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

Monday, September 5, 2016

Are There Still Too Few Suicides to Generate Public Outrage?

Lytle MC, Silenzio VB, Caine ED.
JAMA Psychiatry. Published online August 17, 2016.
doi:10.1001/jamapsychiatry.2016.1736.

Suicide is the 10th leading cause of death in the United States, with the overall rate increasing 28.2% since 1999, driven by a 35.3% increase in suicides among persons 35 to 64 years of age.1 Suicides surpassed road traffic deaths in 2009, and the 42 773 suicides reported were more than double the 16 324 homicides in 2014. When coupled with deaths from other deliberate behaviors, research suggests that the mortality from self-directed injury exceeds 70 000 lives, making it the eighth leading cause of death while the death rates of cardiovascular diseases (CVDs), cancers, and human immunodeficiency virus (HIV)/AIDS continue to decrease.

The entire piece is here.

Are doctors who know the law more likely to follow it?

By Ben White and Lindy Willmott
BMJ Blogs
Originally posted August 17, 2016

Here is an excerpt:

Compliance with the law was low with only 32% of doctors following the advance directive. Of interest was that doctors who knew the relevant law were more likely to comply with it and follow the advance directive than those doctors who did not know the law. Initially we thought that this could indicate that legal knowledge might lead to legal compliance. However, we then examined the reasons doctors gave for decision-making and also the factors they relied on to understand whether law was seen as important or not by doctors in their deliberations.

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So legally knowledgeable doctors are more likely to comply with the law – but law does not seem to be shaping decision-making in this area. This presented a puzzle to us. What else could be responsible for the association between doctors’ legal knowledge and compliance? More work is needed to fully understand what is happening here but we suggest that ethical considerations are a likely candidate. Both law and autonomy-focused ethics point to following the advance directive hence a decision motivated by this ethical orientation would also comply with the law. And medical ethics and law are also often taught together in an integrated way and so more legally-informed specialists are likely to have had more instruction in ethics too.

The blog post is here.

Sunday, September 4, 2016

Relaxing moral reasoning to win: How organizational identification relates to unethical pro-organizational behavior.

Chen, Mo; Chen, Chao C.; Sheldon, Oliver J.
Journal of Applied Psychology, Vol 101(8), Aug 2016, 1082-1096.

Abstract

Drawing on social identity theory and social–cognitive theory, we hypothesize that organizational identification predicts unethical pro-organizational behavior (UPB) through the mediation of moral disengagement. We further propose that competitive interorganizational relations enhance the hypothesized relationships. Three studies conducted in China and the United States using both survey and vignette methodologies provided convergent support for our model. Study 1 revealed that higher organizational identifiers engaged in more UPB, and that this effect was mediated by moral disengagement. Study 2 found that organizational identification once again predicted UPB through the mediation of moral disengagement, and that the mediation relationship was stronger when employees perceived a higher level of industry competition. Finally, Study 3 replicated the above findings using a vignette experiment to provide stronger evidence of causality. Theoretical and practical implications are discussed.

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Managerial Implications Section

In addition to these theoretical contributions, it is also worth briefly touching upon some implications of the present research for managerial practice. Unethical behaviors have proven costly for organizations (Cialdini et al., 2004), especially those behaviors conducted in the name of the organization, which are more likely to undermine stakeholders' organizational trust or even cause the collapse of an organization. In view of the dark side of organizational identification, managers should be aware of blind allegiance and loyalty to the organization among their employees and instead emphasize the importance of social responsibility and caring for all stakeholders. The linkage between organizational identification and moral disengagement we document here suggests that loyal organizational members are under greater pressure to relax their moral reasoning to execute their citizenship behavior, especially when stakes are high in a competitive environment. To counterbalance the tendency toward moral disengagement, organizations and managers need to clearly highlight the importance of hyper ethical values in organizational policies and practices and integrate such ethical standards into managerial decision-making. At the same time, organizations should strive to create a culture of social responsibility so as to reduce UPB (May et al., 2015) and reinforce ethical pro-organizational behavior.

The article is here.

Saturday, September 3, 2016

Evidence-Based Practice and Psychological Treatments: The Imperatives of Informed Consent.

