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, April 12, 2021

Structuring Local Environments to Avoid Diversity: Anxiety Drives Whites’ Geographical and Institutional Self-Segregation Preferences

Anicich, E., Jachimowicz, J., 
(2021, February 16). 
https://doi.org/10.31234/osf.io/yzpr2

Abstract

The current research explores how local racial diversity affects Whites’ efforts to structure their local communities to avoid incidental intergroup contact. In two experimental studies (N=509; Studies 1a-b), we consider Whites’ choices to structure a fictional, diverse city and find that Whites choose greater racial segregation around more (vs. less) self-relevant landmarks (e.g., their workplace and children’s school). Specifically, the more time they expect to spend at a landmark, the more they concentrate other Whites around that landmark, thereby reducing opportunities for incidental intergroup contact. Whites also structure environments to reduce incidental intergroup contact by instituting organizational policies that disproportionately exclude non-Whites: Two large-scale archival studies (Studies 2a-b) using data from every U.S. tennis (N=15,023) and golf (N=10,949) facility revealed that facilities in more racially diverse communities maintain more exclusionary barriers (e.g., guest policies, monetary fees, dress codes) that shield the patrons of these historically White institutions from incidental intergroup contact. In a final experiment (N=307; Study 3), we find that Whites’ anticipated intergroup anxiety is one driver of their choices to structure environments to reduce incidental intergroup contact in more (vs. less) racially diverse communities. Our results suggest that despite increasing racial diversity, White Americans structure local environments to fuel a self-perpetuating cycle of segregation.

General Discussion

Across five studies using a mix of experimental, archival, and survey methods, we provide evidence of a cycle of intergroup avoidance that is reflected in Whites’ efforts to structure their local environments in ways that reduce incidental intergroup contact: Whites experience more intergroup anxiety in the face of local racial diversity, and as such, work to segregate themselves geographically and institutionally from racial outgroup members. This, in turn, reduces the likelihood of incidental intergroup contact, which has the potential for debiasing effects.Specifically, in Studies 1a and 1b, we found that when given the opportunity to do so, Whites exhibited a preference to racially self-segregate when making decisions about the racial distribution of residents in a diverse city even in a controlled experimental setting. In Studies 2a and 2b, we constructed a rich archival dataset using information about every tennis and golf facility in the United States. We found that the gatekeepers of these historically White institutions restrict access in more versus less racially diverse communities by maintaining private (vs. public) access, higher monetary barriers, and stricter dress codes. Finally, Study 3experimentally manipulated the racial composition of a fictitious city and found that Whites who imagined living in a more versus less racially diverse city more strongly endorsed exclusionary policies in their institutions and anticipated feeling more stressed when confronted with the prospect of navigating through a diverse part of town, effects which were statistically mediated by feelings of intergroup anxiety.

Taken together, the current research offers important insights into how local racial diversity shapes Whites’ intergroup avoidance strategies, and ultimately results in Whites structuring communities in ways that reduce incidental intergroup contact and the frequency of potentially debiasing encounters.Moreover, such decisions block critical opportunities (economic, social, etc.) for racial minorities themselves, thus contributing to the persistence of structural racism, even in the face of increasing racial diversity (see also Kraus & Torrez, 2020).

Sunday, April 11, 2021

Personal experiences bridge moral and political divides better than facts

E. Kubin, C. Puryear, C. Shein, & K. Gray
Proceedings of the National Academy of Sciences 
Feb 2021, 118 (6) e2008389118
DOI: 10.1073/pnas.2008389118

