Unconscious Patient With 'Do Not Resuscitate' Tattoo Causes Ethical Conundrum at Hospital

George Dvorsky
Gizmodo
Originally published November 30, 2017

When an unresponsive patient arrived at a Florida hospital ER, the medical staff was taken aback upon discovering the words “DO NOT RESUSCITATE” tattooed onto the man’s chest—with the word “NOT” underlined and with his signature beneath it. Confused and alarmed, the medical staff chose to ignore the apparent DNR request—but not without alerting the hospital’s ethics team, who had a different take on the matter.

But with the “DO NOT RESUSCITATE” tattoo glaring back at them, the ICU team was suddenly confronted with a serious dilemma. The patient arrived at the hospital without ID, the medical staff was unable to contact next of kin, and efforts to revive or communicate with the patient were futile. The medical staff had no way of knowing if the tattoo was representative of the man’s true end-of-life wishes, so they decided to play it safe and ignore it.

The article is here.

Turning Conservatives Into Liberals: Safety First

John Bargh
The Washington Post
Originally published November 22, 2017

Here is an excerpt:

But if they had instead just imagined being completely physically safe, the Republicans became significantly more liberal — their positions on social attitudes were much more like the Democratic respondents. And on the issue of social change in general, the Republicans’ attitudes were now indistinguishable from the Democrats. Imagining being completely safe from physical harm had done what no experiment had done before — it had turned conservatives into liberals.

In both instances, we had manipulated a deeper underlying reason for political attitudes, the strength of the basic motivation of safety and survival. The boiling water of our social and political attitudes, it seems, can be turned up or down by changing how physically safe we feel.

This is why it makes sense that liberal politicians intuitively portray danger as manageable — recall FDR’s famous Great Depression era reassurance of “nothing to fear but fear itself,” echoed decades later in Barack Obama’s final State of the Union address — and why President Trump and other Republican politicians are instead likely to emphasize the dangers of terrorism and immigration, relying on fear as a motivator to gain votes.

In fact, anti-immigration attitudes are also linked directly to the underlying basic drive for physical safety. For centuries, arch-conservative leaders have often referred to scapegoated minority groups as “germs” or “bacteria” that seek to invade and destroy their country from within. President Trump is an acknowledged germaphobe, and he has a penchant for describing people — not only immigrants but political opponents and former Miss Universe contestants — as “disgusting.”

The article is here.

Is There a Right Way to Nudge? The Practice and Ethics of Choice Architecture

Evan Selinger and Kyle Whyte
Sociology Compass, Vol. 5, No. 10, pp. 923-935

Abstract

What exactly is a nudge, and how do nudges differ from alternative ways of modifying people's behavior, such as fines or penalties (e.g. taxing smokers) and increasing access to information (e.g. calorie counts on restaurant menus)? We open Section 2 by defining the concept of a nudge and move on to present some examples of nudges. Though there is certainly a clear concept of what a nudge is, there is some confusion when people design and talk about nudges in practice. In Sections 3 and 4, then, we discuss policies and technologies that get called nudges mistakenly as well as borderline cases where it is unclear whether people are being nudged. Understanding mistaken nudges and borderline cases allows citizens to consider critically whether they should support “alleged” nudge policies proposed by governments, corporations, and non-profit organizations. There are also important concerns about the ethics of nudging people's behavior. In Section 5 we review some major ethical and political issues surrounding nudges, covering both public anxieties and more formal scholarly criticisms. If nudges are to be justified as an acceptable form of behavior modification in democratic societies, nudge advocates must have reasons that allay anxieties and ethical concerns. However, in Section 6, we argue that nudge advocates must confront a particularly challenging problem. A strong justification of nudging, especially for pluralistic democracies, must show that nudge designers really understand how different people re-interpret the meaning of situations after a nudge has been introduced into the situations. We call this the problem of “semantic variance.” This problem, along with the ethical issues we discussed, makes us question whether nudges are truly viable mechanisms for improving people's lives and societies. Perhaps excitement over their potential of nudges is exaggerated.

The article is here.

Re: Nudges in a Post-truth World

Guest Post: Nathan Hodson
Journal of Medical Ethics Blog
Originally posted July 19, 2017

Here is an excerpt:

As Levy notes, some people are concerned that nudges present a threat to autonomy. Attempts at reconciling nudges with ethics, then, are important because nudging in healthcare is here to stay but we need to ensure it is used in ways that respect autonomy (and other moral principles).

