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 Outcomes. Show all posts
Showing posts with label Outcomes. Show all posts

Friday, July 15, 2022

How inferred motives shape moral judgements

Carlson, R.W., Bigman, Y.E., Gray, K. et al. 
Nat Rev Psychol (2022).


When people judge acts of kindness or cruelty, they often look beyond the act itself to infer the agent’s motives. These inferences, in turn, can powerfully influence moral judgements. The mere possibility of self-interested motives can taint otherwise helpful acts, whereas morally principled motives can exonerate those behind harmful acts. In this Review, we survey research showcasing the importance of inferred motives for moral judgements, and show how motive inferences are connected to judgements of actions, intentions and character. This work suggests that the inferences observers draw about peoples’ motives are sufficient for moral judgement (they drive character judgements even without actions) and functional (they effectively aid observers in predicting peoples’ future behaviour). Research that directly probes when and how people infer motives, and how motive properties guide those inferences, can deepen our understanding of the role of inferred motives in moral life.

From Summary and future directions

Moral psychology has long emphasized the importance of actions and character in moral judgements. However, observers frequently go beyond judging actions and seek to understand peoples’ motives. Moral psychology paradigms often feature cues to motives which carry moral weight, such as an agent’s desire to harm others physically, or their lack of motivation to pre-vent harm to others. The inferences people draw about others’ motives are crucial for moral judgement in two respects. First, the mere presence of certain motives can drive moral judgements of character, even in the absence of any action. Second, inferred motives shape what an agent’s actions reveal about their character to observers, and thereby allow observers to better pre-dict others’ future actions. To integrate past work and guide future research in moral psychology, we reviewed research connecting motives with actions, character and other key constructs. These insights can enrich our understanding of moral judgement, and shed light on emerging social phenomena that are relevant to moral psychology (see Box 1). The motive properties reviewed (motive strength, direction and conflict), as well as motive and action multiplicity, offer a guide for future work.

From Box 1

Motives and emerging social challenges researchers and ethicists are expressing growing concern about autonomous technologies and their rapidly increasing role in human life. robots and other artificial agents are perceived as less driven by motives than humans. these agents are increasingly tasked with decisions that have moral implications, such as allocating scarce medical resources, informing parole decisions and guiding autonomous vehicles. understanding the influence of motives in moral judgement can shed light on how the motiveless existence of artificial agents influences how people respond to the decisions of such artificial agents. On the one hand, people are averse to having artificial agents make morally relevant decisions, which can be explained by people perceiving robots as lacking helpful motives. On the other hand, people see artificial agents as less capable of discrimination, and are less outraged when they do discriminate, which can be explained by people perceiving robots as lacking harmful motives, such as prejudice.

Sunday, April 17, 2022

Leveraging artificial intelligence to improve people’s planning strategies

F. Callaway, et al.
PNAS, 2022, 119 (12) e2117432119 


Human decision making is plagued by systematic errors that can have devastating consequences. Previous research has found that such errors can be partly prevented by teaching people decision strategies that would allow them to make better choices in specific situations. Three bottlenecks of this approach are our limited knowledge of effective decision strategies, the limited transfer of learning beyond the trained task, and the challenge of efficiently teaching good decision strategies to a large number of people. We introduce a general approach to solving these problems that leverages artificial intelligence to discover and teach optimal decision strategies. As a proof of concept, we developed an intelligent tutor that teaches people the automatically discovered optimal heuristic for environments where immediate rewards do not predict long-term outcomes. We found that practice with our intelligent tutor was more effective than conventional approaches to improving human decision making. The benefits of training with our cognitive tutor transferred to a more challenging task and were retained over time. Our general approach to improving human decision making by developing intelligent tutors also proved successful for another environment with a very different reward structure. These findings suggest that leveraging artificial intelligence to discover and teach optimal cognitive strategies is a promising approach to improving human judgment and decision making.


