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, July 15, 2019

How the concept of forgiveness is used to gaslight women

Sophie King
Medium.com
Originally posted June 13, 2019

I’m not against the concept of forgiveness, I’ve chosen to forgive people countless times. However, what I’m definitely against, is pressuring people to forgive and shaming them if they don’t. I’ve found there’s a lot of stigma attached to those who choose not to forgive, especially if you’re a woman.

Women that don’t forgive, are assumed to be “scorned”, “bitter and twisted”. The stereotypes that surround “unforgiving” women, are used to gaslight them.

When women express that they’re upset or angry (and justifiably so), as a result of being hurt, people dismiss them as “bitter” and the validity of their feelings and experiences are questioned.

She isn’t psychologically traumatised because she’s been wronged, she’s just a “scorned woman”, “got an axe to grind”, “holding a grudge” and “unable to move on”. The fault lies with her, not the perpetrator because she won’t “let it go” and “get over it”. She’s not the victim, she’s bringing it on herself by not forgiving. The blame is shifted from the wrongdoer to the victim.

The info is here.

Why parents are struggling to find mental health care for their children

Bernard Wolfson
Kaiser Health News/PBS.org
Originally posted May 7, 2019

Here is an excerpt:

Think about how perverse this is. Mental health professionals say that with children, early intervention is crucial to avoid more severe and costly problems later on. Yet even parents with good insurance struggle to find care for their children.

The U.S. faces a growing shortage of mental health professionals trained to work with young people — at a time when depression and anxiety are on the rise. Suicide was the No. 2 cause of death for children and young adults from age 10 to 24 in 2017, after accidents.

There is only one practicing child and adolescent psychiatrist in the U.S. for about every 1,800 children who need one, according to data from the American Academy of Child & Adolescent Psychiatry.

Not only is it hard to get appointments with psychiatrists and therapists, but the ones who are available often don’t accept insurance.

“This country currently lacks the capacity to provide the mental health support that young people need,” says Dr. Steven Adelsheim, director of the Stanford University psychiatry department’s Center for Youth Mental Health and Wellbeing.

The info is here.

Sunday, July 14, 2019

The Voluntariness of Voluntary Consent: Consent Searches and the Psychology of Compliance

Sommers, Roseanna and Bohns, Vanessa K.
Yale Law Journal, Vol. 128, No. 7, 2019. 
Available at SSRN: https://ssrn.com/abstract=3369844

Abstract

Consent-based searches are by far the most ubiquitous form of search undertaken by police. A key legal inquiry in these cases is whether consent was granted voluntarily. This Essay suggests that fact finders’ assessments of voluntariness are likely to be impaired by a systematic bias in social perception. Fact finders are likely to under appreciate the degree to which suspects feel pressure to comply with police officers’ requests to perform searches.

In two preregistered laboratory studies, we approached a total of 209 participants (“Experiencers”) with a highly intrusive request: to unlock their password-protected smartphones and hand them over to an experimenter to search through while they waited in another room. A separate 194 participants (“Forecasters”) were brought into the lab and asked whether a reasonable person would agree to the same request if hypothetically approached by the same researcher. Both groups then reported how free they felt, or would feel, to refuse the request.

Study 1 found that whereas most Forecasters believed a reasonable person would refuse the experimenter’s request, most Experiencers — 100 out of 103 people — promptly unlocked their phones and handed them over. Moreover, Experiencers reported feeling significantly less free to refuse than did Forecasters contemplating the same situation hypothetically.

Study 2 tested an intervention modeled after a commonly proposed reform of consent searches, in which the experimenter explicitly advises participants that they have the right to with- hold consent. We found that this advisory did not significantly reduce compliance rates or make Experiencers feel more free to say no. At the same time, the gap between Experiencers and Forecasters remained significant.

These findings suggest that decision makers judging the voluntariness of consent consistently underestimate the pressure to comply with intrusive requests. This is problematic because it indicates that a key justification for suspicionless consent searches — that they are voluntary — relies on an assessment that is subject to bias. The results thus provide support to critics who would like to see consent searches banned or curtailed, as they have been in several states.

The results also suggest that a popular reform proposal — requiring police to advise citizens of their right to refuse consent — may have little effect. This corroborates previous observational studies, which find negligible effects of Miranda warnings on confession rates among interrogees, and little change in rates of consent once police start notifying motorists of their right to refuse vehicle searches. We suggest that these warnings are ineffective because they fail to address the psychology of compliance. The reason people comply with police, we contend, is social, not informational. The social demands of police-citizen interactions persist even when people are informed of their rights. It is time to abandon the myth that notifying people of their rights makes them feel empowered to exercise those rights.

Saturday, July 13, 2019

The Worst Patients in the World

David Freedman
The Atlantic - July 2019 Issue

Here are two excerpts:

Recriminations tend to focus on how Americans pay for health care, and on our hospitals and physicians. Surely if we could just import Singapore’s or Switzerland’s health-care system to our nation, the logic goes, we’d get those countries’ lower costs and better results. Surely, some might add, a program like Medicare for All would help by discouraging high-cost, ineffective treatments.

