Moral Distress and Moral Strength Among Clinicians in Health Care Systems: A Call for Research

Connie M. Ulrich and Christine Grady
NAM Perspectives. 
https://doi.org/10.31478/201909c


Here is an excerpt:

Evidence shows that dissatisfaction and wanting to leave one’s job—and the profession altogether—often follow morally distressing encounters. Ethics education that builds cognitive and communication skills, teaches clinicians ethical concepts, and helps them gain communication skills and confidence may be essential in building moral strength. One study found, for example, that among practicing nurses and social workers, those with the least ethics education were also the least confident, the least likely to use ethics resources (if available), and the least likely to act on their ethical concerns. In this national study, as many as 23 percent of nurses reported having had no ethics education at all. But the question remains—is ethics education enough?

Many factors likely support or hinder a clinician’s capacity and willingness to act with moral strength. More research is needed to investigate how interdisciplinary ethics education and institutional resources can help nurses, physicians, and others voice their ethical concerns, help them agree on morally acceptable actions, and support their capacity and propensity to act with moral strength and confidence. Research on moral distress and ethical concerns in everyday clinical practice can begin to build a knowledge base that will inform clinical training—in both educational and health care institutions—and that will help create organizational structures and processes to prepare and support clinicians to encounter potentially distressing situations with moral strength. Research can help tease out what is important and predictive for taking (or not taking) ethical action in morally distressing circumstances. This knowledge would be useful for designing strategies to support clinician well-being. Indeed, studies should focus on the influences that affect clinicians’ ability and willingness to become involved or take ownership of ethically-laden patient care issues, and their level of confidence in doing so.

Our illusory sense of agency has a deeply important social purpose

Chris Frith
aeon.com
Originally published September 22, 2019

Here are two excerpts:

We humans like to think of ourselves as mindful creatures. We have a vivid awareness of our subjective experience and a sense that we can choose how to act – in other words, that our conscious states are what cause our behaviour. Afterwards, if we want to, we might explain what we’ve done and why. But the way we justify our actions is fundamentally different from deciding what to do in the first place.

Or is it? Most of the time our perception of conscious control is an illusion. Many neuroscientific and psychological studies confirm that the brain’s ‘automatic pilot’ is usually in the driving seat, with little or no need for ‘us’ to be aware of what’s going on. Strangely, though, in these situations we retain an intense feeling that we’re in control of what we’re doing, what can be called a sense of agency. So where does this feeling come from?

It certainly doesn’t come from having access to the brain processes that underlie our actions. After all, I have no insight into the electrochemical particulars of how my nerves are firing or how neurotransmitters are coursing through my brain and bloodstream. Instead, our experience of agency seems to come from inferences we make about the causes of our actions, based on crude sensory data. And, as with any kind of perception based on inference, our experience can be tricked.

(cut)

These observations point to a fundamental paradox about consciousness. We have the strong impression that we choose when we do and don’t act and, as a consequence, we hold people responsible for their actions. Yet many of the ways we encounter the world don’t require any real conscious processing, and our feeling of agency can be deeply misleading.

If our experience of action doesn’t really affect what we do in the moment, then what is it for? Why have it? Contrary to what many people believe, I think agency is only relevant to what happens after we act – when we try to justify and explain ourselves to each other.

The info is here.

Whistle-blowers act out of a sense of morality

Alice Walton
review.chicagobooth.edu
Originally posted September 16, 2019

Here is an excerpt:

To understand the factors that predict the likelihood of whistle-blowing, the researchers analyzed data from more than 42,000 participants in the ongoing Merit Principles Survey, which has polled US government employees since 1979, and which covers whistle-blowing. Respondents answer questions about their past experiences with unethical behavior, the approaches they’d take in dealing with future unethical behavior, and their personal characteristics, including their concern for others and their feelings about their organizations.

Concern for others was the strongest predictor of whistle-blowing, the researchers find. This was true both of people who had already blown the whistle on bad behavior and of people who expected they might in the future.

Loyalty to an immediate community—or ingroup, in psychological terms—was also linked to whistle-blowing, but in an inverse way. “The greater people’s concern for loyalty, the less likely they were to blow the whistle,” write the researchers. 

Organizational factors—such as people’s perceptions about their employer, their concern for their job, and their level of motivation or engagement—were largely unconnected to whether people spoke up. The only ones that appeared to matter were how fair people perceived their organization to be, as well as the extent to which the organization educated its employees about ways to expose bad behavior and the rights of whistle-blowers. The data suggest these two factors were linked to whether whistle-blowers opted to address the unethical behavior through internal or external avenues. 

