Ethical & Legal Considerations of Patients Audio Recording, Videotaping, & Broadcasting Clinical Encounters

Ferguson BD, Angelos P. 

JAMA Surg. 

Published online October 21, 2020. 

doi:10.1001/jamasurg.2020.2968

Given the increased availability of smartphones and other devices capable of capturing audio and video, it has become increasingly easy for patients to record medical encounters. This behavior can occur overtly, with or without the physician’s express consent, or covertly, without the physician’s knowledge or consent. The following hypothetical cases demonstrate specific scenarios in which physicians have been recorded during patient care.

A patient has come to your clinic seeking a second opinion. She was recently treated for cholangiocarcinoma at another hospital. During her postoperative course, major complications occurred that required a prolonged index admission and several interventional procedures. She is frustrated with the protracted management of her complications. In your review of her records, it becomes evident that her operation may not have been indicated; moreover, it appears that gross disease was left in situ owing to the difficulty of the operation. You eventually recognize that she was never informed of the intraoperative findings and final pathology report. During your conversation, you notice that her husband opens an audio recording app on his phone and places it face up on the desk to document your conversation.

(cut) 

From the Discussion

Each of these cases differs, yet each reflects the general issue of patients recording interactions with their physicians. In the following discussion, we explore a number of ethical and legal considerations raised by such cases and offer suggestions for ways physicians might best navigate these complex situations.

These cases illustrate potentially difficult patient interactions—the first, a delicate conversation involving surgical error; the second, ongoing management of a life-threatening postoperative complication; and the third, a straightforward bedside procedure involving unintended bystanders. When audio or video recording is introduced in clinical encounters, the complexity of these situations can be magnified. It is sometimes challenging to balance a patient’s need to document a physician encounter with the desire for the physician to maintain the patient-physician relationship. Patient autonomy depends on the fidelity with which information is transferred from physician to patient. 

In many cases, patients record encounters to ensure well-informed decision making and therefore to preserve autonomy. In others, patients may have ulterior motives for recording an encounter.

The logic of universalization guides moral judgment

Levine, S., et al.

PNAS October 20, 2020 

117 (42) 26158-26169; 

first published October 2, 2020; 

https://doi.org/10.1073/pnas.2014505117

Abstract

To explain why an action is wrong, we sometimes say, “What if everybody did that?” In other words, even if a single person’s behavior is harmless, that behavior may be wrong if it would be harmful once universalized. We formalize the process of universalization in a computational model, test its quantitative predictions in studies of human moral judgment, and distinguish it from alternative models. We show that adults spontaneously make moral judgments consistent with the logic of universalization, and report comparable patterns of judgment in children. We conclude that, alongside other well-characterized mechanisms of moral judgment, such as outcome-based and rule-based thinking, the logic of universalizing holds an important place in our moral minds.

Significance

Humans have several different ways to decide whether an action is wrong: We might ask whether it causes harm or whether it breaks a rule. Moral psychology attempts to understand the mechanisms that underlie moral judgments. Inspired by theories of “universalization” in moral philosophy, we describe a mechanism that is complementary to existing approaches, demonstrate it in both adults and children, and formalize a precise account of its cognitive mechanisms. Specifically, we show that, when making judgments in novel circumstances, people adopt moral rules that would lead to better consequences if (hypothetically) universalized. Universalization may play a key role in allowing people to construct new moral rules when confronting social dilemmas such as voting and environmental stewardship.

Unethical amnesia responds more to instrumental than to hedonic motives

Galeotti, F, Saucet, C., & Villeval, M. C.

