The effectiveness of moral messages on public health behavioral intentions during the COVID-19 pandemic

J. Everett, C. Colombatta, & others

PsyArXiv PrePrints
Originally posted 20 March 20

Abstrac
With the COVID-19 pandemic threatening millions of lives, changing our behaviors to prevent the spread of the disease is a moral imperative. Here, we investigated the effectiveness of messages inspired by three major moral traditions on public health behavioral intentions. A sample of US participants representative for age, sex and race/ethnicity (N=1032) viewed messages from either a leader or citizen containing deontological, virtue-based, utilitarian, or non-moral justifications for adopting social distancing behaviors during the COVID-19 pandemic. We measured the messages’ effects on participants’ self-reported intentions to wash hands, avoid social gatherings, self-isolate, and share health messages, as well as their beliefs about others’ intentions, impressions of the messenger’s morality and trustworthiness, and beliefs about personal control and responsibility for preventing the spread of disease. Consistent with our pre-registered predictions, deontological messages had modest effects across several measures of behavioral intentions, second-order beliefs, and impressions of the messenger, while virtue-based messages had modest effects on personal responsibility for preventing the spread. These effects were observed for messages from leaders and citizens alike. Our findings are at odds with participants’ own beliefs about moral persuasion: a majority of participants predicted the utilitarian message would be most effective. We caution that these effects are modest in size, likely due to ceiling effects on our measures of behavioral intentions and strong heterogeneity across all dependent measures along several demographic dimensions including age, self-identified gender, self-identified race, political conservatism, and religiosity. Although the utilitarian message was the least effective among those tested, individual differences in one key dimension of utilitarianism—impartial concern for the greater good—were strongly and positively associated with public health intentions and beliefs. Overall, our preliminary results suggest that public health messaging focused on duties and responsibilities toward family, friends and fellow citizens will be most effective in slowing the spread of COVID-19 in the US. Ongoing work is investigating whether deontological persuasion generalizes across different populations, what aspects of deontological messages drive their persuasive effects, and how such messages can be most effectively delivered across global populations.

The research is here.

Sen. Kelly Loeffler Dumped Millions in Stock After Coronavirus Briefing

L. Markay, W. Bredderman, & S. Bordy
thedailybeast.com
Updated 20 March 20

The Senate’s newest member sold off seven figures’ worth of stock holdings in the days and weeks after a private, all-senators meeting on the novel coronavirus that subsequently hammered U.S. equities.

Sen. Kelly Loeffler (R-GA) reported the first sale of stock jointly owned by her and her husband on Jan. 24, the very day that her committee, the Senate Health Committee, hosted a private, all-senators briefing from administration officials, including the CDC director and Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases, on the coronavirus.

“Appreciate today’s briefing from the President’s top health officials on the novel coronavirus outbreak,” she tweeted about the briefing at the time.

That first transaction was a sale of stock in the company Resideo Technologies valued at between $50,001 and $100,000. The company’s stock price has fallen by more than half since then, and the Dow Jones Industrial Average overall has shed approximately 10,000 points, dropping about a third of its value.

It was the first of 29 stock transactions that Loeffler and her husband made through mid-February, all but two of which were sales. One of Loeffler’s two purchases was stock worth between $100,000 and $250,000 in Citrix, a technology company that offers teleworking software and which has seen a small bump in its stock price since Loeffler bought in as a result of coronavirus-induced market turmoil.

The info is here.

Changes in risk perception and protective behavior during the first week of the COVID-19 pandemic in the United States

T. Wise, T. Zbozinek, & others

PsyArXiv
Originally posted 19 March 20

Abstract

By mid-March 2020, the COVID-19 pandemic spread to over 100 countries and all 50 states in the US. Government efforts to minimize the spread of disease emphasized behavioral interventions, including raising awareness of the disease and encouraging protective behaviors such as social distancing and hand washing, and seeking medical attention if experiencing symptoms. However, it is unclear to what extent individuals are aware of the risks associated with the disease, how they are altering their behavior, factors which could influence the spread of the virus to vulnerable populations. We characterized risk perception and engagement in preventative measures in 1591 United States based individuals over the first week of the pandemic (March 11th-16th 2020) and examined the extent to which protective behaviors are predicted by individuals’ perception of risk. Over 5 days, subjects demonstrated growing awareness of the risk posed by the virus, and largely reported engaging in protective behaviors with increasing frequency. However, they underestimated their personal risk of infection relative to the average person in the country. We found that engagement in social distancing and hand washing was most strongly predicted by the perceived likelihood of personally being infected, rather than likelihood of transmission or severity of potential transmitted infections. However, substantial variability emerged among individuals, and using data-driven methods we found a subgroup of subjects who are largely disengaged, unaware, and not practicing protective behaviors. Our results have implications for our understanding of how risk perception and protective behaviors can facilitate early interventions during large-scale pandemics.

