Four pieces of ethical advice for practitioners during COVID-19

Rebecca Schwartz-Mette
APAservices.org
Originally posted 2 April 20

Are you transitioning to full-time telepsychology? Launching a virtual classroom? Want to expand your competence in the use of technology in practice? You can look to APA’s Ethics Committee for support in transforming your practice. Even in times of crisis, the Ethical Principles of Psychologists and Code of Conduct (hereafter “Ethics Code” or “Code;” 2002, Amended June 1, 2010 and Jan. 1, 2017) continues to guide psychologists’ actions based on our shared values. Here are four ways to practice in good faith while meeting the imminent needs of your community:

Lean in

Across the nation, rather than closing their practices and referring out, psychologists are accepting the challenge to diligently obtain training and expand their competence in telepsychology. Standard 2.02, “Providing Services in Emergencies,” allows psychologists to provide services for individuals for whom other services aren’t available through the duration of such emergencies, even if they have not obtained the necessary training. The Ethics Committee supports those psychologists working in good faith to meet the needs of patients, clients, supervisees and students.

Get training and support

Take advantage of the APA’s new (and often free) resources to develop and expand your competence, in line with Standard 2.03, “Maintaining Competence.” Expand your network by connecting with colleagues who can provide peer consultation and supervision to support your efforts.

Consider referrals

The decision to transition to telepsychology may not be for everyone. Competency concerns, lack of access to technology, and specific needs of particular clients may reflect good reasons to refer to practitioners who can provide telepsychology. Psychologists should assess each client’s needs in light of their own professional capacities and refer to others who can provide needed services in line with Standard 10.10(c), “Terminating Therapy.”

Take care of yourself

Psychologists are human and can feel lost in the ambiguity of this unprecedented time. It is your ethical mandate to also care for yourself. Practicing accurate self-assessment, leaning on colleagues when needed, and taking time to unplug from the news and practice to recharge helps to prevent burnout and is entirely consistent with 2.06, “Personal Problems and Conflicts.” Make self-care a verb and connect with your community of psychologists today.

Tavis Smiley Ordered To Pay PBS $1.5 Million For Violating Network's 'Morality' Clause

Vanessa Romo
npr.org
Originally published 4 March 20

Here is an excerpt:

Throughout the three-week civil trial, jurors heard from six women who testified that Smiley subjected subordinates to unwanted sexual advances. "One woman who accused Smiley of sexual harassment left the show and received a $325,000 settlement," Variety reported.

The win for PBS may prove to be significant for other companies facing workplace suits stemming from sexual-misconduct allegations, who are seeking to break ties with accused individuals.

"In the midst of the #MeToo movement, he violated our morals clause... You can't have a consensual relationship between a manager and a subordinate because of the power dynamic. It's never consensual because that manager has power over all aspects of that person's employment," the network's lead attorney, Grace Speights, said in court.

Smiley's dismissal was one of many in the wake of the #MeToo movement which first gained global attention in 2017, after dozens of women accused movie producer Harvey Weinstein of sexual misconduct. Years later, a jury has convicted Weinstein of rape, Bill Cosby is behind bars for sexual assault, and popular hosts including Matt Lauer and Charlie Rose — who was fired by PBS in 2017 — have been removed from the airwaves amid accusations of misconduct.

The info is here.

JAIC launches pilot for implementing new DOD AI ethics principles

Jackson Barnett
fedscoop.com
Originally posted 2 April 20

Here is an excerpt:

The Department of Defense‘s Joint Artificial Intelligence Center is bringing together different types of engineers, policymakers and other DOD personnel to serve as “Responsible AI Champions” in support of the Pentagon’s new principles for AI ethics.

The pilot program brings together a “cross-functional group” of personnel from across the department to receive training on AI and DOD’s new ethical principles from JAIC staff who represent different parts of the AI development lifecycle. The intent is that when these trainees go back to their normal jobs, they will be “champions” for AI and the principles.

The model, which was announced through a JAIC blog post, is similar to a pilot Microsoft launched to implement its artificial intelligence governance structure. The JAIC did not say how many people will participate in the pilot program.

