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

Wednesday, April 21, 2021

Target Dehumanization May Influence Decision Difficulty and Response Patterns for Moral Dilemmas

Bai, H., et al. (2021, February 25). 
https://doi.org/10.31234/osf.io/fknrd

Abstract

Past research on moral dilemmas has thoroughly investigated the roles of personality and situational variables, but the role of targets in moral dilemmas has been relatively neglected. This paper presents findings from four experiments that manipulate the perceived dehumanization of targets in moral dilemmas. Studies 1, 2 and 4 suggest that dehumanized targets may render the decision easier, and with less emotion. Findings from Studies 1 and 3, though not Studies 2 and 4, show that dehumanization of targets in dilemmas may lead participants to make less deontological judgments. Study 3, but not Study 4, suggests that it is potentially because dehumanization has an effect on reducing deontological, but not utilitarian judgments. Though the patterns are somewhat inconsistent across studies, overall, results suggest that targets’ dehumanization can play a role in how people make their decisions in moral dilemmas.

General Discussion

Together, the four studies described in this paper contribute to the literature by providing evidence that the dehumanization of targets may play an important role in how people make decisions in moral dilemmas. In particular, we found some evidence in Studies 1, 2 and 4 suggesting that dehumanized targets may affect how people experience their decisions, rendering the decisions easier and less emotional. We also found some evidence from Studies 1 and 3, though not Studies 2 and 4, that dehumanization of targets in dilemmas may affect what decision people eventually make, suggesting that dehumanized targets may elicit less deontological responses to some extent. Finally, Study 3, but not Study 4, suggests that the decreased level of deontological response pattern may be potentially explained by dehumanization’s effect on reducing deontological, but not utilitarian tendencies. To this point, we conducted a mini-meta-analysis across the combined data for Studies 3 and 4 and compared the differences in the D parameter between the dehumanized condition and humanized conditions. We found an effect size of d = .135, which suggests that if dehumanization has an effect, it may not be a very big effect.

Tuesday, April 20, 2021

State Medical Board Recommendations for Stronger Approaches to Sexual Misconduct by Physicians

King PA, Chaudhry HJ, Staz ML. 
JAMA. 
Published online March 29, 2021. 
doi:10.1001/jama.2020.25775

The Federation of State Medical Boards (FSMB) recently engaged with its member boards and investigators, trauma experts, physicians, resident physicians, medical students, survivors of physician abuse, and the public to critically review practices related to the handling of reports of sexual misconduct (including harassment and abuse) toward patients by physicians. The review was undertaken as part of a core responsibility of boards to protect the public and motivated by concerning reports of unacceptable behavior by physicians. Specific recommendations from the review were adopted by the FSMB’s House of Delegates on May 2, 2020, and are highlighted in this Viewpoint.

Sexual misconduct by physicians exists along a spectrum of severity that may begin with “grooming” behaviors and end with sexual assault. Behaviors at any point on this spectrum should be of concern because unreported minor violations (including sexually suggestive comments or inappropriate physical contact) may lead to greater misconduct. In 2018, the National Academies of Science, Engineering, and Medicine identified sexual harassment as an important problem in scientific communities and medicine, finding that greater than 50% of women faculty and staff and 20% to 50% of women students reportedly have encountered or experienced sexually harassing conduct in academia. Data from state medical boards indicate that 251 disciplinary actions were taken against physicians in 2019 for “sexual misconduct” violations (Table). The actual number may be higher because boards often use a variety of terms, including unprofessional conduct, physician-patient boundary issues, or moral unfitness, to describe such actions. The FSMB has begun a project to encourage boards to align their categorization of all disciplinary actions to better understand the scope of misconduct.

Monday, April 19, 2021

The Military Is Funding Ethicists to Keep Its Brain Enhancement Experiments in Check

Sara Scoles
Medium.com
Originally posted 1 April 21

Here is an excerpt:

The Department of Defense has already invested in a number of projects to which the Minerva research has relevance. The Army Research Laboratory, for example, has funded researchers who captured and transmitted a participant’s thoughts about a character’s movement in a video game, using magnetic stimulation to beam those neural instructions to another person’s brain and cause movement. And it has supported research using deep learning algorithms and EEG readings to predict a person’s “drowsy and alert” states.

Evans points to one project funded by Defense Advanced Research Projects Agency (DARPA): Scientists tested a BCI that allowed a woman with quadriplegia to drive a wheelchair with her mind. Then, “they disconnected the BCI from the wheelchair and connected to a flight simulator,” Evans says, and she brainfully flew a digital F-35. “DARPA has expressed pride that their work can benefit civilians,” says Moreno. “That helps with Congress and with the public so it isn’t just about ‘supersoldiers,’” says Moreno.

