Transformative experience and the right to revelatory autonomy

Farbod Akhlaghi

Analysis

Originally Published: 31 December 2022

Abstract

Sometimes it is not us but those to whom we stand in special relations that face transformative choices: our friends, family or beloved. A focus upon first-personal rational choice and agency has left crucial ethical questions regarding what we owe to those who face transformative choices largely unexplored. In this paper I ask: under what conditions, if any, is it morally permissible to interfere to try to prevent another from making a transformative choice? Some seemingly plausible answers to this question fail precisely because they concern transformative experiences. I argue that we have a distinctive moral right to revelatory autonomy grounded in the value of autonomous self-making. If this right is outweighed then, I argue, interfering to prevent another making a transformative choice is permissible. This conditional answer lays the groundwork for a promising ethics of transformative experience.

Conclusion

Ethical questions regarding transformative experiences are morally urgent. A complete answer to our question requires ascertaining precisely how strong the right to revelatory autonomy is and what competing considerations can outweigh it. These are questions for another time, where the moral significance of revelation and self-making, the competing weight of moral and non-moral considerations, and the sense in which some transformative choices are more significant to one’s identity and self-making than others must be further explored.

But to identify the right to revelatory autonomy and duty of revelatory non-interference is significant progress. For it provides a framework to address the ethics of transformative experience that avoids complications arising from the epistemic peculiarities of transformative experiences. It also allows us to explain cases where we are permitted to interfere in another’s transformative choice and why interference in some choices is harder to justify than others, whilst recognizing plausible grounds for the right to revelatory autonomy itself in the moral value of autonomous self-making. This framework, moreover, opens novel avenues of engagement with wider ethical issues regarding transformative experience, for example concerning social justice or surrogate transformative choice-making. It is, at the very least, a view worthy of further consideration.

The info is here.

This reasoning applies to psychologists in psychotherapy.  Unless significant danger is present, psychologists need to avoid intrusive advocacy, meaning pulling autonomy away from the patient.  Soft paternalism can occur in psychotherapy, when trying to avoid significant harm.

Organs in exchange for freedom? Bill raises ethical concerns

Steve LeBlanc

Associated Press

Originally published 8 FEB 23

BOSTON (AP) — A proposal to let Massachusetts prisoners donate organs and bone marrow to shave time off their sentence is raising profound ethical and legal questions about putting undue pressure on inmates desperate for freedom.

The bill — which faces a steep climb in the Massachusetts Statehouse — may run afoul of federal law, which bars the sale of human organs or acquiring one for “valuable consideration.”

It also raises questions about whether and how prisons would be able to appropriately care for the health of inmates who go under the knife to give up organs. Critics are calling the idea coercive and dehumanizing even as one of the bill’s sponsors is framing the measure as a response to the over-incarceration of Hispanic and Black people and the need for matching donors in those communities.

“The bill reads like something from a dystopian novel,” said Kevin Ring, president of Families Against Mandatory Minimums, a Washington, D.C.-based criminal justice reform advocacy group. “Promoting organ donation is good. Reducing excessive prison terms is also good. Tying the two together is perverse.”

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Offering reduced sentences in exchange for organs is not only unethical, but also violates federal law, according to George Annas, director of the Center for Health Law, Ethics & Human Rights at the Boston University School of Public Health. Reducing a prison sentence is the equivalent of a payment, he said.

“You can’t buy an organ. That should end the discussion,” Annas said. “It’s compensation for services. We don’t exploit prisoners enough?”

Democratic state Rep. Carlos Gonzalez, another co-sponsor of the bill, defended the proposal, calling it a voluntary program. He also said he’s open to establishing a policy that would allow inmates to donate organs and bone marrow without the lure of a reduced sentence. There is currently no law against prisoner organ donation in Massachusetts, he said.

“It’s not quid pro quo. We are open to setting policy without incentives,” Gonzalez said, adding that it is “crucial to respect prisoners’ human dignity and agency by respecting their choice to donate bone marrow or an organ.”

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Yale Changes Mental Health Policies for Students in Crisis

William Wan

The Washington Post

Originally posted 18 JAN 23

Here are some excerpts:

In interviews with The Post, several students — who relied on Yale’s health insurance — described losing access to therapy and health care at the moment they needed it most.

The policy changes announced Wednesday reversed many of those practices.

By allowing students in mental crisis to take a leave of absence rather than withdraw, they will continue to have access to health insurance through Yale, university officials said. They can continue to work as a student employee, meet with career advisers, have access to campus and use library resources.

Finding a way to allow students to retain health insurance required overcoming significant logistical and financial hurdles, Lewis said, since New Haven and Connecticut are where most health providers in Yale’s system are located. But under the new policies, students on leave can switch to “affiliate coverage,” which would cover out-of-network care in other states.

In recent weeks, students and mental advocates questioned why Yale would not allow students struggling with mental health issues to take fewer classes. The new policies will now allow students to drop their course load to as low as two classes under special circumstances. But students can do so only if they require significant time for treatment and if their petition is approved.

