Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Justice. Show all posts
Showing posts with label Justice. Show all posts

Thursday, March 7, 2024

Canada Postpones Plan to Allow Euthanasia for Mentally Ill

Craig McCulloh
Voice of America News
Originally posted 8 Feb 24

The Canadian government is delaying access to medically assisted death for people with mental illness.

Those suffering from mental illness were supposed to be able to access Medical Assistance in Dying — also known as MAID — starting March 17. The recent announcement by the government of Canadian Prime Minister Justin Trudeau was the second delay after original legislation authorizing the practice passed in 2021.

The delay came in response to a recommendation by a majority of the members of a committee made up of senators and members of Parliament.

One of the most high-profile proponents of MAID is British Columbia-based lawyer Chris Considine. In the mid-1990s, he represented Sue Rodriguez, who was dying from amyotrophic lateral sclerosis, commonly known as ALS.

Their bid for approval of a medically assisted death was rejected at the time by the Supreme Court of Canada. But a law passed in 2016 legalized euthanasia for individuals with terminal conditions. From then until 2022, more than 45,000 people chose to die.


Canada originally planned to expand its Medical Assistance in Dying (MAiD) program to include individuals with mental illnesses in March 2024.
  • This plan has been postponed until 2027 due to concerns about the healthcare system's readiness and potential ethical issues.
  • The original legislation passed in 2021, but concerns about safeguards and mental health support led to delays.
  • This issue is complex and ethically charged, with advocates arguing for individual autonomy and opponents raising concerns about coercion and vulnerability.
I would be concerned about the following issues:
  • Vulnerability: Mental illness can impair judgement, raising concerns about informed consent and potential coercion.
  • Safeguards: Concerns exist about insufficient safeguards to prevent abuse or exploitation.
  • Mental health access: Limited access to adequate mental health treatment could contribute to undue pressure towards MAiD.
  • Social inequalities: Concerns exist about disproportionate access to MAiD based on socioeconomic background.

Monday, March 4, 2024

How to Deal with Counter-Examples to Common Morality Theory: A Surprising Result

Herissone-Kelly P.
Cambridge Quarterly of Healthcare Ethics.


Tom Beauchamp and James Childress are confident that their four principles—respect for autonomy, beneficence, non-maleficence, and justice—are globally applicable to the sorts of issues that arise in biomedical ethics, in part because those principles form part of the common morality (a set of general norms to which all morally committed persons subscribe). Inevitably, however, the question arises of how the principlist ought to respond when presented with apparent counter-examples to this thesis. I examine a number of strategies the principlist might adopt in order to retain common morality theory in the face of supposed counter-examples. I conclude that only a strategy that takes a non-realist view of the common morality’s principles is viable. Unfortunately, such a view is likely not to appeal to the principlist.

Herissone-Kelly examines various strategies principlism could employ to address counter-examples:

Refine the principles: This involves clarifying or reinterpreting the principles to better handle specific cases.
  • Prioritize principles: Establish a hierarchy among the principles to resolve conflicts.
  • Supplement the principles: Introduce additional considerations or context-specific factors.
  • Limit the scope: Acknowledge that the principles may not apply universally to all cultures or situations.
Herissone-Kelly argues that none of these strategies are fully satisfactory. Refining or prioritizing principles risks distorting their original meaning or introducing arbitrariness. Supplementing them can lead to an unwieldy and complex framework. Limiting their scope undermines the theory's claim to universality.

He concludes that the most viable approach is to adopt a non-realist view of the common morality's principles. This means understanding them not as objective moral facts but as flexible tools for ethical reflection and deliberation, open to interpretation and adaptation in different contexts. While this may seem to weaken the theory's authority, Herissone-Kelly argues that it allows for a more nuanced and practical application of ethical principles in a diverse world.

Friday, February 16, 2024

Citing Harms, Momentum Grows to Remove Race From Clinical Algorithms

B. Kuehn
Published Online: January 17, 2024.

Here is an excerpt:

The roots of the false idea that race is a biological construct can be traced to efforts to draw distinctions between Black and White people to justify slavery, the CMSS report notes. For example, the third US president, Thomas Jefferson, claimed that Black people had less kidney output, more heat tolerance, and poorer lung function than White individuals. Louisiana physician Samuel Cartwright, MD, subsequently rationalized hard labor as a way for slaves to fortify their lungs. Over time, the report explains, the medical literature echoed some of those ideas, which have been used in ways that cause harm.

“It is mind-blowing in some ways how deeply embedded in history some of this misinformation is,” Burstin said.