The info is here.

Moral and religious convictions: Are they the same or different things?

Skitka LJ, Hanson BE, Washburn AN, Mueller AB (2018)
PLoS ONE 13(6): e0199311.
https://doi.org/10.1371/journal.pone.0199311

Abstract

People often assume that moral and religious convictions are functionally the same thing. But are they? We report on 19 studies (N = 12,284) that tested whether people’s perceptions that their attitudes are reflections of their moral and religious convictions across 30 different issues were functionally the same (the equivalence hypothesis) or different constructs (the distinct constructs hypothesis), and whether the relationship between these constructs was conditional on political orientation (the political asymmetry hypothesis). Seven of these studies (N = 5,561, and 22 issues) also had data that allowed us to test whether moral and religious conviction are only closely related for those who are more rather than less religious (the secularization hypothesis), and a narrower form of the political asymmetry and secularization hypotheses, that is, that people’s moral and religious convictions may be tightly connected constructs only for religious conservatives. Meta-analytic tests of each of these hypotheses yielded weak support for the secularization hypothesis, no support for the equivalence or political asymmetry hypotheses, and the strongest support for the distinct constructs hypothesis.

From the Discussion

People’s lay theories often confound these constructs: If something is perceived as religious, it will also be perceived as moral (and vice versa). Contrary to both people’s lay theories and various scholarly theories of religion, however, we found that the degree to which people perceive a given attitude as a moral or religious conviction is largely orthogonal, sharing only on average 14% common variance.

(cut)

Religious and moral conviction were more strongly related to each other among the religious than the non-religious for 59% of the issues we examined, a finding consistent with the secularization hypothesis. That said, the effect size in support of the secularization hypothesis was very small; the interaction of religiosity and religious conviction only explained a little more than 1% of the variance in moral conviction overall. Taken together, the overwhelming evidence therefore seems most consistent with the distinct constructs hypothesis: Moral and religious convictions are largely independent constructs.

A Social Identity Approach to Engaging Christians in the Issue of Climate Change

Goldberg, M. H., Gustafson, A., Ballew, M. T.,
Rosenthal, S. A., & Leiserowitz, A.
(2019). Science Communication, 
41(4), 442–463.
https://doi.org/10.1177/1075547019860847

Abstract

Using two nationally representative surveys (total N = 2,544) and two experiments (total N = 1,620), we investigate a social identity approach to engaging Christians in the issue of climate change. Results show Christian Americans say “protecting God’s creation” is a top reason for wanting to reduce global warming. An exploratory experiment and a preregistered replication tested a “stewardship frame” message with Christian Americans and found significant increases in pro-environmental and climate change beliefs, which were explained by increases in viewing environmental protection as a moral and religious issue, and perceptions that other Christians care about environmental protection.

From the Discussion:

Two studies using large diverse samples demonstrate that a social identity approach to engaging Christians in the issue of climate change is a promising strategy. In Study 1, in a combined sample of two nationally representative waves of survey data, we found that “protect God’s creation” is one of the most important motivations Christians report for wanting to mitigate global warming. This is important because it indicates that many Americans, and especially Christians, are willing to view climate change through a religious lens, and that messages that frame climate change as a religious issue could encourage greater engagement in the issue among this population.

Greta Thunberg To U.S.: 'You Have A Moral Responsibility' On Climate Change

Bill Chappell and Ailsa Chang
NPR.org
Originally published September 13, 2019

Greta Thunberg led a protest at the White House on Friday. But she wasn't looking to go inside — "I don't want to meet with people who don't accept the science," she says.

The young Swedish activist joined a large crowd of protesters who had gathered outside, calling for immediate action to help the environment and reverse an alarming warming trend in average global temperatures.

She says her message for President Trump is the same thing she tells other politicians: Listen to science, and take responsibility.

Thunberg, 16, arrived in the U.S. last week after sailing across the Atlantic to avoid the carbon emissions from jet travel. She plans to spend nearly a week in Washington, D.C. — but she doesn't plan to meet with anyone from the Trump administration during that time.

"I haven't been invited to do that yet. And honestly I don't want to do that," Thunberg tells NPR's Ailsa Chang. If people in the White House who reject climate change want to change their minds, she says, they should rely on scientists and professionals to do that.

But Thunberg also believes the U.S. has an "incredibly important" role to play in fighting climate change.

"You are such a big country," she says. "In Sweden, when we demand politicians to do something, they say, 'It doesn't matter what we do — because just look at the U.S.'

The info is here.