Many bad decisions and their devastating consequences could be avoided if people used optimal decision strategies. Here, we introduce a principled computational approach to improving human decision making. The basic idea is to give people feedback on how they reach their decisions. We develop a method that leverages artificial intelligence to generate this feedback in such a way that people quickly discover the best possible decision strategies. Our empirical findings suggest that a principled computational approach leads to improvements in decision-making competence that transfer to more difficult decisions in more complex environments. In the long run, this line of work might lead to apps that teach people clever strategies for decision making, reasoning, goal setting, planning, and goal achievement.

From the Discussion

We developed an intelligent system that automatically discovers optimal decision strategies and teaches them to people by giving them metacognitive feedback while they are deciding what to do. The general approach starts from modeling the kinds of decision problems people face in the real world along with the constraints under which those decisions have to be made. The resulting formal model makes it possible to leverage artificial intelligence to derive an optimal decision strategy. To teach people this strategy, we then create a simulated decision environment in which people can safely and rapidly practice making those choices while an intelligent tutor provides immediate, precise, and accurate feedback on how they are making their decision. As described above, this feedback is designed to promote metacognitive reinforcement learning.

Monday, August 9, 2021

Health Care in the U.S. Compared to Other High-Income Countries: Worst Outcomes

The Commonwealth Fund
Mirror, Mirror 2021: Reflecting Poorly
Originally posted 4 Aug 21


No two nations are alike when it comes to health care. Over time, each country has settled on a unique mix of policies, service delivery systems, and financing models that work within its resource constraints. Even among high-income nations that have the option to spend more on health care, approaches often vary substantially. These choices affect health system performance in terms of access to care, patients’ experiences with health care, and people’s health outcomes. In this report, we compare the health systems of 11 high-income countries as a means to generate insights about the policies and practices that are associated with superior performance.

With the COVID-19 pandemic imposing an unprecedented stress test on the health care and public health systems of all nations, such a comparison is especially germane. Success in controlling and preventing infection and disease has varied greatly. The same is true of countries’ ability to address the challenges that the pandemic has presented to the workforce, operations, and financial stability of the organizations delivering care. And while the comparisons we draw are based on data collected prior to the pandemic or during the earliest months of the crisis, the prepandemic strengths and weaknesses of each country’s preexisting arrangements for health care and public health have undoubtedly been shaping its experience throughout the crisis.

For our assessment of health care system performance in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States, we used indicators available across five domains:
  • Access to care
  • Care process
  • Administrative efficiency
  • Equity
  • Health care outcomes
For more information on these performance domains and their component measures, see How We Measured Performance. Most of the data were drawn from surveys examining how members of the public and primary care physicians experience health care in their respective countries. These Commonwealth Fund surveys were conducted by SSRS in collaboration with partner organizations in the 10 other countries. Additional data were drawn from the Organisation for Economic Co-operation and Development (OECD) and the World Health Organization (WHO).

Sunday, July 4, 2021

Understanding Side-Effect Intentionality Asymmetries: Meaning, Morality, or Attitudes and Defaults?

Laurent SM, Reich BJ, Skorinko JLM. 
Personality and Social Psychology Bulletin. 


People frequently label harmful (but not helpful) side effects as intentional. One proposed explanation for this asymmetry is that moral considerations fundamentally affect how people think about and apply the concept of intentional action. We propose something else: People interpret the meaning of questions about intentionally harming versus helping in fundamentally different ways. Four experiments substantially support this hypothesis. When presented with helpful (but not harmful) side effects, people interpret questions concerning intentional helping as literally asking whether helping is the agents’ intentional action or believe questions are asking about why agents acted. Presented with harmful (but not helpful) side effects, people interpret the question as asking whether agents intentionally acted, knowing this would lead to harm. Differences in participants’ definitions consistently helped to explain intentionality responses. These findings cast doubt on whether side-effect intentionality asymmetries are informative regarding people’s core understanding and application of the concept of intentional action.