PNAS, October 13, 2020 117 (41) 25423-25428; 

first published September 28, 2020; 

https://doi.org/10.1073/pnas.2011291117

Abstract

Humans care about morality. Yet, they often engage in actions that contradict their moral self. Unethical amnesia is observed when people do not remember or remember less vividly these actions. This paper explores two reasons why individuals may experience unethical amnesia. Forgetting past unethical behavior may be motivated by purely hedonic or affective reasons, such as the willingness to maintain one’s moral self-image, but also by instrumental or strategic motives, in anticipation of future misbehavior. In a large-scale incentivized online experiment (n = 1,322) using a variant of a mind game, we find that hedonic considerations are not sufficient to motivate the forgetting of past cheating behavior. This is confirmed in a follow-up experiment (n = 1,005) in which recalls are elicited the same day instead of 3 wk apart. However, when unethical amnesia can serve as a justification for a future action, such as deciding on whether to keep undeserved money, motivated forgetting is more likely. Thereby, we show that motivated forgetting occurs as a self-excuse to justify future immoral decisions.

Significance

Using large-scale incentivized online experiments, we tested two possible origins of individuals’ forgetting about their past cheating behavior in a mind game. We found that purely hedonic considerations, such as the maintenance of a positive self-image, are not sufficient to motivate unethical amnesia, but the addition of an instrumental value to forgetting triggers such amnesia. Individuals forget their past lies more when amnesia can serve as an excuse not to engage in future morally responsible behavior. These findings shed light on the interplay between dishonesty and memory and suggest further investigations of the cost function of unethical amnesia. A policy implication is that improving ethics requires making unethical amnesia more difficult for individuals.

When Did We Become Fully Human? What Fossils and DNA Tell Us About the Evolution of Modern Intelligence

Nick Longrich

singularityhub.com

Originally posted 18 OCT 2020 

Here are two excerpts:

Because the fossil record is so patchy, fossils provide only minimum dates. Human DNA suggests even earlier origins for modernity. Comparing genetic differences between DNA in modern people and ancient Africans, it’s estimated that our ancestors lived 260,000 to 350,000 years ago. All living humans descend from those people, suggesting that we inherited the fundamental commonalities of our species, our humanity, from them.

All their descendants—Bantu, Berber, Aztec, Aboriginal, Tamil, San, Han, Maori, Inuit, Irish—share certain peculiar behaviors absent in other great apes. All human cultures form long-term pair bonds between men and women to care for children. We sing and dance. We make art. We preen our hair, adorn our bodies with ornaments, tattoos and makeup.

We craft shelters. We wield fire and complex tools. We form large, multigenerational social groups with dozens to thousands of people. We cooperate to wage war and help each other. We teach, tell stories, trade. We have morals, laws. We contemplate the stars, our place in the cosmos, life’s meaning, what follows death.

(cut)

First, we journeyed out of Africa, occupying more of the planet. There were then simply more humans to invent, increasing the odds of a prehistoric Steve Jobs or Leonardo da Vinci. We also faced new environments in the Middle East, the Arctic, India, Indonesia, with unique climates, foods and dangers, including other human species. Survival demanded innovation.

Many of these new lands were far more habitable than the Kalahari or the Congo. Climates were milder, but Homo sapiens also left behind African diseases and parasites. That let tribes grow larger, and larger tribes meant more heads to innovate and remember ideas, more manpower, and better ability to specialize. Population drove innovation.

The info is here.

The Psychology of Moral Conviction

Skitka, L., Hanson, B. and others

Annual Review of Psychology

(2021). 72:1.

Abstract

This review covers theory and research on the psychological characteristics and consequences of attitudes that are experienced as moral convictions, that is, attitudes that people perceive as grounded in a fundamental distinction between right and wrong. Morally convicted attitudes represent something psychologically distinct from other constructs (e.g., strong but nonmoral attitudes or religious beliefs), are perceived as universally and objectively true, and are comparatively immune to authority or peer influence. Variance in moral conviction also predicts important social and political consequences. Stronger moral conviction about a given attitude object, for example, is associated with greater intolerance of attitude dissimilarity, resistance to procedural solutions for conflict about that issue, and increased political engagement and volunteerism in that attitude domain. Finally, we review recent research that explores the processes that lead to attitude moralization; we integrate these efforts and conclude with a new domain theory of attitude moralization.

