Let's Talk About AI Ethics; We're On A Deadline

Tom Vander Ark
Forbes.com
Originally posted September 13, 2018

Here is an excerpt:

Creating Values-Aligned AI

“The project of creating value-aligned AI is perhaps one of the most important things we will ever do,” said the Future of Life Institute. It’s not just about useful intelligence but “the ends to which intelligence is aimed and the social/political context, rules, and policies in and through which this all happens.”

The Institute created a visual map of interdisciplinary issues to be addressed:

• Validation: ensuring that the right system specification is provided for the core of the agent given stakeholders' goals for the system.

• Security: applying cyber security paradigms and techniques to AI-specific challenges.

• Control: structural methods for operators to maintain control over advanced agents.

• Foundations: foundational mathematical or philosophical problems that have bearing on multiple facets of safety

• Verification: techniques that help prove a system was implemented correctly given a formal specification

• Ethics: effort to understand what we ought to do and what counts as moral or good.

• Governance: the norms and values held by society, which are structured through various formal and informal processes of decision-making to ensure accountability, stability, broad participation, and the rule of law.

The info is here.

How Do Medicalization and Rescue Fantasy Prevent Healthy Dying?

Peter T. Hetzler III and Lydia S. Dugdale
AMA Journal of Ethics
2018;20(8):E766-773.

Abstract

Before antibiotics, cardiopulmonary resuscitation (CPR), and life-sustaining technologies, humans had little choice about the timing and manner of their deaths. Today, the medicalization of death has enabled patients to delay death, prolonging their living and dying. New technology, the influence of the media, and medical professionals themselves have together transformed dying from a natural part of the human experience into a medical crisis from which a patient must be rescued, often through the aggressive extension of life or through its premature termination. In this paper, we examine problematic forms of rescue medicine and suggest the need to rethink medicalized dying within the context of medicine’s orientation to health and wholeness.

The info is here.

A Debate Over ‘Rational Suicide’

Paula Span
The New York Times
Originally posted August 31, 2018

Here is an excerpt:

Is suicide by older adults ever a rational choice? It’s a topic many older people discuss among themselves, quietly or loudly — and one that physicians increasingly encounter, too. Yet most have scant training or experience in how to respond, said Dr. Meera Balasubramaniam, a geriatric psychiatrist at the New York University School of Medicine.

“I found myself coming across individuals who were very old, doing well, and shared that they wanted to end their lives at some point,” said Dr. Balasubramaniam. “So many of our patients are confronting this in their heads.”

She has not taken a position on whether suicide can be rational — her views are “evolving,” she said. But hoping to generate more medical discussion, she and a co-editor explored the issue in a 2017 anthology, “Rational Suicide in the Elderly,” and she revisited it recently in an article in the Journal of the American Geriatrics Society.

The Hastings Center, the ethics institute in Garrison, N.Y., also devoted much of its latest Hastings Center Report to a debate over “voluntary death” to forestall dementia.

Every part of this idea, including the very phrase “rational suicide,” remains intensely controversial. (Let’s leave aside the related but separate issue of physician aid in dying, currently legal in seven states and the District of Columbia, which applies only to mentally competent people likely to die of a terminal illness within six months.)

The info is here.

How our lives end must no longer be a taboo subject

Kathryn Mannix
The Guardian
Originally published August 16, 2018

Here is an excerpt:

As we age and develop long-term health conditions, our chances of becoming suddenly ill rise; prospects for successful resuscitation fall; our youthful assumptions about length of life may be challenged; and our quality of life becomes increasingly more important to us than its length. The number of people over the age of 85 will double in the next 25 years, and dementia is already the biggest cause of death in this age group. What discussions do we need to have, and to repeat at sensible intervals, to ensure that our values and preferences are understood by the people who may be asked about them?

Our families need to know our answers to such questions as: how much treatment is too much or not enough? Do we see artificial hydration and nutrition as “treatment” or as basic care? Is life at any cost or quality of life more important to us? And what gives us quality of life? A 30-year-old attorney may not understand that being able to hear birdsong, or enjoy ice-cream, or follow the racing results, is more important to a family’s 85-year-old relative than being able to walk or shop. When we are approaching death, what important things should our carers know about us?

