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 6, 2022

Reputation fuels moralistic punishment that people judge to be questionably merited

Jordan, J., & Kteily, N. (2020, March 21). 
https://doi.org/10.31234/osf.io/97nhj

Abstract

Critics of outrage culture allege that virtue signaling fuels morally questionable punishment. But does reputation actually have the power to motivate punishment that people see as ambiguously deserved? Across four studies (total n = 9,587), among both liberals and conservatives, we find evidence that the answer is yes. In Studies 1-2, we use a vignette paradigm to demonstrate that even in scenarios where subjects judge punishment to be questionably merited, they often expect punishing to confer reputational benefits. Across a range of such scenarios featuring politicized moral transgressions, many subjects expected punishers to be evaluated positively by co-partisans (and especially more ideologically-minded co-partisans). Furthermore, this expectation sometimes held even for individuals who personally questioned the merits of punishment. In Studies 3-4, we use a behavioral paradigm to investigate the motivational force of reputation in ambiguous situations. To this end, we measure decisions to punish alleged sexual harassment (among liberal subjects) and anti-male discrimination (among conservatives). In conditions where punishment was judged to be morally questionable, subjects nonetheless used punishment to boost their reputations, punishing more frequently when their behavior was public than private. In fact, when approximately equating the strength of reputational incentives, reputation was similarly effective at driving punishment in conditions where punishment was seen as ambiguously vs. unambiguously deserved (Study 3). Furthermore, reputation drove punishment even among individuals with personal reservations about its morality (Study 4, featuring liberal subjects). Together, these results highlight the power of reputation and have implications for debates surrounding virtue signaling and outrage culture.

From the Discussion Section

Theoretical and societal implications.  Our results have important implications, both for theories of psychology and society. More specifically, our findings expand our understanding of the psychological power of reputation, as well as the breadth of its influence on social behavior.  Previous research has documented the robust influence of reputation on behavior in the moral domain. Yet the focus has been on the power of reputation to fuel behaviors that are widely seen as morally good—such as direct acts of cooperation, or acts of punishment that are presumed to be seen by subjects as clearly justified.Thus, previous research has primarily made clear that reputation has the power to inspire socially beneficial behavior.  And while our results do under score this observation (most subjects in the unambiguous conditions of Studies 3 a-b saw punishment as morally merited, and reputation increased their propensity to punish), we also find that reputation can drive behavior that is judged to be morally questionable(as evidenced by the robust influence of reputation on punishment in our ambiguous conditions across Studies 3-4).

Tuesday, April 5, 2022

The Emerging Science of Suicide Prevention

Kim Armstong
PsychologicalScience.org
Originally published 28 FEB 22

The decisions leading up to a person’s death by suicide are made under conditions unlike almost any other. Although we may spend weeks or even months considering whether to purchase a home, change jobs, or get married, the decision to attempt suicide is often made in the spur of the moment amid a crush of emotions, according to Brian W. Bauer and Daniel W. Capron (University of Southern Mississippi). A person may live with suicidal thoughts for years, yet anywhere from 25% to 40% of suicide attempts may take place less than 5 minutes after the individual decides to take their life, Bauer and Capron wrote in a 2020 Perspectives on Psychological Science article. 

These circumstances make people experiencing suicidal ideation uniquely vulnerable to common cognitive biases that can result in irrational decision-making, causing them to act against their own self-interest. We are particularly bad at predicting how our emotional state may change in the future and tend to value short-term relief over long-term outcomes, Bauer and Capron noted. Both of these tendencies can contribute to the decision to end severe psychological pain through suicide despite the strong possibility that those feelings will change given time. 

Nudges could offer some hope to people in crisis. Based in behavioral economics, these microinterventions are designed to push people toward making choices that align with their own self-interest, such as conserving energy or getting vaccinated, by providing easily digestible information about the benefits of those choices (e.g., stickers on washing machines reading “Fuller laundry loads save water”) or even removing barriers to making those choices (e.g., offering walk-in vaccinations instead of requiring appointments). 

Nudges have been used in mental health contexts to help people cut back on their drinking and enroll in treatment programs. In the case of suicide prevention, pre-crisis interventions can occur at several levels, Bauer said in an interview with the Observer.  

Public safety campaigns, for example, might advise gun owners to store their firearms and ammunition separately, creating a barrier to impulsive self-harm, and encourage them to save the number for a local crisis hotline in their phone. In clinical care settings, reframing education on coping skills as a way to assist peers, rather than oneself, may increase patients’ willingness to complete safety plans and participate in suicide prevention workshops. And for individual patients, smartphones may offer an avenue for effective “just-in-time” interventions. 