But lost in these discussions is, well, us. We ought to consider the possibility that if we exported Americans to those other countries, their systems might end up with our costs and outcomes. That although Americans (rightly, in my opinion) love the idea of Medicare for All, they would rebel at its reality. In other words, we need to ask: Could the problem with the American health-care system lie not only with the American system but with American patients?

(cut)

American patients’ flagrant disregard for routine care is another problem. Take the failure to stick to prescribed drugs, one more bad behavior in which American patients lead the world. The estimated per capita cost of drug noncompliance is up to three times as high in the U.S. as in the European Union. And when Americans go to the doctor, they are more likely than people in other countries to head to expensive specialists. A British Medical Journal study found that U.S. patients end up with specialty referrals at more than twice the rate of U.K. patients. They also end up in the ER more often, at enormous cost. According to another study, this one of chronic migraine sufferers, 42 percent of U.S. respondents had visited an emergency department for their headaches, versus 14 percent of U.K. respondents.

Finally, the U.S. stands out as a place where death, even for the very aged, tends to be fought tooth and nail, and not cheaply. “In the U.K., Canada, and many other countries, death is seen as inevitable,” Somava Saha said. “In the U.S., death is seen as optional. When [people] become sick near the end of their lives, they have faith in what a heroic health-care system will accomplish for them.”

The info is here.

Friday, July 12, 2019

The Troubled History of Psychiatry

Jerome Groopman
The New Yorker
Originally posted May 20, 2019

Here is an excerpt:

Yet, despite the phenomenal success of Prozac, and of other SSRIs, no one has been able to produce definitive experimental proof establishing neurochemical imbalances as the pathogenesis of mental illness. Indeed, quite a lot of evidence calls the assumption into question. Clinical trials have stirred up intense controversy about whether antidepressants greatly outperform the placebo effect. And, while SSRIs do boost serotonin, it doesn’t appear that people with depression have unusually low serotonin levels. What’s more, advances in psychopharmacology have been incremental at best; Harrington quotes the eminent psychiatrist Steven Hyman’s assessment that “no new drug targets or therapeutic mechanisms of real significance have been developed for more than four decades.” This doesn’t mean that the available psychiatric medication isn’t beneficial. But some drugs seem to work well for some people and not others, and a patient who gets no benefit from one may do well on another. For a psychiatrist, writing a prescription remains as much an art as a science.

Harrington’s book closes on a sombre note. In America, the final decade of the twentieth century was declared the Decade of the Brain. But, in 2010, the director of the National Institute of Mental Health reflected that the initiative hadn’t produced any marked increase in rates of recovery from mental illness. Harrington calls for an end to triumphalist claims and urges a willingness to acknowledge what we don’t know.

Although psychiatry has yet to find the pathogenesis of most mental illness, it’s important to remember that medical treatment is often beneficial even when pathogenesis remains unknown. After all, what I was taught about peptic ulcers and stress wasn’t entirely useless; though we now know that stress doesn’t cause ulcers, it can exacerbate their symptoms. Even in instances where the discovery of pathogenesis has produced medical successes, it has often worked in tandem with other factors. Without the discovery of H.I.V. we would not have antiretroviral drugs, and yet the halt in the spread of the disease owes much to simple innovations, such as safe-sex education and the distribution of free needles and condoms.

The info is here.

Tribalism is Human Nature

Cory Clark, Brittany Liu, Bo Winegard, and Peter Ditto
Pre-print

Abstract

Humans evolved in the context of intense intergroup competition, and groups comprised of loyal members more often succeeded than those that were not. Therefore, selective pressures have consistently sculpted human minds to be "tribal," and group loyalty and concomitant cognitive biases likely exist in all groups. Modern politics is one of the most salient forms of modern coalitional conflict and elicits substantial cognitive biases. Given the common evolutionary history of liberals and conservatives, there is little reason to expect pro-tribe biases to be higher on one side of the political spectrum than the other. We call this the evolutionarily plausible null hypothesis and recent research has supported it. In a recent meta-analysis, liberals and conservatives showed similar levels of partisan bias, and a number of pro-tribe cognitive tendencies often ascribed to conservatives (e.g., intolerance toward dissimilar others) have been found in similar degrees in liberals. We conclude that tribal bias is a natural and nearly ineradicable feature of human cognition, and that no group—not even one’s own—is immune.

Here is part of the Conclusion:

Humans are tribal creatures. They were not designed to reason dispassionately about the world; rather, they were designed to reason in ways that promote the interests of their coalition (and hence, themselves). It would therefore be surprising if a particular group of individuals did not display such tendencies, and recent work suggests, at least in the U.S. political sphere, that both liberals and conservatives are substantially biased—and to similar degrees. Historically, and perhaps even in modern society, these tribal biases are quite useful for group cohesion but perhaps also for other moral purposes (e.g., liberal bias in favor of disadvantaged groups might help increase equality). Also, it is worth noting that a bias toward viewing one’s own tribe in a favorable light is not necessarily irrational. If one’s goal is to be admired among one’s own tribe, fervidly supporting their agenda and promoting their goals, even if that means having or promoting erroneous beliefs, is often a reasonable strategy (Kahan et al., 2017). The incentives for holding an accurate opinion about global climate change, for example, may not be worth the social rejection and loss of status that could accompany challenging the views of one’s political ingroup. However, these biases decrease the likelihood of consensus across political divides. Thus, developing effective strategies for disincentivizing political tribalism and promoting the much less natural but more salutary tendencies toward civil political discourse and reasonable compromise are crucial priorities for future research. A useful theoretical starting point is that tribalism and concomitant biases are part of human nature, and that no group, not even one’s own, is immune.