Renewed recognition of these harmful legacies and growing evidence of the potential harm caused by structural racism, bias, and discrimination in medicine have led to reconsideration of the use of race in clinical algorithms. The reckoning with racial injustice sparked by the May 2020 murder of George Floyd helped accelerate this work. A few weeks after Floyd’s death, an editorial in the New England Journal of Medicine recommended reconsidering race in 13 clinical algorithms, echoing a growing chorus of medical students and physicians arguing for change.

Congress also got involved. As a Robert Wood Johnson Foundation Health Policy Fellow, Michelle Morse, MD, MPH, raised concerns about the use of race in clinical algorithms to US Rep Richard Neal (D, MA), then chairman of the House Ways and Means Committee. Neal in September 2020 sent letters to several medical societies asking them to assess racial bias and a year later he and his colleagues issued a report on the misuse of race in clinical decision-making tools.

“We need to have more humility in medicine about the ways in which our history as a discipline has actually held back health equity and racial justice,” Morse said in an interview. “The issue of racism and clinical algorithms is one really tangible example of that.”

My summary: There's increasing worry that using race in clinical algorithms can be harmful and perpetuate racial disparities in healthcare. This concern stems from a recognition of the historical harms of racism in medicine and growing evidence of bias in algorithms.

A review commissioned by the Agency for Healthcare Research and Quality (AHRQ) found that using race in algorithms can exacerbate health disparities and reinforce the false idea that race is a biological factor.

Several medical organizations and experts have called for reevaluating the use of race in clinical algorithms. Some argue that race should be removed altogether, while others advocate for using it only in specific cases where it can be clearly shown to improve outcomes without causing harm.

Tuesday, November 28, 2023

Ethics of psychotherapy rationing: A review of ethical and regulatory documents in Canadian professional psychology

Gower, H. K., & Gaine, G. S. (2023).
Canadian Psychology / Psychologie canadienne. 
Advance online publication.


Ethical and regulatory documents in Canadian professional psychology were reviewed for principles and standards related to the rationing of psychotherapy. Despite Canada’s high per capita health care expenses, mental health in Canada receives relatively low funding. Further, surveys indicated that Canadians have unmet needs for psychotherapy. Effective and ethical rationing of psychological treatment is a necessity, yet the topic of rationing in psychology has received scant attention. The present study involved a qualitative review of codes of ethics, codes of conduct, and standards of practice documents for their inclusion of rationing principles and standards. Findings highlight the strengths and shortcomings of these documents related to guiding psychotherapy rationing. The discussion offers recommendations for revising these ethical and regulatory documents to promote more equitable and cost-effective use of limited psychotherapy resources in Canada.

Impact Statement

Canadian professional psychology regulatory documents contain limited reference to rationing imperatives, despite scarce psychotherapy resources. While the foundation of distributive justice is in place, rationing-specific principles, standards, and practices are required to foster the fair and equitable distribution of psychotherapy by Canadian psychologists.

From the recommendations:

Recommendations for Canadian Psychology Regulatory Documents
  1. Explicitly widen psychologists’ scope of concern to include not only current clients but also waiting clients and those who need treatment but face access barriers.
  2. Acknowledge the scarcity of health care resources (in public and private settings) and the high demand for psychology services (e.g., psychotherapy) and admonish inefficient and cost-ineffective use.
  3. Draw an explicit connection between the general principle of distributive justice and the specific practices related to rationing of psychology resources, including, especially, mitigation of biases likely to weaken ethical decision making.
  4. Encourage the use of outcome monitoring measures to aid relative utility calculations for triage and termination decisions and to ensure efficiency and distributive justice.
  5. Recommend advocacy by psychologists to address barriers to accessing needed services (e.g., psychotherapy), including promoting the cost effectiveness of psychotherapy as well as highlighting systemic barriers related to presenting problem, disability, ethnicity, race, gender, sexuality, or income.

Thursday, November 2, 2023

Doesn't everybody jaywalk? On codified rules that are seldom followed and selectively punished

Wylie, J., & Gantman, A. (2023).
Cognition, 231, 105323.

Rules are meant to apply equally to all within their jurisdiction. However, some rules are frequently broken without consequence for most. These rules are only occasionally enforced, often at the discretion of a third-party observer. We propose that these rules—whose violations are frequent, and enforcement is rare—constitute a unique subclass of explicitly codified rules, which we call ‘phantom rules’ (e.g., proscribing jaywalking). Their apparent punishability is ambiguous and particularly susceptible to third-party motives. Across six experiments, (N = 1440) we validated the existence of phantom rules and found evidence for their motivated enforcement. First, people played a modified Dictator Game with a novel frequently broken and rarely enforced rule (i.e., a phantom rule). People enforced this rule more often when the “dictator” was selfish (vs. fair) even though the rule only proscribed fractional offers (not selfishness). Then we turned to third person judgments of the U.S. legal system. We found these violations are recognizable to participants as both illegal and commonplace (Experiment 2), differentiable from violations of prototypical laws (Experiments 3) and enforced in a motivated way (Experiments 4a and 4b). Phantom rule violations (but not prototypical legal violations) are seen as more justifiably punished when the rule violator has also violated a social norm (vs. rule violation alone)—unless the motivation to punish has been satiated (Experiment 5). Phantom rules are frequently broken, codified rules. Consequently, their apparent punishability is ambiguous, and their enforcement is particularly susceptible to third party motives.