From the Conclusion

As this review has revealed, attitudes held with moral conviction have a psychological profile that corresponds well with the domain theory of attitudes. Moral convictions differ from otherwise strong but non-moral attitudes by being perceived as more objectively and universally true, authority independent, and obligatory. In addition to these distinctions, moral convictions predicts the degree to which people perceive that the ends justify the means in achieving morally preferred outcomes, their unwillingness to compromise on morally convicted issues, and increased political engagement and willingness to engage in volunteerism on the one hand, and acceptance of lying, violence, and cheating to achieve preferred ends on the other.

A pdf is here.

Virtuous Victims

Jordan, J., & Kouchaki, M. (2020, April 11).

https://doi.org/10.31234/osf.io/yz8r6

Abstract

Humans ubiquitously encounter narratives about immoral acts and their victims. Here, we demonstrate that these narratives can influence perceptions of victims’ moral character. Specifically, across a wide range of contexts, victims are seen as more moral than non-victims who have behaved identically. Using 13 experiments (total n = 8,358), we explore this Virtuous Victim effect. We show that it is specific to victims of immorality (i.e., it does not extend equally to victims of accidental misfortune) and to moral virtue (i.e., it does not extend equally to positive nonmoral traits). We also show that the Virtuous Victim effect can occur online and in the lab, when subjects have other morally relevant information about the victim, when subjects have a direct opportunity to condemn the perpetrator, and in the context of both third- and first-person victim narratives. Finally, we provide support for the Justice Restoration Hypothesis, which posits that people see victims as moral in order to motivate adaptive justice-restorative action (i.e., punishment of perpetrators and helping of victims). We show that people see victims as having elevated moral character, but do not expect them to behave more morally or less immorally—a pattern that is consistent with the Justice Restoration Hypothesis, but not readily explained by alternative explanations for the Virtuous Victim effect. And we provide both correlational and causal evidence for a key prediction of the Justice Restoration Hypothesis: when people do not perceive incentives to help victims and punish perpetrators, the Virtuous Victim effect disappears.

From the Discussion

Our theory and results negate the hypothesis that people see victims as morally deserving of mistreatment in order to maintain just world beliefs. We suggest that, when exposed to apparent injustice, the default reaction is not to justify what has occurred, but rather to seek to restore justice (by punishing the perpetrator and/or helping the victim)  .It has been proposed that restoring justice is another route through which people can maintain just world beliefs(25, 26). And we have argued it is typically a more adaptive response to wrongdoing, because people frequently face incentives for justice-restorative action.  Our experiments are consistent with the hypothesis that in order to adaptively motivate such action, people see victims as morally good. Future research should investigate whether people also see victims as possessing other traits (e.g., helpless, neediness, or innocence) that might motivate justice-restorative action.

Violent CRED s toward Out-Groups Increase Trustworthiness: Preliminary Experimental Evidence

Řezníček, D., & Kundt, R. (2020).

Journal of Cognition and Culture, 20(3-4), 262-281. 

doi: https://doi.org/10.1163/15685373-12340084

Abstract

In the process of cultural learning, people tend to acquire mental representations and behavior from prestigious individuals over dominant ones, as prestigious individuals generously share their expertise and know-how to gain admiration, whereas dominant ones use violence, manipulation, and intimidation to enforce obedience. However, in the context of intergroup conflict, violent thoughts and behavior that are otherwise associated with dominance can hypothetically become prestigious because parochial altruists, who engage in violence against out-groups, act in the interest of their group members, therefore prosocially. This shift would imply that for other in-groups, individuals behaving violently toward out-groups during intergroup conflicts become simultaneously prestigious, making them desirable cultural models to learn from. Using the mechanism of credibility enhancing displays (CRED s), this article presents preliminary vignette-based evidence that violent CRED s toward out-groups during intergroup conflict increase the perceived trustworthiness of a violent cultural model.