From the Discussion

Second, questions about intentionality of harm may focus people on two distinct elements presented in the vignette: the agent’s  intentional action  (e.g., starting a profit-increasing program) and the harmful secondary outcome he knows this goal-directed action will cause. Because the concept of intentionality is most frequently applied to actions rather than consequences of actions (Laurent, Clark, & Schweitzer, 2015), reframing the question as asking about an intentional action undertaken with foreknowledge of harm has advantages. It allows consideration of key elements from the story and is responsive to what people may feel is at the heart of the question: “Did the chairman act intentionally, knowing this would lead to harm?” Notably, responses to questions capturing this idea significantly mediated intentionality responses in each experiment presented here, whereas other variables tested failed to consistently do so. 

Saturday, February 13, 2021

Allocating moral responsibility to multiple agents

Gantman, A. P., Sternisko, A., et al.
Journal of Experimental Social Psychology
Volume 91, November 2020, 


Moral and immoral actions often involve multiple individuals who play different roles in bringing about the outcome. For example, one agent may deliberate and decide what to do while another may plan and implement that decision. We suggest that the Mindset Theory of Action Phases provides a useful lens through which to understand these cases and the implications that these different roles, which correspond to different mindsets, have for judgments of moral responsibility. In Experiment 1, participants learned about a disastrous oil spill in which one company made decisions about a faulty oil rig, and another installed that rig. Participants judged the company who made decisions as more responsible than the company who implemented them. In Experiment 2 and a direct replication, we tested whether people judge implementers to be morally responsible at all. We examined a known asymmetry in blame and praise. Moral agents received blame for actions that resulted in a bad outcome but not praise for the same action that resulted in a good outcome. We found this asymmetry for deciders but not implementers, an indication that implementers were judged through a moral lens to a lesser extent than deciders. Implications for allocating moral responsibility across multiple agents are discussed.


• Acts can be divided into parts and thereby roles (e.g., decider, implementer).

• Deliberating agent earns more blame than implementing one for a bad outcome.

• Asymmetry in blame vs. praise for the decider but not the implementer

• Asymmetry in blame vs. praise suggests only the decider is judged as moral agent

• Effect is attenuated if decider's job is primarily to implement.

Sunday, November 22, 2020

The logic of universalization guides moral judgment

Levine, S., et al.
PNAS October 20, 2020 
117 (42) 26158-26169; 
first published October 2, 2020; 


To explain why an action is wrong, we sometimes say, “What if everybody did that?” In other words, even if a single person’s behavior is harmless, that behavior may be wrong if it would be harmful once universalized. We formalize the process of universalization in a computational model, test its quantitative predictions in studies of human moral judgment, and distinguish it from alternative models. We show that adults spontaneously make moral judgments consistent with the logic of universalization, and report comparable patterns of judgment in children. We conclude that, alongside other well-characterized mechanisms of moral judgment, such as outcome-based and rule-based thinking, the logic of universalizing holds an important place in our moral minds.


Humans have several different ways to decide whether an action is wrong: We might ask whether it causes harm or whether it breaks a rule. Moral psychology attempts to understand the mechanisms that underlie moral judgments. Inspired by theories of “universalization” in moral philosophy, we describe a mechanism that is complementary to existing approaches, demonstrate it in both adults and children, and formalize a precise account of its cognitive mechanisms. Specifically, we show that, when making judgments in novel circumstances, people adopt moral rules that would lead to better consequences if (hypothetically) universalized. Universalization may play a key role in allowing people to construct new moral rules when confronting social dilemmas such as voting and environmental stewardship.

Saturday, April 11, 2020

The Tyranny of Time: How Long Does Effective Therapy Really Take?

Jonathan Shedler & Enrico Gnaulati
Psychotherapy Networker
Originally posted March/April 20

Here is an excerpt:

Like the Consumer Reports study, this study also found a dose–response relation between therapy sessions and improvement. In this case, the longer therapy continued, the more clients achieved clinically significant change. So just how much therapy did it take? It took 21 sessions, or about six months of weekly therapy, for 50 percent of clients to see clinically significant change. It took more than 40 sessions, almost a year of weekly therapy, for 75 percent to see clinically significant change.