Still, this was a civilian participant, in a Defense-funded study, with “fairly explicitly military consequences,” says Evans. And the big question is whether the experiment’s purpose justifies the risks. “There’s no obvious therapeutic reason for learning to fly a fighter jet with a BCI,” he says. “Presumably warfighters have a job that involves, among other things, fighter jets, so there might be a strategic reason to do this experiment. Civilians rarely do.”

It’s worth noting that warfighters are, says Moreno, required to take on more risks than the civilians they are protecting, and in experiments, military members may similarly be asked to shoulder more risk than a regular-person participant.

DARPA has also worked on implants that monitor mood and boost the brain back to “normal” if something looks off, created prosthetic limbs animated by thought, and made devices that improve memory. While those programs had therapeutic aims, the applications and follow-on capabilities extend into the enhancement realm — altering mood, building superstrong bionic arms, generating above par memory.

Sunday, April 18, 2021

The Antiscience Movement Is Escalating, Going Global and Killing Thousands

Peter J. Hotez
Scientific American
Originally posted 29 MAR 21

Antiscience has emerged as a dominant and highly lethal force, and one that threatens global security, as much as do terrorism and nuclear proliferation. We must mount a counteroffensive and build new infrastructure to combat antiscience, just as we have for these other more widely recognized and established threats.

Antiscience is the rejection of mainstream scientific views and methods or their replacement with unproven or deliberately misleading theories, often for nefarious and political gains. It targets prominent scientists and attempts to discredit them. The destructive potential of antiscience was fully realized in the U.S.S.R. under Joseph Stalin. Millions of Russian peasants died from starvation and famine during the 1930s and 1940s because Stalin embraced the pseudoscientific views of Trofim Lysenko that promoted catastrophic wheat and other harvest failures. Soviet scientists who did not share Lysenko’s “vernalization” theories lost their positions or, like the plant geneticist, Nikolai Vavilov, starved to death in a gulag.

Now antiscience is causing mass deaths once again in this COVID-19 pandemic. Beginning in the spring of 2020, the Trump White House launched a coordinated disinformation campaign that dismissed the severity of the epidemic in the United States, attributed COVID deaths to other causes, claimed hospital admissions were due to a catch-up in elective surgeries, and asserted that ultimately that the epidemic would spontaneously evaporate. It also promoted hydroxychloroquine as a spectacular cure, while downplaying the importance of masks. Other authoritarian or populist regimes in Brazil, Mexico, Nicaragua, Philippines and Tanzania adopted some or all of these elements.   

As both a vaccine scientist and a parent of an adult daughter with autism and intellectual disabilities, I have years of experience going up against the antivaccine lobby, which claims vaccines cause autism or other chronic conditions. This prepared me to quickly recognize the outrageous claims made by members of the Trump White House staff, and to connect the dots to label them as antiscience disinformation. Despite my best efforts to sound the alarm and call it out, the antiscience disinformation created mass havoc in the red states. 

Saturday, April 17, 2021

Binding Moral Values Gain Importance in the Presence of Close Others

Yudkin, D. A., et al. (2019, April 12). 
https://doi.org/10.31234/osf.io/tcq65

Abstract

A key function of morality is to regulate social behavior. Research suggests moral values may be divided into two types: binding values, which govern behavior in groups, and individualizing values, which promote personal rights and freedoms. Because people tend to mentally activate concepts in situations in which they may prove useful, the importance they afford moral values may vary according to whom they are with in the moment. In particular, because binding values help regulate communal behavior, people may afford these values more importance when in the presence of close (versus distant) others. Five studies test and support this hypothesis. First, we use a custom smartphone application to repeatedly record participants’ (n = 1,166) current social context and the importance they afforded moral values. Results show people rate moral values as more important when in the presence of close others, and this effect is stronger for binding than individualizing values—an effect that replicates in a large preregistered online sample (n = 2,016). A lab study (n = 390) and two preregistered online experiments (n = 580 and n = 752) provides convergent evidence that people afford binding, but not individualizing, values more importance when in the real or imagined presence of close others. Our results suggest people selectively activate different moral values according to the demands of the situation, and show how the mere presence of others can affect moral thinking.

Discussion

Centuries of thought in moral philosophy suggest that the purpose of moral values is to regulate social behavior. However, the psychology underlying this process remains underspecified. Here we show that the mere presence of close others increases the importance people afford binding moral values. By contrast, individualizing values are not reliably associated with relational context. In other words, people appear to selectively activate those moral values most relevant to their current social situation. This “moral activation” may play a functional role by helping people to abide by the relevant moral values in a given relational context and monitor adherence to those values in others. 