In the past, withdrawn students had to submit an application for reinstatement, which included letters of recommendation, and proof they had remained “constructively occupied” during their time away. Under new policies, students returning from a medical leave of absence will submit a “simplified reinstatement request” that includes a letter from their clinician and a personal statement explaining why they left, the treatment they received and why they feel ready to return.

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In their updated online policies, the university made clear it still retained the right to impose an involuntary medical leave on students in cases of “a significant risk to the student’s health or safety, or to the health or safety of others.”

The changes were announced one day before Yale officials were scheduled to meet for settlement talks with the group of current and former students who filed a proposed class-action lawsuit against the university, demanding policy changes. 

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In a statement, one of the plaintiffs — a nonprofit group called Elis for Rachael, led by former Yale students — said they are still pushing for more to be done: “We remain in negotiations. We thank Yale for this first step. But if Yale were to receive a grade for its work on mental health, it would be an incomplete at best.”

But after decades of mental health advocacy with little change at the university, some students said they were surprised at the changes Yale has made already.

“I really didn’t think it would happen during my time here,” said Akweley Mazarae Lartey, a senior at Yale who has advocated for mental rights throughout his time at the school. 

“I started thinking of all the situations that I and people I care for have ended up in and how much we could have used these policies sooner.”

The info is here.

Ethics Consult: Keep Patient Alive Due to Spiritual Beliefs?

Jacob M. Appel

MedPageToday

Originally posted 28 Jan 23

Welcome to Ethics Consult -- an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true, but anonymized, patient care case. You vote on your decision in the case and, next week, we'll reveal how you all made the call. Bioethicist Jacob M. Appel, MD, JD, will also weigh in with an ethical framework to help you learn and prepare.

The following case is adapted from Appel's 2019 book, Who Says You're Dead? Medical & Ethical Dilemmas for the Curious & Concerned.

Alexander is a 49-year-old man who comes to a prominent teaching hospital for a heart transplant. While awaiting the transplant, he is placed on a machine called a BIVAD, or biventricular assist device -- basically, an artificial heart the size of a small refrigerator to tide him over until a donor heart becomes available. While awaiting a heart, he suffers a severe stroke.

The doctors tell his wife, Katie, that no patient who has suffered such a severe stroke has ever regained consciousness and that Alexander is no longer a candidate for transplant. They would like to turn off the BIVAD and allow nature to take its course.

Not lost on these doctors is that Alexander occupies a desperately needed ICU bed, which could benefit other patients, and that his care costs the healthcare system upwards of $10,000 a day. The doctors are also aware than Alexander could survive for years on the BIVAD and the other machines that are now helping to keep him alive: a ventilator and a dialysis machine.

Katie refuses to yield to the request. "I realize he has no chance of recovery," she says. "But Alexander believed deeply in reincarnation. What mattered most to him was that he die at the right moment -- so that his soul could return to Earth in the body for which it was destined. To him, that would have meant keeping him on the machines until all brain function ceases, even if it means decades. I feel obligated to honor those wishes."

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Abortion Access Tied to Suicide Rates Among Young Women

Michael DePeau-Wilson

MedPage Today

Originally posted 28 DEC 22

Restrictions on access to reproductive care were associated with suicide rates among women of reproductive age, researchers found.

In a longitudinal ecologic study using state-based data from 1974 to 2016, enforcement of Targeted Regulation of Abortion Providers (TRAP) laws was associated with higher suicide rates among reproductive-age women (β=0.17, 95% CI 0.03-0.32, P=0.02) but not among women of post-reproductive age, according to Ran Barzilay, MD, PhD, of the University of Pennsylvania in Philadelphia, and colleagues.

Nor was enforcement of TRAP laws associated with deaths due to motor vehicle crashes, they reported in JAMA Psychiatry in a new tab or window.

Additionally, enforcement of a TRAP law was associated with a 5.81% higher annual rate of suicide than in pre-enforcement years, the researchers found.

"Taken together, the results suggest that the association between restricting access to abortion and suicide rates is specific to the women who are most affected by this restriction, which are young women," Barzilay told MedPage Today.

Barzilay said their study "can inform, number one, clinicians working with young women to be aware that this is a macro-level suicide risk factor in this population. And number two, that it informs policymakers as they allocate resources for suicide prevention. And number three, that it informs the ethical, divisive debate regarding access to abortion."

In an accompanying editorial, Tyler VanderWeele, PhD, of Harvard T.H. Chan School of Public Health in Boston, wrote that while analyses of this type are always subject to the possibility of changes in trends being attributable to some third factor, Barzilay and colleagues did "control for a number of reasonable candidates and conducted sensitivity analyses indicating that these associations were observed for reproductive-aged women but not for a control group of older women of post-reproductive age."

VanderWeele wrote the findings do suggest that a "not inconsiderable" number of women might be dying by suicide in part because of a lack of access to abortion services, and that "the increase is cause for clinical concern."

But while more research "might contribute more to our understanding," VanderWeele wrote, its role in the legal debates around abortion "seems less clear. Regardless of whether one is looking at potential adverse effects of access restrictions or of abortion, the abortion and mental health research literature will not resolve the more fundamental and disputed moral questions."