Here's my quick summary: 

This research explores the concept of "phantom rules". Phantom rules are rules that are frequently broken without consequence for most, and are only occasionally enforced, often at the discretion of a third-party observer. Examples of phantom rules include jaywalking, speeding, and not coming to a complete stop at a stop sign.

The authors argue that phantom rules are a unique subclass of explicitly codified rules, and that they have a number of important implications for our understanding of law and society. For example, phantom rules can lead to people feeling like the law is unfair and that they are being targeted. They can also create a sense of lawlessness and disorder.

The authors conducted six experiments to investigate the psychological and social dynamics of phantom rules. They found evidence that people are more likely to punish violations of phantom rules when the violator has also violated a social norm. They also found that people are more likely to justify the selective enforcement of phantom rules when they believe that the violator is a deserving target.

The authors conclude by arguing that phantom rules are a significant social phenomenon with a number of important implications for law and society. They call for more research on the psychological and social dynamics of phantom rules, and on the impact of phantom rules on people's perceptions of the law and the criminal justice system.

Tuesday, June 13, 2023

Using the Veil of Ignorance to align AI systems with principles of justice

Weidinger, L. McKee, K.R., et al. (2023).
PNAS, 120(18), e2213709120


The philosopher John Rawls proposed the Veil of Ignorance (VoI) as a thought experiment to identify fair principles for governing a society. Here, we apply the VoI to an important governance domain: artificial intelligence (AI). In five incentive-compatible studies (N = 2, 508), including two preregistered protocols, participants choose principles to govern an Artificial Intelligence (AI) assistant from behind the veil: that is, without knowledge of their own relative position in the group. Compared to participants who have this information, we find a consistent preference for a principle that instructs the AI assistant to prioritize the worst-off. Neither risk attitudes nor political preferences adequately explain these choices. Instead, they appear to be driven by elevated concerns about fairness: Without prompting, participants who reason behind the VoI more frequently explain their choice in terms of fairness, compared to those in the Control condition. Moreover, we find initial support for the ability of the VoI to elicit more robust preferences: In the studies presented here, the VoI increases the likelihood of participants continuing to endorse their initial choice in a subsequent round where they know how they will be affected by the AI intervention and have a self-interested motivation to change their mind. These results emerge in both a descriptive and an immersive game. Our findings suggest that the VoI may be a suitable mechanism for selecting distributive principles to govern AI.


The growing integration of Artificial Intelligence (AI) into society raises a critical question: How can principles be fairly selected to govern these systems? Across five studies, with a total of 2,508 participants, we use the Veil of Ignorance to select principles to align AI systems. Compared to participants who know their position, participants behind the veil more frequently choose, and endorse upon reflection, principles for AI that prioritize the worst-off. This pattern is driven by increased consideration of fairness, rather than by political orientation or attitudes to risk. Our findings suggest that the Veil of Ignorance may be a suitable process for selecting principles to govern real-world applications of AI.

From the Discussion section

What do these findings tell us about the selection of principles for AI in the real world? First, the effects we observe suggest that—even though the VoI was initially proposed as a mechanism to identify principles of justice to govern society—it can be meaningfully applied to the selection of governance principles for AI. Previous studies applied the VoI to the state, such that our results provide an extension of prior findings to the domain of AI. Second, the VoI mechanism demonstrates many of the qualities that we want from a real-world alignment procedure: It is an impartial process that recruits fairness-based reasoning rather than self-serving preferences. It also leads to choices that people continue to endorse across different contexts even where they face a self-interested motivation to change their mind. This is both functionally valuable in that aligning AI to stable preferences requires less frequent updating as preferences change, and morally significant, insofar as we judge stable reflectively endorsed preferences to be more authoritative than their nonreflectively endorsed counterparts. Third, neither principle choice nor subsequent endorsement appear to be particularly affected by political affiliation—indicating that the VoI may be a mechanism to reach agreement even between people with different political beliefs. Lastly, these findings provide some guidance about what the content of principles for AI, selected from behind a VoI, may look like: When situated behind the VoI, the majority of participants instructed the AI assistant to help those who were least advantaged.

Sunday, February 19, 2023

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.”


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.”

Friday, January 13, 2023

How Much (More) Should CEOs Make? A Universal Desire for More Equal Pay

Kiatpongsan, S., & Norton, M. I. (2014).
Perspectives on Psychological Science, 9(6), 587–593.