The info is here.

The Ethics of Medicaid’s Work Requirements and Other Personal Responsibility Policies

Harald Schmidt and Allison K. Hoffman
JAMA. Published online May 7, 2018. doi:10.1001/jama.2018.3384

Here are two excerpts:

CMS emphasizes health improvement as the primary rationale, but the agency and interested states also favor work requirements for their potential to limit enrollment and spending and out of an ideological belief that everyone “do their part.” For example, an executive order by Kentucky’s Governor Matt Bevin announced that the state’s entire Medicaid expansion would be unaffordable if the waiver were not implemented, threatening to end expansion if courts strike down “one or more” program elements. Correspondingly, several nonexpansion states have signaled that the option of introducing work requirements might make them reconsider expansion—potentially covering more people but arguably in a way inconsistent with Medicaid’s broader objectives.

Work requirements have attracted the most attention but are just one of many policies CMS has encouraged as part of apparent attempts to promote personal responsibility in Medicaid. Other initiatives tie levels of benefits to confirming eligibility annually, paying premiums on time, meeting wellness program criteria such as completing health risk assessments, or not using the emergency department (ED) for nonemergency care.

(cut)

It is troubling that these policies could result in some portion of previously eligible individuals being denied necessary medical care because of unduly demanding requirements. Moreover, even if reduced enrollment were to decrease Medicaid costs, it might not reduce medical spending overall. Laws including the Emergency Medical Treatment and Labor Act still require stabilization of emergency medical conditions, entailing more expensive and less effective care.

The article is here.

Deadly gene mutations removed from human embryos in landmark study

Ian Sample
The Guardian
Originally published August 2, 2017

Scientists have modified human embryos to remove genetic mutations that cause heart failure in otherwise healthy young people in a landmark demonstration of the controversial procedure.

It is the first time that human embryos have had their genomes edited outside China, where researchers have performed a handful of small studies to see whether the approach could prevent inherited diseases from being passed on from one generation to the next.

While none of the research so far has created babies from modified embryos, a move that would be illegal in many countries, the work represents a milestone in scientists’ efforts to master the technique and brings the prospect of human clinical trials one step closer.

The work focused on an inherited form of heart disease, but scientists believe the same approach could work for other conditions caused by single gene mutations, such as cystic fibrosis and certain kinds of breast cancer.

The article is here.

More Religious Leaders Challenge Silence, Isolation Surrounding Suicide

Cheryl Platzman Weinstock
npr.org
Originally posted February 11, 2018

Here is an excerpt:

Until recently, many religious leaders were not well-prepared to talk about suicide with their congregants. Now some clergy have become an important part of suicide prevention.

"Where there's faith, there's hope, and where there's hope, there's life," says David Litts, co-leader of the Faith Communities Task Force of the National Action Alliance for Suicide Prevention.

Arnold also leads that task force. "If someone dies from heart disease, for instance, or in an accident, they may wonder where God is, but when someone dies by suicide, a whole lot of other questions get raised," she says. "When you can't talk about this in church, then it feels like God can't talk about it either."

But in her church, she says, there isn't shame surrounding suicide. During the pastoral prayer, for instance, she says she lifts up congregants dealing with cancer, heart disease or mental health issues. "It's a way of signaling to people this is a safe place to talk about such things and be honest about them."

The article is here.

Why It's OK Behavioral Economics Failed To Prevent Heart Attacks

Peter Ubel
Forbes.com
Originally published January 31, 2018

Here are two excerpts:

To increase the chance people will take these important pills, a team out of the University of Pennsylvania created a behavioral economic incentive. The intervention was multipronged. It included enrolling patients in lotteries, which gave them a chance to win money every day they took their pills. It encouraged patients to enlist a friend to help them stay on track taking their pills, a friend who would get notified every time they skipped their medications for a few days in a row.

