Ethical guidelines for social justice in psychology

Hailes, H. and others
Professional Psychology:
Research and Practice

Abstract

As the field of psychology increasingly recognizes the importance of engaging in work that advances social justice and as social justice-focused training and practice in the field grows, psychologists need ethical guidelines for this work. The American Psychological Association’s ethical principles include “justice” as a core principle but do not expand extensively upon its implications. This article provides a proposed set of ethical guidelines for social justice work in psychology. Within the framework of 3 domains of justice—interactional (about relational dynamics), distributive (about provision for all), and procedural (about just processes) justice—this article outlines 7 guidelines for social justice ethics: (1) reflecting critically on relational power dynamics; (2) mitigating relational power dynamics; (3) focusing on empowerment and strengths-based approaches; (4) focusing energy and resources on the priorities of marginalized communities; (5) contributing time, funding, and effort to preventive work; (6) engaging with social systems; and (7) raising awareness about system impacts on individual and community well-being. Vignettes of relevant ethical dilemmas are presented and implications for practice are discussed.

This article explores the need for a set of ethical standards to guide psychologists’ social justice-oriented work. It conceptualizes social justice as having three components, focused on relational dynamics, provision for all, and just processes. Additionally, it outlines and provides examples of seven proposed standards for social justice ethics in psychology.

The article is here.

Are Insects Capable of Moral Behavior?

Livia Gershon
daily.jstor.org
Originally published 6 Feb 20

Are insects conscious, capable of a subjective experience of the world? And, if so, can they be moral actors, or victims of immoral acts (like, say, being flushed down the toilet)? These questions interest modern scientists. And, as Jeanette Samyn writes, they also mattered to nineteenth-century naturalists who asked questions about behavior and morality in relation to the nonhuman world.

Writing in the 1810s and 1820s, British entomologists William Kirby and William Spence presented parasites as tools of God. To them, lice represented a punishment for both “personal uncleanliness” and for “oppression and tyranny.”

Still, Kirby, Spence, and other biologists wrestled with whether insects could be moral actors. Were they driven purely by instinct or capable of some sort of reason? And how could their more disgusting behaviors be reconciled with a universe ordered by God? Charles Darwin wrote that it was difficult to believe “that a beneficent & omnipotent God would have designedly created the Ichneumonidae with the express intention of their feeding within the living bodies of caterpillars.” Instead, he wrote, he preferred to “look at everything as resulting from designed laws, with the details, whether good or bad, left to the working out of what we may call chance.” “Not,” he added somewhat glumly, “that this at all satisfies me.”

Other naturalists presented insects as moral beings. Some chose to focus on a few charismatic species—notably bees, which had long been admired as sociable, productive creatures who were helpful to humans. But Samyn points to a different take on the value of insect life presented by Louis Figuier, a French writer who interpreted science for a popular audience.

The info is here.

Transgender and Intersex Kids Must Have a Voice in Health Care Decisions

Scott Nass
thenation.com
Originally posted 13 Feb 20

Here is an excerpt:

We physicians are not allowed to take critical care away from patients, nor to force interventions on them, just because their bodies and needs don’t fit our personal expectations of “normal.” That’s not a part of our oath. Prioritizing patients means focusing on what they say they need, supporting each patient and their family in age-appropriate ways. The answer is very simple: Individuals must take the lead in making decisions about their own bodies.

Just because individuals are minors now does not mean they won’t have wishes for their bodies in the future. Transgender and intersex youth grow up. When they are denied their own choices, families bear the resulting stress and trauma.

If you don’t know any transgender or intersex kids, it may feel easy to shrug this off. But this is about more than just a few bad bills. Intersex and transgender children’s bodies are being used to uphold regressive ideas about gender’s being based on anatomy and fixed at birth, with medicine used to enforce rather than affirm.

It’s clear to me, as a physician who helps intersex and transgender children live healthy lives, that those who supported the South Dakota bill are putting youth at risk. Nearly 45 percent of transgender youth considered suicide in 2017, according to the Trevor Project. Those numbers are highest when children are not allowed to affirm their gender. Of intersex children who had infant clitoral surgery, 39 percent could not achieve orgasm as adults, compared to 0 percent in a control group. Many families are never told about these types of risks.

The info is here.