Do people from different countries and different backgrounds have similar preferences for how much more the rich should earn than the poor? Using survey data from 40 countries (N = 55,238), we compare respondents’ estimates of the wages of people in different occupations—chief executive officers, cabinet ministers, and unskilled workers—to their ideals for what those wages should be. We show that ideal pay gaps between skilled and unskilled workers are significantly smaller than estimated pay gaps and that there is consensus across countries, socioeconomic status, and political beliefs. Moreover, data from 16 countries reveals that people dramatically underestimate actual pay inequality. In the United States—where underestimation was particularly pronounced—the actual pay ratio of CEOs to unskilled workers (354:1) far exceeded the estimated ratio (30:1), which in turn far exceeded the ideal ratio (7:1). In sum, respondents underestimate actual pay gaps, and their ideal pay gaps are even further from reality than those underestimates.


These results demonstrate a strikingly consistent belief that the gaps in incomes between
skilled and unskilled workers should be smaller than people believe them to be – and much
smaller than these gaps actually are. The consensus that income gaps between skilled and
unskilled workers should be smaller holds in all subgroups of respondents regardless of their age,
education, socioeconomic status, political affiliation and opinions on inequality and pay. As a
result, they suggest that – in contrast to a belief that only the poor and members of left-wing
political parties desire greater income equality – people all over the world, and from all walks of
life, would prefer smaller pay gaps between the rich and poor.

Thursday, January 5, 2023

The Supreme Court Needs Real Oversight

Glen Fine
The Atlantic
Originally posted 5 DEC 22

Here is an excerpt:

The lack of ethical rules that bind the Court is the first problem—and the easier one to address. The Code of Conduct for United States Judges, promulgated by the federal courts’ Judicial Conference, “prescribes ethical norms for federal judges as a means to preserve the actual and apparent integrity of the federal judiciary.” The code covers judicial conduct both on and off the bench, including requirements that judges act at all times to promote public confidence in the integrity and impartiality of the judiciary. But this code applies only to lower-level federal judges, not to the Supreme Court, which has not issued ethical rules that apply to its own conduct. The Court should explicitly adopt this code or a modified one.

Chief Justice Roberts has noted that Supreme Court justices voluntarily consult the Code of Conduct and other ethical rules for guidance. He has also pointed out that the justices can seek ethical advice from a variety of sources, including the Court’s Legal Office, the Judicial Conference’s Committee on Codes of Conduct, and their colleagues. But this is voluntary, and each justice decides independently whether and how ethical rules apply in any particular case. No one—including the chief justice—has the ability to alter a justice’s self-judgment.

Oversight of the judiciary is a more difficult issue, involving separation-of-powers concerns. I was the inspector general of the Department of Justice for 11 years and the acting inspector general of the Department of Defense for four years; I saw the importance and challenges of oversight in two of the most important government agencies. I also experienced the difficulties in conducting complex investigations of alleged misconduct, including leak investigations. But as I wrote in a Brookings Institution article this past May after the Dobbs leak, the Supreme Court does not have the internal capacity to effectively investigate such leaks, and it would benefit from a skilled internal investigator, like an inspector general, to help oversee the Court and the judiciary.

Another example of the Court’s ineffective self-policing and lack of transparency involves its recusal decisions. For example, Justice Thomas’s wife, Virginia Thomas, has argued that the 2020 presidential election was stolen, sent text messages to former White House Chief of Staff Mark Meadows urging him and the White House to seek to overturn the election, and expressed support for the pro-Trump January 6 rally on the Ellipse. Nevertheless, Justice Thomas has not recused himself in cases relating to the subsequent attack on the Capitol.

Notably, Thomas was the only justice to dissent from the Court’s decision not to block the release to the January 6 committee of White House records related to the attack, which included his wife’s texts. Some legal experts have argued that this is a clear instance where recusal should have occurred. Statute 28 U.S.C. 455 requires federal judges, including Supreme Court justices, to recuse themselves from a case when they know that their spouse has any interest that could be substantially affected by the outcome. In addition, the statute requires justices and judges to disqualify themselves in any proceeding in which their impartiality may reasonably be questioned.

Sunday, December 25, 2022

Belief in karma is associated with perceived (but not actual) trustworthiness

H.H. Ong, A.M. Evans, et al.
Judgment and Decision Making, Vol. ‍17,
No. ‍2, March 2022, pp. 362-377


Believers of karma believe in ethical causation where good and bad outcomes can be traced to past moral and immoral acts. Karmic belief may have important interpersonal consequences. We investigated whether American Christians expect more trustworthiness from (and are more likely to trust) interaction partners who believe in karma. We conducted an incentivized study of the trust game where interaction partners had different beliefs in karma and God. Participants expected more trustworthiness from (and were more likely to trust) karma believers. Expectations did not match actual behavior: karmic belief was not associated with actual trustworthiness. These findings suggest that people may use others' karmic belief as a cue to predict their trustworthiness but would err when doing so.

