Burnout in healthcare: the case for organisational change

A Montgomery, E Panagopoulou, A Esmail,
T Richards, & C Maslach
BMJ 2019; 366
doi: https://doi.org/10.1136/bmj.l4774
(Published 30 July 2019)

Burnout has become a big concern within healthcare. It is a response to prolonged exposure to occupational stressors, and it has serious consequences for healthcare professionals and the organisations in which they work. Burnout is associated with sleep deprivation, medical errors, poor quality of care, and low ratings of patient satisfaction. Yet often initiatives to tackle burnout are focused on individuals rather than taking a systems approach to the problem.

Evidence on the association of burnout with objective indicators of performance (as opposed to self report) is scarce in all occupations, including healthcare. But the few examples of studies using objective indicators of patient safety at a system level confirm the association between burnout and suboptimal care. For example, in a recent study, intensive care units in which staff had high emotional exhaustion had higher patient standardised mortality ratios, even after objective unit characteristics such as workload had been controlled for.

The link between burnout and performance in healthcare is probably underestimated: job performance can still be maintained even when burnt out staff lack mental or physical energy as they adopt “performance protection” strategies to maintain high priority clinical tasks and neglect low priority secondary tasks (such as reassuring patients). Thus, evidence that the system is broken is masked until critical points are reached. Measuring and assessing burnout within a system could act as a signal to stimulate intervention before it erodes quality of care and results in harm to patients.

Burnout does not just affect patient safety. Failing to deal with burnout results in higher staff turnover, lost revenue associated with decreased productivity, financial risk, and threats to the organisation’s long term viability because of the effects of burnout on quality of care, patient satisfaction, and safety. Given that roughly 10% of the active EU workforce is engaged in the health sector in its widest sense, the direct and indirect costs of burnout could be substantial.

The info is here.

Can a Woman Rape a Man and Why Does It Matter?

Natasha McKeever
Criminal Law and Philosophy (2019)
13:599–619
https://doi.org/10.1007/s11572-018-9485-6

Abstract

Under current UK legislation, only a man can commit rape. This paper argues that this is an unjustified double standard that reinforces problematic gendered stereotypes about male and female sexuality. I first reject three potential justifications for making penile penetration a condition of rape: (1) it is physically impossible for a woman to rape a man; (2) it is a more serious offence to forcibly penetrate someone than to force them to penetrate you; (3) rape is a gendered crime. I argue that, as these justifications fail, a woman having sex with a man without his consent ought to be considered rape. I then explain some further reasons that this matters. I argue that, not only is it unjust, it is also both a cause and a consequence of harmful stereotypes and prejudices about male and female sexuality: (1) men are ‘always up for sex’; (2) women’s sexual purity is more important than men’s; (3) sex is something men do to women. Therefore, I suggest that, if rape law were made gender neutral, these stereotypes would be undermined and this might make some (albeit small) difference to the problematic ways that sexual relations are sometimes viewed between men and women more generally.

(cut)

3 Final Thoughts on Gender and Rape

The belief that a woman cannot rape a man, therefore, might be both a cause and a consequence of these kinds of harmful gendered stereotypical beliefs:

(a) Sex is something that men do to women.
(b) This is, in part, because men have an uncontrollable desire for sex; women are less bothered about sex.
(c) Due to men’s uncontrollable desire for sex, women must moderate their behaviour so that they don’t tempt men to rape them.
(d) Men are sexually aggressive/dominant (or should be); women are not  (or shouldn’t be).
(e) A woman’s worth is determined, in part, by her sexual purity; a man’s worth is determined, in part, by his sexual prowess.

Of course, these beliefs are outdated, and not held by all people. However, they are pervasive and we do see remnants of them in parts of Western society and in some non‑Western cultures.

What Clinical Ethics Can Learn From Decision Science

Michele C. Gornick and Brian J. Zikmund-Fisher
AMA J Ethics. 2019;21(10):E906-912.
doi: 10.1001/amajethics.2019.906.