Abstract

Both liberals and conservatives believe that using facts in political discussions helps to foster mutual respect, but 15 studies—across multiple methodologies and issues—show that these beliefs are mistaken. Political opponents respect moral beliefs more when they are supported by personal experiences, not facts. The respect-inducing power of personal experiences is revealed by survey studies across various political topics, a field study of conversations about guns, an analysis of YouTube comments from abortion opinion videos, and an archival analysis of 137 interview transcripts from Fox News and CNN. The personal experiences most likely to encourage respect from opponents are issue-relevant and involve harm. Mediation analyses reveal that these harm-related personal experiences increase respect by increasing perceptions of rationality: everyone can appreciate that avoiding harm is rational, even in people who hold different beliefs about guns, taxes, immigration, and the environment. Studies show that people believe in the truth of both facts and personal experiences in nonmoral disagreement; however, in moral disagreements, subjective experiences seem truer (i.e., are doubted less) than objective facts. These results provide a concrete demonstration of how to bridge moral divides while also revealing how our intuitions can lead us astray. Stretching back to the Enlightenment, philosophers and scientists have privileged objective facts over experiences in the pursuit of truth. However, furnishing perceptions of truth within moral disagreements is better accomplished by sharing subjective experiences, not by providing facts.

Significance

All Americans are affected by rising political polarization, whether because of a gridlocked Congress or antagonistic holiday dinners. People believe that facts are essential for earning the respect of political adversaries, but our research shows that this belief is wrong. We find that sharing personal experiences about a political issue—especially experiences involving harm—help to foster respect via increased perceptions of rationality. This research provides a straightforward pathway for increasing moral understanding and decreasing political intolerance. These findings also raise questions about how science and society should understand the nature of truth in the era of “fake news.” In moral and political disagreements, everyday people treat subjective experiences as truer than objective facts.


Saturday, April 10, 2021

Ethical and Professionalism Implications of Physician Employment and Health Care Business Practices

De Camp, M, & Sulmasy, L. S.
Annals of Internal Medicine
Position Paper: 16 March 21

Abstract

The environment in which physicians practice and patients receive care continues to change. Increasing employment of physicians, changing practice models, new regulatory requirements, and market dynamics all affect medical practice; some changes may also place greater emphasis on the business of medicine. Fundamental ethical principles and professional values about the patient–physician relationship, the primacy of patient welfare over self-interest, and the role of medicine as a moral community and learned profession need to be applied to the changing environment, and physicians must consider the effect the practice environment has on their ethical and professional responsibilities. Recognizing that all health care delivery arrangements come with advantages, disadvantages, and salient questions for ethics and professionalism, this American College of Physicians policy paper examines the ethical implications of issues that are particularly relevant today, including incentives in the shift to value-based care, physician contract clauses that affect care, private equity ownership, clinical priority setting, and physician leadership. Physicians should take the lead in helping to ensure that relationships and practices are structured to explicitly recognize and support the commitments of the physician and the profession of medicine to patients and patient care.

Here is an excerpt:

Employment of physicians likewise has advantages, such as financial stability, practice management assistance, and opportunities for collaboration and continuing education, but there is also the potential for dual loyalty when physicians try to be accountable to both their patients and their employers. Dual loyalty is not new; for example, mandatory reporting of communicable diseases may place societal interests in preventing disease at odds with patient privacy interests. However, the ethics of everyday business models and practices in medicine has been less explored.

Trust is the foundation of the patient–physician relationship. Trust, honesty, fairness, and respect among health care stakeholders support the delivery of high-value, patient-centered care. Trust depends on expertise, competence, honesty, transparency, and intentions or goodwill. Institutions, systems, payers, purchasers, clinicians, and patients should recognize and support “the intimacy and importance of patient–clinician relationships” and the ethical duties of physicians, including the primary obligation to act in the patient's best interests (beneficence).

Business ethics does not necessarily conflict with the ethos of medicine. Today, physician leadership of health care organizations may be vital for delivering high-quality care and building trust, including in health care institutions. Truly trustworthy institutions may be more successful (in patient care and financially) in the long term.

Blanket statements about business practices and contractual provisions are unhelpful; most have both potential positives and potential negatives. Nevertheless, it is important to raise awareness of business practices relevant to ethics and professionalism in medical practice and promote the physician's ability to advocate for arrangements that align with medicine's core values. In this paper, the American College of Physicians (ACP) highlights 6 contemporary issues and offers ethical guidance for physicians. Although the observed trends toward physician employment and organizational consolidation merit reflection, certain issues may also resonate with independent practices and in other practice settings.