Our results are consistent with the view that different values play different functional roles in social life. Past research contrasts the values that encourage cohesion in groups and relationships with those that emphasize individual rights and freedoms10.Because violations to individualizing values may be considered wrong regardless of where and when they occur, the importance people ascribe to them may be unaffected by who they are with. By contrast, because binding values concern the moral duties conferred by specific social relationships, they may be particularly subject to social influence. 

Friday, April 16, 2021

Reduced decision bias and more rational decision making following ventromedial prefrontal cortex damage

S. Manohar, et al.
Cortex, Volume 138, 
May 2021, Pages 24-37

Abstract

Human decisions are susceptible to biases, but establishing causal roles of brain areas has proved to be difficult. Here we studied decision biases in 17 people with unilateral medial prefrontal cortex damage and a rare patient with bilateral ventromedial prefrontal cortex (vmPFC) lesions. Participants learned to choose which of two options was most likely to win, and then bet money on the outcome. Thus, good performance required not only selecting the best option, but also the amount to bet. Healthy people were biased by their previous bet, as well as by the unchosen option's value. Unilateral medial prefrontal lesions reduced these biases, leading to more rational decisions. Bilateral vmPFC lesions resulted in more strategic betting, again with less bias from the previous trial, paradoxically improving performance overall. Together, the results suggest that vmPFC normally imposes contextual biases, which in healthy people may actually be suboptimal in some situations.

From the Discussion

The findings presented here show that it is indeed possible for more rational decision making to emerge at least on a value based reversal learning task after bilateral vmPFC lesions. This is not to say that all decisions and behaviours become more rational after such brain damage. Clearly, although he managed to continue to work in a demanding job, patient MJ showed evidence of dysfunction in social cognition
and some aspects of decision making and judgment in everyday life, just as previous reported cases (Bechara et al., 2000; Berlin et al., 2004; Eslinger & Damasio, 1985; ShamayTsoory et al., 2005).

There is some previous circumstantial evidence that mPFC lesions may reduce decision biases. For example, patients with mPFC damage show smaller biases in probabilistic estimation (O’Callaghan et al., 2018), reduced affective contributions to reasoning (Shamay-Tsoory et al., 2005), and may indeed make more utilitarian moral judgements, suggesting more rational valuation with less affective bias (Ciaramelli
et al., 2007; Koenigs et al., 2007; Krajbich et al., 2009). These effects might be underpinned by a more general increase in rationality after damage to this region. One possible explanation for this is that individuals with vmPFC lesions might be free of affective biases that normally contribute to such decision making but this remains to be established.

Thursday, April 15, 2021

Anchoring Effect in Legal Decision-Making: A Meta-Analysis

Bystranowski, P., Janik, B., Próchnicki, M., 
& Skórska, P. 
(2021). Law and Human Behavior, 45(1), 1-23. 
http://dx.doi.org/10.1037/lhb0000438

Objective
We conducted a meta-analysis to examine whether numeric decision-making in law is susceptible to the effect of (possibly arbitrary) values present in the decision contexts (anchoring effect) and to investigate which factors might moderate this effect. 

Hypotheses
We predicted that the presence of numeric anchors would bias legal decision-makers’ judgment in the direction of the anchor value. We hypothesized that the effect size of anchoring would be moderated by several variables, which we grouped into three categories: methodological (type of stimuli; type of sample), psychological (standard vs. basic paradigm; anchor value; type of scale on which the participants assessed the target value), and legal (relevance of the anchor; type of the anchor; area of law to which the presented case belonged; presence of any salient numeric values other than the main anchor). 

Method
Twenty-nine studies (93 effect sizes; N = 8,549) met the inclusion criteria. We divided them into two groups, depending on whether they included a control group, and calculated the overall effect size using a random-effects Model with robust variance estimation. We assessed the influence of moderators using random effects metaregression. 

Results
The overall effect sizes of anchoring for studies with a control group (z = .27, 95% CI [.21, .33], d = .58, 95% CI [.44, .73]) and without a control group (z = .39, 95% CI [.31, .47], d = .91, 95% CI [.69, 1.12]) were both significant, although we provide some evidence of possible publication bias. We found preliminary evidence of a potential moderating effect of some legally relevant factors, such as legal expertise or the anchor relevance. 

Conclusions
Existing research indicates anchoring effects exist in legal contexts. The influence of anchors seems to depend on some situational factors, which paves the way for future research on countering the problematic effect in legal settings.

