Antecedents and Consequences of Medical Students’ Moral Decision Making during Professionalism Dilemmas

Lynn Monrouxe, Malissa Shaw, and Charlotte Rees
AMA Journal of Ethics. June 2017, Volume 19, Number 6: 568-577.

Abstract

Medical students often experience professionalism dilemmas (which differ from ethical dilemmas) wherein students sometimes witness and/or participate in patient safety, dignity, and consent lapses. When faced with such dilemmas, students make moral decisions. If students’ action (or inaction) runs counter to their perceived moral values—often due to organizational constraints or power hierarchies—they can suffer moral distress, burnout, or a desire to leave the profession. If moral transgressions are rationalized as being for the greater good, moral distress can decrease as dilemmas are experienced more frequently (habituation); if no learner benefit is seen, distress can increase with greater exposure to dilemmas (disturbance). We suggest how medical educators can support students’ understandings of ethical dilemmas and facilitate their habits of enacting professionalism: by modeling appropriate resistance behaviors.

Here is an excerpt:

Rather than being a straightforward matter of doing the right thing, medical students’ understandings of morally correct behavior differ from one individual to another. This is partly because moral judgments frequently concern decisions about behaviors that might entail some form of harm to another, and different individuals hold different perspectives about moral trade-offs (i.e., how to decide between two courses of action when the consequences of both have morally undesirable effects). It is partly because the majority of human behavior arises within a person-situation interaction. Indeed, moral “flexibility” suggests that though we are motivated to do the right thing, any moral principle can bring forth a variety of context-dependent moral judgments and decisions. Moral rules and principles are abstract ideas—rather than facts—and these ideas need to be operationalized and applied to specific situations. Each situation will have different affordances highlighting one facet or another of any given moral value. Thus, when faced with morally dubious situations—such as being asked to participate in lapses of patient consent by senior clinicians during workplace learning events—medical students’ subsequent actions (compliance or resistance) differ.

The article is here.

A Robot Goes to College

Lindsay McKenzie
Inside Higher Ed
Originally published December 21, 2017

A robot called Bina48 has successfully taken a course in the philosophy of love at Notre Dame de Namur University, in California.

According to course instructor William Barry, associate professor of philosophy and director of the Mixed Reality Immersive Learning and Research Lab at NDNU, Bina48 is the world’s first socially advanced robot to complete a college course, a feat he described as “remarkable.” The robot took part in class discussions, gave a presentation with a student partner and participated in a debate with students from another institution.

(cut)

Barry said that working with Bina48 had been a valuable experience for him and his students. “We need to get over our existential fear about robots and see them as an opportunity,” he said. “If we approach artificial intelligence with a sense of the dignity and sacredness of all life, then we will produce robots with those same values,” he said.

The information is here.

Science and Morality

Jim Kozubek
Scientific American
Originally published December 27, 2017

Here is an excerpt:

The argument that genes embody a sort of sacrosanct character that should not be interfered with is not too compelling, since artifacts of viruses are burrowed in our genomes, and genes undergo mutations with each passing generation. Even so, the principle that all life has inherent dignity is hardly a bad thought and provides a necessary counterbalance to the impulse to use in vitro techniques and CRISPR to alter any gene variant to reduce risk or enhance features, none of which are more or less perfect but variations in human evolution.

Indeed, the question of dignity is thornier than we might imagine, since science tends to challenge the belief in abstract or enduring concepts of value. How to uphold beliefs or a sense of dignity seems ever confusing and appears to throw us up against an age of radical nihilism as scientists today are using the gene editing tool CRISPR to do things such as tinker with the color of butterfly wings, genetically alter pigs, even humans. If science is a method of truth-seeking, technology its mode of power and CRISPR is a means to the commodification of life. It also raises the possibility this power can erode societal trust. 

The article is here.

How AI & robotics are transforming social care, retail and the logistics industry

Benedict Dellot and Fabian Wallace-Stephens
RSA.org
Originally published September 18, 2017

Here is an excerpt:

The CHIRON project

CHIRON is a two year project funded by Innovate UK. It strives to design care robotics for the future with a focus on dignity, independence and choice. CHIRON is a set of intelligent modular robotic systems, located in multiple positions around the home. Among its intended uses are to help people with personal hygiene tasks in the morning, get ready for the day, and support them in preparing meals in the kitchen. CHIRON’s various components can be mixed and matched to enable the customer to undertake a wide range of domestic and self-care tasks independently, or to enable a care worker to assist an increased number of customers.

