Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy

Monday, May 4, 2020

Differential virtue discounting: Public generosity is seen as more selfish than public impartiality

Kraft-Todd, G., Kleiman-Weiner, M., & Young, L.
(2020, March 25).
https://doi.org/10.31234/osf.io/zqpv7

Abstract

There is a paradox in our desire to be seen as virtuous. If we do not overtly display our virtues, others will not be able to see them; yet, if we do overtly display our virtues, others may think that we do so only for social credit. Here, we investigate how virtue signaling works across two distinct virtues—generosity and impartiality—in eleven online experiments (total N=4,586). We demonstrate the novel phenomenon of differential virtue discounting, revealing that participants perceive actors who demonstrate virtue in public to be less virtuous than actors who demonstrate virtue in private, and, critically, that this effect is greater for generosity than impartiality. Further, we provide evidence for the mechanism underlying these judgments, showing that they are mediated by perceived selfish motivations. We discuss how these findings and our novel terminology can shed light on open questions in the social perception of reputation and motivation.

From the Discussion

We all want to be seen as virtuous. The paradox of this desire is that the best way to be seen as virtuous is to be virtuous in public; yet, if we are virtuous in public—as we have shown here—observers may believe our behavior to be selfishly motivated. Or, as Oscar Wilde put it: “The nicest feeling in the world is to do a good deed anonymously—and have somebody find out.”

Suggestions for a New Integration in the Psychology of Morality

Diane Sunar
Social and Personality Psychology Compass
(2009): 447–474

Abstract

To prepare a basis for a new model of morality, theories in the psychology of morality are reviewed, comparing those put forward before and after the emergence of evolutionary psychology in the last quarter of the 20th century. Concepts of embodied sociality and reciprocal moral emotions are introduced. Three ‘morality clusters’ consisting of relational models (Fiske, 1991), moral domains (Shweder, Much, Mahapatra, & Park, 1997) and reciprocal sets of other-blaming and selfconscious emotions are linked to three evolutionary bases for morality (kin selection, social hierarchy, and reciprocal altruism). Evidence regarding these concepts is marshaled to support the model. The ‘morality clusters’ are compared with classifications based on Haidt’s moral foundations (Haidt & Graham 2007). Further evidence regarding hierarchy based on sexual selection, exchange and
reciprocity, moral development, cultural differences and universals, and neurological discoveries, especially mirror neurons, is also discussed.

An Alternative Model

Alternative combinations of these elements have been suggested, most notably by Haidt and his colleagues (Graham, Haidt, & Nosek, forthcoming; Haidt & Joseph, 2008), mapping Shweder’s three ethics or moral domains, and Fiske’s relational models, onto Haidt’s moral foundations. As described above, these authors match community with ingroup/loyalty and authority; autonomy with harm/care and fairness/reciprocity; and divinity with purity/sanctity. In addition, they suggest that three of the foundations can be matched with three of Fiske’s relational models (leaving out MP). In this scheme, fairness/reciprocity is linked with EM, care and ingroup morality with CS, and authority/respect with AR. Harm and purity as moral foundations are not linked with relational models, as they argue that these two foundations ‘are not primarily modes of interpersonal relationship (Haidt & Joseph, 2008; p. 386). Similar to my proposed clusters, they also link the morality of harm and care to kin selection and that of fairness to evolved mechanisms of reciprocal altruism, but in contrast see purity as a derivative of disgust mechanisms without a specific social basis.

The paper is here.

Sunday, May 3, 2020

Complicit silence in medical malpractice

Editorial
Volume 395, Issue 10223, p. 467
February 15, 2020

Clinicians and health-care managers displayed “a capacity for willful blindness” that allowed Ian Paterson to hide in plain sight—that is the uncomfortable opening statement of the independent inquiry into Paterson's malpractice, published on Feb 4, 2020. Paterson worked as a consultant surgeon from 1993 to 2011 in both private and National Health Service hospitals in West Midlands, UK. During that period, he treated thousands of patients, many of whom had surgery. Paterson demonstrated an array of abhorrent and unsafe activities over this time, including exaggerating patients' diagnoses to coerce them into having surgery, performing his own version of a mastectomy, which goes against internationally agreed oncological principles, and inappropriate conduct towards patients and staff.

