End-of-life care in U.S. not as costly as in Canada

By Jessica McDonald
newsworks.org
Originally posted January 10, 2016

The United States has a reputation for providing costly -- and often unwanted -- end-of-life care. But the first study to do an international comparison finds it's not as egregious as we thought.

Compared with patients in other developed nations, Americans diagnosed with cancer spend more time in the intensive care unit and get more chemotherapy in the last months of their lives.

But fewer patients are in the hospital when they die. And the overall bill, while high, isn't the steepest. That honor goes to Canada.

"We found that end-of-life care in the United States is not the worst in the world, and I think that surprises a lot of people," said Dr. Ezekiel Emanuel, a medical ethicist at the University of Pennsylvania.

The article is here.

The consequences of dishonesty

Scott S Wiltermuth, David T Newman, Medha Raj

Current Opinion in Psychology

Volume 6, December 2015, Pages 20–24

We review recent findings that illustrate that dishonesty yields a host of unexpected consequences. We propose that many of these newly-identified consequences stem from the deceiver choosing to privilege other values over honesty, and note that these values may relate to compassion, material gain, or the desire to maintain a positive self-concept. Furthermore, we argue that conflict between these values and honesty can be used to explain the unexpected consequences of dishonest behavior. We demonstrate that these consequences need not be negative, and discuss research that illustrates that dishonest behavior can help actors generate trust, attain a sense of achievement, and generate creative ideas. In addition, we discuss recently-identified negative consequences that can result from privileging other values over honesty.

Highlights

• Dishonesty yields intriguing consequences that scholars have only recently discovered.

• These consequences may stem from actors privileging other values over honesty.

• Privileging other values over honesty can yield positive consequences.

• The valence of the consequence may depend on the value endorsed over honesty.

The article is here.

On the misguided pursuit of happiness and ethical decision making: The roles of focalism and the impact bias in unethical and selfish behavior

Laura J. Noval
Organizational Behavior and Human Decision Processes
Volume 133, March 2016, Pages 1–16

Abstract

An important body of research in the field of behavioral ethics argues that individuals behave unethically and selfishly because they want to obtain desired outcomes, such as career advancement and monetary rewards. Concurrently, a large body of literature in social psychology has shown that the subjective value of an outcome is determined by its anticipated emotional impact. Such impact has been consistently found to be overestimated both in its intensity and in its duration (i.e. impact bias) due to focalism (i.e. excessive focus on the desired outcome). Across four empirical studies, this investigation demonstrates that reducing focalism and thereby attenuating the impact bias in regards to desired outcomes decreases people’s tendency to engage in both unethical and selfish behavior to obtain those outcomes.

Highlights

• Individuals engage in unethical and selfish behavior to obtain desired outcomes, such as monetary or career rewards.
• The anticipated emotional impact of the outcomes individuals seek to obtain is overestimated (i.e. impact bias).
• The impact bias results from focalism (i.e. excessive focus on an outcome).
• In four studies, focalism and the impact bias about desired outcomes were experimentally reduced.
• The focalism reduction resulted in a decreased tendency of individuals to engage in unethical and selfish behavior.

The article is here.

Ethical dissonance, justifications, and moral behavior

Rachel Barkan, Shahar Ayal, and Dan Ariely
Current Opinion in Psychology
Volume 6, December 2015, Pages 157–161

Abstract

Ethical dissonance is triggered by the inconsistency between the aspiration to uphold a moral self-image and the temptation to benefit from unethical behavior. In terms of a temporal distinction anticipated dissonance occurs before people commit a moral-violation. In contrast, experienced dissonance occurs after people realize they have violated their moral code. We review the psychological mechanisms and justifications people use to reduce ethical dissonance in order to benefit from wrongdoing and still feel moral. We then offer harnessing anticipated-dissonance to help people resist temptation, and utilize experienced-dissonance to prompt moral compensation and atonement. We argue that rather than viewing ethical dissonance as a threat to self-image, we should help people see it as the gate-keeper of their morality.