From the Discussion Section

We asked whether people perceive individuals who believe in karma, compared with those who do not, to be more trustworthy. In an incentivized study of American Christians, we found evidence that this was indeed the case. People expected interaction partners who believed in karma to behave in a more trustworthy manner and trusted these individuals more. Additionally, this tendency did not differ across the perceiver’s belief in karma.

While perceivers expected individuals who believed in karma to be more trustworthy, the individuals’ actual trustworthy behavior did not differ across their belief in karma. This discrepancy indicates that, although participants in our study used karmic belief as a cue when making trustworthiness judgment, it did not track actual trustworthiness. The absence of an association between karmic belief and actual trustworthy behavior among participants in the trustee role may seem to contradict prior research which found that reminders of karma increased generous behavior in dictator games (White et al., 2019; Willard et al., 2020). However, note that our study did not involve any conspicuous reminders of karma – there was only a single question asking if participants believe in karma. Thus, it may be that those who believe in karma would behave in a more trustworthy manner only when the concept is made salient.

Although we had found that karma believers were perceived as more trustworthy, the psychological explanation(s) for this finding remains an open question. One possible explanation is that karma is seen as a source of supernatural justice and that individuals who believe in karma are expected to behave in a more trustworthy manner in order to avoid karmic ]punishment and/or to reap karmic rewards. 

Monday, January 3, 2022

Systemic Considerations in Child Development and the Pursuit of Racial Equality in the United States

Perry, S., Skinner-Dorkenoo, A. L., 
Wages, J., & Abaied, J. L. (2021, October 8). 


In this commentary on Lewis’ (2021) article in Psychological Inquiry, we expand on ways that both systemic and interpersonal contexts contribute to and uphold racial inequalities, with a particular focus on research on child development and socialization. We also discuss the potential roadblocks that may undermine the effectiveness of Lewis’ (2021) recommended strategy of relying on experts as a driving force for change. We conclude by proposing additional strategies for pursuing racial equality that may increase the impact of experts, such as starting anti-racist socialization early in development, family-level interventions, and teaching people about racial injustices and their connections to systemic racism.

From the Conclusion

Ultimately, the expert (Myrdal) concluded that the problem was White people and how they think about and structure society. Despite the immense popularity of his book among the American public and the fact that it did motivate some policy change (Brown v. Board of Education, Warren& Supreme Court of The United States, 1953), many of the same issues persist to this day. As such, we argue that, although relying on experts may be an appealing recommendation, history suggests that our efforts to reduce racial inequality in the U.S. will require substantial, widespread investment from White U.S. residents in order for real change to occur. Based on the literature reviewed here, significant barriers to such investment remain, many of which begin in early childhood. Beyond pursuing policies that promote structural equality on the advice of experts in ways that do not trigger backlash, we should support policies that educate the public—with a special emphasis on childhood socialization—on the history of systemic racism and the past and continued intentional efforts to create and maintain racial inequalities. 

Building upon recommendations offered by Lewis, we also argue that we need to move the societal bar from simply being non-racist, to being actively anti-racist. As a society, we need to recalibrate our norms, such that passively going along with systemic racism will no longer be acceptable (Tatum, 2017). In the summer of 2020, after the police killings of George Floyd and Breonna Taylor, many organizations released statements in support of the Black Lives Movement, confronting systemic racism, and increasing social justice (Nguyen, 2020). But one question that many posed was whether these organizations and institutions were genuinely committed to tackling systemic racism, or if their acts were performative (Duarte, 2020). If groups, organizations, and institutions want to claim that they are committed to anti-racism, then they should be held accountable for these claims and provide concrete evidence of their efforts to dismantle the pervasive system of racial oppression. In addition to this, we recommend a greater investment in educating the public on the history of systemic racism (particularly with children; such as the Ethnic Studies Model Curriculum implemented in the state of California), prompting White parents to actively be anti-racist and teach their children to do the same, and equitable structural policies that facilitate residential and school racial integration to increase quality interracial contact.

Monday, December 13, 2021

Toward an understanding of structural racism: Implications for criminal justice

Julian M. Rucker and Jennifer A. Richeson
Science, 374 (6565)
DOI: 10.1126/science.abj7779


Racial inequality is a foundational feature of the criminal justice system in the United States. Here we offer a psychological account for how Americans have come to tolerate a system that is so at odds with their professed egalitarian values. We argue that beliefs about the nature of racism—as being solely due to prejudiced individuals rather than structural factors that disadvantage marginalized racial groups—work to uphold racial stratification in the criminal justice system. Although acknowledging structural racism facilitates the perception of and willingness to reduce racial inequality in criminal justice outcomes, many Americans appear willfully ignorant of structural racism in society. We reflect on the role of psychological science in shaping popular understandings of racism and discuss how to contribute more meaningfully to its reduction.