From the Discussion:

One explanation for our results is the optimism bias.  This bias is associated with the belief that we are less likely to acquire a disease than others, and has been shown across a variety of diseases including lung  cancer. Indeed,  those  who  show  the  optimism  bias  are  less  likely  to  be  vaccinated  against disease. Recent evidence suggests that this may also be the case for COVID-19 and could result in a failure to engage in behaviors that contribute to the spread this highly contagious disease.  Our results extend  on  these  findings  by  showing  that behavior  changes  over  the  first  week  of  the  COVID-19 pandemic such that as individuals perceive an increase in personal risk they increasingly engage in risk-prevention  behaviors.   Notably,  we  observed  rapid  increases  in  risk  perception  over  a  5-day  period, indicating that public health messages spread through government and the media can be effective in raising awareness of the risk.

The research is here.

Burr moves to quell fallout from stock sales with request for Ethics probe

Jack Brewster
politico.com
Originally posted 20 March 20

Sen. Richard Burr (R-N.C.) on Friday asked the Senate Ethics Committee to review stock sales he made weeks before the markets began to tank in response to the coronavirus pandemic — a move designed to limit the fallout from an intensifying political crisis.

Burr, who chairs the powerful Senate Intelligence Committee, defended the sales, saying he “relied solely on public news reports to guide my decision regarding the sale of stocks" and disputed the notion he used information that he was privy to during classified briefings on the novel coronavirus. Burr specifically name-checked CNBC’s daily health and science reporting from its Asia bureau.

“Understanding the assumption many could make in hindsight however, I spoke this morning with the chairman of the Senate Ethics Committee and asked him to open a complete review of the matter with full transparency,” Burr said in a statement.

Burr, who is retiring at the end of 2022, has faced calls to resign from across the ideological spectrum since ProPublica reported Thursday that he dumped between $628,000 and $1.72 million of his holdings on Feb. 13 in 33 different transactions — a week before the stock market began plummeting amid fears of the coronavirus spreading in the U.S.

The info is here.

Our moral instincts don’t match this crisis

Yascha Mounk
The Atlantic
Originally posted March 19, 2020

Here is an excerpt:

There are at least three straightforward explanations.

The first has to do with simple ignorance. For those of us who have spent the past weeks obsessing about every last headline regarding the evolution of the crisis, it can be easy to forget that many of our fellow citizens simply don’t follow the news with the same regularity—or that they tune into radio shows and television networks that have, shamefully, been downplaying the extent of the public-health emergency. People crowding into restaurants or hanging out in big groups, then, may simply fail to realize the severity of the pandemic. Their sin is honest ignorance.

The second explanation has to do with selfishness. Going out for trivial reasons imposes a real risk on those who will likely die if they contract the disease. Though the coronavirus does kill some young people, preliminary data from China and Italy suggest that they are, on average, less strongly affected by it. For those who are far more likely to survive, it is—from a purely selfish perspective—less obviously irrational to chance such social encounters.

The third explanation has to do with the human tendency to make sacrifices for the suffering that is right in front of our eyes, but not the suffering that is distant or difficult to see.

The philosopher Peter Singer presented a simple thought experiment in a famous paper. If you went for a walk in a park, and saw a little girl drowning in a pond, you would likely feel that you should help her, even if you might ruin your fancy shirt. Most people recognize a moral obligation to help another at relatively little cost to themselves.

Then Singer imagined a different scenario. What if a girl was in mortal danger halfway across the world, and you could save her by donating the same amount of money it would take to buy that fancy shirt? The moral obligation to help, he argued, would be the same: The life of the distant girl is just as important, and the cost to you just as small. And yet, most people would not feel the same obligation to intervene.

The same might apply in the time of COVID-19. Those refusing to stay home may not know the victims of their actions, even if they are geographically proximate, and might never find out about the terrible consequences of what they did. Distance makes them unjustifiably callous.

The info is here.

Moral Courage in the Coronavirus: A Guide for Medical Providers and Institutions

Holly Tabor & Alyssa Burgard
Just Security
Originally published 18 March 20

Times of crisis generate extreme moral dilemmas: situations we can’t begin to imagine, unthinkable choices emerging between options that all seem bad, each with harms and negative outcomes. During the COVID-19 pandemic, these moral dilemmas are experienced across the healthcare landscape — from bedside encounters to executive suites of hospitals and health systems. Who gets put on a ventilator? Who transitions to comfort care? What does end of life care look like when high flow oxygen can’t be used because of viral spread? Who gets a hospital bed? How do we choose which sick person, with or without COVID-19, gets treated? Which patients should be enrolled in research? How do we support patients when their families cannot visit them? We will turn away people who, in any other circumstance in a U.S. medical facility, we would have been obliged to treat. We will second guess these decisions, and perhaps be haunted by them forever. We only know one thing for sure: people will suffer and die regardless of which decisions we make.

How should we confront these intense challenges? Many institutions are doing what they can to provide guidance. But “guidelines” by design are intended to provide broad parameters to aid in decision making, and therefore rarely address the exact situations clinicians face. Certainly no guidelines can reduce the pain of having to actually carry out recommendations that affect an individual patient.  For other decisions, front line providers will have no guidance at all, or will have ill-informed, or even potentially harmful guidance. In perhaps the worst case scenario, they may even be encouraged to keep quiet about their concerns or observations rather than raise them to others’ attention.