“The goal is to learn from this pilot so that we can develop a more robust and comprehensive program that can be implemented across the DOD,” Lt. Cmdr. Arlo Abrahamson, a JAIC spokesman, told FedScoop.

The info is here.

Life and death decisions of autonomous vehicles

Y. E. Bigman and K. Gray
Nature
Originally published 4 May 20

How should self-driving cars make decisions when human lives hang in the balance? The Moral Machine experiment (MME) suggests that people want autonomous vehicles (AVs) to treat different human lives unequally, preferentially killing some people (for example, men, the old and the poor) over others (for example, women, the young and the rich). Our results challenge this idea, revealing that this apparent preference for inequality is driven by the specific ‘trolley-type’ paradigm used by the MME. Multiple studies with a revised paradigm reveal that people overwhelmingly want autonomous vehicles to treat different human lives equally in life and death situations, ignoring gender, age and status—a preference consistent with a general desire for equality.

The large-scale adoption of autonomous vehicles raises ethical challenges because autonomous vehicles may sometimes have to decide between killing one person or another. The MME seeks to reveal people’s preferences in these situations and many of these revealed preferences, such as ‘save more people over fewer’ and ‘kill by inaction over action’ are consistent with preferences documented in previous research.

However, the MME also concludes that people want autonomous vehicles to make decisions about who to kill on the basis of personal features, including physical fitness, age, status and gender (for example, saving women and killing men). This conclusion contradicts well-documented ethical preferences for equal treatment across demographic features and identities, a preference enshrined in the US Constitution, the United Nations Universal Declaration of Human Rights and in the Ethical Guideline 9 of the German Ethics Code for Automated and Connected Driving.

The info is here.

Why your brain is not a computer

Matthew Cobb
theguardian.com
Originally posted 27 Feb 20

Here is an excerpt:

The processing of neural codes is generally seen as a series of linear steps – like a line of dominoes falling one after another. The brain, however, consists of highly complex neural networks that are interconnected, and which are linked to the outside world to effect action. Focusing on sets of sensory and processing neurons without linking these networks to the behaviour of the animal misses the point of all that processing.

By viewing the brain as a computer that passively responds to inputs and processes data, we forget that it is an active organ, part of a body that is intervening in the world, and which has an evolutionary past that has shaped its structure and function. This view of the brain has been outlined by the Hungarian neuroscientist György Buzsáki in his recent book The Brain from Inside Out. According to Buzsáki, the brain is not simply passively absorbing stimuli and representing them through a neural code, but rather is actively searching through alternative possibilities to test various options. His conclusion – following scientists going back to the 19th century – is that the brain does not represent information: it constructs it.

The metaphors of neuroscience – computers, coding, wiring diagrams and so on – are inevitably partial. That is the nature of metaphors, which have been intensely studied by philosophers of science and by scientists, as they seem to be so central to the way scientists think. But metaphors are also rich and allow insight and discovery. There will come a point when the understanding they allow will be outweighed by the limits they impose, but in the case of computational and representational metaphors of the brain, there is no agreement that such a moment has arrived. From a historical point of view, the very fact that this debate is taking place suggests that we may indeed be approaching the end of the computational metaphor. What is not clear, however, is what would replace it.

Scientists often get excited when they realise how their views have been shaped by the use of metaphor, and grasp that new analogies could alter how they understand their work, or even enable them to devise new experiments. Coming up with those new metaphors is challenging – most of those used in the past with regard to the brain have been related to new kinds of technology. This could imply that the appearance of new and insightful metaphors for the brain and how it functions hinges on future technological breakthroughs, on a par with hydraulic power, the telephone exchange or the computer. There is no sign of such a development; despite the latest buzzwords that zip about – blockchain, quantum supremacy (or quantum anything), nanotech and so on – it is unlikely that these fields will transform either technology or our view of what brains do.

The info is here.

Suicide attempt survivors’ recommendations for improving mental health treatment for attempt survivors.

