Why not common morality?

Rhodes R 

Journal of Medical Ethics 

Published Online First: 11 September 2019. 

doi: 10.1136/medethics-2019-105621

Abstract

This paper challenges the leading common morality accounts of medical ethics which hold that medical ethics is nothing but the ethics of everyday life applied to today’s high-tech medicine. Using illustrative examples, the paper shows that neither the Beauchamp and Childress four-principle account of medical ethics nor the Gert et al 10-rule version is an adequate and appropriate guide for physicians’ actions. By demonstrating that medical ethics is distinctly different from the ethics of everyday life and cannot be derived from it, the paper argues that medical professionals need a touchstone other than common morality for guiding their professional decisions. That conclusion implies that a new theory of medical ethics is needed to replace common morality as the standard for understanding how medical professionals should behave and what medical professionalism entails. En route to making this argument, the paper addresses fundamental issues that require clarification: what is a profession? how is a profession different from a role? how is medical ethics related to medical professionalism? The paper concludes with a preliminary sketch for a theory of medical ethics.

The info is here.

Nudging, informed consent and bullshit

William Simkulet
Journal of Medical Ethics Published Online 
First: 18 November 2017. doi: 10.1136/medethics-2017-104480

Abstract

Some philosophers have argued that during the process of obtaining informed consent, physicians should try to nudge their patients towards consenting to the option the physician believes best, where a nudge is any influence that is expected to predictably alter a person’s behaviour without (substantively) restricting her options. Some proponents of nudging even argue that it is a necessary and unavoidable part of securing informed consent. Here I argue that nudging is incompatible with obtaining informed consent. I assume informed consent requires that a physician tells her patient the truth about her options and argue that nudging is incompatible with truth-telling. Instead, nudging satisfies Harry Frankfurt’s account of bullshit.

The article is here.

How To Spot A Fake Science News Story

Alex Berezow
American Council on Science and Health
Originally published January 31, 2017

Here is an excerpt:

How to Detect a Fake Science News Story

Often, I have been asked, "How can you tell if a science story isn't legitimate?" Here are some red flags:

1) The article is very similar to the press release on which it was based. This indicates whether the article is science journalism or just public relations.

2) The article makes no attempt to explain methodology or avoids using any technical terminology. (This indicates the author may be incapable of understanding the original paper.)

3) The article does not indicate any limitations on the conclusions of the research. (For example, a study conducted entirely in mice cannot be used to draw firm conclusions about humans.)

4) The article treats established scientific facts and fringe ideas on equal terms.

5) The article is sensationalized; i.e., it draws huge, sweeping conclusions from a single study. (This is particularly common in stories on scary chemicals and miracle vegetables.)

6) The article fails to separate scientific evidence from science policy. Reasonable people should be able to agree on the former while debating the latter. (This arises from the fact that people ascribe to different values and priorities.)

The article is here.

Editorial retraction

By Marcia McNutt
Science Magazine
Originally posted on May 28, 2015

Science, with the concurrence of author Donald P. Green, is retracting the 12 December 2014 Report “When contact changes minds: An experiment on transmission of support for gay equality” by LaCour and Green.

The reasons for retracting the paper are as follows: (i) Survey incentives were misrepresented. To encourage participation in the survey, respondents were claimed to have been given cash payments to enroll, to refer family and friends, and to complete multiple surveys. In correspondence received from Michael J. LaCour’s attorney, he confirmed that no such payments were made. (ii) The statement on sponsorship was false. In the Report, LaCour acknowledged funding from the Williams Institute, the Ford Foundation, and the Evelyn and Walter Haas Jr. Fund. Per correspondence from LaCour’s attorney, this statement was not true.

In addition to these known problems, independent researchers have noted certain statistical irregularities in the responses (2). LaCour has not produced the original survey data from which someone else could independently confirm the validity of the reported findings.

Michael J. LaCour does not agree to this Retraction.

Published online 28 May 2015

10.1126/science.aac6638

Here is the article

When contact changes minds: An experiment on transmission of support for gay equality
Michael J. LaCour and Donald P. Green
Science 12 December 2014: 1366-1369.

How to get kids to tell the truth? It's not all about carrot or stick

By Dan Jones
Research Digest Blog
Originally published January 15, 2015

All parents have to come to terms with the fact that their little angels will, from time to time, act like little devils. They’ll throw tantrums over trivial issues, or they’ll push, hit, bite or scratch other kids. And at some point they’ll start lying about what they’ve done.

Lying is perfectly normal among children, not a sign of a sociopath in the making. Many kids start telling the odd fib around their second birthday, and by the time they’re 4 or 5 they’re even better at the art of manipulating the truth, and keeping it from us. So how can parents help their kids internalise the lesson that honesty is the best — or at least the socially preferred — policy?