The term “nudge” is perhaps a misnomer. To fill out the concept a bit, it commonly denotes the use of behavioural economics and behavioural psychology to the construction of choice architecture through carefully designed trials. But every choice we face, in any context, already comes with a choice architecture: there are endless contextual factors that impact the decisions we make.

When we ask whether nudging is acceptable we are asking whether an arbitrary or random choice architecture is more acceptable than a deliberate choice architecture, or whether an uninformed choice architecture is better than one informed by research.

In fact the permissibility of a nudge derives from whether it is being used in an ethically acceptable way, something that can only be explored on an individual basis. Thaler and Sunstein locate ethical acceptability in promoting the health of the person being nudged (and call this Libertarian Paternalism — i.e. sensible choices are promoted but no option is foreclosed). An alternative approach was proposed by Mitchell: nudges are justified if they maximise future liberty. Either way the nudging itself is not inherently problematic.

The article is here.

Emotional Judges and Unlucky Juveniles

Ozkan Eren and Naci Mocan
NBER Working Paper No. 22611
September 2016

Abstract

Employing the universe of juvenile court decisions in a U.S. state between 1996 and 2012, we

analyze the effects of emotional shocks associated with unexpected outcomes of football games

played by a prominent college team in the state. We investigate the behavior of judges, the

conduct of whom should, by law, be free of personal biases and emotions. We find that

unexpected losses increase disposition (sentence) lengths assigned by judges during the week

following the game. Unexpected wins, or losses that were expected to be close contests ex-ante,

have no impact. The effects of these emotional shocks are asymmetrically borne by black

defendants. We present evidence that the results are not influenced by defendant or attorney

behavior or by defendants’ economic background. Importantly, the results are driven by judges

who have received their bachelor’s degrees from the university with which the football team is

affiliated. Different falsification tests and a number of auxiliary analyses demonstrate the

robustness of the findings. These results provide evidence for the impact of emotions in one

domain on a behavior in a completely unrelated domain among a uniformly highly-educated

group of individuals (judges), with decisions involving high stakes (sentence lengths). They also

point to the existence of a subtle and previously-unnoticed capricious application of sentencing.

The paper is here.

Why You Don’t Know Your Own Mind

By Alex Rosenberg
The New York Times
Originally published July 18, 2016

Here is an excerpt:

In fact, controlled experiments in cognitive science, neuroimaging and social psychology have repeatedly shown how wrong we can be about our real motivations, the justification of firmly held beliefs and the accuracy of our sensory equipment. This trend began even before the work of psychologists such as Benjamin Libet, who showed that the conscious feeling of willing an act actually occurs after the brain process that brings about the act — a result replicated and refined hundreds of times since his original discovery in the 1980s.

Around the same time, a physician working in Britain, Lawrence Weiskrantz, discovered “blindsight” — the ability, first of blind monkeys, and then of some blind people, to pick out objects by their color without the conscious sensation of color. The inescapable conclusion that behavior can be guided by visual information even when we cannot be aware of having it is just one striking example of how the mind is fooled and the ways it fools itself.

The entire article is here.

There’s No Such Thing as Free Will

By Stephen Cave
The Atlantic
Originally posted June 2016

Here are two excerpts:

The 20th-century nature-nurture debate prepared us to think of ourselves as shaped by influences beyond our control. But it left some room, at least in the popular imagination, for the possibility that we could overcome our circumstances or our genes to become the author of our own destiny. The challenge posed by neuroscience is more radical: It describes the brain as a physical system like any other, and suggests that we no more will it to operate in a particular way than we will our heart to beat. The contemporary scientific image of human behavior is one of neurons firing, causing other neurons to fire, causing our thoughts and deeds, in an unbroken chain that stretches back to our birth and beyond. In principle, we are therefore completely predictable. If we could understand any individual’s brain architecture and chemistry well enough, we could, in theory, predict that individual’s response to any given stimulus with 100 percent accuracy.

(cut)

The big problem, in Harris’s view, is that people often confuse determinism with fatalism. Determinism is the belief that our decisions are part of an unbreakable chain of cause and effect. Fatalism, on the other hand, is the belief that our decisions don’t really matter, because whatever is destined to happen will happen—like Oedipus’s marriage to his mother, despite his efforts to avoid that fate.

The article is here.