But the intervention failed — it neither increased adherence to medications nor reduced hospitalizations for heart attacks. These results are shown in the figure below, which, despite appearances, shows two lines, representing the intervention group and the control group, respectively; the lines practically merge into one...

(cut)

Sometimes behavioral economics is criticized for being over-hyped, for being touted as the answer to all our behavioral problems. I’ve been one of those critics. But my beef isn’t with behavioral economists — my research frequently draws upon insights from that field. My issue is with people who think of behavioral economics as some kind of magic wand we can wave over stubbornly harmful behavior. Changing people’s behavior is hard to do, especially without resorting to draconian measures.

We need to keep experimenting with ways to help people take care of their health.

The article is here.

Alone Together: Who's Lonely and How Do We Measure It?

Tom Harrison
The RSA.org
Originally published January 18, 2018

Here is an excerpt:

What affect does loneliness have on our health?

Neuroscientist John Cacioppo’s seminal work published in ‘Loneliness: Human Nature and Need for Social Connection’ was one of the first to study the health impacts of loneliness. He found that lonely people have a 20 per cent higher premature mortality rate and called for a culture shift that would see loneliness as important a public health issue as obesity. The Campaign to End Loneliness acknowledges this; reporting that 3 out of 4 GPs say they see between 1 and 5 people a day who have come in mainly because they are lonely.

Indeed, research tells us that this phenomenon goes far beyond the familiar stereotype of an isolated grandmother. A recent British Red Cross report found that 32 per cent of those aged 16-24 reported that in the past 2 weeks they had often or always felt lonely. Are 1/3 of young people just snowflakes? It seems unlikely.

This has contributed to pressure for government to respond. But how do we measure the problem and what are responses required to tackle it?

The article is here.

Note to Reader: Psychotherapy can help with loneliness.

Don’t Nudge Me: The Limits of Behavioral Economics in Medicine

Aaron E. Carroll
The New York Times - The Upshot
Originally posted November 6, 2017

Here is an excerpt:

But those excited about the potential of behavioral economics should keep in mind the results of a recent study. It pulled out all the stops in trying to get patients who had a heart attack to be more compliant in taking their medication. (Patients’ adherence at such a time is surprisingly low, even though it makes a big difference in outcomes, so this is a major problem.)

Researchers randomly assigned more than 1,500 people to one of two groups. All had recently had heart attacks. One group received the usual care. The other received special electronic pill bottles that monitored patients’ use of medication. Those patients who took their drugs were entered into a lottery in which they had a 20 percent chance to receive $5 and a 1 percent chance to win $50 every day for a year.

That’s not all. The lottery group members could also sign up to have a friend or family member automatically be notified if they didn’t take their pills so that they could receive social support. They were given access to special social work resources. There was even a staff engagement adviser whose specific duty was providing close monitoring and feedback, and who would remind patients about the importance of adherence.

This was a kitchen-sink approach. It involved direct financial incentives, social support nudges, health care system resources and significant clinical management. It failed.

The article is here.

Burnout at Work Isn’t Just About Exhaustion. It’s Also About Loneliness

Emma Seppala and Marissa King
Harvard Business Review

First published June 29, 2017

More and more people are feeling tired and lonely at work. In analyzing the General Social Survey of 2016, we found that, compared with roughly 20 years ago, people are twice as likely to report that they are always exhausted. Close to 50% of people say they are often or always exhausted due to work. This is a shockingly high statistic — and it’s a 32% increase from two decades ago. What’s more, there is a significant correlation between feeling lonely and work exhaustion: The more people are exhausted, the lonelier they feel.

This loneliness is not a result of social isolation, as you might think, but rather is due to the emotional exhaustion of workplace burnout. In researching the book The Happiness Track, we found that 50% of people — across professions, from the nonprofit sector to the medical field — are burned out. This isn’t just a problem for busy, overworked executives (though the high rates of loneliness and burnout among this group are well known). Our work suggests that the problem is pervasive across professions and up and down corporate hierarchies.

