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 Policy Making. Show all posts
Showing posts with label Policy Making. Show all posts

Sunday, May 8, 2022

MAID Without Borders? Oregon Drops the Residency Requirement

Nancy Berlinger
The Hastings Center: Bioethics
Originally posted 1 APR 22

Oregon, which legalized medical aid-in-dying (MAID) in 1997, has dropped the requirement that had limited MAID access to residents of the state. Under a settlement of a lawsuit filed in federal court by the advocacy group Compassion & Choices, Oregon public health officials will no longer apply or enforce this requirement as part of eligibility criteria for MAID.  The lawsuit was filed on behalf of an Oregon physician who challenged the state’s residency requirement and its consequences for his patients in neighboring Washington State.

In Oregon and in nine other jurisdictions – California, Colorado, the District of Columbia, Hawaii, Maine, New Jersey, New Mexico, Vermont, and Washington – with Oregon-type provisions (Montana has related but distinct case law), MAID eligibility criteria include being an adult with a life expectancy of six months or less; the capacity to make a voluntary medical decision; and the ability to self-administer lethal medication prescribed by a physician for the purpose of ending life. Because hospice eligibility criteria also include a six-month prognosis, all people who are eligible for MAID are already hospice-eligible, and most people who seek to use a provision are enrolled in hospice.

The legal and practical implications of this policy change are not yet known and are potentially complex. Advocates have called attention to potential legal risks associated with traveling to Oregon to gain access to MAID. For example, a family member or friend who accompanies a terminally ill person to Oregon could be liable under the laws of their state of residence for “assisting a suicide.”

What are the ethical and social implications of this policy change? Here are some preliminary thoughts:

First, it is unlikely that many people will travel to Oregon from states without MAID provisions. MAID is used by extremely small numbers of terminally ill people, and Oregon’s removal of its residency requirement did not change the multistep evaluation process to determine eligibility. To relocate to another state for the weeks that this process takes would not be practicable or financially feasible for many terminally ill, usually older, adults who are already receiving hospice care.

Wednesday, December 11, 2019

Veil-of-ignorance reasoning favors the greater good

Karen Huang, Joshua D. Greene and Max Bazerman
PNAS first published November 12, 2019
https://doi.org/10.1073/pnas.1910125116

Abstract

The “veil of ignorance” is a moral reasoning device designed to promote impartial decision-making by denying decision-makers access to potentially biasing information about who will benefit most or least from the available options. Veil-of-ignorance reasoning was originally applied by philosophers and economists to foundational questions concerning the overall organization of society. Here we apply veil-of-ignorance reasoning in a more focused way to specific moral dilemmas, all of which involve a tension between the greater good and competing moral concerns. Across six experiments (N = 5,785), three pre-registered, we find that veil-of-ignorance reasoning favors the greater good. Participants first engaged in veil-of-ignorance reasoning about a specific dilemma, asking themselves what they would want if they did not know who among those affected they would be. Participants then responded to a more conventional version of the same dilemma with a moral judgment, a policy preference, or an economic choice. Participants who first engaged in veil-of-ignorance reasoning subsequently made more utilitarian choices in response to a classic philosophical dilemma, a medical dilemma, a real donation decision between a more vs. less effective charity, and a policy decision concerning the social dilemma of autonomous vehicles. These effects depend on the impartial thinking induced by veil-of-ignorance reasoning and cannot be explained by a simple anchoring account, probabilistic reasoning, or generic perspective-taking. These studies indicate that veil-of-ignorance reasoning may be a useful tool for decision-makers who wish to make more impartial and/or socially beneficial choices.

Significance

The philosopher John Rawls aimed to identify fair governing principles by imagining people choosing their principles from behind a “veil of ignorance,” without knowing their places in the social order. Across 7 experiments with over 6,000 participants, we show that veil-of-ignorance reasoning leads to choices that favor the greater good. Veil-of-ignorance reasoning makes people more likely to donate to a more effective charity and to favor saving more lives in a bioethical dilemma. It also addresses the social dilemma of autonomous vehicles (AVs), aligning abstract approval of utilitarian AVs (which minimize total harm) with support for a utilitarian AV policy. These studies indicate that veil-of-ignorance reasoning may be used to promote decision making that is more impartial and socially beneficial.

Wednesday, August 7, 2019

Veil-of-Ignorance Reasoning Favors the Greater Good

Karen Huang Joshua D. Greene Max Bazerman
PsyArXiv
Originally posted July 2, 2019

Abstract

The “veil of ignorance” is a moral reasoning device designed to promote impartial decision-making by denying decision-makers access to potentially biasing information about who will benefit most or least from the available options. Veil-of-ignorance reasoning was originally applied by philosophers and economists to foundational questions concerning the overall organization of society. Here we apply veil-of-ignorance reasoning in a more focused way to specific moral dilemmas, all of which involve a tension between the greater good and competing moral concerns. Across six experiments (N = 5,785), three pre-registered, we find that veil-of-ignorance reasoning favors the greater good. Participants first engaged in veil-of-ignorance reasoning about a specific dilemma, asking themselves what they would want if they did not know who among those affected they would be. Participants then responded to a more conventional version of the same dilemma with a moral judgment, a policy preference, or an economic choice. Participants who first engaged in veil-of-ignorance reasoning subsequently made more utilitarian choices in response to a classic philosophical dilemma, a medical dilemma, a real donation decision between a more vs. less effective charity, and a policy decision concerning the social dilemma of autonomous vehicles. These effects depend on the impartial thinking induced by veil-of-ignorance reasoning and cannot be explained by a simple anchoring account, probabilistic reasoning, or generic perspective-taking. These studies indicate that veil-of-ignorance reasoning may be a useful tool for decision-makers who wish to make more impartial and/or socially beneficial choices.

The research is here.