Melanie A. Hom and others
Psychological Services. 
Advance online publication.
https://doi.org/10.1037/ser0000415

Abstract

Research indicates that connection to mental health care services and treatment engagement remain challenges among suicide attempt survivors. One way to improve suicide attempt survivors’ experiences with mental health care services is to elicit suggestions directly from attempt survivors regarding how to do so. This study aimed to identify and synthesize suicide attempt survivors’ recommendations for how to enhance mental health treatment experiences for attempt survivors. A sample of 329 suicide attempt survivors (81.5% female, 86.0% White/Caucasian, mean age = 35.07 ± 12.18 years) provided responses to an open-ended self-report survey question probing how treatment might be improved for suicide attempt survivors. Responses were analyzed utilizing both qualitative and quantitative techniques. Analyses identified four broad areas in which mental health treatment experiences might be improved for attempt survivors: (a) provider interactions (e.g., by reducing stigma of suicidality, expressing empathy, and using active listening), (b) intake and treatment planning (e.g., by providing a range of treatment options, including nonmedication treatments, and conducting a thorough assessment), (c) treatment delivery (e.g., by addressing root problems, bolstering coping skills, and using trauma-informed care), and (d) structural issues (e.g., by improving access to care and continuity of care). Findings highlight numerous avenues by which health providers might be able to facilitate more positive mental health treatment experiences for suicide attempt survivors. Research is needed to test whether implementing the recommendations offered by attempt survivors in this study might lead to enhanced treatment engagement, retention, and outcomes among suicide attempt survivors at large.

Here is an excerpt from the Discussion:

On this point, this study revealed numerous recommendations for how providers might be able to improve their interactions with attempt survivors. Suggestions in this domain aligned with prior studies on treatment experiences among suicide attempt survivors. For instance, recommendations that providers not stigmatize attempt survivors and, instead, empathize with them, actively listen to them, and humanize them, are consistent with aforementioned studies (Berglund et al., 2016; Frey et al., 2016; Shand et al., 2018; Sheehan et al., 2017; Taylor et al., 2009). This study’s findings regarding the importance of a collaborative therapeutic relationship are also consistent with previous work (Shand et al., 2018). Though each of these factors has been identified as salient to treatment engagement efforts broadly (see Barrett et al., 2008, for review), several suggestions that emerged in this study were more specific to attempt survivors. For example, ensuring that patients feel comfortable openly discussing suicidal thoughts and behaviors and taking disclosures of suicidality seriously are suggestions specifically applicable to the care of at-risk individuals. These recommendations not only support research indicating that asking about suicidality is not iatrogenic (see DeCou & Schumann, 2018, for review), but they also underscore the importance of considering the unique needs of attempt survivors. Indeed, given that most participants provided a recommendation in this area, the impact of provider-related factors should not be overlooked in the provision of care to this group.

Treating “Moral” Injuries

Anna Harwood-Gross
Scientific American
Originally posted 24 March 20

Here is an excerpt:

Though PTSD symptoms such as avoidance of reminders of the traumatic event and intrusive thought patterns may also be present in moral injury, they appear to serve different purposes, with PTSD sufferers avoiding fear and moral injury sufferers avoiding shame triggers. Few comparison studies of PTSD and moral injury exist, yet there has been research that indirectly compares the two conditions by differentiating between fear-based and non-fear-based (i.e., moral injury) forms of PTSD, which have been demonstrated to have different neurobiological markers. In the context of the military, there are countless examples of potentially morally injurious events (PMIEs), which can include killing or wounding others, engaging in retribution or disproportionate violence, or failing to save the life of a comrade, child or civilian. The experience of PMIEs has been demonstrated to lead to a larger range of psychological distress symptoms, including higher levels of guilt, anger, shame, depression and social isolation, than those seen in traditional PTSD profiles.