"Debates over abortion access are likely to remain contentious in this country and others," he wrote. "However, further steps can nevertheless be taken in finding common ground to promote women's mental health and healthcare."

For their "difference-in-differences" analysis, Barzilay and co-authors relied on data from the TRAP laws index to measure abortion access, and assessed suicide data from CDC's WONDER database in a new tab or window database.

The info is here.

UCSF Issues Report, Apologizes for Unethical 1960-70’s Prison Research

Restorative Justice Calls for Continued Examination of the Past

Laura Kurtzman

Press Release

Originally posted 20 DEC 22

Recognizing that justice, healing and transformation require an acknowledgment of past harms, UCSF has created the Program for Historical Reconciliation (PHR). The program is housed under the Office of the Executive Vice Chancellor and Provost, and was started by current Executive Vice Chancellor and Provost, Dan Lowenstein, MD.

The program’s first report, released this month, investigates experiments from the 1960s and 1970s involving incarcerated men at the California Medical Facility (CMF) in Vacaville. Many of these men were being assessed or treated for psychiatric diagnoses.

The research reviewed in the report was performed by Howard Maibach, MD, and William Epstein, MD, both faculty in UCSF’s Department of Dermatology. Epstein was a former chair of the department who died in 2006. The committee was asked to focus on the work of Maibach, who remains an active member of the department.

Some of the experiments exposed research subjects to pesticides and herbicides or administered medications with side effects. In all, some 2,600 incarcerated men were experimented on.

The men volunteered for the studies and were paid for participating. But the report raises ethical concerns over how the research was conducted. In many cases there was no record of informed consent. The subjects also did not have any of the medical conditions that any of the experiments could have potentially treated or ameliorated.

Such practices were common in the U.S. at the time and were increasingly being criticized both by experts and in the lay press. The research continued until 1977, when the state of California halted all human subject research in state prisons, a year after the federal government did the same.

The report acknowledges that Maibach was working during a time when the governance of human subjects research was evolving, both at UCSF and at institutions across the country. Over a six-month period, the committee gathered some 7,000 archival documents, medical journal articles, interviews, documentaries and books, much of which has yet to be analyzed. UCSF has acknowledged that it may issue a follow-up report.

The report found that “Maibach practiced questionable research methods. Archival records and published articles have failed to show any protocols that were adopted regarding informed consent and communicating research risks to participants who were incarcerated.”

In a review of publications between 1960 and 1980, the committee found virtually all of Maibach’s studies lacked documentation of informed consent despite a requirement for formal consent instituted in 1966 by the newly formed Committee on Human Welfare and Experimentation. Only one article, published in 1975, indicated the researchers had obtained informed consent as well as approval from UCSF’s Committee for Human Research (CHR), which began in 1974 as a result of new federal requirements.

The pressor is here.

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.

The research is here.

The AI Ethicist's Dirty Hands Problem

H. S. Sætra, M. Coeckelbergh, & J. Danaher

Communications of the ACM, January 2023, 

Vol. 66 No. 1, Pages 39-41

Assume an AI ethicist uncovers objectionable effects related to the increased usage of AI. What should they do about it? One option is to seek alliances with Big Tech in order to "borrow" their power to change things for the better. Another option is to seek opportunities for change that actively avoids reliance on Big Tech.

The choice between these two strategies gives rise to an ethical dilemma. For example, if the ethicist's research emphasized the grave and unfortunate consequences of Twitter and Facebook, should they promote this research by building communities on said networks? Should they take funding from Big Tech to promote the reform of Big Tech? Should they seek opportunities at Google or OpenAI if they are deeply concerned about the negative implications of large-scale language models?

The AI ethicist’s dilemma emerges when an ethicist must consider how their success in communicating an

identified challenge is associated with a high risk of decreasing the chances of successfully addressing the challenge.  This dilemma occurs in situations in which the means to achieve one’s goals are seemingly best achieved by supporting that which one wishes to correct and/or practicing the opposite of that which one preaches.

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The Need for More than AI Ethics

Our analysis of the ethicist’s dilemma shows why close ties with Big Tech can be detrimental for the ethicist seeking remedies for AI related problems.   It is important for ethicists, and computer scientists in general, to be aware of their links to the sources of ethical challenges related to AI.  One useful exercise would be to carefully examine what could happen if they attempted to challenge the actors with whom they are aligned. Such actions could include attempts to report unfortunate implications of the company’s activities internally, but also publicly, as Gebru did. Would such actions be met with active resistance, with inaction, or even straightforward sanctions? Such an exercise will reveal whether or not the ethicist feels free to openly and honestly express concerns about the technology with which they work. Such an exercise could be important, but as we have argued, these individuals are not necessarily positioned to achieve fundamental change in this system.

In response, we suggest the role of government is key to balancing the power the tech companies have

through employment, funding, and their control of modern digital infrastructure. Some will rightly argue that political power is also dangerous.   But so are the dangers of technology and unbridled innovation, and private corporations are central sources of these dangers. We therefore argue that private power must be effectively bridled by the power of government.  This is not a new argument, and is in fact widely accepted.

