J.S. Blumenthal-Barby
Patient Education and Counseling
January 2017, Volume 100, Issue 1, Pages 14–17
Abstract
Objective
To review the barriers to patient engagement and techniques to increase patients’ engagement in their medical decision-making and care.
Discussion
Barriers exist to patient involvement in their decision-making and care. Individual barriers include education, language, and culture/attitudes (e.g., deference to physicians). Contextual barriers include time (lack of) and timing (e.g., lag between test results being available and patient encounter). Clinicians should gauge patients’ interest in being involved and their level of current knowledge about their condition and options. Framing information in multiple ways and modalities can enhance understanding, which can empower patients to become more engaged. Tools such as decision aids or audio recording of conversations can help patients remember important information, a requirement for meaningful engagement. Clinicians and researchers should work to create social norms and prompts around patients asking questions and expressing their values. Telehealth and electronic platforms are promising modalities for allowing patients to ask questions on in a non-intimidating atmosphere.
Conclusion
Researchers and clinicians should be motivated to find ways to engage patients on the ethical imperative that many patients prefer to be more engaged in some way, shape, or form; patients have better experiences when they are engaged, and engagement improves health outcomes.
The article is here.
Monday, May 15, 2017
Cassandra’s Regret: The Psychology of Not Wanting to Know
Gigerenzer, Gerd; Garcia-Retamero, Rocio
Psychological Review, Vol 124(2), Mar 2017, 179-196.
Abstract
Ignorance is generally pictured as an unwanted state of mind, and the act of willful ignorance may raise eyebrows. Yet people do not always want to know, demonstrating a lack of curiosity at odds with theories postulating a general need for certainty, ambiguity aversion, or the Bayesian principle of total evidence. We propose a regret theory of deliberate ignorance that covers both negative feelings that may arise from foreknowledge of negative events, such as death and divorce, and positive feelings of surprise and suspense that may arise from foreknowledge of positive events, such as knowing the sex of an unborn child. We conduct the first representative nationwide studies to estimate the prevalence and predictability of deliberate ignorance for a sample of 10 events. Its prevalence is high: Between 85% and 90% of people would not want to know about upcoming negative events, and 40% to 70% prefer to remain ignorant of positive events. Only 1% of participants consistently wanted to know. We also deduce and test several predictions from the regret theory: Individuals who prefer to remain ignorant are more risk averse and more frequently buy life and legal insurance. The theory also implies the time-to-event hypothesis, which states that for the regret-prone, deliberate ignorance is more likely the nearer the event approaches. We cross-validate these findings using 2 representative national quota samples in 2 European countries. In sum, we show that deliberate ignorance exists, is related to risk aversion, and can be explained as avoiding anticipatory regret.
The article is here.
Psychological Review, Vol 124(2), Mar 2017, 179-196.
Abstract
Ignorance is generally pictured as an unwanted state of mind, and the act of willful ignorance may raise eyebrows. Yet people do not always want to know, demonstrating a lack of curiosity at odds with theories postulating a general need for certainty, ambiguity aversion, or the Bayesian principle of total evidence. We propose a regret theory of deliberate ignorance that covers both negative feelings that may arise from foreknowledge of negative events, such as death and divorce, and positive feelings of surprise and suspense that may arise from foreknowledge of positive events, such as knowing the sex of an unborn child. We conduct the first representative nationwide studies to estimate the prevalence and predictability of deliberate ignorance for a sample of 10 events. Its prevalence is high: Between 85% and 90% of people would not want to know about upcoming negative events, and 40% to 70% prefer to remain ignorant of positive events. Only 1% of participants consistently wanted to know. We also deduce and test several predictions from the regret theory: Individuals who prefer to remain ignorant are more risk averse and more frequently buy life and legal insurance. The theory also implies the time-to-event hypothesis, which states that for the regret-prone, deliberate ignorance is more likely the nearer the event approaches. We cross-validate these findings using 2 representative national quota samples in 2 European countries. In sum, we show that deliberate ignorance exists, is related to risk aversion, and can be explained as avoiding anticipatory regret.
The article is here.
Sunday, May 14, 2017
The power thinker
Colin Koopman
Originally posted March 15, 2017
Here is an excerpt:
Foucault’s work shows that disciplinary power was just one of many forms that power has come to take over the past few hundred years. Disciplinary anatomo-politics persists alongside sovereign power as well as the power of bio-politics. In his next book, The History of Sexuality, Foucault argued that bio-politics helps us to understand how garish sexual exuberance persists in a culture that regularly tells itself that its true sexuality is being repressed. Bio-power does not forbid sexuality, but rather regulates it in the maximal interests of very particular conceptions of reproduction, family and health. It was a bio-power wielded by psychiatrists and doctors that, in the 19th century, turned homosexuality into a ‘perversion’ because of its failure to focus sexual activity around the healthy reproductive family. It would have been unlikely, if not impossible, to achieve this by sovereign acts of direct physical coercion. Much more effective were the armies of medical men who helped to straighten out their patients for their own supposed self-interest.