Abstract

Many components of decision science are relevant to clinical ethics practice. Decision science encourages thoughtful definition of options, clarification of information needs, and acknowledgement of the heterogeneity of people’s experiences and underlying values. Attention to decision-making processes reminds participants in consultations that how decisions are made and how information is provided can change a choice. Decision science also helps reveal affective forecasting errors (errors in predictions about how one will feel in a future situation) that happen when people consider possible future health states and suggests strategies for correcting these and other kinds of biases. Implementation of decision science innovations is not always feasible or appropriate in ethics consultations, but their uses increase the likelihood that an ethics consultation process will generate choices congruent with patients’ and families’ values.

Here is an excerpt:

Decision Science in Ethics Practice

Clinical ethicists can support informed, value-congruent decision making in ethically complex clinical situations by working with stakeholders to identify and address biases and the kinds of barriers just discussed. Doing so requires constantly comparing actual decision-making processes with ideal decision-making processes, responding to information deficits, and integrating stakeholder values. One key step involves regularly urging clinicians to clarify both available options and possible outcomes and encouraging patients to consider both their values and the possible meanings of different outcomes.

Scientists 'may have crossed ethical line' in growing human brains

Ian Sample
The Guardian
Originally posted October 20, 2019

Neuroscientists may have crossed an “ethical rubicon” by growing lumps of human brain in the lab, and in some cases transplanting the tissue into animals, researchers warn.

The creation of mini-brains or brain “organoids” has become one of the hottest fields in modern neuroscience. The blobs of tissue are made from stem cells and, while they are only the size of a pea, some have developed spontaneous brain waves, similar to those seen in premature babies.

Many scientists believe that organoids have the potential to transform medicine by allowing them to probe the living brain like never before. But the work is controversial because it is unclear where it may cross the line into human experimentation.

On Monday, researchers will tell the world’s largest annual meeting of neuroscientists that some scientists working on organoids are “perilously close” to crossing the ethical line, while others may already have done so by creating sentient lumps of brain in the lab.

“If there’s even a possibility of the organoid being sentient, we could be crossing that line,” said Elan Ohayon, the director of the Green Neuroscience Laboratory in San Diego, California. “We don’t want people doing research where there is potential for something to suffer.”

The info is here.

Bridging cognition and emotion in moral decision making: Role of emotion regulation

Raluca D. Szekely and Andrei C. Miu
In M. L. Bryant (Ed.): Handbook on Emotion Regulation: Processes,
Cognitive Effects and Social Consequences. Nova Science, New York

Abstract

In the last decades, the involvement of emotions in moral decision making was investigated using moral dilemmas in healthy volunteers, neuropsychological and psychiatric patients. Recent research characterized emotional experience in moral dilemmas and its association with deontological decisions. Moreover, theories debated the roles of emotion and reasoning in moral decision making and suggested that emotion regulation may be crucial in overriding emotion-driven deontological biases. After briefly introducing the reader to moral dilemma research and current perspectives on emotion and emotion-cognition interactions in this area, the present chapter reviews emerging evidence for emotion regulation in moral decision making. Inspired by recent advances in the field of emotion regulation, this chapter also highlights several avenues for future research on emotion regulation in moral psychology.

The book chapter can be downloaded here.

This is a good summary for those starting to learn about cognition, decision-making models, emotions, and morality.

In U.S., Decline of Christianity Continues at Rapid Pace

Pew Research Center
Originally published October 17, 2019

The religious landscape of the United States continues to change at a rapid clip. In Pew Research Center telephone surveys conducted in 2018 and 2019, 65% of American adults describe themselves as Christians when asked about their religion, down 12 percentage points over the past decade. Meanwhile, the religiously unaffiliated share of the population, consisting of people who describe their religious identity as atheist, agnostic or “nothing in particular,” now stands at 26%, up from 17% in 2009.

Both Protestantism and Catholicism are experiencing losses of population share. Currently, 43% of U.S. adults identify with Protestantism, down from 51% in 2009. And one-in-five adults (20%) are Catholic, down from 23% in 2009. Meanwhile, all subsets of the religiously unaffiliated population – a group also known as religious “nones” – have seen their numbers swell. Self-described atheists now account for 4% of U.S. adults, up modestly but significantly from 2% in 2009; agnostics make up 5% of U.S. adults, up from 3% a decade ago; and 17% of Americans now describe their religion as “nothing in particular,” up from 12% in 2009. Members of non-Christian religions also have grown modestly as a share of the adult population.



The info is here.