Loneliness, whether it results from social isolation or exhaustion, has serious consequences for individuals. John Cacioppo, a leading expert on loneliness and coauthor of Loneliness: Human Nature and the Need for Social Connection, emphasizes its tremendous impact on psychological and physical health and longevity. Research by Sarah Pressman, of the University of California, Irvine, corroborates his work and demonstrates that while obesity reduces longevity by 20%, drinking by 30%, and smoking by 50%, loneliness reduces it by a whopping 70%. In fact, one study suggests that loneliness increases your chance of stroke or coronary heart disease — the leading cause of death in developed countries — by 30%. On the other hand, feelings of social connection can strengthen our immune system, lengthen our life, and lower rates of anxiety and depression.

The article is here.

Who Decides When a Patient Can’t? Statutes on Alternate Decision Makers

Erin S. DeMartino and others
The New England Journal of Medicine
DOI: 10.1056/NEJMms1611497

Many patients cannot make their own medical decisions, having lost what is called decisional capacity. The estimated prevalence of decisional incapacity approaches 40% among adult medical
inpatients and residential hospice patients and exceeds 90% among adults in some intensive care
units.3,4 Patients who lack capacity may guide decisions regarding their own care through an
advance directive, a legal document that records treatment preferences or designates a durable
power of attorney for health care, or both. Unfortunately,the rate of completion of advance directives
in the general U.S. population hovers around 20 to 29%, creating uncertainty about who will
fill the alternate decision-maker role for many patients.

There is broad ethical consensus that other persons may make life-and-death decisions on
behalf of patients who lack decisional capacity. Over the past few decades, many states have enacted
legislation designed to delineate decisionmaking authority for patients who lack advance directives. Yet the 50 U.S. states and the District of Columbia vary in their procedures for appointing and challenging default surrogates, the attributes they require of such persons, their priority ranking of possible decision makers, and dispute resolution. These differences have important implications for clinicians, patients, and public health.

The article is here.

Informed Patient? Don’t bet on it

Mikkael Sekeres and Timothy Gilligan
The New York Times
Originally posted March 1, 2017

Here is an excerpt:

The secret is that informed consent in health care is commonly not-so-well informed. It might be a document we ask you to sign, at the behest of our lawyers, in case we end up in court if a bad outcome happens. Unfortunately, it’s often not really about informing you. In schools, teachers determine what students know through tests and homework. The standard is not whether the teacher has explained how to add, but instead whether the student can add. If we were truly invested in whether you were informed, we’d give you a quiz, or at least ask you to repeat back to us what you heard so we could assess its accuracy.

The article is here.

What We Know About Moral Distress

Patricia Rodney
AJN, American Journal of Nursing:
February 2017 - Volume 117 - Issue 2 - p S7–S10
doi: 10.1097/01.NAJ.0000512204.85973.04

Moral distress arises when nurses are unable to act according to their moral judgment. The concept is relatively recent, dating to American ethicist Andrew Jameton's 1984 landmark text on nursing ethics. Until that point, distress among clinicians had been understood primarily through psychological concepts such as stress and burnout, which, although relevant, were not sufficient. With the introduction of the concept of moral distress, Jameton added an ethical dimension to the study of distress.

Background

In the 33 years since Jameton's inaugural work, many nurses, inspired by the concept of moral distress, have continued to explore what happens when nurses are constrained from translating moral choice into moral action, and are consequently unable to uphold their sense of integrity and the values emphasized in the American Nurses Association's Code of Ethics for Nurses with Interpretive Statements. Moral distress might occur when, say, a nurse on a busy acute medical unit can't provide comfort and supportive care to a dying patient because of insufficient staffing.

The article is here.

What is a moral epigenetic responsibility?

Charles Dupras & Vardit Ravitsky
BMJ Blog
Originally posted August 23, 2016

Epigenetics is a recent yet promising field of scientific research. It explores the influence of the biochemical environment (food, toxic pollutants) and the social environment (stress, child abuse, socio-economic status) on the expression of genes, i.e. on whether and how they will switch ‘on’ or ‘off’. Epigenetic modifications can have a significant impact on health and disease later in life. Most surprisingly, it was suggested that some epigenetic variants (or ‘epi-mutations’) acquired during one’s life could be transmitted to offspring, thus having long-term effects on the health of future generations.