Other forms of power also persist in our midst. Some regard the power of data – that is the info-power of social media, data analytics and ceaseless algorithmic assessment – as the most significant kind of power that has emerged since Foucault’s death in 1984.
The article is here.
Originally posted March 15, 2017
Here is an excerpt:
Foucault’s work shows that disciplinary power was just one of many forms that power has come to take over the past few hundred years. Disciplinary anatomo-politics persists alongside sovereign power as well as the power of bio-politics. In his next book, The History of Sexuality, Foucault argued that bio-politics helps us to understand how garish sexual exuberance persists in a culture that regularly tells itself that its true sexuality is being repressed. Bio-power does not forbid sexuality, but rather regulates it in the maximal interests of very particular conceptions of reproduction, family and health. It was a bio-power wielded by psychiatrists and doctors that, in the 19th century, turned homosexuality into a ‘perversion’ because of its failure to focus sexual activity around the healthy reproductive family. It would have been unlikely, if not impossible, to achieve this by sovereign acts of direct physical coercion. Much more effective were the armies of medical men who helped to straighten out their patients for their own supposed self-interest.
Other forms of power also persist in our midst. Some regard the power of data – that is the info-power of social media, data analytics and ceaseless algorithmic assessment – as the most significant kind of power that has emerged since Foucault’s death in 1984.
The article is here.
Saturday, May 13, 2017
Justices Blast One-Stop-Shop Experts in Alabama
Tim Ryan
Courthouse News
Originally posted April 24, 2017
The Supreme Court’s liberal justices shredded an argument by Alabama’s solicitor general Monday that criminal defendants are not entitled to a mental health expert separate from the ones tapped by prosecutors.
McWilliams v. Dunn, the case the Supreme Court heard this morning, is nested inside the court’s 1984 decision in Ake v. Oklahoma, which held that poor criminal defendants using a defense of insanity are entitled to an expert to help support their claim.
A split has emerged in the 30 years since the decision, with some states deciding one expert helping both the prosecution and defense satisfies the requirement, and others choosing to assign an expert for the defendant to use exclusively.
The article is here.
Courthouse News
Originally posted April 24, 2017
The Supreme Court’s liberal justices shredded an argument by Alabama’s solicitor general Monday that criminal defendants are not entitled to a mental health expert separate from the ones tapped by prosecutors.
McWilliams v. Dunn, the case the Supreme Court heard this morning, is nested inside the court’s 1984 decision in Ake v. Oklahoma, which held that poor criminal defendants using a defense of insanity are entitled to an expert to help support their claim.
A split has emerged in the 30 years since the decision, with some states deciding one expert helping both the prosecution and defense satisfies the requirement, and others choosing to assign an expert for the defendant to use exclusively.
The article is here.
Friday, May 12, 2017
US Suicide Rates Display Growing Geographic Disparity.
JAMA.
2017;317(16):1616. doi:10.1001/jama.2017.4076
As the overall US suicide rate increases, a CDC study showed that the trend toward higher rates in less populated parts of the country and lower rates in large urban areas has become more pronounced.
Using data from the National Vital Statistics System and the US Census Bureau, the researchers reported that from 1999 to 2015, the annual suicide rate increased by 14%, from 12.6 to 14.4 per 100, 000 US residents aged 10 years or older.
(cut)
Higher suicide rates in less urban areas could be linked with limited access to mental health care, the opioid overdose epidemic, and social isolation, the investigators suggested. The 2007-2009 economic recession may have caused the sharp upswing, they added, because rural areas and small towns were hardest hit.
The article is here
2017;317(16):1616. doi:10.1001/jama.2017.4076
As the overall US suicide rate increases, a CDC study showed that the trend toward higher rates in less populated parts of the country and lower rates in large urban areas has become more pronounced.
Using data from the National Vital Statistics System and the US Census Bureau, the researchers reported that from 1999 to 2015, the annual suicide rate increased by 14%, from 12.6 to 14.4 per 100, 000 US residents aged 10 years or older.
(cut)
Higher suicide rates in less urban areas could be linked with limited access to mental health care, the opioid overdose epidemic, and social isolation, the investigators suggested. The 2007-2009 economic recession may have caused the sharp upswing, they added, because rural areas and small towns were hardest hit.