Unfortunately, no nudge is a one-size-fits-all solution, Bauer said. 

Monday, April 4, 2022

Pushed to Their Limits, 1 in 5 Physicians Intends to Leave Practice

Abbasi J.
JAMA. Published online March 30, 2022.
doi:10.1001/jama.2022.5074

Here is an excerpt:

Worsening staffing issues are now the biggest stressor for clinicians. Health care worker shortages, especially in rural and otherwise underserved areas of the country, have reached critical and unsustainable levels, according to the National Institute for Occupational Safety and Health (NIOSH).

“The evidence shows that health workers have been leaving the workforce at an alarming rate over the past 2 years,” Thomas R. Cunningham, PhD, a senior behavioral scientist at NIOSH, wrote in a statement emailed to JAMA.

In the absence of national data, Etz says the Green Center data point to a meaningful reduction in the primary care workforce during the pandemic. In the February 2022 survey, 62% of 847 clinicians had personal knowledge of other primary care clinicians who retired early or quit during the pandemic and 29% knew of practices that had closed up shop. That’s on top of a preexisting shortage of general and family medicine physicians. “I think we have a platform that is collapsed, and we haven’t recognized it yet,” Etz said.

In fact, surveys indicate that a “great clinician resignation” lies ahead. A quarter of clinicians said they planned to leave primary care within 3 years in Etz’s February survey. The Coping With COVID study predicts a more widespread clinician exodus: in the pandemic’s first year, 23.8% of the more than 9000 physicians from various disciplines in the study and 40% of 2301 nurses planned to exit their practice in the next 2 years. (The Coping With COVID study was funded by the American Medical Association, the publisher of JAMA.)

A lesson that’s been underscored during the pandemic is that physician wellness has a lot to do with other health workers’ satisfaction. “The ‘great resignation’ is affecting a lot of our staff, who don’t feel necessarily cared for by their organizations,” Linzer said. “The staff are leaving, which leaves the physicians to do more nonphysician work. So really, in order to solve this, we need to pay attention to all of our health care workers.”

Nurses who said they intended to leave their positions within 6 months cited 3 main drivers in an American Nurses Foundation survey: work negatively affecting their health and well-being, insufficient staffing, and a lack of employer support during the pandemic.

“Health care is a team sport,” L. Casey Chosewood, MD, MPH, director of the NIOSH Office for Total Worker Health, wrote in the agency’s emailed statement. “When nurses and other support personnel are under tremendous strain or not able to perform at optimal levels, or when staffing is inadequate, the impact flows both upstream to physicians who then face a heavier workload and loss of efficiency, and downstream impacting patient care and treatment outcomes.”

Sunday, April 3, 2022

Enhanced Interplay of Neuronal Coherence and Coupling in the Dying Human Brain

R. Vicente, M. Rizzuto, et al. 
Front. Aging Neurosci., 22 February 2022

Abstract

The neurophysiological footprint of brain activity after cardiac arrest and during near-death experience (NDE) is not well understood. Although a hypoactive state of brain activity has been assumed, experimental animal studies have shown increased activity after cardiac arrest, particularly in the gamma-band, resulting from hypercapnia prior to and cessation of cerebral blood flow after cardiac arrest. No study has yet investigated this matter in humans. Here, we present continuous electroencephalography (EEG) recording from a dying human brain, obtained from an 87-year-old patient undergoing cardiac arrest after traumatic subdural hematoma. An increase of absolute power in gamma activity in the narrow and broad bands and a decrease in theta power is seen after suppression of bilateral hemispheric responses. After cardiac arrest, delta, beta, alpha and gamma power were decreased but a higher percentage of relative gamma power was observed when compared to the interictal interval. Cross-frequency coupling revealed modulation of left-hemispheric gamma activity by alpha and theta rhythms across all windows, even after cessation of cerebral blood flow. The strongest coupling is observed for narrow- and broad-band gamma activity by the alpha waves during left-sided suppression and after cardiac arrest. Albeit the influence of neuronal injury and swelling, our data provide the first evidence from the dying human brain in a non-experimental, real-life acute care clinical setting and advocate that the human brain may possess the capability to generate coordinated activity during the near-death period.