Ethical concerns with online direct-to-consumer pharmaceutical companies

Curtis H, Milner J
Journal of Medical Ethics 
2020;46:168-171.

Abstract

In recent years, online direct-to-consumer pharmaceutical companies have been created as an alternative method for individuals to get prescription medications. While these companies have noble aims to provide easier, more cost-effective access to medication, the fact that these companies both issue prescriptions (via entirely online medical reviews that can have no direct contact between physician and patient) as well as distribute and ship medications creates multiple ethical concerns. This paper aims to explore two in particular. First, this model creates conflicts of interest for the physicians hired by these companies to write prescriptions. Second, the lack of direct contact from physicians may be harmful to prospective patients. After analysing these issues, this paper argues that there ought to be further consideration for regulation and oversight for these companies.

The info is here.

Docs Decry ‘Moral Injury’ From Financial Pressures Of Health Care

Melissa Bailey
Kaiser Health News
Originally published 4 Feb 20

Here are two excerpts:

But “the real priority is speed and money and not our patients’ care,” Corl said. “That makes it tough for doctors who know they could be doing better for their patients.”

Dean said people often frame burnout as a personal failing. Doctors get the message: “If you did more yoga, if you ate more salmon salad, if you went for a longer run, it would help.” But, she argued, burnout is a symptom of deeper systemic problems beyond clinicians’ control.

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“The health system is not set up to help patients. It’s set up to make money,” he said.

The best way to approach this problem, he said, is to help future generations of doctors understand “how decisions made at the systems level impact how we care about patients” — so they can “stand up for what’s right.”

Whether these experiences amount to moral injury is open for discussion.

Cynda Rushton, a nurse and professor of clinical ethics at Johns Hopkins University, who has studied the related notion of “moral distress” for 25 years, said there isn’t a base of research, as there is for moral distress, to measure moral injury among clinicians.

But “what both of these terms signify,” Rushton said, “is a sense of suffering that clinicians are experiencing in their roles now, in ways that they haven’t in the past.”

Dean grew interested in moral injury from personal experience: After a decade of treating patients as a psychiatrist, she stopped because of financial pressures. She said she wanted to treat her patients in longer visits, offering both psychotherapy and medication management, but that became more difficult. Insurers would rather pay her for only a 15-minute session to manage medications and let a lower-paid therapist handle the therapy.

The info is here.

How Common Mental Shortcuts Can Cause Major Physician Errors

Anupam B. Jena and Andrew R. Olenski
The New York Times
Originally posted 20 Feb 20

Here is an excerpt:

In health care, such unconscious biases can lead to disparate treatment of patients and can affect whether similar patients live or die.

Sometimes these cognitive biases are simple overreactions to recent events, what psychologists term availability bias. One study found that when patients experienced an unlikely adverse side effect of a drug, their doctor was less likely to order that same drug for the next patient whose condition might call for it, even though the efficacy and appropriateness of the drug had not changed.

A similar study found that when mothers giving birth experienced an adverse event, their obstetrician was more likely to switch delivery modes for the next patient (C-section vs. vaginal delivery), regardless of the appropriateness for that next patient. This cognitive bias resulted in both higher spending and worse outcomes.

Doctor biases don’t affect treatment decisions alone; they can shape the profession as a whole. A recent study analyzed gender bias in surgeon referrals and found that when the patient of a female surgeon dies, the physician who made the referral to that surgeon sends fewer patients to all female surgeons in the future. The study found no such decline in referrals for male surgeons after a patient death.

This list of biases is far from exhaustive, and though they may be disconcerting, uncovering new systematic mistakes is critical for improving clinical practice.

The info is here.

Stressed Out at the Office? Therapy Can Come to You

Rachel Feintzeig
The Wall Street Journal
Originally published 31 Jan 20

Here is an excerpt:

In the past, discussion of mental-health issues at the office was uncommon. Workers were largely expected to leave their personal struggles at home. Crying was confined to the bathroom stall.

Today, that’s changing. One reason is a broadening of the popular understanding of “mental health” to encompass anxiety, stress and other widespread issues.

It’s also a reflection of a changing workplace. Younger workers are more comfortable talking about their struggles and expect their employers to take emotional distress seriously, says Jeffrey Pfeffer, a professor of organizational behavior at the Stanford Graduate School of Business.

