Runner, A.I., and Westworld), viewers tend to think of the robots differently when they are portrayed in a way that suggests they express and feel emotions.  No matter how intelligent or complex their behavior, the robots do not come across as free and autonomous until they seem to care about what happens to them (and perhaps others). Often this is portrayed by their showing fear of their own or others’ deaths, or expressing love, anger, or joy. Sometimes it is portrayed by the robots’ expressing reactive attitudes, such as indignation about how humans treat them, or our feeling such attitudes towards them, for instance when they harm humans.

The research paper is here.

Sunday, June 30, 2019

Doctors are burning out twice as fast as other workers. The problem's costing the US $4.6 billion each year.

Lydia Ramsey
www.businessinsider.com
Originally posted May 31, 2019

Here is an excerpt:

To avoid burnout, some doctors have turned to alternative business models.

That includes new models like direct primary care, which charges a monthly fee and doesn't take insurance. Through direct primary care, doctors manage the healthcare of fewer patients than they might in a traditional model. That frees them up to spend more time with patients and ideally help them get healthier.

It's a model that has been adopted by independent doctors who would otherwise have left medicine, with insurers and even the government starting to take notes on the new approach.

Others have chosen to set their own hours by working for sites that virtually link up patients with doctors.

Even so, it'll take more to cut through the note-taking and other tedious tasks that preoccupy doctors, from primary-care visits to acute surgery. It has prompted some to look into ways to alleviate how much work they do on their computers for note-taking purposes by using new technology like artificial-intelligence voice assistants.

The info is here.

Thursday, June 13, 2019

Alleviating Burdensome Beliefs Through a Care Ethics Approach

Medical Bag
Originally posted May 29, 2019

Compared with a principles-based approach, taking a care ethics approach to patients who believe they are a burden may be more effective for addressing moral dilemmas related to treatment, according to research published in Bioethics.

Two clinical ethicists from the department of medical humanities at VU University Medical Center in Amsterdam, The Netherlands, shared the case of Mrs K, a 66-year-old patient with leukemia, and examined the ways in which physicians can approach treating a patient who feels like a burden.

Mrs K recently received a bone marrow transplant, but because of rejection symptoms, is now taking an antirejection treatment. Although a cure is possible, the treatment is both taxing and extensive and presents a host of physical and mental challenges. Although Mrs K had previously focused on survival, her mindset has shifted: She says that she is burdening her husband and feels that he deserves better. Mrs K feels that life is no longer worth living and has considered stopping her antirejection treatment, which will result in her death.

Noticing that Mrs K’s mood has been poor over a long period of time, the treating physician suggests antidepressant therapy; they believe that by treating the patient’s depression, the patient will be more optimistic about continuing the antirejection therapy. Mrs K’s husband — also a physician — strongly disagrees with this course of treatment. Mrs K’s care team contacts the clinical ethicist to address this moral dilemma.

The info is here.