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Individuals prefer to harm their own group rather than help an opposing group

Rachel Gershon and Ariel Fridman

PNAS, 119 (49) e2215633119

https://doi.org/10.1073/pnas.221563311

Abstract

Group-based conflict enacts a severe toll on society, yet the psychological factors governing behavior in group conflicts remain unclear. Past work finds that group members seek to maximize relative differences between their in-group and out-group (“in-group favoritism”) and are driven by a desire to benefit in-groups rather than harm out-groups (the “in-group love” hypothesis). This prior research studies how decision-makers approach trade-offs between two net-positive outcomes for their in-group. However, in the real world, group members often face trade-offs between net-negative options, entailing either losses to their group or gains for the opposition. Anecdotally, under such conditions, individuals may avoid supporting their opponents even if this harms their own group, seemingly inconsistent with “in-group love” or a harm minimizing strategy. Yet, to the best of our knowledge, these circumstances have not been investigated. In six pre-registered studies, we find consistent evidence that individuals prefer to harm their own group rather than provide even minimal support to an opposing group across polarized issues (abortion access, political party, gun rights). Strikingly, in an incentive-compatible experiment, individuals preferred to subtract more than three times as much from their own group rather than support an opposing group, despite believing that their in-group is more effective with funds. We find that identity concerns drive preferences in group decision-making, and individuals believe that supporting an opposing group is less value-compatible than harming their own group. Our results hold valuable insights for the psychology of decision-making in intergroup conflict as well as potential interventions for conflict resolution.

Significance

Understanding the principles guiding decisions in intergroup conflicts is essential to recognizing the psychological barriers to compromise and cooperation. We introduce a novel paradigm for studying group decision-making, demonstrating that individuals are so averse to supporting opposing groups that they prefer equivalent or greater harm to their own group instead. While previous models of group decision-making claim that group members are driven by a desire to benefit their in-group (“in-group love”) rather than harm their out-group, our results cannot be explained by in-group love or by a harm minimizing strategy. Instead, we propose that identity concerns drive this behavior. Our theorizing speaks to research in psychology, political theory, and negotiations by examining how group members navigate trade-offs among competing priorities.

From the Conclusion

We synthesize prior work on support-framing and propose the Identity-Support model, which can parsimoniously explain our findings across win-win and lose-lose scenarios. The model suggests that individuals act in group conflicts to promote their identity, and they do so primarily by providing support to causes they believe in (and avoid supporting causes they oppose; see also SI Appendix, Study S1). Simply put, in win-win contexts, supporting the in-group is more expressive of one’s identity as a group member than harming the opposing group, thereby leading to a preference for in-group support. In lose-lose contexts, supporting the opposing group is more negatively expressive of one’s identity as a group member than harming the in-group, resulting in a preference for in-group harm. Therefore, the principle that individuals make decisions in group conflicts to promote and protect their identity, primarily by allocating their support in ways that most align with their values, offers a single framework that predicts individual behavior in group conflicts in both win-win and lose-lose contexts.

The research is here.

San Francisco will allow police to deploy robots that kill

Janie Har

Associated Press

Originally posted 29 Nov 22

Supervisors in San Francisco voted Tuesday to give city police the ability to use potentially lethal, remote-controlled robots in emergency situations -- following an emotionally charged debate that reflected divisions on the politically liberal board over support for law enforcement.

The vote was 8-3, with the majority agreeing to grant police the option despite strong objections from civil liberties and other police oversight groups. Opponents said the authority would lead to the further militarization of a police force already too aggressive with poor and minority communities.

Supervisor Connie Chan, a member of the committee that forwarded the proposal to the full board, said she understood concerns over use of force but that “according to state law, we are required to approve the use of these equipments. So here we are, and it’s definitely not a easy discussion.”

The San Francisco Police Department said it does not have pre-armed robots and has no plans to arm robots with guns. But the department could deploy robots equipped with explosive charges “to contact, incapacitate, or disorient violent, armed, or dangerous suspect” when lives are at stake, SFPD spokesperson Allison Maxie said in a statement.

“Robots equipped in this manner would only be used in extreme circumstances to save or prevent further loss of innocent lives,” she said.

Supervisors amended the proposal Tuesday to specify that officers could use robots only after using alternative force or de-escalation tactics, or concluding they would not be able to subdue the suspect through those alternative means. Only a limited number of high-ranking officers could authorize use of robots as a deadly force option.

The info is here.

How Bullying Manifests at Work — and How to Stop It

Ludmila N. Praslova, Ron Carucci, & Caroline Stokes

Harvard Business Review

Originally posted 4 NOV 22

While the organizational costs of incivility and toxicity are well documented, bullying at work is still a problem. An estimated 48.6 million Americans, or about 30% of the workforce, are bullied at work. In India, that percentage is reported to be as high as 46% or even 55%. In Germany, it’s a lower but non-negligible 17%. Yet bullying often receives little attention or effective action.

To maximize workplace health and well-being, it’s critical to create workplaces where all employees — regardless of their position — are safe. Systemic, organizational-level approaches can help prevent the harms associated with different types of bullying.