From the Discussion

The findings we report here are similar to the alterations in neuronal activity that have been observed in rodents, where an increase of low gamma band frequencies was observed 10–30 s after cardiac arrest (Borjigin et al., 2013). Our data reveals enhanced relative gamma power compared to other bands along with a decrease in theta. An interesting difference between the two studies can be observed when comparing phase-amplitude coupling (cross-frequency coupling): Post cardiac arrest, delta, theta, and alpha modulate low gamma activity in the rodent (Borjigin et al., 2013), whereas in the human brain, such modulation occurs in all gamma bands and is mostly mediated by alpha waves, to a lesser degree by theta rhythms. The alpha band is thought to critically interfere in cognitive processes by inhibiting networks that are irrelevant or disruptive (Klimesch, 2012). Given that cross-coupling between alpha and gamma activity is involved in cognitive processes and memory recall in healthy subjects, it is intriguing to speculate that such activity could support a last “recall of life” that may take place in the near-death state. Unlike previous reports, our study is the first to use full EEG placement, which allows a more complete neurophysiological analysis in a larger dimension. Further, the data was obtained from an acutely deteriorating patient. Previous human reports were limited to frontal cortex EEG signals that were analyzed by neuromonitoring devices, which may have captured artifacts and the focus was set on critically ill patients in chronic settings (Chawla et al., 2009, 2017). In line with our findings, electrical surges were also reported in these studies after cessation of blood circulation.

Saturday, April 2, 2022

Race and reactions to women's expressions of anger at work: Examining the effects of the "angry Black woman" stereotype

Motro, D., Evans, J. B., Ellis, A., & Benson, L. 
(2022). The Journal of applied psychology, 
107(1), 142–152.
https://doi.org/10.1037/apl0000884

Abstract

Across two studies (n = 555), we examine the detrimental effects of the "angry black woman" stereotype in the workplace. Drawing on parallel-constraint-satisfaction theory, we argue that observers will be particularly sensitive to expressions of anger by black women due to widely held stereotypes. In Study 1, we examine a three-way interaction among anger, race, and gender, and find that observers are more likely to make internal attributions for expressions of anger when an individual is a black woman, which then leads to worse performance evaluations and assessments of leadership capability. In Study 2, we focus solely on women and expand our initial model by examining stereotype activation as a mechanism linking the effects of anger and race on internal attributions. We replicated findings from Study 1 and found support for stereotype activation as an underlying mechanism. We believe our work contributes to research on race, gender, and leadership, and highlights an overlooked stereotype in the management literature. Theoretical and practical implications are discussed.

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Conclusion 

Black employees have to overcome a myriad of hurdles at work based on the color of their skin. For black women, our research indicates that there may be additional considerations when identifying biases at work. Anger is an emotion that employees may display in a variety of contexts, often stemming from a
perceived injustice. Bolstered by cultural reinforcement, our studies suggest that the angry black woman stereotype can affect how individuals view displays of anger at work. The angry black woman stereotype represents another hurdle for black women, and we urge future research to expand upon our understanding of the effects of perceptions on black women at work.

Friday, April 1, 2022

Implementing The 988 Hotline: A Critical Window To Decriminalize Mental Health

P. Krass, E. Dalton, M. Candon, S. Doupnik
Health Affairs
Originally posted 25 FEB 22

Here is an excerpt:

Decriminalization Of Mental Health

The 988 hotline holds incredible promise toward decriminalizing the response to mental health emergencies. Currently, if an individual is experiencing a mental health crisis, they, their caregivers, and bystanders have few options beyond calling 911. As a result, roughly one in 10 individuals with mental health disorders have interacted with law enforcement prior to receiving psychiatric care, and 10 percent of police calls are for mental health emergencies. When police arrive, if they determine an acute safety risk, they transport the individual in crisis for further psychiatric assessment, most commonly at a medical emergency department. This almost always takes place in a police vehicle, many times in handcuffs, a scenario that contradicts central tenets of trauma-informed mental health care. In the worst-case scenario, confrontation with police results in injury or death. Adverse outcomes during response to mental health emergencies are more than 10-fold more likely for individuals with mental health conditions than for individuals without, and are disproportionately experienced by people of color. This consequence was tragically highlighted by the death of Walter Wallace, Jr., who was killed by police while experiencing a mental health emergency in October 2021.

Ideally, the new 988 number would activate an entirely different cascade of events. An individual in crisis, their family member, or even a bystander will be able to immediately reach a trained crisis counselor who can provide phone-based triage, support, and local resources. If needed, the counselor can activate a mobile mental health crisis team that will arrive on site to de-escalate; provide brief therapeutic interventions; either refer for close outpatient follow up or transport the individual for further psychiatric evaluation; and even offer food, drink, and hygiene supplies.
 