Epigenetics is increasingly capturing the attention of social scientists and ethicists, because it brings attention to the importance of environmental exposure for the developing foetus and child as a risk factor for common diseases such as cardiovascular, diabetes, obesity, allergies and cancers. Scholars such as Hannah Landecker, Mark Rothstein and Maurizio Meloni have argued that epigenetics may be used to promote various arguments in ongoing debates on environmental and social justice, as well as intergenerational equity. Some even suggested that epigenetics could lead to novel ways of thinking about moral responsibilities for health.

The blog post is here.

Mental health on college campuses: A look at the numbers

By Sarah Sabatke
USA Today
Originally published January 30, 2016

Approximately 42,773 Americans commit suicide every year, according to the American Foundation for Suicide Prevention, many of whom are college students.

The University of Pennsylvania, Tulane University, Appalachian State University and Yale University, among others, made national headlines in recent years after student suicides rocked their campus communities, highlighting a growing need for comprehensive mental healthcare on college campuses.

The page of statistics and infographics is here.

Way more Americans are drinking themselves to death. Here's why.

By German Lopez
The Vox
Originally published on December 28, 2015

Here are two excerpts:

For one, Americans are drinking more. According to the latest National Survey on Drug Use and Health, the number of Americans who reportedly drank in the previous month slightly increased as alcohol-induced deaths did: from 51 percent of all persons 12 and older in 2006, when deaths began to climb, to 52.7 percent in 2014.

(cut)

So for the US, boosting alcohol prices 10 percent could save as many as 6,000 lives each year. To put that in context, paying about 50 cents more for a six-pack of Bud Light could save thousands of lives. And this is a conservative estimate, since it only counts alcohol-related liver cirrhosis deaths — the number of lives saved would be higher if it accounted for deaths due to alcohol-related violence and car crashes.

Aside from raising taxes, a 2014 report from the RAND Drug Policy Research Center suggested state-run shops kept prices higher, reduced access to youth, and reduced overall levels of use. And a 2013 study from RAND of South Dakota's 24/7 Sobriety Program, which briefly jails people whose drinking has repeatedly gotten them in trouble with the law (like a DUI) if they fail a twice-a-day alcohol blood test, attributed a 12 percent reduction in repeat DUI arrests and a 9 percent reduction in domestic violence arrests at the county level to the program.

The article is here.

The Concept of a Feminist Bioethics

By Mary C. Rawlinson
Journal of Medicine and Philosophy
(2001), Vol. 26, No. 4, pp 405-416.

Abstract

Feminist bioethics poses a challenge to bioethics by exposing the masculine marking of its
supposedly generic human subject, as well as the fact that the tradition does not view women's
rights as human rights. This essay traces the way in which this invisible gendering of the
universal renders the other gender invisible and silent. It shows how this attenuation of the
human in `man' is a source of sickness, both cultural and individual. Finally, it suggests several
ways in which images drawn from women's experience and women's bodies might contribute
to a constructive rethinking of basic ethical concepts.

The entire paper 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.

Should Pro-Anorexia Sites Be Criminalized?

Italy’s Parliament recently proposed a bill that would criminalize pro-anorexia site authors with a $67,000 fine and up to a year in jail. But health experts say this is a bad idea.

By Carrie Arnold
The Daily Beast
Originally published August 30, 2014

Here is an excerpt:

While Pinterest, Tumblr, and Instagram banned “thinspiration” photos on the basis that they were linked to self-harm, they continue to allow healthy living advice that isn’t necessarily so healthy, extreme diet and exercise hints, and so-called “fitspiration,” which some in the eating disorder community say is thinspiration disguised in workout clothes. Many of the slogans most closely associated with pro-anorexia rhetoric (“Nothing Tastes As Good As Skinny Feels”) are actually from commercial weight loss sites, as are many of the tips the sites share. Although some use pro-anorexia sites to “learn” how to be better at their eating disorder, many of these tips also exist in stories and television shows designed to teach people about the dangers of eating disorders.

The entire article is here.