Friday, April 9, 2021

The Ordinary Concept of a Meaningful Life

Prinzing, M., De Freitas, J., & Fredrickson, B. 
(2020, May 5). 
https://doi.org/10.31234/osf.io/6sx4t

Abstract

The desire for a meaningful life is ubiquitous, yet the ordinary concept of a meaningful life is poorly understood. Across six experiments (total N = 2,539), we investigated whether third-person attributions of meaning depend on the psychological states an agent experiences (feelings of interest, engagement, and fulfillment), or on the objective conditions of their life (e.g., their effects on others). Studies 1a–b found that laypeople think subjective and objective factors contribute independently to the meaningfulness of a person’s life. Studies 2a–b found that positive mental states are thought to make a life more meaningful, even if derived from senseless activities (e.g., hand-copying the dictionary). Studies 3a–b found that agents engaged in morally bad activities are not thought to have meaningful lives, even if they feel fulfilled. In short, both an agents’ subjective mental states and objective impact on the world affect how meaningful their lives appear.

General Discussion

What, according to the ordinary concept, makes a life meaningful?  Studies1a-b found that  laypeople  think positive  mental states (interest,  engagement, fulfillment) can make an agent’s life meaningful. These studies also found that, according to lay assessments, doing something that has value for others can also make an agent’s life meaningful. These findings conflict with the predominant philosophical theories of meaning in life. These theories posit an exclusive role for either positive mental states (subjectivist theories) or objective states of an agent’s life (objectivist theories), or they require that both criteria be met (hybrid theories). In contrast, we found that laypeople think an agent’s life is meaningful when either criterion is met.This indicates that the ordinary concept of a meaningful life does not fit neatly with these three philosophical theories. Instead, they seem to be captured by what we will call the independent-additive theory: subjective factors  (positive mental states like fulfillment) and objective factors (like contribution, sensibility, and morality)each affect the meaningfulness of an agent’s life, and their effects are both independent and additive.  

We investigated the roles of sensibility and morality as plausible boundary conditions for lay attributions of meaningfulness. For sensibility, we saw somewhat mixed results. Study 2a found no evidence that a life characterized by sensible activities (wine connoisseurship) was  seen as more  meaningful than a  life characterized  by senseless  activities(rubber  band collecting). However, Study 2b, with a larger sample and wider variety of vignettes, did find such  an  effect. Nevertheless, in both  studies, fulfilling  lives were seen as  more  meaningful than  unfulfilling  ones—regardless  of  whether  that fulfillment was derived  from sensible  or senseless activities.  Hence, on the ordinary concept, sensibility contributes to meaningfulness, though  not  as  much  as  fulfillment  does. Moreover, in  alignment  with  the independent-additive theory, fulfillment maintains its additive effect, independently of sensibility.  Regarding morality, Studies 3a-b found that morally good lives were viewed as much more meaningful than morally bad ones. In fact, morally bad agents were not thought to live meaningful lives, even if those agents felt very fulfilled. In contrast, morally good agents were seen as having meaningful lives even if they didn’t feel fulfilled.Nevertheless,  though the effect of morality was larger than that of fulfillment, participants still thought that a fulfilled, immoral agent was living more meaningfully than an unfulfilled, immoral agent. Supporting the independent-additive  theory,  the additive  effect  of  fulfillment was independent  of morality.

In short, we identified four factors (fulfillment, contribution, sensibility, and morality) that seem to have independent, additive effects on third-person attributions of meaningfulness.  There  may well be more such  factors.  But  the  evidence  from  these  six experiments supports a model of third-person meaningfulness judgments that—in contrast to subjectivist,  objectivist,  and  hybrid  theories—emphasizes  independent  and  additive  factors that  contribute  to  the  meaning in a person’s life.  We  have called such a model the “independent-additive theory”.

