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

Sunday, August 31, 2014

Medicare considers funding end-of-life talks

By Pam Belluck
The New York Times
Originally published August 31, 2014

Five years after it exploded into a political conflagration over “death panels,” the issue of paying doctors to talk to patients about end-of-life care is making a comeback, and such sessions may be covered for the 50 million Americans on Medicare as early as next year.

Bypassing the political process, private insurers have begun reimbursing doctors for these “advance care planning” conversations as interest in them rises along with the number of aging Americans.

The entire article is here.

Editorial note: Politics will continue to affect health care delivery in the United States.  It is critical that healthcare providers cite foundational ethical principles when advocating for changes in our healthcare system, and not become immersed in sloganeering or bumper sticker politics to support one political party or the other.  High quality health care and informed patient choice are paramount.

Fast, Frugal, and (Sometimes) Wrong

Cass R. Sunstein
University of Chicago Law School and Department of Political Science
Originally published in 2005

Abstract

Do moral heuristics operate in the moral domain? If so, do they lead to moral errors? This brief essay offers an affirmative answer to both questions. In so doing, it responds to an essay by Gerd Gigerenzer on the nature of heuristics, moral and otherwise. While focused on morality, the discussion bears on the general debate between those who emphasize cognitive errors, sometimes produced by heuristics, and those who emphasize the frequent success of heuristics in producing sensible judgments in the real world. General claims are that it is contentious to see moral problems as ones of arithmetic, and that arguments about moral heuristics will often do well to steer clear of contentious arguments about what morality requires.

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But no one should deny that in many contexts, moral and other heuristics, in the form of simple rules of thumb, lead to moral error on any plausible view of morality. Consider, for example, the idea, emphasized by Gigerenzer, that one ought to do as the majority does, a source of massive moral blunders (see Sunstein, 2003). Or consider the fast and frugal idea that one ought not to distort the truth—a heuristic that generally works well, but that also leads (in my view) to moral error when, for example, the distortion is necessary to avoid significant numbers of deaths. Or consider the act- omission distinction, which makes moral sense in many domains, but which can lead to unsupportable moral judgments as well (Baron, 2004).

The entire article is here.

Saturday, August 30, 2014

The New Scientism

We can value scientific inquiry without viewing the natural sciences as free of politics.

By Kamil Ahsan
Jacobin Magazine
Originally published August 5, 2014

Here is an excerpt:

Ever since its coining by conservatives, “scientism” has been used pejoratively, most commonly by the same people who deny evolution and climate change. Consequently, leftists have historically renounced the word, signaling that that they fall on the side of scientific truth and not religion or spirituality.

This is a false dichotomy. One can value scientific inquiry without viewing the natural sciences as unimpeachable truth. And one can assail purported scientific progress without assailing science itself.

But try telling that to Michael Shermer, who, writing in Scientific American, sees in every critique of corporate behavior an anti-science temper tantrum: “Try having a conversation with a liberal progressive about GMOs…in which the words “Monsanto’ and ‘profit’ are not dropped like syllogistic bombs… The fact is that we’ve been genetically modifying organisms for 10,000 years through breeding and selection.”

The tunnel vision brought on by scientism resolves itself in a kind of social apathy, a dismissiveness of “real” problems, for which scientific data is the only antidote. This “just the facts, ma’am” approach excises ethics from the discussion and frames science as an appropriately depoliticized sphere. And in the process, it completely disregards what the humanities or the social sciences are able to tell us.

The entire article is here.

Free Will & Moral Responsibility in a Secular Society

By Michael Shermer
TAM 2014
Originally posted August 10, 2014

Michael Shermer, PhD presents theory and research on understanding the concepts of free will, moral responsibility and agency in current American society.  He draws from neuroscience, social psychology, and comparative psychology to develop ideas about how moral emotions play a part in understanding moral responsibility and culpability.

 

Friday, August 29, 2014

Artificial Wombs Are Coming, but the Controversy Is Already Here

By Zoltan Istvan
MotherBoard
Originally posted August 4, 2014

Of all the transhumanist technologies coming in the near future, one stands out that both fascinates and perplexes people. It's called ectogenesis: raising a fetus outside the human body in an artificial womb.

It has the possibility to change one of the most fundamental acts that most humans experience: the way people go about having children. It also has the possibility to change the way we view the female body and the field of reproductive rights.

Naturally, it's a social and political minefield.

The entire article is here.