Wednesday, April 14, 2021

Signaling When No One Is Watching: A Reputation Heuristics Account of Outrage and Punishment In One-Shot Anonymous Interactions

Jordan, J. J., & Rand, D. G. (2020). 
Journal of Personality and 
Social Psychology, 118(1), 57–88. 

Abstract

Moralistic punishment can confer reputation benefits by signaling trustworthiness to observers. However, why do people punish even when nobody is watching? We argue that people often rely on the heuristic that reputation is typically at stake, such that reputation concerns can shape moralistic outrage and punishment even in one-shot anonymous interactions. We then support this account using data from Amazon Mechanical Turk. In anonymous experiments, subjects (total n = 8,440) report more outrage in response to others’ selfishness when they cannot signal their trustworthiness through direct prosociality (sharing with a third party)—such that if the interaction were not anonymous, punishment would have greater signaling value. Furthermore, mediation analyses suggest that sharing opportunities reduce outrage by influencing reputation concerns. Additionally, anonymous experiments measuring costly punishment (total n = 6,076) show the same pattern: subjects punish more when sharing is not possible. Moreover, and importantly, moderation analyses provide some evidence that sharing opportunities do not merely reduce outrage and punishment by inducing empathy toward selfishness or hypocrisy aversion among non-sharers. Finally, we support the specific role of heuristics by investigating individual differences in deliberateness. Less deliberative individuals (who typically rely more on heuristics) are more sensitive to sharing opportunities in our anonymous punishment experiments, but, critically, not in punishment experiments where reputation is at stake (total n = 3,422); and not in our anonymous outrage experiments (where condemning is costless). Together, our results suggest that when nobody is watching, reputation cues nonetheless can shape outrage and—among individuals who rely on heuristics—costly punishment. 

Conclusion

Third-party punishment is central to human morality, and plays a key role in promoting cooperation. However, from an ultimate perspective, it is also puzzling, especially in the context of oneshot anonymous interactions: why should we make personal sacrifices to punish wrongdoing toward others? Our results support the theory that even in such contexts, some people rely on the heuristic that reputation is typically at stake. As a result, even when reputation is not actually at stake, reputation cues can shape moral outrage—and, among less deliberative individuals, costly punishment. Our results thus demonstrate how a reputation framework can shed light on these key features of human morality.

Tuesday, April 13, 2021

Can Clinical Empathy Survive? Distress, Burnout, and Malignant Duty in the Age of Covid‐19

A. Anzaldua & J. Halpern
Hastings Report
Jan-Feb 2021 22-27.

Abstract

The Covid‐19 crisis has accelerated a trend toward burnout in health care workers, making starkly clear that burnout is especially likely when providing health care is not only stressful and sad but emotionally alienating; in such situations, there is no mental space for clinicians to experience authentic clinical empathy. Engaged curiosity toward each patient is a source of meaning and connection for health care providers, and it protects against sympathetic distress and burnout. In a prolonged crisis like Covid‐19, clinicians provide care out of a sense of duty, especially the duty of nonabandonment. We argue that when duty alone is relied on too heavily, with fear and frustration continually suppressed, the risk of burnout is dramatically increased. Even before Covid‐19, clinicians often worked under dehumanizing and unjust conditions, and rates of burnout were 50 percent for physicians and 33 percent for nurses. The Covid‐19 intensification of burnout can serve as a wake‐up call that the structure of health care needs to be improved if we are to prevent the loss of a whole generation of empathic clinicians.

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The Dynamics of Clinical Empathy

Clinical empathy, a specific form of empathy that has therapeutic impact in the medical setting and is professionally sustainable, was first conceptualized by one of us, Jodi Halpern, as emotionally engaged curiosity. Her work challenged the expectation that physicians should limit themselves to detached cognitive empathy, showing how affective resonance, when redirected into curiosity about the patient, is essential for therapeutic impact. Halpern's interactive model of affective and cognitive empathy has been supported by empirical research, including findings regarding improved diagnosis, treatment adherence, and coping as well as studies of specific diseases (for example, about improved diabetes outcomes), though more research is needed to precisely identify the specific ways that affective resonance and cognitive curiosity contribute to meeting specific clinical needs. This model is also supported by neuroscientific findings showing how affective attunement improves cognitive empathy.

Models of compassion in medical care add valuable practices of mindfulness but do not emphasize an individualized appreciation of each patient's predicament. We thus work with Halpern's model, which emphasizes using emotional resonance to inform imagining the world from each patient's perspective. Halpern defines the cognitive aim of imagining each patient's perspective as “curiosity” because the practice of clinical empathy as engaged curiosity is founded on the recognition that each patient brings their own distinct world, with a unique set of values and needs that the physician cannot presume to know. This is a subtle but vital point.