Thursday, April 8, 2021

How social relationships shape moral judgment

Earp, B. D., McLoughlin, et al.
(2020, September 18).
https://doi.org/10.31234/osf.io/e7cgq

Abstract

Our judgments of whether an action is morally wrong depend on who is involved and their relationship to one another. But how, when, and why do social relationships shape such judgments? Here we provide new theory and evidence to address this question. In a pre- registered study of U.S. participants (n = 423, nationally representative for age, race and gender), we show that particular social relationships (like those between romantic partners, housemates, or siblings) are normatively expected to serve distinct cooperative functions – including care, reciprocity, hierarchy, and mating – to different degrees. In a second pre- registered study (n = 1,320) we show that these relationship-specific norms, in turn, influence the severity of moral judgments concerning the wrongness of actions that violate cooperative expectations. These data provide evidence for a unifying theory of relational morality that makes highly precise out-of-sample predictions about specific patterns of moral judgments across relationships. Our findings show how the perceived morality of actions depends not only on the actions themselves, but also on the relational context in which those actions occur.

From the Discussion

Lewin famously argued that behavior is a product of the person and the situation. In a similar spirit, our data confirm that judgments of moral behavior cannot be understood solely with reference to a given act or actor, but rather, must be interpreted in light of the interaction between the parties. And crucially, the nature of their relationship--including the cooperative norms by which the relationship is governed in a given society --will typically be one of the most important situational factors in terms of explanatory power. Although relationship theorists have, for decades, worked to characterize the structural elements of various close relationships and have sometimes categorized relationships in terms of cooperative functions necessary for human thriving, here we systematically described lay perceptions of the ideal functional make-up of a wide range of common relationships. Moreover, we were able to use this information to make accurate out-of-sample predictions of moral judgments concerning a host of actions that are likely to occur in daily life. We hope that our approach will inspire further research in this vein, both theoretical and empirical, at the interface of relationship science and moral psychology. Ideally, such research will help to integrate and enrich work in both domains, which has so far remained largely separate.

From a theoretical perspective, one aspect of our current account that requires further attention is the reciprocity function. In contrast with the other three functions considered, relationship-specific functional expectations for reciprocity did not significantly predict relationship-specific judgments concerning reciprocity violations. Why might this be so? One possibility, suggested by previous research, is that the model we tested did not distinguish between two different types of reciprocity. In some relationships, such as those between strangers, acquaintances, or individuals doing business with one another, reciprocity takes a tit-for-tat form in which benefits are offered and accepted on a highly contingent basis. This type of reciprocity is transactional, in that resources are provided, not in response to a real or perceived need on the part of the other, but rather, in response to the past or expected future provision of a similarly valued resource from the cooperation partner. In this, it relies on an explicit accounting of who owes what to whom, and is thus characteristic of so-called “exchange” relationships.

Wednesday, April 7, 2021

Actionable Principles for Artificial Intelligence Policy: Three Pathways

Stix, C. 
Sci Eng Ethics 27, 15 (2021). 
https://doi.org/10.1007/s11948-020-00277-3

Abstract

In the development of governmental policy for artificial intelligence (AI) that is informed by ethics, one avenue currently pursued is that of drawing on “AI Ethics Principles”. However, these AI Ethics Principles often fail to be actioned in governmental policy. This paper proposes a novel framework for the development of ‘Actionable Principles for AI’. The approach acknowledges the relevance of AI Ethics Principles and homes in on methodological elements to increase their practical implementability in policy processes. As a case study, elements are extracted from the development process of the Ethics Guidelines for Trustworthy AI of the European Commission’s “High Level Expert Group on AI”. Subsequently, these elements are expanded on and evaluated in light of their ability to contribute to a prototype framework for the development of 'Actionable Principles for AI'. The paper proposes the following three propositions for the formation of such a prototype framework: (1) preliminary landscape assessments; (2) multi-stakeholder participation and cross-sectoral feedback; and, (3) mechanisms to support implementation and operationalizability.

(cut)