Information from the surveys of clients and therapists turned out to be pretty spot on. Three independent data sources converge on similar time frames. Every client is different, and no one can predict how much therapy is enough for a specific person, but on average, clinically meaningful change begins around the six-month mark and grows from there. And while some people will get what they need with less therapy, others will need a good deal more.

This is consistent with what clinical theorists have been telling us for the better part of a century. It should come as no surprise. Nothing of deep and lasting value is cheap or easy, and changing oneself and the course of one’s life may be most valuable of all.

Consider what it takes to master any new and complex skill, say learning a language, playing a musical instrument, learning to ski, or becoming adept at carpentry. With six months of practice, you might attain beginner- or novice-level proficiency, maybe. If someone promised to make you an expert in six months, you’d suspect they were selling snake oil. Meaningful personal development takes time and effort. Why would psychotherapy be any different?

The info is here.

Thursday, March 12, 2020

Business gets ready to trip

Jeffrey O'Brien
Forbes. com
Originally posted 17 Feb 20

Here is an excerpt:

The need for a change in approach is clear. “Mental illness” is an absurdly large grab bag of disorders, but taken as a whole, it exacts an astronomical toll on society. The National Institute of Mental Health says nearly one in five U.S. adults lives with some form of it. According to the World Health Organization, 300 million people worldwide have an anxiety disorder. And there’s a death by suicide every 40 seconds—that includes 20 veterans a day, according to the U.S. Department of Veterans Affairs. Almost 21 million Americans have at least one addiction, per the U.S. Surgeon General, and things are only getting worse. The Lancet Commission—a group of experts in psychiatry, public health, neuroscience, etc.—projects that the cost of mental disorders, currently on the rise in every country, will reach $16 trillion by 2030, including lost productivity. The current standard of care clearly benefits some. Antidepressant medication sales in 2017 surpassed $14 billion. But SSRI drugs—antidepressants that boost the level of serotonin in the brain—can take months to take hold; the first prescription is effective only about 30% of the time. Up to 15% of benzodiazepine users become addicted, and adults on antidepressants are 2.5 times as likely to attempt suicide.

Meanwhile, in various clinical trials, psychedelics are demonstrating both safety and efficacy across the terrain. Scientific papers have been popping up like, well, mushrooms after a good soaking, producing data to blow away conventional methods. Psilocybin, the psychoactive ingredient in magic mushrooms, has been shown to cause a rapid and sustained reduction in anxiety and depression in a group of patients with life-threatening cancer. When paired with counseling, it has improved the ability of some patients suffering from treatment-resistant depression to recognize and process emotion on people’s faces. That correlates to reducing anhedonia, or the inability to feel pleasure. The other psychedelic agent most commonly being studied, MDMA, commonly called ecstasy or molly, has in some scientific studies proved highly effective at treating patients with persistent PTSD. In one Phase II trial of 107 patients who’d had PTSD for an average of over 17 years, 56% no longer showed signs of the affliction after one session of MDMA-assisted therapy. Psychedelics are helping to break addictions, as well. A combination of psilocybin and cognitive therapy enabled 80% of one study’s participants to kick cigarettes for at least six months. Compare that with the 35% for the most effective available smoking-cessation drug, varenicline.

The info is here.

Sunday, March 8, 2020

Humility and self-doubt are hallmarks of a good therapist

<p><em>Photo by Kelly Sikema/Unsplash</em></p>Helene Nissen-Lie
Originally posted 5 Feb 20

Here is an excerpt:

However, therapist humility on its own is not sufficient for therapy to be effective. In our latest study, we assessed how much therapists treat themselves in a kind and forgiving manner in their personal lives (ie, report more ‘self-affiliation’) and their perceptions of themselves professionally. We anticipated that therapists’ level of personal self-affiliation would enhance the effect that professional self-doubt has on therapeutic change. Our hypothesis was supported: therapists who reported more self-doubt in their work alleviated client distress more if they also reported being kind to themselves outside of work (in contrast, therapists who scored low on self-doubt and high on self-affiliation contributed to the least change).