The vision for CHIRON is to move from an ‘end of life’ institutional model, widely regarded as unsustainable and not fit for purpose, to a more dynamic and flexible market that offers people greater choice in the care sector when they require it.

The CHIRON project is being managed by a consortium led by Designability. The key technology partners are Bristol Robotics Laboratory and Shadow Robot Company, who have considerable expertise in conducting pioneering research and development in robotics. Award winning social enterprise care provider, Three Sisters Care will bring user-centred design to the core of the project. Smart Homes & Buildings Association will work to introduce the range of devices that will create CHIRON and make it a valuable presence in people’s homes.

The article is here.

Antecedents and Consequences of Medical Students’ Moral Decision Making during Professionalism Dilemmas

Lynn Monrouxe, Malissa Shaw, and Charlotte Rees
AMA Journal of Ethics. June 2017, Volume 19, Number 6: 568-577.

Abstract

Medical students often experience professionalism dilemmas (which differ from ethical dilemmas) wherein students sometimes witness and/or participate in patient safety, dignity, and consent lapses. When faced with such dilemmas, students make moral decisions. If students’ action (or inaction) runs counter to their perceived moral values—often due to organizational constraints or power hierarchies—they can suffer moral distress, burnout, or a desire to leave the profession. If moral transgressions are rationalized as being for the greater good, moral distress can decrease as dilemmas are experienced more frequently (habituation); if no learner benefit is seen, distress can increase with greater exposure to dilemmas (disturbance). We suggest how medical educators can support students’ understandings of ethical dilemmas and facilitate their habits of enacting professionalism: by modeling appropriate resistance behaviors.

The article is here.

Dignity, Politics, and Medical Assistance in Dying

by Harry Critchley
Impact Ethics
Originally published June 6, 2016

Here is an excerpt:

A common problem with both of these approaches to understanding dignity, however, is the underlying assumption that dignity is best understood from a theoretical perspective. Another, more fruitful approach might be to examine the meaning of dignity with reference to its use in public discourse. On this view, to determine what dignity is requires that we ask what appeals to dignity are intended to do. Dignity is not only, or even primarily, appealed to in the solitude of philosophical contemplation, but rather in the company of others. Regardless of whether we understand dignity as sanctity of life or as autonomy, its emergence and acknowledgement in the political arena is an achievement not wholly dependent on its theoretical grounding.

The article is here.

Only two sexes?

By Sarah Graham
The Independent
Originally posted October 17, 2015

Here is an excerpt:

It’s not surprising so many people are ignorant about us intersex people: Our very existence has been erased since the Roman Empire. It continued in the 20th century, as doctors got their scalpels out to “normalise” our bodies. In the last fifteen years, since some of us started finding our dissident voices and protesting, doctors have tried to rebrand us and said we have “Disorders of Sexual Development (DSDs)” - to legitimize their paternalism and on-going annihilation of our beings.

This is all to keep you - the public - in the dark. And to rigidly enforce the pink and blue boxes: the boring binary, straight-laced order. But let me bring you up-to-speed. There are not only the two sexes of male and female. This is an absolute barefaced lie. Nature produces bodies on a spectrum; a continuum of possibilities.

You have met one of us somewhere, for sure. As many as 1 in 1,500 babies is born visibly intersex, while many more are born not so obviously unique and interesting to the eye.

The entire article is here.

Microaggression, macro harm

By Regina Rini
The Los Angeles Times
Originally published on October 15, 2015

Here is an excerpt:

There is a serious problem with Campbell and Manning's moral history, and exposing it helps us see that the culture of victimhood label is misleading. Their history is a history of the dominant moral culture: It describes the mores of those social groups with the greatest access to power. Think about the culture of honor and notice how limited it must have been. If you were a woman in medieval Europe, you were not expected or permitted to respond to insults with aggression. Even if you were a lower-class man, you certainly would not have drawn your sword in response to an insult from a superior.