Guilt is difficult to address in therapy and often lingers following standardized PTSD treatment (that is, if the sufferer is able to access therapy). It may, in fact, be a factor in the more than 49 percent of veterans who drop out of evidence-based PTSD treatment or in why, at times, up to 72% of sufferers, despite meaningful improvement in their symptoms, do not actually recover enough after such treatment for their PTSD diagnosis to be removed. Most often, moral injury symptoms that are present in the clinic are addressed through traditional PTSD treatments, with thoughts of guilt and shame treated similarly to other distorted cognitions. When guilt and the events it relates to are treated as “a feeling and not a fact,” as psychologist Lisa Finlay put it in a 2015 paper, there is an attempt to lessen or relieve such emotions while taking a shortcut to avoid experiencing those that are legitimate and reasonable after-wartime activities. Continuing, Finlay stated that “the idea that we might get good, as a profession, at talking people out of guilt following their involvement in traumatic incidents is frighteningly short-sighted in more ways than one.”

The info is here.

Managing mental health challenges faced by healthcare workers during COVID-19 pandemic

Greenberg N., & others
BMJ 2020; 368 :m1211

Here is an excerpt:

Moral injury

Moral injury, a term that originated in the military, can be defined as the psychological distress that results from actions, or the lack of them, which violate someone’s moral or ethical code.1 Unlike formal mental health conditions such as depression or post-traumatic stress disorder, moral injury is not a mental illness. But those who develop moral injuries are likely to experience negative thoughts about themselves or others (for example, “I am a terrible person” or “My bosses don’t care about people’s lives”) as well as intense feelings of shame, guilt, or disgust. These symptoms can contribute to the development of mental health difficulties, including depression, post-traumatic stress disorder, and even suicidal ideation. Equally, some people who have to contend with significant challenges, moral or traumatic, experience a degree of post-traumatic growth,3 a term used to describe a bolstering of psychological resilience, esteem, outlook, and values after exposure to highly challenging situations. Whether someone develops a psychological injury or experiences psychological growth is likely to be influenced by the way that they are supported before, during, and after a challenging incident.

Moral injury has already been described in medical students, who report great difficulty coping with working in prehospital and emergency care,4 where they were exposed to trauma that they felt unprepared for. This may be similar to the unprecedented nature of the challenges healthcare staff are currently facing. In the UK, most NHS staff may have felt, with some justification, that with all its faults, the NHS gives the sickest people the greatest chance of recovery. As such, staff should and usually do feel that it is something to be proud of.

The huge current effort to ensure adequate staffing and resources may be successful, but it looks likely that during the covid-19 outbreak many healthcare workers will encounter situations where they cannot say to a grieving relative, “We did all we could” but only, “We did our best with the staff and resources available, but it wasn’t enough.” That is the seed of a moral injury. Not all staff members will be adversely affected by the challenges ahead (table 1) but no one is invulnerable, and some healthcare workers will hurt, perhaps for a long time, unless we begin now to prepare and support our staff.

The info is here.

Intelligence, Surveillance, and Ethics in a Pandemic

Jessica Davis
JustSecurity.org
Originally posted 31 March 20

Here is an excerpt:

It is imperative that States and their citizens question how much freedom and privacy should be sacrificed to limit the impact of this pandemic. It is also not sufficient to ask simply “if” something is legal; we should also ask whether it should be, and under what circumstances. States should consider the ethics of surveillance and intelligence, specifically whether it is justified, done under the right authority, if it can be done with intentionality and proportionality and as a last resort, and if targets of surveillance can be separated from non-targets to avoid mass surveillance. These considerations, combined with enhanced transparency and sunset clauses on the use of intelligence and surveillance techniques, can allow States to ethically deploy these powerful tools to help stop the spread of the virus.

States are employing intelligence and surveillance techniques to contain the spread of the illness because these methods can help track and identify infected or exposed people and enforce quarantines. States have used cell phone data to track people at risk of infection or transmission and financial data to identify places frequented by at-risk people. Social media intelligence is also ripe for exploitation in terms of identifying social contacts. This intelligence, is increasingly being combined with health data, creating a unique (and informative) picture of a person’s life that is undoubtedly useful for virus containment. But how long should States have access to this type of information on their citizens, if at all? Considering natural limits to the collection of granular data on citizens is imperative, both in terms of time and access to this data.

The info is here.