From the Summary and self-reflection

In this Review, we sought to illustrate key social-psychological factors that shape the maintenance and justification of a racially unjust criminal justice system, despite large scale support for racially egalitarian values.  Psychological motives to substantiate the racial hierarchy and protect one’s self-image work against opportunities to increase exposure to critical education on the structural underpinnings of contemporary racial inequality.  In essence, ignorance and denial of structural racism protect against an indictment of the legitimacy of the criminal justice system. By contrast, acknowledgment of structural racism in society motivates efforts to reduce racially disparate outcomes. With this framework, it becomes clear that merely holding egalitarian attitudes is insufficient to reform and dismantle systems that reproduce racial inequality—a structural understanding of racism is integral to these objectives.

Friday, November 12, 2021

Supernatural punishment beliefs as cognitively compelling tools of social control

Fitouchi, L., & Singh, M. 
(2021, July 5).


Why do humans develop beliefs in supernatural entities that punish uncooperative behaviors? Leading hypotheses maintain that these beliefs are widespread because they facilitate cooperation, allowing their groups to outcompete others in inter-group competition. Focusing on within-group interactions, we present a model in which people strategically endorse supernatural punishment beliefs to manipulate others into cooperating. Others accept these beliefs, meanwhile, because they are made compelling by various cognitive biases: They appear to provide information about why misfortune occurs; they appeal to intuitions about immanent justice; they contain threatening information; and they allow believers to signal their trustworthiness. Explaining supernatural beliefs requires considering both motivations to invest in their endorsement and the reasons others adopt them.


Unlike previous accounts, our model is agnostic to whether supernatural punishment beliefs cause people to behave cooperatively. Many cultural traits, from shamanism to rain magic to divination, remain stable as long as people see them—potentially wrongly—as useful for achieving their goals. Prosocial supernatural beliefs, we argue, are no different. People endorse them to motivate others to be cooperative. Their interaction partners accept these beliefs, meanwhile, because they are cognitively compelling and socially useful.Supernatural punishment beliefs, like so many cultural products, are shaped by people’s psychological biases and strategic goals

Sunday, September 19, 2021

How Does Cost-Effectiveness Analysis Inform Health Care Decisions?

David D. Kim & Anirban Basu
AMA J Ethics. 2021;23(8):E639-647. 
doi: 10.1001/amajethics.2021.639.


Cost-effectiveness analysis (CEA) provides a formal assessment of trade-offs involving benefits, harms, and costs inherent in alternative options. CEA has been increasingly used to inform public and private organizations’ reimbursement decisions, benefit designs, and price negotiations worldwide. Despite the lack of centralized efforts to promote CEA in the United States, the demand for CEA is growing. This article briefly reviews the history of CEA in the United States, highlights advances in practice guidelines, and discusses CEA’s ethical challenges. It also offers a way forward to inform health care decisions.


Ethical Considerations

There have been a few criticisms on ethical grounds of CEA’s use for decision making. These include (1) controversies associated with the use of QALYs, (2) distributive justice, and (3) incomplete valuation. We discuss each of them in detail here. However, it is worth pointing out that cost-effectiveness evidence is only one of many factors considered in resource allocation decisions. We have found that none of the international HTA bodies bases its decisions solely on cost-effectiveness evidence. Therefore, much of CEA’s criticisms, fair or not, can be addressed through deliberative processes.

QALYs. The lower health utility, or health-related quality of life, assigned to patients with worse health (because of more severe disease, disability, age, and so on) raises distributional issues in using QALYs for resource allocation decisions. For example, because patients with disabilities have a lower overall health utility weight, any extension of their lives by reducing the health burden from one disease “would not generate as many QALYs as a similar extension of life for otherwise healthy people.” This distributional limitation arises because of the multiplicative nature of QALYs, which are a product of life-years and health utility weight. Consequently, the National Council on Disability has strongly denounced the use of QALYs.

Alternatives to QALYs have been proposed. The Institute for Clinical and Economic Review has started using the equal value of life-years gained metric, a modified version of the equal value of life (EVL) metric, to supplement QALYs. In EVL calculations, any life-year gained is valued at a weight of 1 QALY, irrespective of individuals’ health status during the extra year. EVL, however, “has had limited traction among academics and decision-making bodies” because it undervalues interventions that extend life-years by the same amount as other interventions but that substantially improve quality of life. More recently, a health-years-in-total metric was proposed to overcome the limitations of both QALYs and EVL, but more work is needed to fully understand its theoretical foundations.