Actionable Principles

In many areas, including AI, it has proven challenging to bridge ethics and governmental policy-making (Müller 2020, 1.3). To be clear, many AI Ethics Principles, such as those developed by industry actors or researchers for self-governance purposes, are not aimed at directly informing governmental policy-making, and therefore the challenge of bridging this gulf may not apply. Nonetheless, a significant subset of AI Ethics Principles are addressed to governmental actors, from the 2019 OECD Principles on AI (OECD 2019) to the US Defence Innovation Board’s AI Principles adopted by the Department of Defence (DIB 2019). Without focussing on any single effort in particular, the aggregate success of many AI Ethics Principles remains limited (Rességuier and Rodriques 2020). Clear shifts in governmental policy which can be directly traced back to preceding and corresponding sets of AI Ethics Principles, remain few and far between. This could mean, for example, concrete textual references reflecting a specific section of the AI Ethics Principle, or the establishment of (both enabling or preventative) policy actions building on relevant recommendations. A charitable interpretation could be that as governmental policy-making takes time, and given that the vast majority of AI Ethics Principles were published within the last two years, it may simply be premature to gauge (or dismiss) their impact. However, another interpretation could be that the current versions of AI Ethics Principles have fallen short of their promise, and reached their limitation for impact in governmental policy-making (henceforth: policy).

It is worth noting that successful actionability in policy goes well beyond AI Ethics Principles acting as a reference point. Actionable Principles could shape policy by influencing funding decisions, taxation, public education measures or social security programs. Concretely, this could mean increased funding into societally relevant areas, education programs to raise public awareness and increase vigilance, or to rethink retirement structures with regard to increased automation. To be sure, actionability in policy does not preclude impact in other adjacent domains, such as influencing codes of conduct for practitioners, clarifying what demands workers and unions should pose, or shaping consumer behaviour. Moreover, during political shifts or in response to a crisis, Actionable Principles may often prove to be the only (even if suboptimal) available governance tool to quickly inform precautionary and remedial (legal and) policy measures.


Tuesday, April 6, 2021

Uniting against a common enemy: Perceived outgroup threat elicits ingroup cohesion in chimpanzees

Brooks J, Onishi E, Clark IR, Bohn M, Yamamoto S
PLoS ONE 16(2): e0246869. 
https://doi.org/10.1371/journal.pone.0246869

Abstract

Outgroup threat has been identified as an important driver of ingroup cohesion in humans, but the evolutionary origin of such a relationship is unclear. Chimpanzees (Pan troglodytes) in the wild are notably aggressive towards outgroup members but coordinate complex behaviors with many individuals in group hunting and border patrols. One hypothesis claims that these behaviors evolve alongside one another, where outgroup threat selects for ingroup cohesion and group coordination. To test this hypothesis, 5 groups of chimpanzees (N = 29 individuals) were observed after hearing either pant-hoots of unfamiliar wild chimpanzees or control crow vocalizations both in their typical daily environment and in a context of induced feeding competition. We observed a behavioral pattern that was consistent both with increased stress and vigilance (self-directed behaviors increased, play decreased, rest decreased) and increased ingroup cohesion (interindividual proximity decreased, aggression over food decreased, and play during feeding competition increased). These results support the hypothesis that outgroup threat elicits ingroup tolerance in chimpanzees. This suggests that in chimpanzees, like humans, competition between groups fosters group cohesion.

Discussion

We observed chimpanzees’ behavioral response to outgroup pant-hoots compared to crow vocalizations. Overall, our results were consistent with the social cohesion hypothesis but not with the generalized stress hypothesis. Indicators of stress and vigilance were higher after hearing vocalizations from unfamiliar chimpanzees compared to crow vocalizations but this did not translate into within group tension. Instead, indicators of affiliation and tolerance were higher in the outgroup vocalization condition compared to control crow vocalization condition. Upon receiving semi-monopolizable food, play was higher and aggression lower in the outgroup compared to control condition, indicating a shift towards prosocial strategies in releasing tension induced by feeding competition. These results suggest that outgroup threat directly induces ingroup cohesion in chimpanzees, and importantly, that this effect translates to feeding contexts with high within group tension.