The entire blog post is here.

The effects of punishment and appeals for honesty on children’s truth-telling behavior

By Victoria Talwar, Cindy Arruda, & Sarah Yachison

Journal of Experimental Child Psychology

Volume 130, February 2015, Pages 209–217

Abstract

This study examined the effectiveness of two types of verbal appeals (external and internal motivators) and expected punishment in 372 children’s (4- to 8-year-olds) truth-telling behavior about a transgression. External appeals to tell the truth emphasized social approval by stating that the experimenter would be happy if the children told the truth. Internal appeals to tell the truth emphasized internal standards of behavior by stating that the children would be happy with themselves if they told the truth. Results indicate that with age children are more likely to lie and maintain their lie during follow-up questioning. Overall, children in the External Appeal conditions told the truth significantly more compared with children in the No Appeal conditions. Children who heard internal appeals with no expected punishment were significantly less likely to lie compared with children who heard internal appeals when there was expected punishment. The results have important implications regarding the impact of socialization on children’s honesty and promoting children’s veracity in applied situations where children’s honesty is critical.

Highlights

• The effectiveness of verbal appeals and punishment on children’s honesty was examined.

• External appeals emphasized the importance of truth-telling for social approval.

• Internal appeals emphasized internal standards of behavior.

•Overall children in the external appeal conditions were least likely to lie.

•The efficacy of internal appeals was attenuated by expected punishment.

The article is here.

The Lies We Tell in the Exam Room

By Abigail Zuger
The New York Times - Well Column
Published April 22, 2013

Here are some excerpts:

In a recent issue of The American Journal of Bioethics, a half-dozen ethicists chewed over the question of whether a decision to play Robin Hood with the medical insurer is actually ethical. Say that the patient’s health — or even life — is at stake: The insurer, for example, is refusing to pay for an essential test or medication unless the doctor writes down a bogus diagnosis the patient does not have. The experts came down firmly and eloquently on both sides of the issue.

Nicolas Tavaglione and Dr. Samia A. Hurst, both at the Institute for Biomedical Ethics at Geneva University Medical School in Switzerland, argued that lying for a patient under such circumstances was not only ethically permissible but mandatory. Helping a patient takes precedence over all other considerations, they wrote. Telling the truth would be “honoring an ideal principle in a nonideal world.”

Other ethicists protested, pointing out that too many doctors playing Robin Hood would make insurers tighten purse strings further. Dr. Thomas S. Huddle, of the medical school at the University of Alabama, Birmingham, wrote that all lies, even those told for a good cause, imperil the moral fabric of medicine. Dr. Robert M. Sade, of the Medical University of South Carolina, feared instead for the moral fabric of the doctor, pointing out that every lie “reinforces the habit of lying,” which then becomes easier and easier until the “morally disengaged” doctor is capable of really bad behavior.

The entire article is here.

Patient Communication Study Shows Doctors Regularly Withhold Truth

Catherine Pearson
The Huffington Post - Healthy Living
Originally published February 9, 2012

If you think your doctor is hiding something from you, you might be right.

According to a new study, published Wednesday in the journal Health Affairs, some physicians are not always forthright when it comes to patient communication, withholding information about medical errors, relationships with drug companies and severity of a person's prognosis.

"It should be a source of caution," said Dr. Lisa Lezzioni, a professor of medicine at Harvard Medical School and the study's author. "The caution requires patients to think about and discuss what they want in terms of communication with their doctors."

Researchers surveyed more than 1,800 physicians from around the country, working in a variety of specialties, to ask about how they perceive and handle patient communications.

Nearly 35 percent of respondents said they did not "completely agree" that they should disclose serious medical errors to their patients, and approximately 20 percent said they had not revealed a mistake to a patient in the last year because they feared being sued.

Additionally, 35 percent of the doctors said they did not "completely agree" that they should disclose their financial relationships with drug and medical device companies, and 11 percent admitted that they had told a patient something untrue in the past year.

The entire story is here.

Here is a portion of the abstract from the original article in Health Affairs.

Overall, approximately one-third of physicians did not completely agree with disclosing serious medical errors to patients, almost one-fifth did not completely agree that physicians should never tell a patient something untrue, and nearly two-fifths did not completely agree that they should disclose their financial relationships with drug and device companies to patients. Just over one-tenth said they had told patients something untrue in the previous year. Our findings raise concerns that some patients might not receive complete and accurate information from their physicians, and doubts about whether patient-centered care is broadly possible without more widespread physician endorsement of the core communication principles of openness and honesty with patients.