Why Health Professionals Should Speak Out Against False Beliefs on the Internet

Joel T. Wu and Jennifer B. McCormick
AMA J Ethics. 2018;20(11):E1052-1058.
doi: 10.1001/amajethics.2018.1052.

Abstract

Broad dissemination and consumption of false or misleading health information, amplified by the internet, poses risks to public health and problems for both the health care enterprise and the government. In this article, we review government power for, and constitutional limits on, regulating health-related speech, particularly on the internet. We suggest that government regulation can only partially address false or misleading health information dissemination. Drawing on the American Medical Association’s Code of Medical Ethics, we argue that health care professionals have responsibilities to convey truthful information to patients, peers, and communities. Finally, we suggest that all health care professionals have essential roles in helping patients and fellow citizens obtain reliable, evidence-based health information.

Here is an excerpt:

We would suggest that health care professionals have an ethical obligation to correct false or misleading health information, share truthful health information, and direct people to reliable sources of health information within their communities and spheres of influence. After all, health and well-being are values shared by almost everyone. Principle V of the AMA Principles of Ethics states: “A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated” (italics added). And Principle VII states: “A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health” (italics added). Taken together, these principles articulate an ethical obligation to make relevant information available to the public to improve community and public health. In the modern information age, wherein the unconstrained and largely unregulated proliferation of false health information is enabled by the internet and medical knowledge is no longer privileged, these 2 principles have a special weight and relevance.

Document ‘informed refusal’ just as you would informed consent

James Scibilia
AAP News
Originally posted October 20, 2018

Here is an excerpt:

The requirements of informed refusal are the same as informed consent. Providers must explain:

• the proposed treatment or testing;
• the risks and benefits of refusal;
• anticipated outcome with and without treatment; and
• alternative therapies, if available.

Documentation of this discussion, including all four components, in the medical record is critical to mounting a successful defense from a claim that you failed to warn about the consequences of refusing care.

Since state laws vary, it is good practice to check with your malpractice carrier about preferred risk management documentation. Generally, the facts of these discussions should be included and signed by the caretaker. This conversation and documentation should not be delegated to other members of the health care team. At least one state has affirmed through a Supreme Court decision that informed consent must be obtained by the provider performing the procedure and not another team member; it is likely the concept of informed refusal would bear the same requirements.

The info is here.

Chinese Ethics

Wong, David
The Stanford Encyclopedia of Philosophy (Fall 2018 Edition)

The tradition of Chinese ethical thought is centrally concerned with questions about how one ought to live: what goes into a worthwhile life, how to weigh duties toward family versus duties toward strangers, whether human nature is predisposed to be morally good or bad, how one ought to relate to the non-human world, the extent to which one ought to become involved in reforming the larger social and political structures of one’s society, and how one ought to conduct oneself when in a position of influence or power. The personal, social, and political are often intertwined in Chinese approaches to the subject. Anyone who wants to draw from the range of important traditions of thought on this subject needs to look seriously at the Chinese tradition. The canonical texts of that tradition have been memorized by schoolchildren in Asian societies for hundreds of years, and at the same time have served as objects of sophisticated and rigorous analysis by scholars and theoreticians rooted in widely variant traditions and approaches. This article will introduce ethical issues raised by some of the most influential texts in Confucianism, Mohism, Daoism, Legalism, and Chinese Buddhism.

The info is here.

Horrific deaths, brutal treatment: Mental illness in America’s jails

Gary A. Harki
The Virginian-Pilot
Originally published August 23, 2018

Here is an excerpt:

“We are arresting people who have no idea what the laws are or the rules are because they're off their medications,” said Nashville Sheriff Daron Hall, a vice president of the National Sheriffs’ Association. “You'd never arrest someone for a heart attack, but you're comfortable arresting someone who is diagnosed mentally ill. No other country in the world is doing it this way.”

In addition to causing pain and suffering for people with mental illness, the practice is costing municipalities millions.

