An experiment in end-of-life care: Tapping AI’s cold calculus to nudge the most human of conversations

Rebecca Robbins
statnews.com
Originally posted 1 July 20

Here is an excerpt:

The architects of Stanford’s system wanted to avoid distracting or confusing clinicians with a prediction that may not be accurate — which is why they decided against including the algorithm’s assessment of the odds that a patient will die in the next 12 months.

“We don’t think the probability is accurate enough, nor do we think human beings — clinicians — are able to really appropriately interpret the meaning of that number,” said Ron Li, a Stanford physician and clinical informaticist who is one of the leaders of the rollout there.

After a pilot over the course of a few months last winter, Stanford plans to introduce the tool this summer as part of normal workflow; it will be used not just by physicians like Wang, but also by occupational therapists and social workers who care for and talk with seriously ill patients with a range of medical conditions.

All those design choices and procedures build up to the most important part of the process: the actual conversation with the patient.

Stanford and Penn have trained their clinicians on how to approach these discussions using a guide developed by Ariadne Labs, the organization founded by the author-physician Atul Gawande. Among the guidance to clinicians: Ask for the patient’s permission to have the conversation. Check how well the patient understands their current state of health.

And don’t be afraid of long moments of silence.

There’s one thing that almost never gets brought up in these conversations: the fact that the discussion was prompted, at least in part, by an AI.

Researchers and clinicians say they have good reasons for not mentioning it.

”To say a computer or a math equation has predicted that you could pass away within a year would be very, very devastating and would be really tough for patients to hear,” Stanford’s Wang said.

The info is here.

It’s in Your Control: Free Will Beliefs and Attribution of Blame to Obese People and People with Mental Illness

Chandrashekar, S. P. (2020).
Collabra: Psychology, 6(1), 29.
DOI: http://doi.org/10.1525/collabra.305

Abstract

People’s belief in free will is shown to influence the perception of personal control in self and others. The current study tested the hypothesis that individuals who believe in free will attribute stronger personal blame to obese people and to people with mental illness (schizophrenia) for their adverse health outcomes. Results from a sample of 1110 participants showed that the belief in free will subscale is positively correlated with perceptions of the controllability of these adverse health conditions. The findings suggest that free will beliefs are correlated with attribution of blame to people with obesity and mental health issues. The study contributes to the understanding of the possible negative implications of people’s free will beliefs.

Discussion

The purpose of this brief report was to test the hypothesis that belief in free will is strongly correlated with attribution of personal blame to obese people and to people with mental illness for their adverse health outcomes. The results showed consistent positive correlations between the free will subscale and the extent of blame to obese individuals and individuals with mental illness. The study employed both generic survey measures of internal blame attributions and a survey that measured the responses based on a person described in a vignette. The current study, although correlational, contributes to recent work that argues that belief in free will is linked to processes underlying human social perception (Genschow et al., 2017). Besides theoretical implications, the findings demonstrate the societal consequences of free-will beliefs. Perception of controllability and personal responsibility is a well-documented predictor of negative stereotypes and stigma associated with people with mental illness and obesity (Blaine & Williams, 2004; Crandall, 1994). Perceptions of controllability related to people with health issues have detrimental social outcomes such as social rejection of the affected individuals (Crandall & Moriarty, 1995), and reduced social support and help from others (Crandall, 1994). The current study underlines that belief in free will as an individual-level factor is particularly relevant for developing a broader understanding of predictors of stigmatization of those with mental illness and obesity.

Blame-Laden Moral Rebukes and the Morally Competent Robot: A Confucian Ethical Perspective

Zhu, Q., Williams, T., Jackson, B. et al.
Sci Eng Ethics (2020).
https://doi.org/10.1007/s11948-020-00246-w

Abstract

Empirical studies have suggested that language-capable robots have the persuasive power to shape the shared moral norms based on how they respond to human norm violations. This persuasive power presents cause for concern, but also the opportunity to persuade humans to cultivate their own moral development. We argue that a truly socially integrated and morally competent robot must be willing to communicate its objection to humans’ proposed violations of shared norms by using strategies such as blame-laden rebukes, even if doing so may violate other standing norms, such as politeness. By drawing on Confucian ethics, we argue that a robot’s ability to employ blame-laden moral rebukes to respond to unethical human requests is crucial for cultivating a flourishing “moral ecology” of human–robot interaction. Such positive moral ecology allows human teammates to develop their own moral reflection skills and grow their own virtues. Furthermore, this ability can and should be considered as one criterion for assessing artificial moral agency. Finally, this paper discusses potential implications of the Confucian theories for designing socially integrated and morally competent robots.