We interpreted this finding to imply that a benign self-critical stance in a therapist is beneficial, but that self-care and forgiveness without reflective self-criticism is not. The combination of self-affiliation and professional self-doubt seems to pave the way for an open, self-reflective attitude that allows psychotherapists to respect the complexity of their work, and, when needed, to correct the therapeutic course to help clients more effectively.

What does all this mean? At a time when people tend to think that their value is based on how confident they are and that they must ‘sell themselves’ in every situation, the finding that therapist humility is an underrated virtue and a paradoxical ingredient of expertise might be a relief.

The info is here.

Monday, February 24, 2020

Physician Burnout Is Widespread, Especially Among Those in Midcareer

Brianna Abbott
The Wall Street Journal
Originally posted 15 Jan 20

Burnout is particularly pervasive among health-care workers, such as physicians or nurses, researchers say. Risk for burnout among physicians is significantly greater than that of general U.S. working adults, and physicians also report being less satisfied with their work-life balance, according to a 2019 study published in Mayo Clinic Proceedings.

Overall, 42% of the physicians in the new survey, across 29 specialties, reported feeling some sense of burnout, down slightly from 46% in 2015.

The report, published on Wednesday by medical-information platform Medscape, breaks down the generational differences in burnout and how doctors cope with the symptoms that are widespread throughout the profession.

“There are a lot more similarities than differences, and what that highlights is that burnout in medicine right now is really an entire-profession problem,” said Colin West, a professor of medicine at the Mayo Clinic who researches physician well-being. “There’s really no age group, career stage, gender or specialty that’s immune from these issues.”

In recent years, hospitals, health systems and advocacy groups have tried to curb the problem by starting wellness programs, hiring chief wellness officers or attempting to reduce administrative tasks for nurses and physicians.

Still, high rates of burnout persist among the medical community, from medical-school students to seasoned professionals, and more than two-thirds of all physicians surveyed in the Medscape report said that burnout had an impact on their personal relationships.

Nearly one in five physicians also reported that they are depressed, with the highest rate, 18%, reported by Gen Xers.

The info is here.

Tuesday, February 18, 2020

Can an Evidence-Based Approach Improve the Patient-Physician Relationship?

A. S. Cifu, A. Lembo, & A. M. Davis
JAMA. 2020;323(1):31-32.

Here is an excerpt:

Through these steps, the research team identified potentially useful clinical approaches that were perceived to contribute to physician “presence,” defined by the authors as a purposeful practice of “awareness, focus, and attention with the intent to understand and connect with patients.”

These practices were rated by patients and clinicians on their likely effects and feasibility in practice. A Delphi process was used to condense 13 preliminary practices into 5 final recommendations, which were (1) prepare with intention, (2) listen intently and completely, (3) agree on what matters most, (4) connect with the patient’s story, and (5) explore emotional cues. Each of these practices is complex, and the authors provide detailed explanations, including narrative examples and links to outcomes, that are summarized in the article and included in more detail in the online supplemental material.

If implemented in practice, these 5 practices suggested by Zulman and colleagues are likely to enhance patient-physician relationships, which ideally could help improve physician satisfaction and well-being, reduce physician frustration, improve clinical outcomes, and reduce health care costs.

Importantly, the authors also call for system-level interventions to create an environment for the implementation of these practices.

Although the patient-physician interaction is at the core of most physicians’ activities and has led to an entire genre of literature and television programs, very little is actually known about what makes for an effective relationship.

The info is here.