At least 53 percent of the deaths examined have resulted in a lawsuit. Combined, the cases have cost municipalities at least $145 million. The true cost is much higher – in many cases, lawsuits are still pending and in others the settlement amount is secret. The figures also do not take into account lawyers’ fees.

The article is here.

There are a series of articles related to mental health issues in prison.

Google to disclose ethical framework on use of AI

Richard Walters
The Financial Times
Originally published June 3, 2018

Here is an excerpt:

However, Google already uses AI in other ways that have drawn criticism, leading experts in the field and consumer activists to call on it to set far more stringent ethical guidelines that go well beyond not working with the military.

Stuart Russell, a professor of AI at the University of California, Berkeley, pointed to the company’s image search feature as an example of a widely used service that perpetuates preconceptions about the world based on the data in Google’s search index. For instance, a search for “CEOs” returns almost all white faces, he said.

“Google has a particular responsibility in this area because the output of its algorithms is so pervasive in the online world,” he said. “They have to think about the output of their algorithms as a kind of ‘speech act’ that has an effect on the world, and to work out how to make that effect beneficial.”

The information is here.

The Moral Value of Compassion

Alfred Archer
Forthcoming in Justin Caouette and Carolyn Price (Eds.) The Moral Psychology of Compassion

Introduction

Many people think that compassion has an important role to play in our moral lives. We might
even think, as Arthur Schopenhauer (2010 [1840]) did, that compassion is the basis of morality.
More modestly, we might think that compassion is one important source of moral motivation and
would play an important role in the life of a virtuous person. Recently, however philosophers such
as Roger Crisp (2008), and Jesse Prinz (2011) and psychologists such as Paul Bloom (2016) have
called into question the value of sharing in another’s suffering. All three argue that this should not
play a significant role in the life of the morally virtuous person. In its place, Crisp endorses rational
benevolence as the central form of moral motivation for virtuous people.

The issue of whether compassion is a superior form of motivation to rational benevolence is
important for at least two reasons. First, it is important for both ethics and political theory. Care
ethicists for example, seek to defend moral and political outlooks based on compassion. Carol
Gilligan, for instance, claims that care ethics is “tied to feelings of empathy and compassion” (1982,
69). Similarly, Elizabeth Porter (2006) argues in favour of basing politics on compassion. These
appeals are only plausible if we accept that compassion is a valuable part of morality. Second, the
issue of whether or not compassion plays a valuable role in morality is also important for moral
education. Whether or not we see compassion as having a valuable role here is likely to be largely
settled by the issue of whether compassion plays a useful role in our moral lives.

I will argue that despite the problems facing compassion, it has a distinctive role to play in moral
life that cannot be fully captured by rational benevolence. My discussion will proceed as follows. In
§1, I examine the nature of compassion and explain how I will be using the term in this paper. I
will then, in §2, explain the traditional account of the value of compassion as a source of moral
motivation. In §3, I will investigate a number of challenges to the value of compassionate moral
motivation. I will then, in §4, explain why, despite facing important problems, compassion has a
distinctive role to play in moral life.

The penultimate version is here.

Living with the animals: animal or robotic companions for the elderly in smart homes?

Dirk Preuß and Friederike Legal
J Med Ethics doi:10.1136/medethics-2016-103603

Abstract

Although the use of pet robots in senior living facilities and day-care centres, particularly for individuals suffering from dementia, has been intensively researched, the question of introducing pet robots into domestic settings has been relatively neglected. Ambient assisted living (AAL) offers many interface opportunities for integrating motorised companions. There are diverse medical reasons, as well as arguments from animal ethics, that support the use of pet robots in contrast to living with live animals. However, as this paper makes clear, we should not lose sight of the option of living with animals at home for as long as possible and in conformity with the welfare of the animal assisted by AAL technology.

The article is here.