Ethical Dilemmas of Confidentiality with Adolescent Clients: Case Studies from Psychologists

Rony E. Duncan, Annette C. Hall, Ann Knowles
Ethics & Behavior 
DOI:10.1080/10508422.2014.923314

Abstract

Navigating limits to confidentiality with adolescent clients can be ethically and professionally challenging. This study follows on from a previous quantitative survey of psychologists about confidentiality dilemmas with adolescents. The current study used qualitative methods to explore such dilemmas in greater depth. Twenty Australian psychologists were interviewed and asked to describe an ethically challenging past case. Cases were then used to facilitate discussion about the decision-making process and outcomes. Interviews were transcribed and analysed using interpretive content and thematic analysis. Three key findings are discussed. First, it is of little use to perceive confidentiality dilemmas as binary choices (breach/don’t breach) because psychologists described five distinct options. These can be conceptualised on a spectrum of varying degrees of client autonomy, ranging from ‘no disclosure’ (highest client autonomy) to ‘disclosure without the client’s knowledge or consent’ (lowest client autonomy). Second, confidentiality dilemmas often involve balancing multiple and conflicting risks regarding both immediate and future harm. Third, a range of strategies are employed by psychologists to minimise potential harms when disclosing information. These are primarily aimed at maintaining the therapeutic relationship and empowering clients. These findings and the case studies described provide a valuable resource for teaching and professional development.

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1. It is of little use to conceptualise confidentiality as a binary choice.

2. Reaching a final decision about confidentiality dilemmas often entails balancing multiple and conflicting risks.

3. Participants demonstrated significant practice wisdom about how to negotiate confidentiality with adolescents in a manner that minimises harm.

The entire article is here.

Thursday, August 28, 2014

Punishment or therapy? The ethics of sexual offending treatment

Tony Ward
Journal of Sexual Aggression 
Vol. 16, Iss. 3, 2010
DOI:10.1080/13552600.2010.483822

Abstract

The claim that sex offender treatment is a form of punishment and as such cannot be covered by traditional ethical codes is a controversial one. It challenges the ethical basis of current practice and compels clinicians to rethink the work they do with sex offenders. In this paper I comment on Bill Glaser's defence of that idea in a challenging and timely paper and David Prescott and Jill Leveson's rejection of his claims. First, I consider briefly the nature of both punishment and treatment and outline Glaser's argument and Prescott and Levenson's rejoinder. I then investigate what a comprehensive argument for either position should look like and finish with a few comments on each paper.

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The Core Argument

The ethical problem concerning treatment and punishment is straightforward and can be outlined in terms of two broad possibilities, with some suboptions. First, do actions associated with punishment and treatment coexist within a sex offender treatment programme? And should they? Secondly, if not, is this because (a) they are functionally separate with punishment occurring outside the therapeutic orbit or (b) because only (or primarily) punishment is actually apparent within the therapy context? Prescott and Levenson argue for (a) and Glaser opts for (b). My own preference is for the rather messier option of coexistence, namely the first possibility.

The entire article is here.

What We Need to Learn From the Ebola Epidemic

By Robert Klitzman
The Huffington Post
Originally posted August 9, 2014

Here is an excerpt:

Still, even if the medication works and is provided abroad, obstacles will remain to educate patients adequately about it and obtain appropriate informed consent. The fact that the drug is experimental and may still fail or make patients sicker -- even if it seems to offer benefit to a few patients -- needs to be explained in a way that patients in Africa, many of whom have little education, can understand. Barriers exist in part for cultural and linguistic reasons. In some African languages, for instance, there is no word for "placebo" or "experimental treatment," only for "cure. Questions remain regarding whether the drug should first be tested against a placebo or simply given to everyone. Use of a placebo will help scientists understand the drug's effectiveness. But if the medication turns out to work, patients who were randomized not to receive it will have lost out. These quandaries are complex, and WHO needs to explore and address them very carefully.

The entire article is here.

Wednesday, August 27, 2014

Practicing School Psychology While Impaired: Ethical, Professional, and Legal Issues

Emery B. Mahoney, Richard J. Morris
Journal of Applied School Psychology 
Vol. 28, Iss. 4, 2012
DOI:10.1080/15377903.2012.722180

Abstract

Studies on impairment in psychologists and other mental health practitioners began appearing in the literature 30–35 years ago. Since then, research and related scholarly writings have continued to be published to more fully understand this concept and its components. In school psychology, however, little has been written regarding school psychologists’ delivery of psychological services while they are impaired. This is true even though the provision of such services violates numerous ethical principles and standards of professional conduct in the ethics code of the National Association of School Psychologists and the American Psychological Association. In this article, the authors review the prevalence and incidence data regarding impairment, as well as definitional issues regarding what constitutes impairment. Ethical and legal issues associated with practicing while impaired are also discussed, followed by a discussion of assessing risk for impairment in school psychologists and the presentation of a self-administered risk assessment scale on the basis of empirical and other literature in the area of ethics and professional standards in the practice of psychology. Future directions for developing an agreed-upon definition of impairment within the field of school psychology and future directions for research on assessing and predicting impairment in school psychologists are discussed.

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It is unfortunate that there is a paucity of research investigating impairment issues as applied specifically to school psychologists. As a result, on the basis of empirical research and risk assessment models developed with psychologists practicing in mental health clinics, private practice, and hospital settings, we have presented in Figure 1 the Instrument for Monitoring Psychologists’ Awareness of Impaired Responding (IMPAIR).

The entire article is here.