The article is here
Physicians, Not Conscripts — Conscientious Objection in Health Care
Ronit Y. Stahl and Ezekiel J. Emanuel
N Engl J Med 2017; 376:1380-1385
“Conscience clause” legislation has proliferated in recent years, extending the legal rights of health care professionals to cite their personal religious or moral beliefs as a reason to opt out of performing specific procedures or caring for particular patients. Physicians can refuse to perform abortions or in vitro fertilization. Nurses can refuse to aid in end-of-life care. Pharmacists can refuse to fill prescriptions for contraception. More recently, state legislation has enabled counselors and therapists to refuse to treat lesbian, gay, bisexual, and transgender (LGBT) patients, and in December, a federal judge issued a nationwide injunction against Section 1557 of the Affordable Care Act, which forbids discrimination on the basis of gender identity or termination of a pregnancy.
The article is here, and you need a subscription.
Here is an excerpt:
Objection to providing patients interventions that are at the core of medical practice – interventions that the profession deems to be effective, ethical, and standard treatments – is unjustifiable (AMA Code of Medical Ethics [Opinion 11.2.2]10).
Making the patient paramount means offering and providing accepted medical interventions in accordance with patients’ reasoned decisions. Thus, a health care professional cannot deny patients access to medications for mental health conditions, sexual dysfunction, or contraception on the basis of their conscience, since these drugs are professionally accepted as appropriate medical interventions.
N Engl J Med 2017; 376:1380-1385
“Conscience clause” legislation has proliferated in recent years, extending the legal rights of health care professionals to cite their personal religious or moral beliefs as a reason to opt out of performing specific procedures or caring for particular patients. Physicians can refuse to perform abortions or in vitro fertilization. Nurses can refuse to aid in end-of-life care. Pharmacists can refuse to fill prescriptions for contraception. More recently, state legislation has enabled counselors and therapists to refuse to treat lesbian, gay, bisexual, and transgender (LGBT) patients, and in December, a federal judge issued a nationwide injunction against Section 1557 of the Affordable Care Act, which forbids discrimination on the basis of gender identity or termination of a pregnancy.
The article is here, and you need a subscription.
Here is an excerpt:
Objection to providing patients interventions that are at the core of medical practice – interventions that the profession deems to be effective, ethical, and standard treatments – is unjustifiable (AMA Code of Medical Ethics [Opinion 11.2.2]10).
Making the patient paramount means offering and providing accepted medical interventions in accordance with patients’ reasoned decisions. Thus, a health care professional cannot deny patients access to medications for mental health conditions, sexual dysfunction, or contraception on the basis of their conscience, since these drugs are professionally accepted as appropriate medical interventions.
Thursday, May 11, 2017
The Implications of Libertarianism for Compulsory Vaccination
Justin Bernstein
BMJ Blogs
Originally posted April 24, 2017
Here is an excerpt:
Some libertarians, however, attempt to avoid the controversial conclusion that libertarianism is incompatible with compulsory vaccination. In my recent paper, “The Case Against Libertarian Arguments for Compulsory Vaccination,” I argue that such attempts are unsuccessful, and so libertarians must either develop new arguments, or join Senator Paul in opposing compulsory vaccination.
How might a libertarian try to defend compulsory vaccination? One argument is that going unvaccinated exposes others to risk, and this violates their rights. Since the state is permitted to use coercive measures to protect rights, the state may require parents to vaccinate their children. But for libertarians, this argument has two shortcomings. First, there are other, far riskier activities that the libertarian prohibits the government from regulating. For instance, owning and using automobiles or firearms imposes far more significant risk than going unvaccinated, but libertarians defend our rights to own and use automobiles and firearms. Second, one individual going unvaccinated poses very little risk; the risk eventuates only if many collectively go unvaccinated, thereby endangering herd immunity. Imposing such an independently small risk hardly seems to be a rights violation.
The entire blog post is here.
BMJ Blogs
Originally posted April 24, 2017
Here is an excerpt:
Some libertarians, however, attempt to avoid the controversial conclusion that libertarianism is incompatible with compulsory vaccination. In my recent paper, “The Case Against Libertarian Arguments for Compulsory Vaccination,” I argue that such attempts are unsuccessful, and so libertarians must either develop new arguments, or join Senator Paul in opposing compulsory vaccination.
How might a libertarian try to defend compulsory vaccination? One argument is that going unvaccinated exposes others to risk, and this violates their rights. Since the state is permitted to use coercive measures to protect rights, the state may require parents to vaccinate their children. But for libertarians, this argument has two shortcomings. First, there are other, far riskier activities that the libertarian prohibits the government from regulating. For instance, owning and using automobiles or firearms imposes far more significant risk than going unvaccinated, but libertarians defend our rights to own and use automobiles and firearms. Second, one individual going unvaccinated poses very little risk; the risk eventuates only if many collectively go unvaccinated, thereby endangering herd immunity. Imposing such an independently small risk hardly seems to be a rights violation.