Friday, February 7, 2020

Business ethics and morality have their limitations, new analysis suggests

Jayne Smith
Originally published 16 Jan 20

Morality has its limitations in the business domain, according to a new analysis of available research by Dr Hannes Leroy from Rotterdam School of Management (RSM) Erasmus University and his co-authors. This is despite the fact that there is a widespread belief that morality and business ethics matter in the way organisations act, although there is also a concomitant belief that there is a general lack of attention to morality in the world of leadership. This appears to be true regardless of industry, firm size, or the status and level of a leader in a company.

The researchers reviewed 300 studies on moral leadership and discovered the pitfalls of morality at work.The study, Taking Stock of Moral Approaches to Leadership: An Integrative Review of Ethical, Authentic, and Servant Leadership was published in the journal Academy of Management Annals.

The info is here.

Wednesday, February 5, 2020

A Reality Check On Artificial Intelligence: Are Health Care Claims Overblown?

Liz Szabo
Kaiser Health News
Originally published 30 Dec 19

Here is an excerpt:

“Almost none of the [AI] stuff marketed to patients really works,” said Dr. Ezekiel Emanuel, professor of medical ethics and health policy in the Perelman School of Medicine at the University of Pennsylvania.

The FDA has long focused its attention on devices that pose the greatest threat to patients. And consumer advocates acknowledge that some devices ― such as ones that help people count their daily steps ― need less scrutiny than ones that diagnose or treat disease.

Some software developers don’t bother to apply for FDA clearance or authorization, even when legally required, according to a 2018 study in Annals of Internal Medicine.

Industry analysts say that AI developers have little interest in conducting expensive and time-consuming trials. “It’s not the main concern of these firms to submit themselves to rigorous evaluation that would be published in a peer-reviewed journal,” said Joachim Roski, a principal at Booz Allen Hamilton, a technology consulting firm, and co-author of the National Academy’s report. “That’s not how the U.S. economy works.”

But Oren Etzioni, chief executive officer at the Allen Institute for AI in Seattle, said AI developers have a financial incentive to make sure their medical products are safe.

The info is here.

Friday, January 31, 2020

Most scientists 'can't replicate studies by their peers'

Test tubesTom Feilden
Originally posted 22 Feb 17

Here is an excerpt:

The authors should have done it themselves before publication, and all you have to do is read the methods section in the paper and follow the instructions.

Sadly nothing, it seems, could be further from the truth.

After meticulous research involving painstaking attention to detail over several years (the project was launched in 2011), the team was able to confirm only two of the original studies' findings.

Two more proved inconclusive and in the fifth, the team completely failed to replicate the result.

"It's worrying because replication is supposed to be a hallmark of scientific integrity," says Dr Errington.

Concern over the reliability of the results published in scientific literature has been growing for some time.

According to a survey published in the journal Nature last summer, more than 70% of researchers have tried and failed to reproduce another scientist's experiments.

Marcus Munafo is one of them. Now professor of biological psychology at Bristol University, he almost gave up on a career in science when, as a PhD student, he failed to reproduce a textbook study on anxiety.

"I had a crisis of confidence. I thought maybe it's me, maybe I didn't run my study well, maybe I'm not cut out to be a scientist."

The problem, it turned out, was not with Marcus Munafo's science, but with the way the scientific literature had been "tidied up" to present a much clearer, more robust outcome.

The info is here.

Wednesday, January 29, 2020

Why morals matter in foreign policy

Joseph Nye
Originally published 10 Jan 20

Here is the conclusion:

Good moral reasoning should be three-dimensional, weighing and balancing intentions, consequences and means. A foreign policy should be judged accordingly. Moreover, a moral foreign policy must consider consequences such as maintaining an institutional order that encourages moral interests, in addition to particular newsworthy actions such as helping a dissident or a persecuted group in another country. And it’s important to include the ethical consequences of ‘nonactions’, such as President Harry S. Truman’s willingness to accept stalemate and domestic political punishment during the Korean War rather than follow General Douglas MacArthur’s recommendation to use nuclear weapons. As Sherlock Holmes famously noted, much can be learned from a dog that doesn’t bark.