Senior leaders are responding, rolling out mental-health services and sometimes speaking about their own experiences. Lloyds Banking Group Plc chief executive António Horta-Osório has said publicly in recent years that the pressure he felt around the bank’s financial situation in 2011 dominated his thoughts, leaving him unable to sleep and exhausted. He took eight weeks off from the company to recover, working with a psychiatrist. The psychiatrist later helped him devise a mental-health program for Lloyds employees.

Brynn Brichet, a lead product manager at Cerner Corp., a maker of electronic medical-records systems, said she sometimes returns from her counseling appointments with an on-site therapist red-faced from crying. (The therapist sits a few floors down.) If colleagues ask, she tells them that she just got out of an intense therapy session. Some are taken aback when she mentions her therapy, she said. But she thinks it’s important to be open.

“We all are terrified. We all are struggling,” she said. “If we don’t talk about it, it can run our lives.”

The info is here.

It Pays to Be Yourself

Francesca Gino
hbr.org
Originally posted 13 Feb 20

Whether it’s trying to land a new job or a new deal or client, we often focus on making a good initial impression on people, especially when they don’t know us well or the stakes are high. One strategy people often use is to cater to the interests, preferences, and expectations of the person they want to impress. Most people, it seems, believe this is a more promising strategy than being themselves and use it in high-stakes interpersonal first meetings. But research I conducted with Ovul Sezer of the University of Carolina at Chapel Hill and Laura Huang of Harvard Business School found those beliefs are wrong.

Our research confirmed that catering to others’ interests and expectations is quite common. When we asked over 450 employed adults to imagine they were about to have an important professional interaction — such as interviewing for their dream job, conducting a valuable negotiation for their company, pitching an entrepreneurial idea to potential investors, or making a presentation to a client — 66% of them indicated they would use catering techniques, rather than simply being themselves; 71% reported believing that catering would be the most effective approach in the situation.

But another study we conducted found that catering was much less effective than being yourself. We asked 166 entrepreneurs to participate in a “fast-pitch” competition held at a private university in the northeastern United States. Each entrepreneur presented his or her venture idea to a panel of three judges: experienced, active members of angel investment groups. The ideas pitched were all in the early stages; none had received any external financing. At the end of the event, the judges collectively deliberated to choose 10 semifinalists who would be invited to participate in the final round. After entrepreneurs made their pitches, we had them answer a few questions about their presentations. We found that when they were genuine in their pitches, they were more than three times as likely to be chosen as semifinalists than when they tried to cater to the judges.

The info is here.

The lesser of two evils: Explaining a bad choice by revealing the choice set

Andras Molnar & Shereen J. Chaudhry
PsyArXiv
Last edited 4 Feb 20

Abstract

Making the right choice does not always lead to a good outcome—sometimes there are only bad outcomes to choose from. Situations like this are likely to lead others to misunderstand the decision maker’s intentions. However, simply revealing the choice set could set the record straight. Are decision-makers intrinsically driven to fix this misjudgment? If so, why, and what is the effect on the audience? Previous studies could not examine this desire to be understood because the research designs used did not isolate the decision to reveal information from the original choice. In two experiments (N=448 pairs), we address this gap in the literature and show that people are willing to pay ex post to reveal their choice set to the person who was negatively affected by their decision (the recipient), even after a one-shot anonymous interaction with no reputational consequences, and in some cases even when doing so reveals their selfish intentions. We find that this revealing behavior is effective at improving recipients’ rating of their outcome when it signals generous intentions, but not when it signals selfish intentions. It follows that the choice to reveal is driven by concern for the thoughts and feelings of strangers, but only when revealing signals generous intentions; those who reveal a choice that appears selfish report doing so out of a desire to be and/or appear honest. Individual differences in the drive to reveal cannot be explained by selection effects or mistakes in predicting the observer’s reaction. Thus, we find that people are intrinsically (i.e., even in one-shot anonymous settings) driven to correct a misunderstanding of their intentions, but they may do so for a variety of reasons, not all of which are self-enhancing. And though some people leave a misunderstanding in place when it is self-enhancing to do so, almost no one is willing to create a misunderstanding (by hiding the other option), even when it could conceal selfish behavior.

The research is here.