A pre-print is here.

Thursday, July 11, 2019

Civic honesty around the globe

Alain Cohn, Michel André Maréchal, David Tannenbaum, & Christian Lukas Zünd
Science  20 Jun 2019:
DOI: 10.1126/science.aau8712

Abstract

Civic honesty is essential to social capital and economic development, but is often in conflict with material self-interest. We examine the trade-off between honesty and self-interest using field experiments in 355 cities spanning 40 countries around the globe. We turned in over 17,000 lost wallets with varying amounts of money at public and private institutions, and measured whether recipients contacted the owner to return the wallets. In virtually all countries citizens were more likely to return wallets that contained more money. Both non-experts and professional economists were unable to predict this result. Additional data suggest our main findings can be explained by a combination of altruistic concerns and an aversion to viewing oneself as a thief, which increase with the material benefits of dishonesty.

Here is the conclusion:

Our findings also represent a unique data set for examining cross-country differences in civic honesty. Honesty is a key component of social capital, and here we provide an objective measure to supplement the large body of work that has traditionally examined social capital using subjective survey measures. Using average response rates across countries, we find substantial variation in rates of civic honesty, ranging from 14% to 76%. This variation largely persists even when controlling for a country’s gross domestic product, suggesting that other factors besides country wealth are also at play. In the supplementary materials, we provide an analysis suggesting that economically favorable geographic conditions, inclusive political institutions, national education, and cultural values that emphasize moral norms extending beyond one’s in-group are also positively associated with rates of civic honesty. Future research is needed to identify how these and other factors may contribute to societal differences in honest behavior.

The research is here.

The Business of Health Care Depends on Exploiting Doctors and Nurses

Danielle Ofri
The New York Times
Originally published June 8, 2019

One resource seems infinite and free: the professionalism of caregivers.

You are at your daughter’s recital and you get a call that your elderly patient’s son needs to talk to you urgently.  A colleague has a family emergency and the hospital needs you to work a double shift.  Your patient’s M.R.I. isn’t covered and the only option is for you to call the insurance company and argue it out.  You’re only allotted 15 minutes for a visit, but your patient’s medical needs require 45.

These quandaries are standard issue for doctors and nurses.  Luckily, the response is usually standard issue as well: An overwhelming majority do the right thing for their patients, even at a high personal cost.

It is true that health care has become corporatized to an almost unrecognizable degree.  But it is also true that most clinicians remain committed to the ethics that brought them into the field in the first place.  This makes the hospital an inspiring place to work.

Increasingly, though, I’ve come to the uncomfortable realization that this ethic that I hold so dear is being cynically manipulated.

By now, corporate medicine has milked just about all the “efficiency” it can out of the system.  With mergers and streamlining, it has pushed the productivity numbers about as far as they can go.

But one resource that seems endless — and free — is the professional ethic of medical staff members.

This ethic holds the entire enterprise together.  If doctors and nurses clocked out when their paid hours were finished, the effect on patients would be calamitous.  Doctors and nurses know this, which is why they don’t shirk.  The system knows it, too, and takes advantage.

The demands on medical professionals have escalated relentlessly in the past few decades, without a commensurate expansion of time and resources.  For starters, patients are sicker these days.  The medical complexity per patient — the number and severity of chronic conditions — has steadily increased, meaning that medical encounters are becoming ever more involved.  They typically include more illnesses to treat, more medications to administer, more complications to handle — all in the same-length office or hospital visit.

The information is here.

Wednesday, July 10, 2019

Fostering an Ethical Culture on Your Sales Team

Kristen Bell DeTienne, Bradley R. Agle, and others
Harvard Business Review
Originally posted June 20, 2019

Here is an excerpt:

Create a Culture of Ethical Values. 

Employees can suffer several negative consequences if they are told to do things that conflict with their ethical values. Meanwhile, companies can suffer negative consequences from employees not living up to the organization’s values. Managers can help by involving sales associates in conversations about personal and organizational values and by helping employees reconcile discrepancies and honor both their personal and organizational values.

During one of our ethics training sessions with a U.S.-based corporation, employees first described their own values and the company’s values. In teams, they set goals for sales achievement, then wrote a code of conduct that would promote that achievement while still respecting both individual and company values. One associate’s value was “not to push the clients too much when they need time to decide.” This seemed at odds with the company’s values to “finalize the sale” and “never abandon an opportunity.” So, the employees created a rule that honored both values: “Give your customers the time they need to think about your offer, but immediately fix the next appointment.” This hybrid rule brought peace of mind to employees—and a better sales experience to their customers.

The info is here.