Scientists show how we start stereotyping the moment we see a face

Sarah Kaplan
The Independent
Originally posted May 2, 2016

Scientists have known for a while that stereotypes warp our perceptions of things. Implicit biases — those unconscious assumptions that worm their way into our brains, without our full awareness and sometimes against our better judgment — can influence grading choices from teachers, split-second decisions by police officers and outcomes in online dating.

We can't even see the world without filtering it through the lens of our assumptions, scientists say. In a study published Monday in the journal Nature Neuroscience, psychologists report that the neurons that respond to things such as sex, race and emotion are linked by stereotypes, distorting the way we perceive people's faces before that visual information even reaches our conscious brains.

The article is here.

Complex ideas can enter consciousness automatically

Science Daily
Originally posted April 18, 2016

Summary

New research provides further evidence for 'passive frame theory,' the groundbreaking idea that suggests human consciousness is less in control than previously believed. The study shows that even complex concepts, such as translating a word into pig latin, can enter your consciousness automatically, even when someone tells you to avoid thinking about it. The research provides the first evidence that even a small amount of training can cause unintentional, high-level symbol manipulation.

Here is an excerpt:

This surprising effect offers further evidence that the contents of our consciousness -- the state of being awake and aware of our surroundings -- are often generated involuntarily, said Morsella, an assistant professor of psychology. In fact, the study published in the journal Acta Psychologica provides the first demonstration that even a small amount of training can cause unintentional, high-level symbol manipulation.

The article is here.

Seeking better health care outcomes: the ethics of using the "nudge".

Blumenthal-Barby JS, Burroughs H.
Am J Bioeth. 2012;12(2):1-10.
doi: 10.1080/15265161.2011.634481.

Abstract

Policymakers, employers, insurance companies, researchers, and health care providers have developed an increasing interest in using principles from behavioral economics and psychology to persuade people to change their health-related behaviors, lifestyles, and habits. In this article, we examine how principles from behavioral economics and psychology are being used to nudge people (the public, patients, or health care providers) toward particular decisions or behaviors related to health or health care, and we identify the ethically relevant dimensions that should be considered for the utilization of each principle.

The article is here.

Moral cleansing and moral licenses: experimental evidence

Pablo Brañas-Garzaa, Marisa Buchelia, María Paz Espinosa and Teresa García-Muñoz
Economics and Philosophy / Volume 29 / Special Issue 02 / July 2013, pp 199-212

ABSTRACT

Research on moral cleansing and moral self-licensing has introduced dynamic considerations in the theory of moral behavior. Past bad actions trigger negative feelings that make people more likely to engage in future moral behavior to offset them. Symmetrically, past good deeds favor a positive self-perception that creates licensing effects, leading people to engage in behavior that is less likely to be moral. In short, a deviation from a “normal state of being” is balanced with a subsequent action that compensates the prior behavior. We model the decision of an individual trying to reach the optimal level of moral self-worth over time and show that under certain conditions the optimal sequence of actions follows a regular pattern which combines good and bad actions. We conduct an economic experiment where subjects play a sequence of giving decisions (dictator games) to explore this phenomenon. We find that donation in the previous period affects present decisions and the sign is negative: participants’ behavior in every round is negatively correlated to what they did in the past. Hence donations over time seem to be the result of a regular pattern of self-regulation: moral licensing (being selfish after altruist) and cleansing (altruistic after selfish).

The entire article is here.

Believing What You Don’t Believe

By Jane L. Risen and David Nussbaum
The New York Times - Gray Matter
Originally published October 30, 2015

Here is an excerpt:

But as one of us, Professor Risen, discusses in a paper just published in Psychological Review, many instances of superstition and magical thinking indicate that the slow system doesn’t always behave this way. When people pause to reflect on the fact that their superstitious intuitions are irrational, the slow system, which is supposed to fix things, very often doesn’t do so. People can simultaneously recognize that, rationally, their superstitious belief is impossible, but persist in their belief, and their behavior, regardless. Detecting an error does not necessarily lead people to correct it.

This cognitive quirk is particularly easy to identify in the context of superstition, but it isn’t restricted to it. If, for example, the manager of a baseball team calls for an ill-advised sacrifice bunt, it is easy to assume that he doesn’t know that the odds indicate his strategy is likely to cost his team runs. But the manager may have all the right information; he may just choose not to use it, based on his intuition in that specific situation.