Disrupting the System Constructively: Testing the Effectiveness of Nonnormative Nonviolent Collective Action

Shuman, E. (2020, June 21).
https://doi.org/10.31234/osf.io/rvgup

Abstract

Collective action research tends to focus on motivations of the disadvantaged group, rather than on which tactics are effective at driving the advantaged group to make concessions to the disadvantaged. We focused on the potential of nonnormative nonviolent action as a tactic to generate support for concessions among advantaged group members who are resistant to social change. We propose that this tactic, relative to normative nonviolent and to violent action, is particularly effective because it reflects constructive disruption: a delicate balance between disruption (which can put pressure on the advantaged group to respond), and perceived constructive intentions (which can help ensure that the response to action is a conciliatory one). We test these hypotheses across four contexts (total N = 3650). Studies 1-3 demonstrate that nonnormative nonviolent action (compared to inaction, normative nonviolent action, and violent action) is uniquely effective at increasing support for concessions to the disadvantaged among resistant advantaged group members (compared to advantaged group members more open to social change). Study 3 shows that constructive disruption mediates this effect. Study 4 shows that perceiving a real-world ongoing protest as constructively disruptive predicts support for the disadvantaged, while Study 5 examines these processes longitudinally over 2 months in the context of an ongoing social movement. Taken together, we show that nonnormative nonviolent action can be an effective tactic for generating support for concessions to the disadvantaged among those who are most resistant because it generates constructive disruption.

From the General Discussion

Based on this research, which collective action tactic should disadvantaged groups choose to advance their status? While a simple reading of these findings might suggest that nonnormative nonviolent action is the “most effective” form of action, a closer reading of these findings and other research (Saguy & Szekeres, 2018; Teixeira et al., 2020; Thomas & Louis, 2014) would suggest that what type of action is most effective depends on the goal. We demonstrate that nonnormative nonviolent action is effective for generating support for concessions to the protest that would advance its policy goals from those who were more resistant. On the other hand, other prior research has found that normative nonviolent action was more effective at turning sympathizers into active supporters (Teixeira et al., 2020; Thomas & Louis, 2014)16. Thus, which action tactic will be most useful to the disadvantaged may depend on the goal: If they are facing resistance from the advantaged blocking the achievement of their goals, nonnormative nonviolent action may be more effective. However, if the disadvantaged are seeking to build a movement that includes members of the advantaged group, the nonnormative nonviolent action will likely be more effective. The question is thus not which tactic is “most effective”, but which tactic is most effective to achieve which goal for what audience.

Four Ways to Avoid the Pitfalls of Motivated Moral Reasoning

Notre Dame
Deloitte Center for Ethical Leadership

Here is an excerpt:

Four Ways to Control Motivated Reasoning

Motivated reasoning happens all the time, and we can never fully eradicate it. But we can recognize it and guard against its worst effects. Use these guidelines as a way to help quiet your inner lawyer and access your inner judge.

Use the "Front Page" Test

Studies have shown that when we expect our decisions to be made public we are more circumspect. Ask yourself, "Would I be comfortable having this choice published on the front page of a local newspaper?" Doing so provides an opportunity to step back from the conditions that may induce motivated reasoning and engage in more critical thinking.

Don’t Go It Alone

While it is difficult to notice motivated reasoning in ourselves, we can much more easily recognize it in others. Surround yourself with the voices of those you trust, and make sure you’re prepared to listen and acknowledge your limitations. You can even make it someone's job to voice dissent. If you're surrounded only by "yes men" it can be all too easy for motivated reasoning to take over.