It’s pointless to argue that ethics will play no role in the foreign policy debates that await this year. We should acknowledge that we always use moral reasoning to judge foreign policy, and we should learn to do it better.

The info is here.

Thursday, January 23, 2020

Colleges want freshmen to use mental health apps. But are they risking students’ privacy?

 (iStock)Deanna Paul
The New York Times
Originally posted 2 Jan 20

Here are two excepts:

TAO Connect is just one of dozens of mental health apps permeating college campuses in recent years. In addition to increasing the bandwidth of college counseling centers, the apps offer information and resources on mental health issues and wellness. But as student demand for mental health services grows, and more colleges turn to digital platforms, experts say universities must begin to consider their role as stewards of sensitive student information and the consequences of encouraging or mandating these technologies.

The rise in student wellness applications arrives as mental health problems among college students have dramatically increased. Three out of 5 U.S. college students experience overwhelming anxiety, and 2 in 5 students reported debilitating depression, according to a 2018 survey from the American College Health Association.

Even so, only about 15 percent of undergraduates seek help at a university counseling center. These apps have begun to fill students’ needs by providing ongoing access to traditional mental health services without barriers such as counselor availability or stigma.


“If someone wants help, they don’t care how they get that help,” said Lynn E. Linde, chief knowledge and learning officer for the American Counseling Association. “They aren’t looking at whether this person is adequately credentialed and are they protecting my rights. They just want help immediately.”

Yet she worried that students may be giving up more information than they realize and about the level of coercion a school can exert by requiring students to accept terms of service they otherwise wouldn’t agree to.

“Millennials understand that with the use of their apps they’re giving up privacy rights. They don’t think to question it,” Linde said.

The info is here.

Thursday, January 9, 2020

How implicit bias harms patient care

Jeff Bendix
Originally posted 25 Nov 19

Here is an excerpt:

While many people have difficulty acknowledging that their actions are influenced by unconscious biases, the concept is particularly troubling for doctors, who have been trained to view—and treat—patients equally, and the vast majority of whom sincerely believe that they do.

“Doctors have been molded throughout medical school and all our training to be non-prejudiced when it comes to treating patients,” says James Allen, MD, a pulmonologist and medical director of University Hospital East, part of Ohio State University’s Wexner Medical Center. “It’s not only asked of us, it’s demanded of us, so many physicians would like to think they have no biases. But it’s not true. All human beings have biases.”

“Among physicians, there’s a stigma attached to any suggestion of racial bias,” adds Penner. “And were a person to be identified that way, there could be very severe consequences in terms of their career prospects or even maintaining their license.”

Ironically, as Penner and others point out, the conditions under which most doctors practice today—high levels of stress, frequent distractions, and brief visits that allow little time to get to know patients--are the ones most likely to heighten their vulnerability to unintentional biases.

“A doctor under time pressure from a backlog of overdue charting and whatever else they’re dealing with will have a harder time treating all patients with the same level of empathy and concern,” van Ryn says.

The info is here.

Sunday, November 3, 2019

The Sex Premium in Religiously Motivated Moral Judgment

Image result for sexual behavior moralityLiana Hone, Thomas McCauley, Eric Pedersen,
Evan Carter, and Michael McCullough
PsyArXiv Preprints


Religion encourages people to reason about moral issues deontologically rather than on the basis of the perceived consequences of specific actions. However, recent theorizing suggests that religious people’s moral convictions are actually quite strategic (albeit unconsciously so), designed to make their worlds more amenable to their favored approaches to solving life’s basic challenges. In six experiments, we find that religious cognition places a “sex premium” on moral judgments, causing people to judge violations of conventional sexual morality as particularly objectionable. The sex premium is especially strong among highly religious people, and applies to both legal and illegal acts. Religion’s influence on moral reasoning, even if deontological, emphasizes conventional sexual norms, and may reflect the strategic projects to which religion has been applied throughout history.