Highlights

• Ethical dissonance represents the tension between moral-self and unethical behavior.
• Justifications reduce ethical dissonance, allowing to do wrong and feel moral.
• Ethical dissonance can be anticipated before, or experienced after, the violation.
• Effective moral interventions can harness ethical dissonance as a moral gate-keeper.

The article is here.

Episode 24: The Nudge in Ethics, Psychotherapy, and Public Policy

Nudge theory has gained popularity in behavioral science, mainly in the field of behavioral economics.  The theory broadly indicates that indirect suggestions or contextual changes can influence choices or compliance with healthy behaviors or decisions.  Nudge theory contrasts its approach with direct suggestions, instructions, and education.  In psychotherapy, we nudge patients frequently.  Sometimes we do it consciously, other times unconsciously.  Because of this potentially powerful influence over our clients, we must remain vigilant about our nudges in the form of soft paternalism or projecting our values onto our patients.  Psychologists must be mindful of the power imbalance in the psychotherapy relationship and our duty to respect client autonomy. 

John’s guest is Dr. Jennifer Blumenthal-Barby, Associate Professor of Medicine and Medical Ethics, Center for Medical Ethics and Health Policy, Baylor College of Medicine, located in Texas.

Click here for CE Credit for psychologists and other professionals

At the end of the podcast, the participants will be able to:

1. Describe what “Nudge Theory” is;
2. Explain how Nudge Theory applies to ethics in the psychotherapy relationship;
3. Name two ways that psychologists can use nudge theory to promote healthy behaviors.

References

Blumenthal-Barby J.S., Burroughs H. (2012). Seeking better health care outcomes: the ethics of using the "nudge".   American Journal of Bioethics. Volume 12(2): 1-10.

Blumenthal-Barby, J.S. McCullough, L.B., Kreiger, H. and Coverdale, J.C. (2013). Methods of Influencing the Decisions of Psychiatric Patients: An Ethical Analysis. Harvard Review of Psychiatry, Volume 21 (5), 275-279.

DeAngelis, T. Coaxing Better Behavior. (2014). The Monitor on Psychology. Volume 45(11): 62.

Knapp, S. and Gavazzi, J. (2014). Is it Ever Ethical to Lie to a Patient? The Pennsylvania Psychologist.

Barkan, R. Ayal, S. and Ariely, D. (2010). Ethical dissonance, justifications, and moral behavior. Current Opinion in Psychology, Volume 6, December 2015, 157-161.

Sunstein, C. R. Fifty Shades of Manipulation. (2015). Journal of Behavioral Marketing.

Sunstein, C. R. The Ethics of Nudging. (2014). Social Science Research Network.

Tolerable Risks? Physicians and Youth Tackle Football

Kathleen E. Bachynski, M.P.H.
N Engl J Med 2016; 374:405-407

At least 11 U.S. high-school athletes died playing football during the fall 2015 season. Their deaths attracted widespread media attention and provided fodder for ongoing debates over the safety of youth tackle football. In October 2015, the American Academy of Pediatrics (AAP) issued its first policy statement directly addressing tackling in football. The organization’s Council on Sports Medicine and Fitness conducted a review of the literature on tackling and football-related injuries and evaluated the potential effects of limiting or delaying tackling on injury risk. It found that concussions and catastrophic injuries are particularly associated with tackling and that eliminating tackling from football would probably reduce the incidence of concussions, severe injuries, catastrophic injuries, and overall injuries.

But rather than recommend that tackling be eliminated in youth football, the AAP committee primarily proposed enhancing adult supervision of the sport. It recommended that officials enforce the rules of the game, that coaches teach young players proper tackling techniques, that physical therapists and other specialists help players strengthen their neck muscles to prevent concussions, and that games and practices be supervised by certified athletic trainers. There is no systematic evidence that tackling techniques believed to be safer, such as the “heads-up” approach promoted by USA Football (amateur football’s national governing body), reduce the incidence of concussions in young athletes. Consequently, the AAP statement acknowledged the need for further study of these approaches. The policy statement also encouraged the expansion of nontackling leagues as another option for young players.