The entire article is here.

Believing What We Do Not Believe: Acquiescence to Superstitious Beliefs and Other Powerful Intuitions

By Risen, Jane L.
Psychological Review, Oct 19 , 2015

Abstract

Traditionally, research on superstition and magical thinking has focused on people’s cognitive shortcomings, but superstitions are not limited to individuals with mental deficits. Even smart, educated, emotionally stable adults have superstitions that are not rational. Dual process models—such as the corrective model advocated by Kahneman and Frederick (2002, 2005), which suggests that System 1 generates intuitive answers that may or may not be corrected by System 2—are useful for illustrating why superstitious thinking is widespread, why particular beliefs arise, and why they are maintained even though they are not true. However, to understand why superstitious beliefs are maintained even when people know they are not true requires that the model be refined. It must allow for the possibility that people can recognize—in the moment—that their belief does not make sense, but act on it nevertheless. People can detect an error, but choose not to correct it, a process I refer to as acquiescence. The first part of the article will use a dual process model to understand the psychology underlying magical thinking, highlighting features of System 1 that generate magical intuitions and features of the person or situation that prompt System 2 to correct them. The second part of the article will suggest that we can improve the model by decoupling the detection of errors from their correction and recognizing acquiescence as a possible System 2 response. I suggest that refining the theory will prove useful for understanding phenomena outside of the context of magical thinking.

The article is here.

Neuromodulation of Group Prejudice and Religious Belief

C. Holbrook, K. Izuma, C, Deblieck, D. Fessler, and M. Iacoboni
Social Cognitive and Affective Neuroscience (2015)
doi: 10.1093/scan/nsv107

Abstract

People cleave to ideological convictions with greater intensity in the aftermath of threat. The posterior medial frontal cortex (pMFC) plays a key role in both detecting discrepancies between desired and current conditions and adjusting subsequent behavior to resolve such conflicts. Building on prior literature examining the role of the pMFC in shifts in relatively low-level decision processes, we demonstrate that the pMFC mediates adjustments in adherence to political and religious ideologies. We presented participants with a reminder of death and a critique of their in-group ostensibly written by a member of an out-group, then experimentally decreased both avowed belief in God and out-group derogation by down-regulating pMFC activity via transcranial magnetic stimulation. The results provide the first evidence that group prejudice and religious belief are susceptible to targeted neuromodulation, and point to a shared cognitive mechanism underlying concrete and abstract decision processes. We discuss the implications of these findings for further research characterizing the cognitive and affective mechanisms at play.

The entire article is here.

Intuitive and Counterintuitive Morality

Guy Kahane
Moral Psychology and Human Agency: Philosophical  Essays on the Science of Ethics, Oxford University Press

Abstract

 Recent work in the cognitive science of morality has been taken to show that moral judgment is largely based on immediate intuitions and emotions. However, according to Greene's influential dual process model, deliberative processing not only plays a significant role in moral judgment, but also favours a distinctive type of content broadly utilitarian approach to ethics. In this chapter, I argue that this proposed tie between process and content is based on conceptual errors, and on a misinterpretation of the empirical evidence. Drawing on some of our own empirical research, I will argue so-called "utilitarian" judgments in response to trolley cases often have little to do with concern for the greater good, and may actually express antisocial tendencies. A more general lesson of my argument is that much of current empirical research in moral psychology is based on a far too narrow understanding of intuition and deliberation.

The entire book chapter is here.

Researchers can change the outcome of studies just by being white

By Nikhil Sonnad
Quartz
Originally posted October 5, 2015

Here is an excerpt:

The implication is that every aspect of a study matters. Decision research has been criticized for attempting to explain all of human behavior based mainly on studies of undergraduates in rich democracies. That has led to repeating such research in other parts of the world, as the chart above shows. But that might not be enough.

“Behavioral studies that offer ‘cultural’ or other contextual explanations for variation in generosity should be taken with a grain of salt, unless we are confident that such differences aren’t driven by simpler explanations such as who was in the room at the time,” said Bilal Murtaza Siddiqi, an economist at the World Bank and one of the paper’s co-authors.

The entire article is here.

How can healthcare professionals better manage their unconscious racial bias?

By April Dembosky
MedCity News
Originally published August 21, 2015

Here is an excerpt:

Racial Disparity In Medical Treatment Persists

Even as the health of Americans has improved, the disparities in treatment and outcomes between white patients and black and Latino patients are almost as big as they were 50 years ago.