The term workplace bullying describes a wide range of behaviors, and this complexity makes addressing it difficult and often ineffective. Here, we’ll discuss the different types of bullying, the myths that prevent leaders from addressing it, and how organizations can effectively intervene and create a safer workplace.

The Different Types of Bullying

To develop more comprehensive systems of bullying prevention and support employees’ psychological well-being, leaders first need to be aware of the different types of bullying and how they show up. We’ve identified 15 different features of bullying, based on standard typologies of aggression, data from the Workplace Bullying Institute (WBI), and Ludmila’s 25+ years of research and practice focused on addressing workplace aggression, discrimination, and incivility to create healthy organizational cultures.

These 15 features can be mapped to some of the common archetypes of bullies. Take the “Screamer,” who is associated with yelling and fist-banging or the quieter but equally dangerous “Schemer” who uses Machiavellian plotting, gaslighting, and smear campaigns to strip others of resources or push them out. The Schemer doesn’t necessarily have a position of legitimate power and can present as a smiling and eager-to-help colleague or even an innocent-looking intern. While hostile motivation and overt tactics align with the Screamer bully archetype and instrumental, indirect, and covert bullying is typical of the Schemer, a bully can have multiple motives and use multiple tactics — consciously or unconsciously.

Caroline mediated a situation that illustrates both conscious and unconscious dynamics. At the reception to celebrate Ewa’s* national-level achievement award, Harper, her coworker, spent most of the time talking about her own accomplishments, then took the stage to congratulate herself on mentoring Ewa and letting her take “ownership” of their collective work. But there had been no mentorship or collective work. After overtly and directly putting Ewa down and (perhaps unconsciously) attempting to elevate herself, Harper didn’t stop. She “accidentally” removed Ewa from crucial information distribution lists — an act of indirect, covert sabotage.  

In another example, Ludmila encountered a mixed-motive, mixed-tactic situation. Charles, a manager with a strong xenophobic sentiment, regularly berated Noor, a work visa holder, behind closed doors — an act of hostile and direct bullying. Motivated by a desire to take over the high-stakes, high-visibility projects Noor had built, Charles also engaged in indirect, covert bullying by falsifying performance records to make a case for her dismissal.

The info is here.

‘What if Yale finds out?’

William Wan

The Washington Post

Originally posted November 11, 2022

Suicidal students are pressured to withdraw from Yale, then have to apply to get back into the university

Here are two excerpt:

‘Getting rid of me’

Five years before the pandemic derailed so many college students’ lives, a 20-year-old math major named Luchang Wang posted this message on Facebook:

“Dear Yale, I loved being here. I only wish I could’ve had some time. I needed time to work things out and to wait for new medication to kick in, but I couldn’t do it in school, and I couldn’t bear the thought of having to leave for a full year, or of leaving and never being readmitted. Love, Luchang.”

Wang had withdrawn from Yale once before and feared that under Yale’s policies, a second readmission could be denied.

Instead, she flew to San Francisco, and, according to authorities, climbed over the railing at the Golden Gate Bridge and jumped to her death.

Her 2015 suicide sparked demands for change at Yale. Administrators convened a committee to evaluate readmission policies, but critics said the reforms they adopted were minor.

They renamed the process “reinstatement” instead of “readmission,” eliminated a $50 reapplication fee and gave students a few more days at the beginning of each semester to take a leave of absence without having to reapply.

Students who withdrew still needed to write an essay, secure letters of recommendation, interview with Yale officials and prove their academic worth by taking two courses at another four-year university. Those who left for mental health reasons also had to demonstrate to Yale that they’d addressed their problems.

In April — nearly 10 months after S. had been pressured to withdraw — Yale officials announced another round of changes to the reinstatement process. 

They eliminated the requirement that students pass two courses at another university and got rid of a mandatory interview with the reinstatement committee.

The reforms have not satisfied student activists at Yale, where the mental health problems playing out on many American campuses has been especially prominent.

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In recent years, Yale has also faced an “explosion” in demand for mental health counseling, university officials said. Last year, roughly 5,000 Yale students sought treatment — a 90 percent increase compared with 2015.

“It’s like nothing we’ve ever seen before,” said Hoffman, the director of Yale Mental Health and Counseling. Roughly 34 percent of the 14,500 students at 

Yale seek mental health help from college counselors, compared with a national average of 11 percent at other universities.

Meeting that need has been challenging, even at a school with a $41.4 billion endowment.

Bluebelle Carroll, 20, a Yale sophomore who sought help in September 2021, said she waited six months to be assigned a therapist. She secured her first appointment only after emailing the counseling staff repeatedly.

“The appointment was 20 minutes long,” she said, “and we spent the last five minutes figuring out when he could see me again.”

Because of staffing constraints, students are often asked to choose between weekly therapy that lasts 30 minutes or 45-minute sessions every two weeks.

The info is here.