Automated empathy allows doctors to check on patients daily

By Barbara Feder Ostrov
Kaiser Health News
Originally posted February 10, 2016

Here is an excerpt:

"Automating empathy" is a new healthcare buzzword for helping doctors stay in touch with patients before and after medical procedures — cheaply and with minimal effort from already overextended physicians.

It may sound like an oxymoron, but it's a powerful draw for hospitals and other health care providers scrambling to adjust to sweeping changes in how they're paid for the care they provide. Whether the emails actually trigger an empathetic connection or not, the idea of tailoring regular electronic communications to patients counts as an innovation in health care with potential to save money and improve quality.

Startups like HealthLoop are promising that their technologies will help patients stick to their treatment and recovery regimens, avoid a repeat hospital stay, and be more satisfied with their care. Similar companies in the "patient engagement" industry include Wellframe, Curaspan, and Infield Health.

The article is here.

Harm is all you need? Best interests and disputes about parental decision-making

by Giles Birchley
J Med Ethics 2016;42:111-115
doi:10.1136/medethics-2015-102893

Abstract

A growing number of bioethics papers endorse the harm threshold when judging whether to override parental decisions. Among other claims, these papers argue that the harm threshold is easily understood by lay and professional audiences and correctly conforms to societal expectations of parents in regard to their children. English law contains a harm threshold which mediates the use of the best interests test in cases where a child may be removed from her parents. Using Diekema's seminal paper as an example, this paper explores the proposed workings of the harm threshold. I use examples from the practical use of the harm threshold in English law to argue that the harm threshold is an inadequate answer to the indeterminacy of the best interests test. I detail two criticisms: First, the harm standard has evaluative overtones and judges are loath to employ it where parental behaviour is misguided but they wish to treat parents sympathetically. Thus, by focusing only on ‘substandard’ parenting, harm is problematic where the parental attempts to benefit their child are misguided or wrong, such as in disputes about withdrawal of medical treatment. Second, when harm is used in genuine dilemmas, court judgments offer different answers to similar cases. This level of indeterminacy suggests that, in practice, the operation of the harm threshold would be indistinguishable from best interests. Since indeterminacy appears to be the greatest problem in elucidating what is best, bioethicists should concentrate on discovering the values that inform best interests.

The article is here.

Reputation, a universal currency for human social interactions

Manfred Milinski
Philosophical Transactions B
Published 4 January 2016.
DOI: 10.1098/rstb.2015.0100

Abstract

Decision rules of reciprocity include ‘I help those who helped me’ (direct reciprocity) and ‘I help those who have helped others’ (indirect reciprocity), i.e. I help those who have a reputation to care for others. A person's reputation is a score that members of a social group update whenever they see the person interacting or hear at best multiple gossip about the person's social interactions. Reputation is the current standing the person has gained from previous investments or refusal of investments in helping others. Is he a good guy, can I trust him or should I better avoid him as a social partner? A good reputation pays off by attracting help from others, even from strangers or members from another group, if the recipient's reputation is known. Any costly investment in others, i.e. direct help, donations to charity, investment in averting climate change, etc. increases a person's reputation. I shall argue and illustrate with examples that a person's known reputation functions like money that can be used whenever the person needs help. Whenever possible I will present tests of predictions of evolutionary theory, i.e. fitness maximizing strategies, mostly by economic experiments with humans.

The article is here.

Will America Pass the Test of Morality in 2016?

By Marian Wright Edelman
The Milwaukee Courier
Originally posted January 9, 2016

Here is an excerpt:

We are better than this. Dietrich Bonhoeffer, the great German Protestant theologian who died opposing Hitler’s holocaust, believed the test of the morality of society is how it treats its children. We flunk Bonhoeffer’s test every hour and every day in America, as we let the violence of guns and the violence of poverty relentlessly sap countless child lives. A child or teenager is killed by a gun every three and a half hours, nearly 7 a day, 48 a week.