Now think about the culture of dignity, which Campbell and Manning claim “existed perhaps in its purest form among respectable people in the homogenous towns of mid-20th century America.” Another thing that existed among the “respectable people” in those towns was approval of racial segregation; “homogenous towns” did not arise by accident.

People of color, women, gay people, immigrants: none could rely on the authorities to respond fairly to reports of mistreatment.

The cultures of honor and dignity left many types of people with no recognized way of responding to moral mistreatment.

The entire article is here.

Dignity is a useless concept

It means no more than respect for persons or their autonomy

By Ruth Macklin
BMJ. 2003 Dec 20; 327(7429): 1419–1420.
doi:  10.1136/bmj.327.7429.1419

Appeals to human dignity populate the landscape of medical ethics. Claims that some feature of medical research or practice violates or threatens human dignity abound, often in connection with developments in genetics or reproductive technology. But are such charges coherent? Is dignity a useful concept for an ethical analysis of medical activities? A close inspection of leading examples shows that appeals to dignity are either vague restatements of other, more precise, notions or mere slogans that add nothing to an understanding of the topic.

Possibly the most prominent references to dignity appear in the many international human rights instruments, such as the United Nations' universal declaration of human rights. With few exceptions, these conventions do not address medical treatment or research.

The entire article is here.

Modernizing Human Subjects Research Protections: Informed Consent for Genetic Research

Written by Nicolle Strand
blog.bioethics.gov
September 24, 2015

Here is an excerpt:

Despite these challenges, the Commission emphasized the importance of obtaining fully informed consent from all participants. Being asked to provide informed consent about the use of their data, the Commission argued, conveys respect to participants, separate and apart from their interest in preventing the unauthorized use or disclosure of their data. In other words—there is value to informed consent in and of itself, as it respects autonomy and personhood.

The entire blog post is here.

Note: The blog posts are short.  These are excellent resources from the Presidential Commission for the Study of Bioethical Issues.

Microaggression and Moral Cultures

By Bradley Campbell and Jason Manning
Comparative Sociology 13 (2014) 692–726

Here is an except:

A culture of victimhood is one characterized by concern with status and sensitivity to slight combined with a heavy reliance on third parties. People are intolerant of insults, even if unintentional, and react by bringing them to the attention of authorities or to the public at large. Domination is the main form of deviance, and victimization a way of attracting sympathy, so rather than emphasize either their strength or inner worth, the aggrieved emphasize their oppression and social marginalization. This culture shares some characteristics and conditions with the culture of dignity out of which it evolved, and it may even be viewed as a variant of this culture. It emerges in contemporary settings, such as college campuses, that increasingly lack the intimacy and cultural homogeneity that once characterized towns and suburbs, but in which organized authority and public opinion remain as powerful sanctions. Under such conditions complaint to third parties has supplanted both toleration
and negotiation. People increasingly demand help from others, and advertise their oppression as evidence that they deserve respect and assistance. Thus we might call this moral culture a culture of victimhood because the moral status of the victim, at its nadir in honor cultures, has risen to new heights.

The culture of victimhood is currently most entrenched on college campuses, where microaggression complaints are most prevalent. Other ways of campaigning for support from third parties and emphasizing one’s own oppression – from protest demonstrations to the invented victimization of
hate-crime hoaxes – are prevalent in this setting as well.

The entire article is here.

Microaggression and Changing Moral Cultures

By Bradley Campbell and Jason Manning
The Chronicle of Higher Education
Originally posted July 9, 2015

Here is an excerpt:

We can better understand complaints about microaggression and the reactions to them if we understand that each side of the debate draws from a different moral culture. Those calling attention to microaggressions have rejected the morality dominant among middle-class Americans during the 20th century — what sociologists and historians have sometimes called a dignity culture, which abhors private vengeance and encourages people to go to the police or use the courts when they are seriously harmed. Less serious offenses might be ignored, and certainly any merely verbal offense should be. Parents thus teach their children to say, "Sticks and stones may break my bones, but words can never hurt me."

Microaggression complaints make clear that this is no longer settled morality. Those who see microaggressions as a serious problem and who bring up minor and unintentional slights reject the idea that words can’t hurt, that slights should be brushed off, that even overt insults should be ignored. This attitude reveals the emergence of a new moral culture, one we call victimhood culture, since it valorizes victimhood.