Ethics a distant second to profits in Silicon Valley

Gabriel Fairman
www.sdtimes.com
Originally published September 9, 2019

Here is an excerpt:

For ethics to become a part of the value system that drives behavior in Silicon Valley, it would have to be incentivized as such. I have a hard time envisioning a world were ethics can offer shareholders huge returns. Ethics is about doing the right thing, and the right thing and the lucrative thing typically don’t necessarily go hand in hand.

Everyone can understand ethics. Basic questions such as “Will this be good for the world in a year, 10 years or 20 years?”, “Would I want this for my kids?” are easy litmus tests to differentiate between ethical and unethical conduct. The challenge is that considerations on ethics slow down development by raising challenges and concerns early on.  Ethics are about amplifying potential problems that can be foreseen down the road.

On the other hand, venture-funded start-ups are about minimizing the ramifications of these problems as they move on quickly. How can ethics compete with billion-dollar exits? It can’t. Ethics are just this thing that we read about in articles or hear about in lectures. It is not driving day-to-day decision-making. You listen to people in boardrooms asking, “How will this impact our valuation?,” or “What is the ROI of this initiative?” but you don’t hear top-level execs brainstorming about how their product or company could be more ethical because there is no compensation tied to that. The way we have built our world, ethics are just fluff.

We are also extraordinary at differentiating private vs. public lives. Many people working at tech companies don’t allow their kids to use electronic devices ubiquitously or would not want their kids bossed around by an algorithm as they let go of full-time employee benefits. But they promote these things and further them because these things are highly profitable, not because they are fundamentally good. This key distinction between private and public behavior allows people to behave in wildly hypocritical ways, by helping advance the very things they do not want in their own homes.

The info is here.

A Theranos Whistleblower’s Mission to Make Tech Ethical

Brian Gallagher
ethicalsystems.org
Originally published September 12, 2019

Here is an excerpt from the interview:

Is Theranos emblematic of a cultural trend or an anomaly of unethical behavior?

My initial impression was that Theranos was some very bizarre one-off scandal. But as I started to review thousands of startups, I realized that there is quite a lot of unethical behavior in tech. The stories may not be quite as grandiose or large-scale as Theranos’, but it was really common to see companies lie to investors, mislead customers, and create abusive work environments. Many founders lacked an understanding of how their products could have negative impacts on society. The frustration of seeing the same mistakes happen over and over again made it clear that something needed to be done about this.

How has your experience at Theranos helped shape your understanding of the link between ethics and culture?

If the company had effective and ethically mature leadership, the company may not have used underdeveloped technology on patients without their consent. If the board was constructed in a way to properly challenge the product, perhaps it would have been developed. If employees weren’t scared and disillusioned, perhaps constructive conversations about novel solutions could have arisen. On rare occasions are these scandals a sort of random surprise or the result of an unexpected disaster. They are often an accumulation of poor ethical decisions. Having a culture where, at every stakeholder level, people can speak-up and be properly considered when they see something wrong is crucial. It makes the difference in building ethical organizations and preventing large disastrous events from happening.

The info is here.

Thinking Fast and Furious: Emotional Intensity and Opinion Polarization in Online Media

David Asker & Elias Dinas
Public Opinion Quarterly
Published: 09 September 2019
https://doi.org/10.1093/poq/nfz042

Abstract

How do online media increase opinion polarization? The “echo chamber” thesis points to the role of selective exposure to homogeneous views and information. Critics of this view emphasize the potential of online media to expand the ideological spectrum that news consumers encounter. Embedded in this discussion is the assumption that online media affects public opinion via the range of information that it offers to users. We show that online media can induce opinion polarization even among users exposed to ideologically heterogeneous views, by heightening the emotional intensity of the content. Higher affective intensity provokes motivated reasoning, which in turn leads to opinion polarization. The results of an online experiment focusing on the comments section, a user-driven tool of communication whose effects on opinion formation remain poorly understood, show that participants randomly assigned to read an online news article with a user comments section subsequently express more extreme views on the topic of the article than a control group reading the same article without any comments. Consistent with expectations, this effect is driven by the emotional intensity of the comments, lending support to the idea that motivated reasoning is the mechanism behind this effect.

From the Discussion:

These results should not be taken as a challenge to the echo chamber argument, but rather as a complement to it. Selective exposure to desirable information and motivated rejection of undesirable information constitute separate mechanisms whereby online news audiences may develop more extreme views. Whereas there is already ample empirical evidence about the first mechanism, previous research on the second has been scant. Our contribution should thus be seen as an attempt to fill this gap.