Saturday, December 12, 2020

‘All You Want Is to Be Believed’: The Impacts of Unconscious Bias in Health Care

April Dembosky
Originally published 21 Oct 20

Here is an excerpt:

Research shows how doctors’ unconscious bias affects the care people receive, with Latino and Black patients being less likely to receive pain medications or get referred for advanced care than white patients with the same complaints or symptoms, and more likely to die in childbirth from preventable complications.

In the hospital that day in May, Monterroso was feeling woozy and having trouble communicating, so she had a friend and her friend’s cousin, a cardiac nurse, on the phone to help. They started asking questions: What about Karla’s accelerated heart rate? Her low oxygen levels? Why are her lips blue?

The doctor walked out of the room. He refused to care for Monterroso while her friends were on the phone, she said, and when he came back, the only thing he wanted to talk about was Monterroso’s tone and her friends’ tone.

“The implication was that we were insubordinate,” Monterroso said.

She told the doctor she didn’t want to talk about her tone. She wanted to talk about her health care. She was worried about possible blood clots in her leg and she asked for a CT scan.

“Well, you know, the CT scan is radiation right next to your breast tissue. Do you want to get breast cancer?” Monterroso recalled the doctor saying to her. “I only feel comfortable giving you that test if you say that you’re fine getting breast cancer.”

Monterroso thought to herself, “Swallow it up, Karla. You need to be well.” And so she said to the doctor: “I’m fine getting breast cancer.”

He never ordered the test.

Monterroso asked for a different doctor, for a hospital advocate. No and no, she was told. She began to worry about her safety. She wanted to get out of there. Her friends, all calling every medical professional they knew to confirm that this treatment was not right, came to pick her up and drove her to the University of California-San Francisco. The team there gave her an EKG, a chest X-ray and a CT scan.

Friday, July 3, 2020

American Psychiatric Association Presidential Task Force to Address Structural Racism Throughout Psychiatry

Press Release
American Psychiatric Association
2 July 2020

The American Psychiatric Association today announced the members and charge of its Presidential Task Force to Address Structural Racism Throughout Psychiatry. The
Task Force was initially described at an APA Town Hall on June 15 amidst rising calls from psychiatrists for action on racism. It held its first meeting on June 27, and efforts, including the planning of future town halls, surveys and the establishment of related committees, are underway.

Focusing on organized psychiatry, psychiatrists, psychiatric trainees, psychiatric patients, and others who work to serve psychiatric patients, the Task Force is initially charged with:
  1. Providing education and resources on APA’s and psychiatry’s history regarding structural racism;
  2. Explaining the current impact of structural racism on the mental health of our patients and colleagues;
  3. Developing achievable and actionable recommendations for change to eliminate structural racism in the APA and psychiatry now and in the future;
  4. Providing reports with specific recommendations for achievable actions to the APA Board of Trustees at each of its meetings through May 2021; and
  5. Monitoring the implementation of tasks 1-4.

Wednesday, June 10, 2020

The moral courage of the military in confronting the commander in chief

Robert Bruce Adolph
Tampa Bay Times
Originally posted 9 June 20

The president recently threatened to use our active duty military to “dominate” demonstrators nationwide, who are exercising their wholly legitimate right to assemble and be heard.

The distinguished former Secretary of Defense Jim Mattis nailed it in his recent broadside published in The Atlantic that took aim at our current commander-in-chief. Mattis states, “When I joined the military, some 50 years ago … I swore an oath to support and defend the Constitution. Never did I dream that troops taking the same oath would be ordered under any circumstances to violate the constitutional rights of their fellow citizens—much less to provide a bizarre photo op for the elected commander-in-chief, with military leadership standing alongside.”

The current Secretary of Defense, Mike Esper, who now perhaps regrets being made into a photographic prop for the president, has come out publicly against using the active duty military to quell civil unrest in our cities; as has 89 high ranking former defense officials who stated that they were “alarmed” by the chief executive’s threat to use troops against our country’s citizens on U.S. soil. Former Secretary of State Colin Powell, a former U.S. Army general and Republican Party member, has also taken aim at this presidency by stating that he will vote for Joe Biden in the next election.

The info is here.

Wednesday, June 3, 2020

Justice without Retribution: An Epistemic Argument against Retributive Criminal Punishment

Gregg D. Caruso (2020)
Neuroethics ​13(1): 13-28.