Charlotte R. Blease, Scott O. Lilienfeld and John M. Kelley
Front. Psychol., 10 August 2016

Here is an excerpt:

Professional competence—the ability to accurately assess problems, diagnose psychological disorders, recommend an appropriate course of treatment, and successfully carry out that treatment—varies depending on the degree to which the clinician keeps up to date with the latest research and effectively evaluates the evidence. The APA requires that clinicians be trained in EBP to be equipped to appraise the range of evidence regarding the efficacy of different forms of psychotherapy, to recognize the strengths and limitations of clinical intuition, and to understand the importance of patient preferences and values, as well as the relevance of the socio-cultural context in treating clients. In this way, the APA acknowledges that EBP requires knowledge of controlled clinical trials, but also underlines that trial data have inherent limitations. For example, such trials can be unrepresentative of individual patients given that they can be largely insensitive to such factors as age of patient, and comorbidity [American Psychological Association (APA), 2006; cf. Greenhalgh et al., 2014; Sheridan and Julian, 2016]. The APA also emphasizes the importance of keeping up to date with the latest process—and not merely outcome—data on how psychotherapies work [American Psychological Association (APA), 2006].

The duty to be professionally competent carries significant additional implications for the duty to respect patient autonomy. Historically, paternalism was the largely unquestioned bedrock of healthcare practice. Paternalism is defined as “the interference of a state or an individual by another person, against their will, and defended or motivated by the claim that the person interfered with will be better off or protected from harm” (Dworkin, 2010); it was defended on the grounds that doctors were the gatekeepers of medical knowledge, as well as the best judges of how to use that knowledge to serve the interests of patients. Today, healthcare ethics codes (in the West) eschew paternalism: professional clinicians are now obliged to be truthful and to provide adequate disclosure to patients about their diagnosis, the risks and benefits of various treatment options, and their duration and costs (Trachsel et al., 2015; Blease et al., 2016; Trachsel and Gaab, 2016). However, the quality of disclosures to patients depends on practitioner knowledge, illustrating once again why standards of evidence are enmeshed with ethics.

The article is here.

Friday, September 2, 2016

Small-scale societies exhibit fundamental variation in the role of intentions in moral judgment

H. Clark Barrett and others
PNAS 2016 113 (17) 4688-4693
Published ahead of print March 28, 2016
doi:10.1073/pnas.1522070113

Abstract

Intent and mitigating circumstances play a central role in moral and legal assessments in large-scale industrialized societies. Although these features of moral assessment are widely assumed to be universal, to date, they have only been studied in a narrow range of societies. We show that there is substantial cross-cultural variation among eight traditional small-scale societies (ranging from hunter-gatherer to pastoralist to horticulturalist) and two Western societies (one urban, one rural) in the extent to which intent and mitigating circumstances influence moral judgments. Although participants in all societies took such factors into account to some degree, they did so to very different extents, varying in both the types of considerations taken into account and the types of violations to which such considerations were applied. The particular patterns of assessment characteristic of large-scale industrialized societies may thus reflect relatively recently culturally evolved norms rather than inherent features of human moral judgment.

Significance

It is widely considered a universal feature of human moral psychology that reasons for actions are taken into account in most moral judgments. However, most evidence for this moral intent hypothesis comes from large-scale industrialized societies. We used a standardized methodology to test the moral intent hypothesis across eight traditional small-scale societies (ranging from hunter-gatherer to pastoralist to horticulturalist) and two Western societies (one urban, one rural). The results show substantial variation in the degree to which an individual’s intentions influence moral judgments of his or her actions, with intentions in some cases playing no role at all. This dimension of cross-cultural variation in moral judgment may have important implications for understanding cultural disagreements over wrongdoing.

The article is here.

But Did They Do It on Purpose?