The inquiry makes a range of valuable recommendations that cover regulatory reform, corporate accountability, information for patients, informed consent, complaints, and clinical indemnity. The crucial message is that these reforms must occur across both the NHS and the private sector and must be implemented earnestly and urgently. But many of the issues in the Paterson case cannot be regulated and flow from the murky waters of medical professionalism. At times during the 87 pages of patient testimony, patients suggested in hindsight they could see that other clinicians knew there was a problem with Paterson but did not say anything. The hurt and disappointment that patients felt with the medical profession are chilling.

The info is here.

Saturday, May 2, 2020

Decision-Making Competence: More Than Intelligence?

Bruine de Bruin, W., Parker, A. M., & Fischhoff, B.
(2020). Current Directions in Psychological Science.
https://doi.org/10.1177/0963721420901592

Abstract

Decision-making competence refers to the ability to make better decisions, as defined by decision-making principles posited by models of rational choice. Historically, psychological research on decision-making has examined how well people follow these principles under carefully manipulated experimental conditions. When individual differences received attention, researchers often assumed that individuals with higher fluid intelligence would perform better. Here, we describe the development and validation of individual-differences measures of decision-making competence. Emerging findings suggest that decision-making competence may tap not only into fluid intelligence but also into motivation, emotion regulation, and experience (or crystallized intelligence). Although fluid intelligence tends to decline with age, older adults may be able to maintain decision-making competence by leveraging age-related improvements in these other skills. We discuss implications for interventions and future research.

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Implications for Interventions

Better understanding of how fluid intelligence and other skills support decision-making competence should facilitate the design of interventions. Below, we briefly consider directions for future research into potential cognitive, motivational, emotional, and experiential interventions for promoting decision-making competence.

In one intervention that aimed to provide cognitive support, Zwilling and colleagues (2019) found that training in core cognitive abilities improved decision-making competence, compared to an active control group (in which participants practiced to process visual information faster.) Effects of cognitive training can be enhanced by high-intensity cardioresistance fitness training, which improves connectivity in the brain (Zwilling et al., 2019).  Rosi, Vecchi, & Cavallini (2019) found that prompting older people to ask ‘metacognitive’ questions (e.g., what is the main information?) was more effective than general memory training for improving performance on Applying Decision Rules. This finding is in line with suggestions that older adults perform better when they are asked to explain their choices (Kim, Goldstein, Hasher, & Zachs, 2005). Additional intervention approaches have aimed to reduce the need to rely on fluid intelligence. Using simple instead of complex decision rules may decrease cognitive demands, and cause fewer errors (Payne et al., 1993). Reducing the number of options also reduces cognitive demands, and may help especially older adults to improve their choices (Tanius, Wood, Hanoch, & Rice, 2009).

Friday, May 1, 2020

During the Pandemic, the FCC Must Provide Internet for All

Gigi Sohn
Wired.com
Originally published 28 April 20

If anyone believed access to the internet was not essential prior to the Covid-19 pandemic, nobody is saying that today. With ongoing stay-at-home orders in most states, high-speed broadband internet access has become a necessity to learn, work, engage in commerce and culture, keep abreast of news about the virus, and stay connected to neighbors, friends, and family. Yet nearly a third of American households do not have this critical service, either because it is not available to them, or, as is more often the case, they cannot afford it.

Lifeline is a government program that seeks to ensure that all Americans are connected, regardless of income. Started by the Reagan administration and placed into law by Congress in 1996, Lifeline was expanded by the George W. Bush administration and expanded further during the Obama administration. The program provides a $9.25 a month subsidy per household to low-income Americans for phone and/or broadband service. Because the subsidy is so minimal, most Lifeline customers use it for mobile voice and data services.