Institutional betrayal, institutional courage and the church

Susan Shaw

Baptist News Global

Originally published 26 JUL 22

Betrayal by trusted people, like pastors, teachers, supervisors and coaches can inflict devastating consequences on victims. According to psychologists who study trauma, betrayal trauma affects the brain differently than any other trauma, particularly when the victim depends upon the perpetrator. Betrayal trauma threatens the very sense of self of the victim, who often cannot easily escape because of physical, psychological or spiritual dependence.

Institutional betrayal

When institutions don’t address perpetrators but rather meet survivors with denial, harassment and attack, they engage in institutional betrayal. Institutional betrayal occurs “when an institution causes harm to people who depend on it.”

Betrayal blindness describes ignoring, overlooking, “not-knowing” and forgetting betrayal. People, including victims themselves as well as perpetrators and witnesses, exhibit betrayal blindness to “preserve relationships, institutions and social systems upon which they depend.”

We don’t have to think very long to name a depressing list of instances of institutional betrayal by the church: segregation, clergy sex abuse, conversion therapy, exclusion of women from church leadership and ordained ministry, purity culture, the Magdalene laundries, witch hunts, Indian schools, on and on.

In recent days, we’ve seen institutional betrayal at work in megachurches like Hillsong and Highpoint, where popular pastors engaged in abusive conduct and their churches enabled them. The clergy abuse scandals in the Catholic Church and Southern Baptist Convention are textbook examples of institutional betrayal — institutions that chose to protect themselves rather than address the harm done to members.

Rather than challenging itself to create welcome, repair harm and do justice, the church often has chosen to preserve itself, to overlook harmful behavior by leaders and to demonize and ostracize those who speak out against abuse

Findley Edge, who taught religious education at Southern Baptist Theological Seminary, wrote about the process of institutionalization. Edge explained people developed great and exciting ideas, and these ideas lead to innovations and movements. As time goes along, these innovations and movements develop structure to continue to facilitate their growth. Eventually, the first generation that formed the great and exciting idea dies out, and soon people only know the institution and not the idea that sparked it. Their goal then becomes preservation of the institution, not the idea.

Uncritical dedication to the preservation of an institution can easily lead to institutional betrayal, especially when people depend upon organizations like the church, work or family.

Jennifer Freyd, the psychologist who coined “institutional betrayal,” says people protect institutions by participating in what she calls DARVO — Deny, Attack and Reverse Victim and Offender.

The info is here.

How the Classics Changed Research Ethics

Scott Sleek

Psychological Science

Originally posted 31 AUG 22

Here is an excerpt:

Social scientists have long contended that the Common Rule was largely designed to protect participants in biomedical experiments—where scientists face the risk of inducing physical harm on subjects—but fits poorly with the other disciplines that fall within its reach.

“It’s not like the IRBs are trying to hinder research. It’s just that regulations continue to be written in the medical model without any specificity for social science research,” she explained. 

The Common Rule was updated in 2018 to ease the level of institutional review for low-risk research techniques (e.g., surveys, educational tests, interviews) that are frequent tools in social and behavioral studies. A special committee of the National Research Council (NRC), chaired by APS Past President Susan Fiske, recommended many of those modifications. Fisher was involved in the NRC committee, along with APS Fellows Richard Nisbett (University of Michigan) and Felice J. Levine (American Educational Research Association), and clinical psychologist Melissa Abraham of Harvard University. But the Common Rule reforms have yet to fully expedite much of the research, partly because the review boards remain confused about exempt categories, Fisher said.  

Interference or support? 

That regulatory confusion has generated sour sentiments toward IRBs. For decades, many social and behavioral scientists have complained that IRBs effectively impede scientific progress through arbitrary questions and objections. 

In a Perspectives on Psychological Science paper they co-authored, APS Fellows Stephen Ceci of Cornell University and Maggie Bruck of Johns Hopkins University discussed an IRB rejection of their plans for a study with 6- to 10-year-old participants. Ceci and Bruck planned to show the children videos depicting a fictional police officer engaging in suggestive questioning of a child.  

“The IRB refused to approve the proposal because it was deemed unethical to show children public servants in a negative light,” they wrote, adding that the IRB held firm on its rejection despite government funders already having approved the study protocol (Ceci & Bruck, 2009). 

Other scientists have complained the IRBs exceed their Common Rule authority by requiring review of studies that are not government funded. In 2011, psychological scientist Jin Li sued Brown University in federal court for barring her from using data she collected in a privately funded study on educational testing. Brown’s IRB objected to the fact that she paid her participants different amounts of compensation based on need. (A year later, the university settled the case with Li.) 

In addition, IRBs often hover over minor aspects of a study that have no genuine relation to participant welfare, Ceci said in an email interview.  

The article is here.

A Call to Surrender: A Human Dignity Approach to Russian Citizens Kidnapped to Serve

From Ukraine's Department of Defense
 

Preventing an AI-related catastrophe

Benjamin Hilton

8000 Hours

Originally Published August 25th, 2022

Summary

We expect that there will be substantial progress in AI in the next few decades, potentially even to the point where machines come to outperform humans in many, if not all, tasks. This could have enormous benefits, helping to solve currently intractable global problems, but could also pose severe risks. These risks could arise accidentally (for example, if we don’t find technical solutions to concerns about the safety of AI systems), or deliberately (for example, if AI systems worsen geopolitical conflict). We think more work needs to be done to reduce these risks.