Punish or Protect? How Close Relationships Shape Responses to Moral Violations

Weidman, A. C., Sowden, W. J., Berg, M. K.,
& Kross, E. (2019).
Personality and Social Psychology Bulletin.
https://doi.org/10.1177/0146167219873485

Abstract

People have fundamental tendencies to punish immoral actors and treat close others altruistically. What happens when these tendencies collide—do people punish or protect close others who behave immorally? Across 10 studies (N = 2,847), we show that people consistently anticipate protecting close others who commit moral infractions, particularly highly severe acts of theft and sexual harassment. This tendency emerged regardless of gender, political orientation, moral foundations, and disgust sensitivity and was driven by concerns about self-interest, loyalty, and harm. We further find that people justify this tendency by planning to discipline close others on their own. We also identify a psychological mechanism that mitigates the tendency to protect close others who have committed severe (but not mild) moral infractions: self-distancing. These findings highlight the role that relational closeness plays in shaping people’s responses to moral violations, underscoring the need to consider relational closeness in future moral psychology work.

From the General Discussion

These findings also clarify the mechanisms through which people reconcile behaving loyally (by protecting close others who commit moral infractions) at the cost of behaving dishonestly while allowing an immoral actor to evade formal punishment (by lying to a police officer). It does not appear that people view close others’ moral infractions as less immoral: A brother’s heinous crime is still a heinous crime.  Instead, when people observe close others behaving immorally, we found through an exploratory linguistic coding analysis that they overwhelmingly intend to enact a lenient form of punishment by confronting the perpetrator to discuss the act. We suspect that doing so allows a person to simultaneously (a) maintain their self-image as a morally upstanding individual and (b) preserve and even enhance the close relationship, in line with the finding in Studies 1d and 1e that protecting close others from legal fallout is viewed as an act of self-interest. These tactics are also broadly consistent with prior work suggesting that people often justify their own immoral acts by focusing on positive consequences of the act or reaffirming their own moral standing (Bandura, 2016). In contrast, we found that when people observe distant others behaving immorally, they report greater intentions to subject these individuals to external, formal means of punishment, such as turning them in to law enforcement or subjecting them to social ostracization.

Should we create artificial moral agents? A Critical Analysis

John Danaher
Philosophical Disquisitions
Originally published September 21, 2019

Here is an excerpt:

So what argument is being made? At first, it might look like Sharkey is arguing that moral agency depends on biology, but I think that is a bit of a red herring. What she is arguing is that moral agency depends on emotions (particularly second personal emotions such as empathy, sympathy, shame, regret, anger, resentment etc). She then adds to this the assumption that you cannot have emotions without having a biological substrate. This suggests that Sharkey is making something like the following argument:

(1) You cannot have explicit moral agency without having second personal emotions.

(2) You cannot have second personal emotions without being constituted by a living biological substrate.

(3) Robots cannot be constituted by a living biological substrate.

(4) Therefore, robots cannot have explicit moral agency.

Assuming this is a fair reconstruction of the reasoning, I have some questions about it. First, taking premises (2) and (3) as a pair, I would query whether having a biological substrate really is essential for having second personal emotions. What is the necessary connection between biology and emotionality? This smacks of biological mysterianism or dualism to me, almost a throwback to the time when biologists thought that living creatures possessed some élan vital that separated them from the inanimate world. Modern biology and biochemistry casts all that into doubt. Living creatures are — admittedly extremely complicated — evolved biochemical machines. There is no essential and unbridgeable chasm between the living and the inanimate.

The info is here.

Elon Musk's AI Project to Replicate the Human Brain Receives $1B from Microsoft

Anthony Cuthbertson
The Independent
Originally posted July 23, 2019

Microsoft has invested $1 billion in the Elon Musk-founded artificial intelligence venture that plans to mimic the human brain using computers.

OpenAI said the investment would go towards its efforts of building artificial general intelligence (AGI) that can rival and surpass the cognitive capabilities of humans.

“The creation of AGI will be the most important technological development in human history, with the potential to shape the trajectory of humanity,” said OpenAI CEO Sam Altman.

“Our mission is to ensure that AGI technology benefits all of humanity, and we’re working with Microsoft to build the supercomputing foundation on which we’ll build AGI.”

The two firms will jointly build AI supercomputing technologies, which OpenAI plans to commercialise through Microsoft and its Azure cloud computing business.

The info is here.