Within the United States, the most prominent justification for criminal punishment is retributivism. This retributivist justification for punishment maintains that punishment of a wrongdoer is justified for the reason that she deserves something bad to happen to her just because she has knowingly done wrong—this could include pain, deprivation, or death. For the retributivist, it is the basic desert attached to the criminal’s immoral action alone that provides the justification for punishment. This means that the retributivist position is not reducible to consequentialist considerations nor in justifying punishment does it appeal to wider goods such as the safety of society or the moral improvement of those being punished. A number of sentencing guidelines in the U.S. have adopted desert as their distributive principle, and it is increasingly given deference in the “purposes” section of state criminal codes, where it can be the guiding principle in the interpretation and application of the code’s provisions. Indeed, the American Law Institute recently revised the Model Penal Code so as to set desert as the official dominate principle for sentencing. And courts have identified desert as the guiding principle in a variety of contexts, as with the Supreme Court’s enthroning retributivism as the “primary justification for the death penalty.” While retributivism provides one of the main sources of justification for punishment within the criminal justice system, there are good philosophical and practical reasons for rejecting it. One such reason is that it is unclear that agents truly deserve to suffer for the wrongs they have done in the sense required by retributivism. In the first section, I explore the retributivist justification of punishment and explain why it is inconsistent with free will skepticism. In the second section, I then argue that even if one is not convinced by the arguments for free will skepticism, there remains a strong epistemic argument against causing harm on retributivist grounds that undermines both libertarian and compatibilist attempts to justify it. I maintain that this argument provides sufficient reason for rejecting the retributive justification of criminal punishment. I conclude in the third section by briefly sketching my public health-quarantine model, a non-retributive alternative for addressing criminal behavior that draws on the public health framework and prioritizes prevention and social justice. I argue that the model is not only consistent with free will skepticism and the epistemic argument against retributivism, it also provides the most justified, humane, and effective way of dealing with criminal behavior.

The info is here.

Friday, May 29, 2020

When Is “Gay Panic” Accepted? Exploring Juror Characteristics and Case Type as Predictors of a Successful Gay Panic Defense

Michalski, N. D., & Nunez, N. (2020).
Journal of Interpersonal Violence. 


“Gay panic” refers to a situation in which a heterosexual individual charged with a violent crime against a homosexual individual claims they lost control and reacted violently because of an unwanted sexual advance that was made upon them. This justification for a violent crime presented by the defendant in the form of a provocation defense is used as an effort to mitigate the charges brought against him. There has been relatively little research conducted concerning this defense strategy and the variables that might predict when the defense is likely to be successful in achieving a lesser sentence for the defendant. This study utilized 249 mock jurors to assess the effects of case type (assault or homicide) and juror characteristics (homophobia, religious fundamentalism, and political orientation) on the success of the gay panic defense compared with a neutral provocation defense. Participant homophobia was found to be the driving force behind their willingness to accept the gay panic defense as legitimate. Higher levels of homophobia and religious fundamentalism were found to predict more leniency in verdict decisions when the gay panic defense was presented. This study furthers the understanding of decision making in cases involving the gay panic defense and highlights the need for more research to be conducted to help understand and combat LGBT (lesbian, gay, bisexual, and transgender) prejudice in the courtroom.

The research is here.

Thursday, May 28, 2020

Global health without justice or ethics

S Venkatapuram
Journal of Public Health

The great promise at the start of the twenty-first century that Anglo-American philosophers would produce transformative theories and practical guidance for realizing global health equity and justice has largely gone unfulfilled. The publication of The Law of Peoples by John Rawls in 1999 formally inaugurated the emerging academic field of global justice philosophy.1 After 2000, numerous monographs, journal articles and conferences discussed global justice. And new academic associations, journals and research centres were established.

One remarkable aspect of the new field was that the stark inequalities in health across societies were often the starting concern. Despite our diverse philosophical and ethical views, reasonable people are likely to be morally troubled about the large inequalities in life expectancies between some sub-Saharan country X and the USA or another rich country. This initially shared moral intuition or indignation, then, motivated diverse arguments about what precisely is morally bad about global health inequalities and global poverty and the possible demands of justice. Some philosophers described what ‘our’ duties are or, indeed, are not, to help ‘those people over there’. Others minimized the distinction between us and them by arguing for theories of radical global equality, the arbitrariness of political borders and duties that follow from our complicity in transnational harms experienced in other countries.

Progress in global justice philosophy seemingly promised real-world progress in global health equity and justice, because health inequality was the foremost issue in philosophical debates on global inequality, poverty and claims of the ‘global poor’. At the same time, largely driven by HIV research, bioethics went global as it was exported alongside medical research to resource poor settings. Bioethicists also began to go beyond clinical and research settings to examine public health ethics, social inequalities in health and social determinants—from local conditions all the way to global institutions and processes. Nevertheless, as of 2020, it is difficult to identify any compelling conceptions of global justice or global health justice or to identify any significant philosophical contributions to the practical improvement of global health and inequalities. What happened?

The rest of the article is linked above.