Some of these risks from advanced AI could be existential — meaning they could cause human extinction, or an equally permanent and severe disempowerment of humanity. There have not yet been any satisfying answers to concerns — discussed below — about how this rapidly approaching, transformative technology can be safely developed and integrated into our society. Finding answers to these concerns is very neglected, and may well be tractable. We estimate that there are around 300 people worldwide working directly on this.3 As a result, the possibility of AI-related catastrophe may be the world’s most pressing problem — and the best thing to work on for those who are well-placed to contribute.

Promising options for working on this problem include technical research on how to create safe AI systems, strategy research into the particular risks AI might pose, and policy research into ways in which companies and governments could mitigate these risks. If worthwhile policies are developed, we’ll need people to put them in place and implement them. There are also many opportunities to have a big impact in a variety of complementary roles, such as operations management, journalism, earning to give, and more — some of which we list below.

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When can we expect transformative AI?

It’s difficult to predict exactly when we will develop AI that we expect to be hugely transformative for society (for better or for worse) — for example, by automating all human work or drastically changing the structure of society. But here we’ll go through a few approaches.

One option is to survey experts. Data from the 2019 survey of 300 AI experts implies that there is 20% probability of human-level machine intelligence (which would plausibly be transformative in this sense) by 2036, 50% probability by 2060, and 85% by 2100. There are a lot of reasons to be suspicious of these estimates,8 but we take it as one data point.

Ajeya Cotra (a researcher at Open Philanthropy) attempted to forecast transformative AI by comparing modern deep learning to the human brain. Deep learning involves using a huge amount of compute to train a model, before that model is able to perform some task. There’s also a relationship between the amount of compute used to train a model and the amount used by the model when it’s run. And — if the scaling hypothesis is true — we should expect the performance of a model to predictably improve as the computational power used increases. So Cotra used a variety of approaches (including, for example, estimating how much compute the human brain uses on a variety of tasks) to estimate how much compute might be needed to train a model that, when run, could carry out the hardest tasks humans can do. She then estimated when using that much compute would be affordable.

Cotra’s 2022 update on her report’s conclusions estimates that there is a 35% probability of transformative AI by 2036, 50% by 2040, and 60% by 2050 — noting that these guesses are not stable.22

Tom Davidson (also a researcher at Open Philanthropy) wrote a report to complement Cotra’s work. He attempted to figure out when we might expect to see transformative AI based only on looking at various types of research that transformative AI might be like (e.g. developing technology that’s the ultimate goal of a STEM field, or proving difficult mathematical conjectures), and how long it’s taken for each of these kinds of research to be completed in the past, given some quantity of research funding and effort.

Davidson’s report estimates that, solely on this information, you’d think that there was an 8% chance of transformative AI by 2036, 13% by 2060, and 20% by 2100. However, Davidson doesn’t consider the actual ways in which AI has progressed since research started in the 1950s, and notes that it seems likely that the amount of effort we put into AI research will increase as AI becomes increasingly relevant to our economy. As a result, Davidson expects these numbers to be underestimates.

The info is here.

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.

The info is here.

Seven years of sex abuse: How Mormon officials let it happen

Michael Rezendes

The Associated Press

Originally posted 4 AUG 22

Here is an excerpt:

When it comes to child sexual abuse, the Mormon church says “the first responsibility of the church in abuse cases is to help those who have been abused and protect those who may be vulnerable to future abuse,” according to its 2010 handbook for church leaders. The handbook also says, “Abuse cannot be tolerated in any form.”

But church officials, from the bishops in the Bisbee ward to officials in Salt Lake City, tolerated abuse in the Adams family for years.

“They just let it keep happening,” said MJ, in her AP interview. “They just said, ‘Hey, let’s excommunicate her father.’ It didn’t stop. ‘Let’s have them do therapy.’ It didn’t stop. ‘Hey, let’s forgive and forget and all this will go away.’ It didn’t go away.”

A similar dynamic played out in West Virginia, where church leaders were accused of covering up the crimes committed by a young abuser from a prominent Mormon family even after he’d been convicted on child sex abuse charges in Utah. The abuser, Michael Jensen, today is serving a 35- to 75-year prison sentence for abusing two children in West Virginia. Their family, along with others, sued the church and settled out of court for an undisclosed sum.

“Child abuse festers and grows in secrecy,” said Lynne Cadigan, a lawyer for the Adams children who filed suit. “That is why the mandatory reporting came into effect. It’s the most important thing in the world to immediately report to the police.”

The lawsuit filed by the three Adams children accuses The Church of Jesus Christ of Latter-day Saints and several members, including Bishops Herrod and Mauzy, of negligence and conspiring to cover up child sex abuse to avoid “costly lawsuits” and protect the reputation of the church, which relies on proselytizing and tithing to attract new members and raise money. In 2020, the church claimed approximately 16 million members worldwide, most of them living outside the United States.