Microaggression complaints are just one manifestation; from the same circles of campus activists also come calls for trigger warnings to alert sensitive students to course material that might disturb them, and the creation of "safe spaces" to shield students from offensive ideas.

The entire blog post is here.

Steven Pinker is right about biotech and wrong about bioethics

Bill Gardner
The Incidental Economist
Originally published August 7, 2015

Here is an excerpt:

First, even by newspaper op-ed standards this is lazily argued. Pinker attributes a host of opinions to bioethicists without quoting any bioethicist. He does not cite any cases to document that bioethicists’ concerns about long term consequences have impeded research and caused harms. There likely are such cases, but he writes as if they are common. I served for years on the University of Pittsburgh IRB. For better or worse, the long term risks of biomedical research were never even discussed.

Worse, Pinker brackets “dignity” and “social justice”* in sneer quotes, as if it were self-evident that affronts to these values do not fall into the class of “identifiable harms” and as if these concerns can be dismissed without any actual argument. The only normative framework that has weight, by his lights, are the mortality and morbidity of disease. Of course mortality and morbidity are exceptionally important. But if that is the only framework that matters to Pinker he is in a very small minority.

The entire critique is here.

Detox or lose your benefits

New welfare proposals are based on bad evidence and worse ethics

Ian Hamilton

The Conversation

Originally posted August 3, 2015

When is a choice not really a choice? It could be argued that the latest proposal from the government aimed at people who have problems with drugs and alcohol is not a choice but an ultimatum – accept help for your problem or lose your right to welfare benefits.

This proposal raises some very serious issues. Treating any condition is based on consent – the person should be willing to have the treatment. In this case, people have little choice and therefore they would probably be consenting to treatment to avoid losing money. This also passes on an ethical dilemma to treatment staff, who would need to decide if they are willing to participate in state-sponsored coercion.

The entire article is here.

The Evolutionary Roots of Morality and Professional Ethics

By John Gavazzi
Originally published in The Pennsylvania Psychologist

          Every aspect of human existence stems from biological and cultural evolution.  Even though evolutionary psychology is not a priority for clinical psychologists, the goal of this article is to highlight the evolutionary roots of human morals and professional ethics.  At the broadest level possible, morality is defined as the ability to differentiate between right and wrong or good and bad.  Most research in moral psychology highlights that many moral decisions are based on emotional responses and cognitive intuitions of right and wrong.  Moral judgments are typically affective, rapid, instinctive and unconscious.  The speedy cognitive processes and emotional responses are shortcuts intended to respond to environmental demands quickly and effectively.  Most individuals do not take long to determine if abortion is right or not; or if same-sex marriage is right or not.  How are our morals a function of evolution?

  Primatologist Frans de Waal (2013) attempted to answer this question in his book, The Bonobo and The Atheist.  The book is based on his work studying primates as well as other animals, like elephants.  According to de Waal, morality originated within animal relationships first, prior to homo sapiens culture.  He used observations to determine if there are any similarities between primates and humans in terms of morality.  Both are social creatures who depend on relationships to function more effectively in the world.  In order for primates to cooperate, form relationships, and work as groups, reciprocity and empathy are the two essential “pillars of morality” reported by de Wall.  Reciprocity encompasses the bidirectional nature of relationships, including concepts such as give and take, returning favors, and playing fairly.  Empathy, defined as the ability to understand and share the feelings of others, can occur at both the cognitive and affective levels.  In terms of cognitive empathy, a person or a primate needs to have the mental capacity to understand another group members’ perspective.  People and primates also need to gage or feel the emotions of others.  As an example of empathy, humans and primates can both see emotional pain in others, demonstrate distress at what they are witnessing, and seek to console the sufferer.

The entire article is here.

Do Killer Robots Violate Human Rights?

When machines are anthropomorphized, we risk applying a human standard that should not apply to mere tools.

By Patrick Lin
The Atlantic
Originally published April 20, 2015

Here is an excerpt:

What’s objectionable to many about lethal autonomous weapons systems is that, even if the weapons aim only at lawful targets, they seem to violate a basic right to life. This claim is puzzling at first, since killing is so commonplace and permitted in war. If you’re a combatant, you are legally liable to be killed at any time; so it’s unclear that there’s a right to life at all.