From the Discussion section

We found support for hypotheses H1–3 regarding the seemingly paradoxical relationship between trustworthiness, prestige, dominance, and violence during an intergroup conflict (see Figures 1 and 2). Violent cultural model’s trustworthiness was positively predicted by CREDs and prestige, while it was negatively predicted by dominance. This suggests that in-groups violent toward out-groups during an intergroup conflict are not perceived as dominant manipulators who are better to be avoided and not learned from but rather as prestigious heroes who deserve to be venerated. Thus, it appears that a positive perception of violence toward out-groups, as modeled or tested by various researchers (Bowles, 2008; Castano & Leidner, 2012; Choi & Bowles, 2007;Cohen, Montoya, & Insko, 2006; Roccas, Klar, & Liviatan, 2006), is an eligible notion. Our study offers preliminary evidence for the suggestion that fighting violently for one’s group may increase the social status of fighters via prestige, not dominance.

A pdf of the research is here.

Religious moral righteousness over care: a review and a meta-analysis

Current Opinion in Psychology

Volume 40, August 2021, Pages 79-85

Abstract

Does religion enhance an ‘extended’ morality? We review research on religiousness and Schwartz’s values, Haidt’s moral foundations (through a meta-analysis of 45 studies), and deontology versus consequentialism (a review of 27 studies). Instead of equally encompassing prosocial (care for others) and other values (duties to the self, the community, and the sacred), religiosity implies a restrictive morality: endorsement of values denoting social order (conservation, loyalty, and authority), self-control (low autonomy and self-expansion), and purity more strongly than care; and, furthermore, a deontological, non-consequentialist, righteous orientation, that could result in harm to (significant) others. Religious moral righteousness is highest in fundamentalism and weakens in secular countries. Only spirituality reflects an extended morality (care, fairness, and the binding foundations). Evolutionarily, religious morality seems to be more coalitional and ‘hygienic’ than caring.

Highlights

• We meta-analyzed 45 studies on religion and Haidt’s five moral foundations.

• Religiosity implies high purity, authority, and loyalty; care is involved only weakly.

• Only spirituality reflects extended morality: care, fairness, and the binding values.

• Results parallel findings on religion and Schwartz’s values across the world.

• Religious morality is primarily deontological, non-consequentialist, and righteous.

Conclusion

On the basis of the findings of the various research areas examined in this article, we think it is reasonable to infer that the role of religious (ingroup) prosociality in forming and consolidating large coalitions involving reciprocal interpersonal helping may have been overestimated in the contemporary evolutionary psychology of religion.  This role may not reflect the very center of religious morality. Rather, the results of the present review suggest that the evolutionary perspectives of religion focusing on the importance of hygienic and righteous/coalitional morality (avoidance of pathogens, loyalty, group conformity, as well as preservation of personal and social order) may be more central in explaining, from a moral perspective, religions’ origin and maintenance.

Determined to Be Humble? Exploring the Relationship Between Belief in Free Will and Humility

Earp, B. D., et al.

https://doi.org/10.31234/osf.io/3bxra

Abstract

In recent years, diminished belief in free will or increased belief in determinism have been associated with a range of antisocial or otherwise negative outcomes: unjustified aggression, cheating, prejudice, less helping behavior, and so on. Only a few studies have entertained the possibility of prosocial or otherwise positive outcomes, such as greater willingness to forgive and less motivation to punish retributively. Here, five studies (open data, materials, and pre-print at https://osf.io/hmy39/) explore the relationship between belief in determinism and another positive outcome or attribute, namely, humility. The reported findings suggest that relative disbelief in free will is reliably associated in our samples with at least one type of humility—what we call ‘Einsteinian’ humility—but is not associated with, or even negatively associated with, other types of humility described in the literature.

From the Conclusion

At the same time, in our final study, we found a positive relationship between belief in free will and several other measures of humility: ethical/epistemic humility, Landrum humility, and modesty, with the last of these remaining significant even with a conservative alpha criterion. Although this is contrary to what we expected, it is consistent with the dominant narrative in the literature according to which belief in free will is associated with pro-social traits and behaviors. We believe we are the first to show a relationship of any kind between belief in free will and this particular trait—modesty—and we hope to explore this relationship in more detail in future work.