The Federal Communications Commission sets Lifeline’s policies, including rules about who is eligible to receive the subsidy, its amount, and which companies can provide the service. Americans whose income is below a certain level or who receive government assistance—such as Medicaid, the Supplemental Nutrition Assistance Program, or SNAP, and Supplemental Security Income, or SSI—are eligible.

During this crisis, President Donald Trump’s FCC could make an enormous dent in the digital divide if it expanded Lifeline, even if just on a temporary basis. The FCC could increase the subsidy so that it can be used to pay for robust fixed internet access. It could also make Lifeline available to a broader subset of Americans, specifically the tens of millions who have just filed for unemployment benefits. But that’s unlikely to be a priority for this FCC and its chairman, Ajit Pai, who has spent nearly his entire tenure trying to destroy the program.

The info is here.

The therapist's dilemma: Tell the whole truth?

Image result for psychotherapyJackson, D.
J. Clin. Psychol. 2020; 76: 286– 291.
https://doi.org/10.1002/jclp.22895

Abstract

Honest communication between therapist and client is foundational to good psychotherapy. However, while past research has focused on client honesty, the topic of therapist honesty remains almost entirely untouched. Our lab's research seeks to explore the role of therapist honesty, how and why therapists make decisions about when to be completely honest with clients (and when to abstain from telling the whole truth), and the perceived consequences of these decisions. This article reviews findings from our preliminary research, presents a case study of the author's honest disclosure dilemma, and discusses the role of therapeutic tact and its function in the therapeutic process.

Here is an excerpt:

Based on our preliminary research, one of the most common topics of overt dishonesty among therapists was their feelings of frustration or disappointment toward their clients. For example, a therapist working with a client with a diagnosis of avoidant personality disorder may find herself increasingly frustrated by the client’s continual resistance to discussing emotional topics or engaging in activities that would broaden his or her world. Such a client —let’s assume male—is also likely to feel preoccupied with concerns about whether the therapist “likes” him or feels as frustrated with him as he does with himself. Should this client apologize for his behavior and ask if the therapist is frustrated with him, the therapist may feel compelled to reduce the discomfort he is already experiencing by dispelling his concern: “No, it’s okay, I’m not frustrated.”

But either at this moment or at a later point in therapy, once rapport (i.e., the therapeutic alliance) has been more firmly established, a more honest answer to this question might be fruitful: “Yes, I am feeling frustrated that we haven’t been able to find ways for you to implement the changes we discuss here, outside of session. How does it feel for you to hear that I am feeling frustrated?” Or, arguably, an even more honest answer: “Yes, I am sometimes frustrated. I sometimes think we could go deeper here—I think it’d be helpful.” Or, an honest answer that is somewhat less critical of the patient and more self‐focused: “I do feel frustrated that I haven’t been able to be more helpful.” Clearly, there are many ways for a therapist to be honest and/or dishonest, and there are also gradations in whichever direction a therapist chooses.

Thursday, April 30, 2020

Suicide Mortality and Coronavirus Disease 2019—A Perfect Storm?

Reger MA, Stanley IH, Joiner TE.
JAMA Psychiatry. 
Published online April 10, 2020.
doi:10.1001/jamapsychiatry.2020.1060

Suicide rates have been rising in the US over the last 2 decades. The latest data available (2018) show the highest age-adjusted suicide rate in the US since 1941.1 It is within this context that coronavirus disease 2019 (COVID-19) struck the US. Concerning disease models have led to historic and unprecedented public health actions to curb the spread of the virus. Remarkable social distancing interventions have been implemented to fundamentally reduce human contact. While these steps are expected to reduce the rate of new infections, the potential for adverse outcomes on suicide risk is high. Actions could be taken to mitigate potential unintended consequences on suicide prevention efforts, which also represent a national public health priority.

COVID-19 Public Health Interventions and Suicide Risk

Secondary consequences of social distancing may increase the risk of suicide. It is important to consider changes in a variety of economic, psychosocial, and health-associated risk factors.