“The failure to prevent or report abuse was part of the policy of the defendants, which was to block public disclosure to avoid scandals, to avoid the disclosure of their tolerance of child sexual molestation and assault, to preserve a false appearance of propriety, and to avoid investigation and action by public authority, including law enforcement,” the suit alleges. “Plaintiffs are informed and believe that such actions were motivated by a desire to protect the reputation of the defendants.”

Very few of the scores of lawsuits against The Church of Jesus Christ of Latter-day Saints mention the help line, in part because details of its operations have been a closely guarded secret. The documents in the sealed court records show how it works.

“The help line is certainly there to help — to help the church keep its secrets and to cover up abuse,” said Craig Vernon, an Idaho attorney who has filed several sex abuse lawsuits against the church.

Vernon, a former member, routinely demands that the church require bishops to report sex abuse to police or state authorities rather than the help line.

The sealed records say calls to the help line are answered by social workers or professional counselors who determine whether the information they receive is serious enough to be referred to an attorney with Kirton McConkie, a Salt Lake City firm that represents the church.

The info is here.

Morally Exhausted: Why Russian Soldiers are Refusing to Fight in the Unprovoked War on Ukraine

Tіmofеі Rоzhаnskіy

Syndicated

Originally posted 23 July 22

Here is an excerpt:

I Had To Refuse So I Could Stay Alive

Russia’s troops in Ukraine are largely made up of contract soldiers: volunteer personnel who sign fixed-term contracts for service. The range of experience varies. Other units include troops from private military companies like Vagner, or specialized, semiautonomous units overseen by Chechnya’s strongman leader, Ramzan Kadyrov.

The discontent in Kaminsky’s 11th Brigade is not an isolated case, and there are indications that Russian commanders are trying different tactics to keep the problem from spiraling out of control: for example, publicly shaming soldiers who are refusing to fight.

In Buryatia, where the 11th Brigade is based, dozens of personnel have sought legal assistance from local activists, seeking to break their contracts and get out of service in Ukraine, for various reasons.

In the southern Russian town of Budyonnovsk, on the home base for the 205th Cossack Motorized Rifle Brigade, commanders have erected a “wall of shame” with the names, ranks, and photographs of some 300 soldiers who have disobeyed orders in the Ukraine war.

“They forgot their military oaths, the ceremonial promise, their vows of duty to their Fatherland,” the board reads.

In conversations via the Russian social media giant VK, several soldiers from the brigade disputed the circumstances behind their inclusion on the wall of shame. All asked that their names be withheld for fear of further punishment or retaliation by commanders.

“I understand everything, of course. I signed a contract. I’m supposed to be ready for any situation; this war, this special operation,” one soldier wrote. “But I was thinking, I’m still young; at any moment, a piece of shrapnel, a bullet could fly into my head.”

The soldier said he broke his contract and resigned from the brigade before the February 24 invasion, once he realized it was in fact going forward.

“I thought a long time about it and came to the decision. I understood that I had to refuse so I could stay alive,” he said. “I don’t regret it one bit.”

The article is here.

South Carolina bill permits health care providers refuse non-emergency care based on beliefs

Brooke Migdon

The Hill

Originally posted 1 APR 22

Story at a glance

• Legislators in South Carolina on Friday passed a bill which would allow healthcare providers to deny care based on their personal beliefs. It would also apply to insurance companies, which may be entitled to refuse to pay for care.

• The bill would also protect those who decline to provide medical services from civil, criminal or administrative liability.

• Some say the bill, known as the “Medical Ethics and Diversity Act,” would disproportionately affect the LGBTQ+ community, as well as women and people of color.

South Carolina lawmakers on Friday passed a bill allowing medical professionals and insurance companies to deny care based on personal belief. Some say the legislation, which now heads to the state Senate for consideration, would disproportionately impact LGBTQ+ people, women, and people of color.

Under the bill, titled the “Medical Ethics and Diversity Act,” South Carolina law would be altered to excuse medical practitioners, health care institutions and health care payers from providing care that violates their “conscience.” It would also shield those who decline to provide medical services to patients from civil, criminal or administrative liability.

Dozens of state residents in February testified against the bill, calling it vague and overbroad. They also shared concerns that the legislation would disproportionately impact marginalized communities.

In a statement on Friday, Human Rights Campaign Legal Director Sarah Warbelow said she finds it “disturbing” that politicians in South Carolina are prioritizing individual providers’ beliefs over the wellbeing of patients.

“This legislation is dangerously silent in regards to the needs of patients and fails to consider the impact that expanding refusals can have on their health,” she said. “Religious freedom is a fundamental American value that is entirely compatible with providing quality, non-discriminatory healthcare. It is not a license to deprive others of their rights simply because of personal beliefs.”

Warbelow said the bill sends a message to patients with non-medical views inconsistent with that of their doctors that they are “not equal members of society entitled to dignity and respect.”

The info is here.

Editor's Note: Those politicians who pass laws based on culture wars are clearly violating the principle-based ethics on which all medical ethics rely.  If they pass harmful laws that conflict with health care ethics, then they are not fit to serve.