As bioethicists, we know that moral dilemmas require personal moral courage, that is, the ability to take action for moral reasons, despite the risk of adverse consequences. We have already seen several stark examples of moral courage from doctors, nurses, and researchers in this outbreak. In late December in Wuhan, China, a 34 year-old ophthalmologist, Dr. Li Wenliang, raised the alarm in a chat group of doctors about a new virus he was seeing. He was subsequently punished by the Chinese government. He continued to share his story via social media, even from his hospital bed, and was repeatedly censored. Dr. Wenliang died of the virus on February 7.

The info is here.

Oceanside council approves its first ethics code

Phil Diehl
San Diego Union Tribune
Originally posted 1 March 20

Facing a public backlash over infighting, campaign contributions and alleged conflicts of interest, the Oceanside City Council unanimously approved its first code of ethics.

“This is a start,” said Councilwoman Esther Sanchez before Wednesday’s vote. The need for a policy is evident from the efforts underway to recall two council members (including herself) and for a referendum to overturn the council’s recent approval of a controversial Morro Hills development project, she said.

“We need to respect each other, and we need to respect the public,” Sanchez said, noting that she too at times has been critical of her fellow council members. “Sometimes it gets personal ... we need to do better.”

Residents said the policy should go further to include more specifics and penalties. Some suggested the city should limit campaign contributions, or not allow council members to vote on projects proposed by developers who contribute to their election campaigns.

The info is here.

Flawed science? Two efforts launched to improve scientific validity of psychological test evidence in court

Karen Franklin
forensicpsychologist Blog
Originally posted 15 Feb 20

Here is an excerpt:

New report slams "junk science” psychological assessments

In one of two significant developments, a group of researchers today released evidence of systematic problems with the state of psychological test admissibility in court. The researchers' comprehensive survey found that only about two-thirds of the tools used by clinicians in forensic settings were generally accepted in the field, while even fewer -- only about four in ten -- were favorably reviewed in authoritative sources such as the Mental Measurements Yearbook.

Despite this, psychological tests are rarely challenged when they are introduced in court, Tess M.S. Neal and her colleagues found. Even when they are, the challenges fail about two-thirds of the time. Worse yet, there is little relationship between a tool’s psychometric quality and the likelihood of it being challenged.

“Some of the weakest tools tend to get a pass from the courts,” write the authors of the newly issued report, "Psychological Assessments in Legal Contexts: Are Courts Keeping 'Junk Science' Out of the Courtroom?”

The report, currently in press in the journal Psychological Science in the Public Interest, proposes that standard batteries be developed for forensic use, based on the consensus of experts in the field as to which tests are the most reliable and valid for assessing a given psycho-legal issue. It further cautions against forensic deployment of newly developed tests that are being marketed by for-profit corporations before adequate research or review by independent professionals.

The info is here.

Responding to Unprofessional Behavior by Trainees — A “Just Culture” Framework

J. A. Wasserman, M. Redinger, and T. Gibb
New England Journal of Medicine
February 20, 2020
doi: 10.1056/NEJMms1912591

Professionalism lapses by trainees can be addressed productively if viewed through a lens of medical error, drawing on “just culture” principles. With this approach, educators can promote a formative learning environment while fairly addressing problematic behaviors.

Addressing lapses in professionalism is critical to professional development. Yet characterizing the ways in which the behavior of emerging professionals may fall short and responding to those behaviors remain difficult.

Catherine Lucey suggests that we “consider professionalism lapses to be either analogous to or a form of medical error,” in order to create “a ‘just environment’ in which people are encouraged to report professionalism challenges, lapses, and near misses.” Applying a framework of medical error promotes an understanding of professionalism as a set of skills whose acquisition requires a psychologically safe learning environment.

 Lucey and Souba also note that professionalism sometimes requires one to act counter to one’s other interests and motivations (e.g., to subordinate one’s own interests to those of others); the skills required to navigate such dilemmas must be acquired over time, and therefore trainees’ behavior will inevitably sometimes fall short.

We believe that lapses in professional behavior can be addressed productively if we view them through this lens of medical error, drawing on “just culture” principles and related procedural approaches.

(cut)

The Just Culture Approach

Thanks to a movement catalyzed by an Institute of Medicine report, error reduction has become a priority of health systems over the past two decades. Their efforts have involved creating a “culture of psychological safety” that allows for open dialogue, dissent, and transparent reporting. Early iterations involved “blame free” approaches, which have increasingly given way to an emphasis on balancing individual and system accountability.

Drawing on these just culture principles, a popular approach for defining and responding to medical error recognizes the qualitative differences among inadvertent human error, at-risk behavior, and reckless behavior (the Institute for Safe Medication Practices also provides an excellent elaboration of these categories).

“Inadvertent human errors” result from suboptimal individual functioning, but without intention or the knowledge that a behavior is wrong or error-prone (e.g., an anesthesiologist inadvertently grabbing a paralyzing agent instead of a reversal agent). These errors are not considered blameworthy, and proper response involves consolation and assessment of systemic changes to prevent them in the future.