More than 15.5 million children are poor and children are the poorest age group in America – the world’s largest economy, and the younger the children are, the poorer they are. Children of color, already the majority of our youngest children, will be the majority of our children in 2020.

The article is here.

Prostitution, Harm, and Disability: Should Only People with Disabilities be Allowed to Pay for Sex?

By Brian D. Earp
BMJ Blogs
Originally posted June 17, 2015

Introduction

Is prostitution harmful? And if it is harmful, should it be illegal to buy (or sell) sexual services? And if so, should there ever be any exceptions? What about for people with certain disabilities—say—who might find it difficult or even impossible to find a sexual partner if they weren’t allowed to exchange money for sex? Do people have a “right” to sexual fulfillment?

In a recent issue of the Journal of Medical Ethics, Frej Klem Thomsen[1] explores these and other controversial questions. His focus is on the issue of exceptions—specifically for those with certain disabilities. According to Thomsen, a person is “relevantly disabled” (for the sake of this discussion) if and only if:

(1) she has sexual needs, and desires to exercise her sexuality, and

(2) she has an anomalous physical or mental condition that, given her social circumstances, sufficiently limits her possibilities of exercising her sexuality, including fulfilling her sexual needs. (p. 455)

There is a lot to say here.

The entire article is here.

Teaching doctors when to stop treatment

By Diane E. Meier
The Washington Post
Originally published May 19, 2014

Here is an excerpt:

For years I had tried to understand why so many of my colleagues persisted in ordering tests, procedures and treatments that seemed to provide no benefit to patients and even risked harming them. I didn’t buy the popular and cynical explanation: Physicians do this for the money. It fails to acknowledge the care and commitment that these same physicians demonstrate toward their patients. Besides, my patient’s oncologist would make no money from the neurosurgery required for the intrathecal chemotherapy procedure.

It seemed that giving more treatment was the only way the oncologist knew to express his care and commitment. To him, stopping treatment was akin to abandoning his patient. And yet the only sense in which she felt abandoned was in her oncologist’s unwillingness to talk with her about what would happen when treatment stopped working.

The entire story is here.

Moral Foundations Theory: The Pragmatic Validity of Moral Pluralism

By Jesse Graham, Jonathan Haidt, S. Koleva, M. Motyl,  R. Iyera, S. P. Wojcikd, & P. H. Ditto
in press, Advances in Experimental Social Psychology

Abstract: 

Where does morality come from? Why are moral judgments often so similar across cultures, yet sometimes so variable? Is morality one thing, or many? Moral Foundations Theory (MFT) was created to answer these questions. In this chapter we describe the origins, assumptions, and current conceptualization of the theory, and detail the empirical findings that MFT has made possible, both within social psychology and beyond. Looking toward the future, we embrace several critiques of the theory, and specify five criteria for determining what should be considered a foundation of human morality. Finally, we suggest a variety of future directions for MFT and for moral psychology. 

Here is an excerpt:

But what if, in some cultures, even the most advanced moral thinkers value groups, institutions, traditions, and gods? What should we say about local rules for how to be a good group member, or how to worship? If these rules are not closely linked to concerns about justice or care, then should we distinguish them from true moral rules, as Turiel did when he labeled such rules as “social conventions?” Shweder (1990) argued that the cognitive-developmental tradition was studying only a subset of moral concerns, the ones that are most highly elaborated in secular Western societies. Shweder argued for a much more extensive form of pluralism based on his research in Bhubaneswar, India (Shweder, Much, Mahapatra, & Park, 1997). He proposed that around the world, people talk in one or more of three moral languages: the ethic of autonomy (relying on concepts such as harm, rights, and justice, which protect autonomous individuals), the ethic of community (relying on concepts such as duty, respect, and loyalty, which preserve institutions and social order), and the ethic of divinity (relying on concepts such as purity, sanctity, and sin, which protect the divinity inherent in each person against the degradation of hedonistic selfishness.) 