From the Discussion

How does the sex premium in religiously motivated moral judgment arise during development? We see three plausible pathways. First, society’s vectors for religious cultural learning may simply devote more attention to sex and reproduction than to prosociality when they seek to influence others’ moral stances. Conservative preachers, for instance, devote more time to issues of sexual purity than do liberal preachers, and religious parents discuss the morality of sex with their children more frequently than do less religious parents, even though they discuss sex with their children less frequently overall. Second, strong emotions facilitate cultural learning by improving attention, memory, and motivation, and few human experiences generate stronger emotions than do sex and reproduction. If the emotions that regulate sexual attraction, arousal, and avoidance (e.g., sexual disgust) are stronger than those that regulate prosocial behavior (e.g., empathy; moralistic anger), then the sex premium documented here may emerge from the fact that religiously motivated sexual moralists can create more powerful cultural learning experiences than prosocial moralists can.  Finally, given the extreme importance of sex and reproduction to fitness, the children of religiously adherent adults may observe that violations of local sexual standards to evoke greater moral outrage and condemnation from third parties than do violations of local standards for prosocial behavior.

The research is here.

Thursday, October 17, 2019

AI ethics and the limits of code(s)

Machine learningGeoff Mulgan
Originally published September 16, 2019

Here is an excerpt:

1. Ethics involve context and interpretation - not just deduction from codes.

Too much writing about AI ethics uses a misleading model of what ethics means in practice. It assumes that ethics can be distilled into principles from which conclusions can then be deduced, like a code. The last few years have brought a glut of lists of principles (including some produced by colleagues at Nesta). Various overviews have been attempted in recent years. A recent AI Ethics Guidelines Global Inventory collects over 80 different ethical frameworks. There’s nothing wrong with any of them and all are perfectly sensible and reasonable. But this isn’t how most ethical reasoning happens. The lists assume that ethics is largely deductive, when in fact it is interpretive and context specific, as is wisdom. One basic reason is that the principles often point in opposite directions - for example, autonomy, justice and transparency. Indeed, this is also the lesson of medical ethics over many decades. Intense conversation about specific examples, working through difficult ambiguities and contradictions, counts for a lot more than generic principles.

The info is here.

Saturday, July 13, 2019

The Worst Patients in the World

David Freedman
The Atlantic - July 2019 Issue

Here are two excerpts:

Recriminations tend to focus on how Americans pay for health care, and on our hospitals and physicians. Surely if we could just import Singapore’s or Switzerland’s health-care system to our nation, the logic goes, we’d get those countries’ lower costs and better results. Surely, some might add, a program like Medicare for All would help by discouraging high-cost, ineffective treatments.

But lost in these discussions is, well, us. We ought to consider the possibility that if we exported Americans to those other countries, their systems might end up with our costs and outcomes. That although Americans (rightly, in my opinion) love the idea of Medicare for All, they would rebel at its reality. In other words, we need to ask: Could the problem with the American health-care system lie not only with the American system but with American patients?


American patients’ flagrant disregard for routine care is another problem. Take the failure to stick to prescribed drugs, one more bad behavior in which American patients lead the world. The estimated per capita cost of drug noncompliance is up to three times as high in the U.S. as in the European Union. And when Americans go to the doctor, they are more likely than people in other countries to head to expensive specialists. A British Medical Journal study found that U.S. patients end up with specialty referrals at more than twice the rate of U.K. patients. They also end up in the ER more often, at enormous cost. According to another study, this one of chronic migraine sufferers, 42 percent of U.S. respondents had visited an emergency department for their headaches, versus 14 percent of U.K. respondents.

Finally, the U.S. stands out as a place where death, even for the very aged, tends to be fought tooth and nail, and not cheaply. “In the U.K., Canada, and many other countries, death is seen as inevitable,” Somava Saha said. “In the U.S., death is seen as optional. When [people] become sick near the end of their lives, they have faith in what a heroic health-care system will accomplish for them.”

The info is here.