Avoid Ambiguity

Motivated reasoning becomes more likely when the rules are fuzzy or vague. Rely on accepted standards and definitions of ethical behavior, and make sure that your principles are clear enough for employees to understand what they mean in practice. In ethics training, make sure to use scenarios and stories to show what ethical behavior looks like. If your values or principles are too general, they may provide convenient justifications for unethical behavior instead of guarding against it.

Stay Humble

In addition to intelligence tests, research suggests that we’re touchy about receiving any feedback we don’t agree with. One study found that when participants received negative feedback about their leadership qualities they were likely to use racial stereotypes to dismiss the person giving the feedback. The next time you receive feedback you’d rather ignore, slow down, pay attention, and consider how the feedback could help you grow as a person and as a leader.

Every Decision Is A Risk. Every Risk Is A Decision.

Maggie Koerth
fivethirtyeight.com
Originally posted 21 July 20

Here is an excerpt:

In general, research has shown that indoors is riskier than outside, long visits riskier than short ones, crowds riskier than individuals — and, look, just avoid situations where you’re being sneezed, yelled, coughed or sung at.

But the trouble with the muddy middle is that a general idea of what is riskier isn’t the same thing as a clear delineation between right and wrong. These charts — even the best ones — aren’t absolute arbiters of safety: They’re the result of surveying experts. In the case of Popescu’s chart, the risk categorizations were assigned based on discussions among herself, Emanuel and Dr. James P. Phillips, the chief of disaster medicine at George Washington University Emergency Medicine. They each independently assigned a risk level to each activity, and then hashed out the ones on which they disagreed.

Take golf. How safe is it to go out to the links? Initially, the three experts had different risk levels assigned to this activity because they were all making different assumptions about what a game of golf naturally involved, Popescu said. “Are people doing it alone? If not, how many people are in a cart? Are they wearing masks? Are they drinking? …. those little variables that can increase the risk,” she told me.

Golf isn’t just golf. It’s how you golf that matters.

Those variables and assumptions aren’t trivial to calculating risk. Nor are they static. There’s different muck under your boggy feet in different parts of the country, at different times. For instance, how safe is it to eat outdoors with friends? Popescu’s chart ranks “outdoor picnic or porch dining” with people outside your household as low risk — a very validating categorization, personally. But a chart produced by the Texas Medical Association, based on a survey of its 53,000 physician members, rates “attending a backyard barbeque” as a moderate risk, a 5 on a scale in which 9 is the stuff most of us have no problem eschewing.

The info is here.

Personality and prosocial behavior: A theoretical framework and meta-analysis

Thielmann, I., Spadaro, G., & Balliet, D. (2020).
Psychological Bulletin, 146(1), 30–90.
https://doi.org/10.1037/bul0000217

Abstract

Decades of research document individual differences in prosocial behavior using controlled experiments that model social interactions in situations of interdependence. However, theoretical and empirical integration of the vast literature on the predictive validity of personality traits to account for these individual differences is missing. Here, we present a theoretical framework that identifies 4 broad situational affordances across interdependent situations (i.e., exploitation, reciprocity, temporal conflict, and dependence under uncertainty) and more specific subaffordances within certain types of interdependent situations (e.g., possibility to increase equality in outcomes) that can determine when, which, and how personality traits should be expressed in prosocial behavior. To test this framework, we meta-analyzed 770 studies reporting on 3,523 effects of 8 broad and 43 narrow personality traits on prosocial behavior in interdependent situations modeled in 6 commonly studied economic games (Dictator Game, Ultimatum Game, Trust Game, Prisoner’s Dilemma, Public Goods Game, and Commons Dilemma). Overall, meta-analytic correlations ranged between −.18 ≤ ρ̂ ≤ .26, and most traits yielding a significant relation to prosocial behavior had conceptual links to the affordances provided in interdependent situations, most prominently the possibility for exploitation. Moreover, for several traits, correlations within games followed the predicted pattern derived from a theoretical analysis of affordances. On the level of traits, we found that narrow and broad traits alike can account for prosocial behavior, informing the bandwidth-fidelity problem. In sum, the meta-analysis provides a theoretical foundation that can guide future research on prosocial behavior and advance our understanding of individual differences in human prosociality.