By Dan Falk
Scientific American
Originally published July 1, 2016

Here is an excerpt:

In all societies, the most severe transgressions draw the harshest judgments, but cultures differ on whether or not intent is weighed heavily in such crimes. One scenario, for example, asked respondents to imagine that someone had poisoned a communal well, harming dozens of villagers. In many nonindustrial societies, this was seen as the most severe wrongdoing—and yet intent seemed to matter very little. The very act of poisoning the well “was judged to be so bad that, whether it was on purpose or accidental, it ‘maxed out’ the badness judgments,” explains lead author H. Clark Barrett of the University of California, Los Angeles. “They accepted that it was accidental but said it's your responsibility to be vigilant in cases that cause that degree of harm.”

The findings also suggest that people in industrial societies are more likely in general than those in traditional societies to consider intent. This, Barrett says, may reflect the fact that people raised in the West are immersed in complex sets of rules; judges, juries and law books are just the tip of the moral iceberg. “In small-scale societies, judgment may be equally sophisticated, but it isn't codified in these elaborate systems,” he notes. “In some of these societies, people argue about moral matters for just as long as they do in any court in the U.S.”

The article is here.

Thursday, September 1, 2016

The science of getting angry: Do moral outrage and mob mentality help or harm us?

Apoorva Sripathi
Firstpost.com
Originally published August 15, 2016

As often as these things go, it's imperative to turn to science for answers. Such as, why do we get wound up about incidents that happen around the world; incidents over which we have no control? Common sense notwithstanding, we go ahead and log on to social media (Twitter, Facebook, Instagram, and the ilk) to let the immediate world know what's bothering us. Soon, someone else posts an opposing view, which gets us hopping mad — rinse, lather and repeat.

Why do we give in to outrage and what does science have to say about it? Well for one, there are countless platforms to express our frustrations on. Two, some of the platforms give us the freedom to be anonymous — such as newspapers online — which, in turn, encourages participation and risk-taking. Three, getting angry is rather easy when there's always something to be angry about; a judiciously-available trigger.

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If not the complete answer, science gives us significant clues as to why we like to shame people online. New York Magazine's Science of Us talks about how stories that were widely shared online were happy in nature, while those that invited nasty comments belonged to the data set termed arousal, or in other words, stories that evoked feelings of anger and distress. Furthermore, shaming (whether online or offline) gives us a clue about the evolution of human behaviour: that we like to indulge in a little something called third-party punishment where we derive joy from punishing strangers.

The article is here.

A General Benevolence Dimension That Links Neural, Psychological, Economic, and Life-Span Data on Altruistic Tendencies

J. Hubbard; W.T. Harbaugh; S. Srivastava; D. Degras; and U. Mayr
Journal of Experimental Psychology: General, Aug 11 , 2016

Abstract

Individual and life span differences in charitable giving are an important economic force, yet the underlying motives are not well understood. In an adult, life span sample, we assessed manifestations of prosocial tendencies across 3 different measurement domains: (a) psychological self-report measures, (b) actual giving choices, and (c) fMRI-derived, neural indicators of "pure altruism." The latter expressed individuals' activity in neural valuation areas when charities received money compared to when oneself received money and thus reflected an altruistic concern for others. Results based both on structural equation modeling and unit-weighted aggregate scores revealed a strong higher-order General Benevolence dimension that accounted for variability across all measurement domains. The fact that the neural measures likely reflect pure altruistic tendencies indicates that General Benevolence is based on a genuine concern for others. Furthermore, General Benevolence exhibited a robust increase across the adult life span, potentially providing an explanation for why older adults typically contribute more to the public good than young adults.

The article is here.

Wednesday, August 31, 2016

How Artificial Intelligence Could Help Diagnose Mental Disorders

Joseph Frankel
The Atlantic
Originally posted August 23, 2016

Here is an excerpt:

In addition to the schizophrenia screener, an idea that earned Schwoebel an award from the American Psychiatric Association, NeuroLex is hoping to develop a tool for psychiatric patients who are already being treated in hospitals. Rather than trying to help diagnose a mental disorder from a single sample, the AI would examine a patient’s speech over time to track their progress.

For Schwoebel, this work is personal: he thinks this approach may help solve problems his older brother faced in seeking treatment for schizophrenia. Before his first psychotic break, Schwoebel’s brother would send short, one-word responses, or make cryptic to references to going “there” or “here”—worrisome abnormalities that “all made sense” after his brother’s first psychotic episode, he said.

The article is here.