But what we mean is that, in armed conflicts, a right to life means a right not to be killed arbitrarily, unaccountably, or otherwise inhumanely. To better understand the claim, a right to life can be thought of as a right to human dignity. Human dignity is arguably more basic than a right to life, which can be more easily forfeited or trumped. For instance, even lawful executions should be humane in civilized society.

The entire article is here.

It’s All for Your Own Good

By Jeremy Waldron
The New York Book Review
Originally published on October 9, 2014

Here is an excerpt:

Nudging is an attractive strategy. People are faced with choices all the time, from products to pensions, from vacations to voting, from requests for charity to ordering meals in a restaurant, and many of these choices have to be made quickly or life would be overwhelming. For most cases the sensible thing is not to agonize but to use a rule of thumb—a heuristic is the technical term—to make the decision quickly. “If it ain’t broke don’t fix it,” “Choose a round number,” “Always order the special,” and “Vote the party line” are all heuristics. But the ones people use are good for some decisions and not others, and they have evolved over a series of past situations that may or may not resemble the important choices people currently face.

The entire article is here.

APA Member-Initiated Task Force to Reconcile Policies Related to Psychologists' Involvement in National Security Settings

The goal of this grassroots task force is to develop a clear, comprehensive policy statement that consolidates existing APA policies into a unified, consistent document. The consolidated policy document will highlight the following principles drawn from existing APA policies:

1. Torture is always a violation of human rights and psychologists' professional ethics;
2. Psychologists are always prohibited from engaging in torture or other cruel, inhuman, or degrading treatment or punishment;
3. Abusive interrogation techniques, such as waterboarding and sensory deprivation, constitute torture or cruel, inhuman, or degrading treatment or punishment and are always prohibited;
4. The role of psychologists in unlawful detention settings is limited to working on behalf of detainees or providing treatment for military personnel;
5. There is absolutely no defense to a violation of human rights under the APA Ethics Code.

The web page for this member-initiated task force is here.

Here is a copy of the proposed policy:

This is a policy recommendation related to psychologists' work in national security settings and reaffirmat...

'Modern Slavery' in England Is a Prevalent Problem, Report Suggests

By Science Daily
Originally published on July 2, 2013

The first evidence of widespread 'modern slavery' in England for refugees and asylum seekers is revealed in a study published today.

The two-year study calls for an overhaul of government policy to restore asylum seekers' right to work and ensure all workers can access basic employment rights, such as National Minimum Wage, irrespective of immigration status.

Dr Stuart Hodkinson from the University of Leeds, who co-authored of the study, said: "We found that in the majority of cases, if the asylum seeker had been able to work legally then the employer or agent would not have been able to exploit and abuse them to such an appalling extent."

The entire story is here.

The original report can be found at the link below:
PRECARIOUS LIVES: Experiences of forced labour among refugees and asylum seekers in England

Gag Orders on Sexuality

By Allie Grasgreen

Inside Higher Ed

Originally posted on May 23, 2013

When Brittney Griner, Baylor University’s star basketball player and one of the most celebrated athletes in the history of the sport, came out publicly as gay last month, she was rather nonchalant about it. She didn’t write a Sports Illustrated cover story – à la professional basketball player Jason Collins, a few weeks later – she just sort of mentioned it in media interviews. Griner is “someone who’s always been open,” she said, with family, friends and teammates.

But, as Griner revealed a few weeks later, she wasn’t allowed to be open as much as she might have liked. That’s because Baylor head coach Kim Mulkey told her and her teammates not to talk publicly about their sexuality.

“It was a recruiting thing,” Griner told ESPN. “The coaches thought that if it seemed like they condoned it, people wouldn’t let their kids come play for Baylor.”

Griner's account followed on the heels of speculation that her coming out signaled a new age at Baylor – a private Christian university whose nondiscrimination policy does not cover sexual orientation and whose student handbook entry for “sexual misconduct” includes as examples of inappropriate actions "homosexual behavior" and participation in “advocacy groups which promote understanding of sexuality that are contrary to biblical teaching.”

Read more here.