Consistent with previous studies, we found behavioral indicators of vigilance and stress increased. More specifically, in the playback phase there were more self-directed behaviors (self-grooming and self-scratching), less rest, and a lower proportion of lying down in the outgroup vocalization condition compared to control crow vocalization condition. For the latter two this effect decreased for later presentations of the vocalizations, presumably due to habituation to the stimuli (see S1 File). The increase in self-directed behaviors, often interpreted as signals of stress, is likely due to chimpanzees finding outgroup sounds more stressful than crow vocalizations, consistent with a previous study documenting a rise in cortisol following outgroup auditory stimuli in many of the same individuals as those involved in this study. The decrease in rest, through its interaction with trial, is consistent with field research on gorillas where rest decreased following intergroup encounters, but in this case may simply have been due to a trade-off with the relative increase in other behaviors including self-directed behavior and social grooming. The decrease in proportion of rest lying down (as an interaction with trial) may further be interpreted as a sign of vigilance, where chimpanzees remained alert even while not engaged in other behaviors. In the playback phase, contrary to the social cohesion hypothesis, there was a decrease in play in the outgroup compared to the control crow vocalization condition. One explanation is that this was also indicative of increased vigilance or stress. Taken together, the results of several behavioral measures converge on the result that chimpanzees were more stressed and vigilant when outgroup vocalizations were played, compared to crow vocalizations.

Monday, April 5, 2021

Japan has appointed a 'Minister of Loneliness' after seeing suicide rates in the country increase for the first time in 11 years

Kaite Warren
Insider.com
Originally posted 22 Feb 21

Here is an excerpt:

Loneliness has long been an issue in Japan, often discussed alongside "hikikomori," or people who live in extreme social isolation. People have worked to create far-ranging solutions to this issue: Engineers in Japan previously designed a robot to hold someone's hand when they're lonely and one man charges people to "do nothing" except keep them company.

A rise in suicides during the pandemic

During the COVID-19 pandemic in 2020, with people more socially isolated than ever, Japan saw a rise in suicides for the first time in 11 years.

In October, more people died from suicide than had died from COVID-19 in Japan in all of 2020. There were 2,153 suicide deaths that month and 1,765 total virus deaths up to the end of October 2020, per the Japanese National Police Agency. (After a surge in new cases starting in December, Japan has now recorded 7,506 total coronavirus deaths as of February 22.) Studies show that loneliness has been linked to a higher risk of health issues like heart disease, dementia, and eating disorders.

Women in Japan, in particular, have contributed to the uptick in suicides. In October, 879 women died by suicide in Japan — a 70% increase compared to the same month in 2019. 

More and more single women live alone in Japan, but many of them don't have stable employment, Michiko Ueda, a Japanese professor who studies suicide in Japan, told the BBC last week.

"A lot of women are not married anymore," Ueda said. "They have to support their own lives and they don't have permanent jobs. So, when something happens, of course, they are hit very, very hard."

Sunday, April 4, 2021

4 widespread cognitive biases and how doctors can overcome them

Timothy M. Smith
American Medical Association
Originally posted 4 Feb 21

Here is an excerpt:

Four to look out for

Cognitive biases are worrisome for physicians because they can affect one’s ability to gather evidence, interpret evidence, take action and evaluate their decisions, the authors noted. Here are four biases that commonly surface in medicine.

Confirmation bias involves selectively gathering and interpretation evidence to conform with one’s beliefs, as well as neglecting evidence that contradicts them. An example is refusing to consider alternative diagnoses once an initial diagnosis has been established, even though data, such as laboratory results, might contradict it.

“This bias leads physicians to see what they want to see,” the authors wrote. “Since it occurs early in the treatment pathway, confirmation bias can lead to mistaken diagnoses being passed on to and accepted by other clinicians without their validity being questioned, a process referred to as diagnostic momentum."

Anchoring bias is much like confirmation bias and refers to the practice of prioritizing information and data that support one’s initial impressions of evidence, even when those impressions are incorrect. Imagine attributing a patient’s back pain to known osteoporosis without ruling out other potential causes.

Affect heuristic describes when a physician’s actions are swayed by emotional reactions instead of rational deliberation about risks and benefits. It is context or patient specific and can manifest when physician experiences positive or negative feelings toward a patient based on prior experiences.

Outcomes bias refers to the practice of believing that clinical results—good or bad—are always attributable to prior decisions, even if the physician has no valid reason to think this, preventing him from assimilating feedback to improve his performance.

“Although the relation between decisions and outcomes might seem intuitive, the outcome of a decision cannot be the sole determinant of its quality; that is, sometimes a good outcome can happen despite a poor clinical decision, and vice versa,” the authors wrote.