The article is here.

Understanding Responses to Moral Dilemmas

Deontological Inclinations, Utilitarian Inclinations, and General Action Tendencies

Bertram Gawronski, Paul Conway, Joel B. Armstrong, Rebecca Friesdorf, and Mandy Hütter
In: J. P. Forgas, L. Jussim, & P. A. M. Van Lange (Eds.). (2016). Social psychology of morality. New York, NY: Psychology Press.

Introduction

For  centuries,  societies  have  wrestled  with  the  question  of  how  to  balance  the  rights of the individual versus the greater good (see Forgas, Jussim, & Van Lange, this volume); is it acceptable to ignore a person’s rights in order to increase the overall well-being of a larger number of people? The contentious nature of this issue is reflected in many contemporary examples, including debates about whether it is legitimate to cause harm in order to protect societies against threats (e.g., shooting an abducted passenger plane to prevent a terrorist attack) and whether it is acceptable to refuse life-saving support for some people in order to protect the well-being  of  many  others  (e.g.,  refusing  the  return  of  American  citizens  who  became infected with Ebola in Africa for treatment in the US). These issues have captured the attention of social scientists, politicians, philosophers, lawmakers, and citizens alike, partly because they involve a conflict between two moral principles.

The  first  principle,  often  associated  with  the  moral  philosophy  of  Immanuel  Kant, emphasizes the irrevocable universality of rights and duties. According to the principle of deontology, the moral status of an action is derived from its consistency with context-independent norms (norm-based morality). From this perspective, violations of moral norms are unacceptable irrespective of the anticipated outcomes (e.g.,  shooting  an  abducted  passenger  plane  is  always  immoral  because it violates  the moral norm not to kill others). The second principle, often associated with the moral philosophy of John Stuart Mill, emphasizes the greater good. According to the principle of utilitarianism, the moral status of an action depends on its outcomes, more  specifically  its consequences  for  overall  well-being  (outcome-based  morality).

The book chapter is here.

Artificial intelligence: Who’s regulating the robots?

By Selina Chignall
iPolitics Canada
Originally published Jan 13, 2016

In 2014, famed theoretical physicist Stephen Hawking warned ominously that “the development of full artificial intelligence could spell the end of the human race.”

While the prospect of humanity being taken over by super-intelligent robots may seem less fanciful that it once was, the more immediate threat, say AI experts, is the lack of mobilization by governments to deal with the policy implications of AI.

John Danaher, an assistant professor of law at the National University of Ireland, Galway, who researches and blogs on AI and the relationship between humans and technology, predicts that AI will affect our lives incrementally.

“Indeed, they are already doing so. We rely on AI systems all the time, many times in ways we do not fully appreciate,” Danaher said.

With this technology already a part of our daily lives, or soon to be — with driverless cars, robots and machines helping doctors in the medical profession — there has been little attention paid to how and should it be regulated.

The article is here.

Lawyer told police of client's alleged plot after speaking with ethics hotline

By Debra Cassens Weiss
American Bar Association Journal
Originally published January 12,2016

A Pennsylvania lawyer revealed his client’s alleged plot “take back” the home of his ex-girlfriend using an AR-15 rifle and body armor after consulting with the state bar’s ethics hotline, police say.

Revelations by the lawyer, Seamus Dubbs of York, likely saved lives, police say. The York Daily Record has a story.

The client, Howard Timothy Cofflin Jr., told police after his arrest that he planned to kill the ex-girlfriend as well as anyone who tried to stop him, according to court records cited by the York Daily Report. Charging documents said he planned to decapitate the ex-girlfriend and to go to war with state police, Pennlive.com reports. He also had a plan to bomb state police barracks, police said.

The article is here.