The entire blog post is here.
Is There a Duty to Use Moral Neurointerventions?
Michelle Ciurria
Topoi (2017).
doi:10.1007/s11245-017-9486-4
Abstract
Do we have a duty to use moral neurointerventions to correct deficits in our moral psychology? On their surface, these technologies appear to pose worrisome risks to valuable dimensions of the self, and these risks could conceivably weigh against any prima facie moral duty we have to use these technologies. Focquaert and Schermer (Neuroethics 8(2):139–151, 2015) argue that neurointerventions pose special risks to the self because they operate passively on the subject’s brain, without her active participation, unlike ‘active’ interventions. Some neurointerventions, however, appear to be relatively unproblematic, and some appear to preserve the agent’s sense of self precisely because they operate passively. In this paper, I propose three conditions that need to be met for a medical intervention to be considered low-risk, and I say that these conditions cut across the active/passive divide. A low-risk intervention must: (i) pass pre-clinical and clinical trials, (ii) fare well in post-clinical studies, and (iii) be subject to regulations protecting informed consent. If an intervention passes these tests, its risks do not provide strong countervailing reasons against our prima facie duty to undergo the intervention.
The article is here.
Topoi (2017).
doi:10.1007/s11245-017-9486-4
Abstract
Do we have a duty to use moral neurointerventions to correct deficits in our moral psychology? On their surface, these technologies appear to pose worrisome risks to valuable dimensions of the self, and these risks could conceivably weigh against any prima facie moral duty we have to use these technologies. Focquaert and Schermer (Neuroethics 8(2):139–151, 2015) argue that neurointerventions pose special risks to the self because they operate passively on the subject’s brain, without her active participation, unlike ‘active’ interventions. Some neurointerventions, however, appear to be relatively unproblematic, and some appear to preserve the agent’s sense of self precisely because they operate passively. In this paper, I propose three conditions that need to be met for a medical intervention to be considered low-risk, and I say that these conditions cut across the active/passive divide. A low-risk intervention must: (i) pass pre-clinical and clinical trials, (ii) fare well in post-clinical studies, and (iii) be subject to regulations protecting informed consent. If an intervention passes these tests, its risks do not provide strong countervailing reasons against our prima facie duty to undergo the intervention.
The article is here.
Wednesday, May 10, 2017
How do you punish a criminal robot?
Christopher Markou
The Independent
Originally posted on April 20, 2017
Here is an excerpt:
Among the many things that must now be considered is what role and function the law will play. Expert opinions differ wildly on the likelihood and imminence of a future where sufficiently advanced robots walk among us, but we must confront the fact that autonomous technology with the capacity to cause harm is already around. Whether it’s a military drone with a full payload, a law enforcement robot exploding to kill a dangerous suspect or something altogether more innocent that causes harm through accident, error, oversight, or good ol’ fashioned stupidity.
There’s a cynical saying in law that “wheres there’s blame, there’s a claim”. But who do we blame when a robot does wrong? This proposition can easily be dismissed as something too abstract to worry about. But let’s not forget that a robot was arrested (and released without charge) for buying drugs; and Tesla Motors was absolved of responsibility by the American National Highway Traffic Safety Administration when a driver was killed in a crash after his Tesla was in autopilot.
While problems like this are certainly peculiar, history has a lot to teach us. For instance, little thought was given to who owned the sky before the Wright Brothers took the Kitty Hawk for a joyride. Time and time again, the law is presented with these novel challenges. And despite initial overreaction, it got there in the end. Simply put: law evolves.
The article is here.
The Independent
Originally posted on April 20, 2017
Here is an excerpt:
Among the many things that must now be considered is what role and function the law will play. Expert opinions differ wildly on the likelihood and imminence of a future where sufficiently advanced robots walk among us, but we must confront the fact that autonomous technology with the capacity to cause harm is already around. Whether it’s a military drone with a full payload, a law enforcement robot exploding to kill a dangerous suspect or something altogether more innocent that causes harm through accident, error, oversight, or good ol’ fashioned stupidity.
There’s a cynical saying in law that “wheres there’s blame, there’s a claim”. But who do we blame when a robot does wrong? This proposition can easily be dismissed as something too abstract to worry about. But let’s not forget that a robot was arrested (and released without charge) for buying drugs; and Tesla Motors was absolved of responsibility by the American National Highway Traffic Safety Administration when a driver was killed in a crash after his Tesla was in autopilot.
While problems like this are certainly peculiar, history has a lot to teach us. For instance, little thought was given to who owned the sky before the Wright Brothers took the Kitty Hawk for a joyride. Time and time again, the law is presented with these novel challenges. And despite initial overreaction, it got there in the end. Simply put: law evolves.
The article is here.
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