Economic Stress

There are fears that the combination of canceled public events, closed businesses, and shelter-in-place strategies will lead to a recession. Economic downturns are usually associated with higher suicide rates compared with periods of relative prosperity.2 Since the COVID-19 crisis, businesses have faced adversity and laying off employees. Schools have been closed for indeterminable periods, forcing some parents and guardians to take time off work. The stock market has experienced historic drops, resulting in significant changes in retirement funds. Existing research suggests that sustained economic stress could be associated with higher US suicide rates in the future.

Social Isolation

Leading theories of suicide emphasize the key role that social connections play in suicide prevention. Individuals experiencing suicidal ideation may lack connections to other people and often disconnect from others as suicide risk rises.3 Suicidal thoughts and behaviors are associated with social isolation and loneliness.3 Therefore, from a suicide prevention perspective, it is concerning that the most critical public health strategy for the COVID-19 crisis is social distancing. Furthermore, family and friends remain isolated from individuals who are hospitalized, even when their deaths are imminent. To the extent that these strategies increase social isolation and loneliness, they may increase suicide risk.

The info is here.

Difficult Conversations: Navigating the Tension between Honesty and Benevolence

E. Levine, A. Roberts, & T. Cohen
PsyArXiv
Originally published 18 Jul 19

Abstract

Difficult conversations are a necessary part of everyday life. To help children, employees, and partners learn and improve, parents, managers, and significant others are frequently tasked with the unpleasant job of delivering negative news and critical feedback. Despite the long-term benefits of these conversations, communicators approach them with trepidation, in part, because they perceive them as involving intractable moral conflict between being honest and being kind. In this article, we review recent research on egocentrism, ethics, and communication to explain why communicators overestimate the degree to which honesty and benevolence conflict during difficult conversations, document the conversational missteps people make as a result of this erred perception, and propose more effective conversational strategies that honor the long-term compatibility of honesty and benevolence. This review sheds light on the psychology of moral tradeoffs in conversation, and provides practical advice on how to deliver unpleasant information in ways that improve recipients’ welfare.

From the Summary:

Difficult conversations that require the delivery of negative information from communicators to targets involve perceived moral conflict between honesty and benevolence. We suggest that communicators exaggerate this conflict. By focusing on the short-term harm and unpleasantness associated with difficult conversations, communicators fail to realize that honesty and benevolence are actually compatible in many cases. Providing honest feedback can help a target to learn and grow, thereby improving the target’s overall welfare. Rather than attempting to resolve the honesty-benevolence dilemma via communication strategies that focus narrowly on the short-term conflict between honesty and emotional harm, we recommend that communicators instead invoke communication strategies that integrate and maximize both honesty and benevolence to ensure that difficult conversations lead to long-term welfare improvements for targets. Future research should explore the traits, mindsets, and contexts that might facilitate this approach. For example, creative people may be more adept at integrative solutions to the perceived honesty-dilemma conflict, and people who are less myopic and more cognizant of the future consequences of their choices may be better at recognizing the long-term benefits of honesty.

The info is here.

This research has relevance to psychotherapy.

Wednesday, April 29, 2020

Physician at Epicenter of COVID-19 Crisis Lost to Suicide

Dr. Lorna Breem
Marcia Frellick
MedScape.com
Originally published 28 April 20

Grief-laden posts are coursing through social media following the suicide on Sunday of emergency department physician Lorna M. Breen, MD, who had been immersed in treating COVID-19 patients at the epicenter of the disease in New York City.

Breen, 49, was the medical director of the ED at NewYork-Presbyterian Allen Hospital in Manhattan.

According to a New York Times report, her father, Dr Philip C. Breen, of Charlottesville, Virginia, said his daughter did not have a history of mental illness but had described wrenching scenes, including that patients "were dying before they could even be taken out of ambulances."

The report said Lorna Breen had also contracted the virus but had returned to work after recovering for about 10 days.

Her father told the Times that when he last spoke with her, she seemed "detached" and he knew something was wrong.

"The hospital sent her home again, before her family intervened to bring her to Charlottesville," the elder Breen told the newspaper.

The article indicated that Charlottesville police officers on Sunday responded to a call and Breen was taken to University of Virginia Hospital, where she died from self-inflicted injuries.

The info is here.