The entire piece is here.

At Issue in 2 Wrenching Cases: What to Do After the Brain Dies

By BENEDICT CAREY and DENISE GRADY
The New York Times
Originally posted January 9, 2014

In one way, the cases are polar opposites: the parents of Jahi McMath in Oakland, Calif., have fought to keep their daughter connected to a ventilator, while the parents and husband of Marlise Muñoz in Fort Worth, Tex., want desperately to turn the machine off. In another way, the cases are identical: both families have been shocked to learn that a loved one was declared brain-dead — and that hospital officials defied the family’s wishes for treatment.

Their wrenching stories raise questions about how brain death is determined, and who has the right to decide how such patients are treated.

The entire story is here.

The Ethics of Care: An Interview with Virginia Held

3:AM Magazine
Interview by Richard Marshall

Here are some excerpts:

3:AM: You’ve developed an ethical theory around ‘care.’ You see this as an alternative to the dominant ethical theories of the last couple of centuries. It’s important to you that it isn’t an ethics to be added on to Kantianism or utilitarianism or virtue ethics. Can you say something about why it is so important that a care ethics is not an adjunct but is a fresh start? The Kantian Christine Korsgaard has placed reciprocity and human relations at the heart of Kantianism. Onora O’Neill has argued that justice and care are not opposed. In the light of these views, would you still defend the break, or would you be happier to see it as a continuation?

VH: I don’t find it satisfactory merely to add some considerations of care to the traditional moral theories for reasons similar to why it is not enough to simply insert women into the traditional structures of society and politics built on gender domination. Feminists should understand that the structures themselves have to change. The history of ethics shows it to be a very biased enterprise. Very roughly, what men have done in public life has been deemed important and relevant to moral theory, and what women have done in the household has been considered irrelevant. I think it plausible to see Kantian ethics and utilitarianism as expansions to the whole of morality of what can be thought appropriate for law and for public policy.

I have come to see, in contrast, caring relations as the wider network, and the ethics of care as the comprehensive morality, within which we should develop legal and political institutions. Caring relations should be guided by the ethics of care, which we can best understand and which is most applicable in contexts of families and friendship. But we can and should also have weaker forms of caring relations with all persons, and within these, the more limited institutions of law should be guided, roughly, by Kantian norms, and the more limited political institutions by utilitarian ones. Yes I see the legal and political as importantly different, and both as significantly different from the contexts of family and friendship. This is a very oversimplified statement of a complex position but I try to clarify and delineate these matters in my written work.

3:AM: So ‘care’ is at the heart of this new ethic but it isn’t to replace justice. So how do you get from care to justice in your system? Do we end up losing the common use of ‘care’ for a more term of art, technical use, as is the wont with philosophers? And isn’t that a cheat?

VH: Yes, various Kantians are trying to acknowledge the concerns of care, and various philosophers interested in the ethics of care are trying to combine it with Kantian ethics. I think the ethics of care has the resources to be an alternative moral theory that can include persuasive aspects of Kantian ethics and also of utilitarianism and virtue theory. It’s nevertheless a feminist ethics that includes the goal of overcoming gender domination, in our thinking as well as our institutions. And I see it as the more comprehensive view. Korsgaard and O’Neill are still Kantians, though more persuasive ones than some traditional Kantians. I think ethics should start with a vast amount of experience (the experience of caring and being cared for) overlooked by traditional moral theories, and see how the many important and valid concerns of other moral theories can be brought into care ethics. I think it is a strength of care ethics that it is based on experience. It is experience which everyone has had: no one would have survived without enormous amounts of care, in childhood at least. Most women, and increasingly men, have also had a great deal of experience providing care, especially for children.

The entire interview is here.

Virginia Held has written: Feminist Morality: Transforming Culture, Society, and Politics, Justice and Care: Essential Reading in Feminist Ethics, and The Ethics of Care: Personal, Political and Global.