Conclusion

Individual differences in prosocial behavior have consistently been documented over decades of research using economic games – and personality traits have been shown to account for such individual variation. The present meta-analysis offers an affordance-based theoretical framework that can illuminate which, when, and how personality traits relate to prosocial behavior across various interdependent situations. Specifically, the framework and meta-analysis identify a few situational affordances that form the basis for the expression of certain traits in prosocial behavior. In this regard, the meta-analysis also shows that no single trait is capable to account for individual variation in prosocial behavior across the variety of interdependent situations that individuals may encounter in everyday social interactions.  Rather, individual differences in prosocial behavior are best viewed as a result of traits being expressed in response to certain situational features that influence the affordances involved in interdependent situations. In conclusion, research on individual differences in prosocial behavior – and corresponding trait conceptualizations – should consider the affordances
provided in interdependent situations to allow for a complete understanding of how personality can shape the many aspects of human prosociality.

San Quentin’s coronavirus outbreak shows why ‘herd immunity’ could mean disaster

Rong-Gong Lin II and Kim Christensen
The Los Angeles Times
Originally published 11 August 20

Here are two excerpts:

San Quentin is an imperfect setting to help understand when herd immunity might be achieved. Prisons are crowded settings that will promote coronavirus transmission more so than among people in other settings, like those who live in single-family homes.

But the San Quentin experience — as well as other data — does show that, in the absence of a vaccine, “in order to get to something that approaches herd immunity, we’re going to have to get something well on the far side of 50% of people infected,” Rutherford said. “Which comes with a resultant large cost in mortality and severe morbidity.

“If you believe the San Quentin stuff, you got to get up to way-up-there before you start seeing slowing of transmission,” Rutherford said.

Dr. Anthony Fauci, the U.S. government’s top infectious diseases expert, last week guessed it will probably require 50% to 75% of a population to be immune before achieving herd immunity — a goal that should be achieved not just through infected people recovering but also through vaccination.

California has a long way to go before the vast majority of residents have been infected.

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Sweden famously pursued a herd immunity strategy when it decided not to impose a severe lockdown.

But now, Sweden has among the highest mortality rates among European countries, and has a worse rate than that of the United States.

The info is here.

Mental Health and Clinical Psychological Science in the Time of COVID-19: Challenges, Opportunities, and a Call to Action

June Gruber et al.
American Psychologist. 
Advance online publication.
http://dx.doi.org/10.1037/amp0000707

Abstract

COVID-19 presents significant social, economic, and medical challenges. Because COVID-19 has already begun to precipitate huge increases in mental health problems, clinical psychological science must assert a leadership role in guiding a national response to this secondary crisis. In this article, COVID-19 is conceptualized as a unique, compounding, multidimensional stressor that will create a vast need for intervention and necessitate new paradigms for mental health service delivery and training. Urgent challenge areas across developmental periods are discussed, followed by a review of psychological symptoms that likely will increase in prevalence and require innovative solutions in both science and practice. Implications for new research directions, clinical approaches, and policy issues are discussed to highlight the opportunities for clinical psychological science to emerge as an updated, contemporary field capable of addressing the burden of mental illness and distress in the wake of COVID-19 and beyond.

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Concluding Comments

Clinical psychological science is needed more than ever in response to both the acute and enduring psychological effects of COVID-19 (Adhanom Ghebreyesus, 2020). This article is intended to inspire dialogue surrounding the challenges the field faces and how it must adapt to meet the mental health demands of a rapidly evolving psychological landscape. Of course, sustained change will require strong advocacy to ensure that mental health research funding is available to understand and address mental health challenges following COVID-19. To secure a leadership role, clinical psychological scientists must be prepared to raise their voices not only within scientific outlets, but also in public discussions on the airwaves (radio, cable news), alongside colleagues in other scientific fields. Sustained effort, collaboration with other disciplines, and unity within psychology will be necessary to address the multifaceted impacts of COVID-19 on humanity.