A growing body of research suggests that doctors’ unconscious behavior plays a role in these statistics, and the Institute of Medicine of the National Academy of Sciences has called for more studies looking at discrimination and prejudice in health care.

For example, several studies show that African-American patients are often prescribed less pain medication than white patients with the same complaints. Black patients with chest pain are referred for advanced cardiac care less often than white patients with identical symptoms.

Doctors, nurses and other health workers don’t mean to treat people differently, says Howard Ross, founder of management consulting firm Cook Ross, who has worked with many groups on diversity issues. But all these professionals harbor stereotypes that they’re not aware they have, he says. Everybody does.

The entire article is here.

Neuroscience of free will: Does reaching for beer with robotic arm mean free will doesn’t exist?

By Andrew Porterfield
Genetic Literacy Project
Originally published on July 21, 2015

Here is an excerpt:

But researchers at CalTech tried something different with him. Instead of hooking up electrodes to the motor cortex, they choose another site in the brain: The posterior parietal cortex is another part of the brain that controls actions like limb movements, but it does so on a far more sophisticated level than the motor cortex. The posterior parietal is involved in the planning of movements, and much of this planning is unconscious. So, when the CalTech team implanted electrodes in Soto’s posterior parietal, they found that they could predict movements before he actually made them. And once the brain signals doing the predicting were known, they could be used to smoothly move his limbs. Essentially, the electrode was helping him unconsciously decide to move his arms, hands and fingers. Which made beer drinking all the easier.

The fact that scientists can chart the brain’s behavior has led many to revisit an old argument over the existence of free will. If we can predict a person’s intentions just by picking up brain signals (and it took a computer two years to predict Sorto’s), then how free are our minds? How many decisions that we make every day are truly under our conscious control? Is there really free will?

The entire article is here.

Welcoming the Concept of Alief to Medical Ethics

By J.S. Blumenthal-Barby
bioethics.net
Originally published June 15, 2015

Philosopher Tamar Gendler has introduced (circa 2008) a new concept in the philosophical literature that could be of interest to medical ethicists. The concept is that of ‘alief’ and it is meant to contrast with the concept of ‘belief.’ An example Gendler discusses to tease out the difference between the two concepts is the example of a woman who believes African American and Caucasian people to be of equal intelligence, yet in her behavioral responses it seems as if she believes differently (e.g., she is more surprised when an African American student of hers makes an intelligent comment than she is when a Caucasian student does, she more quickly associates intelligence with her Caucasian students, when grading exams she might grade the same quality exam differently if written by an African American student than a Caucasian student, etc.). In other words, if you ask her explicitly, she says she believes P (in this case, P is “all races are of equal intelligence”), and she says it sincerely. But, you might think from the outside that she believes ~P (in this case, “all races are not of equal intelligence”). You might be tempted to say that she does not really believe P. What Gendler wants to say is that this woman does believe P, but that she has an ‘alief’ that is in tension with her belief of P (she has a “belief discordant alief”). The content of this alief is a set of associations that get activated (usually from habit) and show themselves in behavioral responses. Another example Gendler discusses is a glass walkway over the Grand Canyon. When walking across, a person may believe that the walkway is completely safe, but alieve something very different. The content of the alief is: ““Really high up, long long way down. Not a safe place to be! Get off!!”” While beliefs change in response to evidence, aliefs might not (they change in response to habits or affective associations).

The entire blog post is here.

Death Denial

By Marc Parry
The Chronicle of Higher Education
Originally published May 22, 2015

Here is an excerpt:

The terror trio’s conclusion: People react differently to conscious and unconscious thoughts of death. While thinking about death directly, Pyszczynski says, folks do rational things to get away from it, like trying to get healthy. It’s when death lurks on the fringes of consciousness that they cling to worldviews and seek self-esteem. "That helps explain why these ideas might seem strange to some people," says Pyszczynski, a professor at the University of Colorado at Colorado Springs. "You can’t really introspect on it. While you’re thinking about death, this isn’t what you do."

Pyszczynski, Solomon, and Greenberg published their work consistently in the prestigious Journal of Personality and Social Psychology. But early on, as Greenberg tells it, "its main impact was to get us ostracized by the rest of the field of social psychology." Part of that was due to the disconcerting subject matter. Colleagues referred to them as "the death guys."

The entire article is here.