Rather than forcing families to call 911 for any type of help—regardless of criminal activity—the 988 line will allow individuals to access mental health crisis support without involving law enforcement. This approach can empower families to self-advocate for the right level of mental health care—including avoiding unnecessary medical emergency department visits, which are not typically designed to handle mental health crises and can further traumatize individuals and their families—and to initiate psychiatric assessment and treatment sooner. 911 dispatchers will also be able to re-route calls to 988 when appropriate, allowing law enforcement personnel to spend more time on their primary role of ensuring public safety. Finally, the 988 number will help offer a middle option for individuals who need rapid linkage to care, including rapid psychiatric evaluation and initiation of treatment, but do not yet meet criteria for crisis. This is a crucial service given current difficulties in accessing timely, in-network outpatient mental health care.

Thursday, March 31, 2022

Democrats push for Supreme Court ethics code following Ginni Thomas revelations

Lauren Fedor 
The Financial Times
Originally published 29 MAR 22

Senior Democratic lawmakers are increasing calls to create a code of ethical conduct for the US Supreme Court amid mounting scrutiny of associate justice Clarence Thomas and his wife, Virginia “Ginni” Thomas.

Chris Murphy and Amy Klobuchar, Democratic senators from Connecticut and Minnesota, respectively, and Hank Johnson, a Democratic representative from Georgia, have made a renewed push for the Supreme Court Ethics Act, a piece of legislation first introduced last summer to create a code of ethical conduct for America’s highest court.

Unlike other federal judges, Supreme Court justices are not required to follow the existing code of conduct.

The lawmakers said in a joint statement on Tuesday: “Recent revelations regarding the political activities of Supreme Court justices and their spouses have increased scrutiny of the court and eroded public confidence in the institution.”

The Washington Post first reported last week the existence of almost 30 text messages exchanged between Ginni Thomas, a conservative activist, and Mark Meadows, the former Republican congressman who served as Donald Trump’s final chief of staff, in late 2020 and early 2021.

The texts showed Ginni Thomas repeatedly espousing conspiracy theories and pushing Meadows to overturn the results of the 2020 presidential election.

The publication of the messages has raised fresh questions about the independence of the federal judiciary and led several Democratic lawmakers to call for Thomas to recuse himself from cases relating to the 2020 election and the January 6 2021 attack on the US Capitol. Earlier this month, Ginni Thomas revealed in an interview that she had attended the “Stop the Steal” rally on January 6.


Editor's Note: As a professional organization and highest court in the land, why does the Supreme Court not have a code of ethics?  More than slightly disturbing.

Wednesday, March 30, 2022

When Good People Break Bad: Moral Impression Violations in Everyday Life

Guan, K. W., & Heine, S. J. (2022).
Social Psychological and Personality Science. 
https://doi.org/10.1177/19485506221076685

Abstract

The present research investigated the emotional, interpersonal, and impression-updating consequences of witnessing events that violate the moral character impressions people hold of others. Across three studies, moral character-violations predicted broad disruptions to participants’ sense of meaning, confidence judging moral character, and expectations of others’ moral characters. Participants who were in real life closer to perpetrators, directly victimized, and higher in preferences for closure and behavioral stability reported more negative outcomes. Moreover, experimental manipulations showed that character-violations lead to worse outcomes than the comparable experience of encountering consistently immoral others. The authors discuss implications for research on moral perception and meaning, as well as on understanding responses to everyday revelations about people’s characters.

From the General Discussion

Moral character-violations appear frequently in the media and occasionally in everyday life. The present research provides an explanation of how these experiences affect perceivers, grounded in the meaning maintenance model (Heine et al., 2006) and social perception literature (Goodwin et al., 2014). Across all three studies, good-to-bad character-violations were associated with disruptions in perceivers’ sense that they understand the world, their confidence judging character, and their impressions of people’s morality in general. In other words, the psychological impact is not restricted to people’s views of specific character-violated targets, but spills over to color how people view other people more generally. Studies 1 and 2 also illuminated the types of moral character-violations people tend to encounter in everyday life, exploring additional situational and dispositional factors that predict stronger feelings of loss of meaning. Study 3 found causal evidence for these effects.

Our findings speak to general experiences, but a few key variables powerfully predict recalled outcomes. Directly victimized targets, and those with higher preferences for closure and personality stability reported greater disruptions in meaning. These findings line up with past evidence that being directly betrayed or transgressed upon leads to strong negative emotions (Adams & Inesi, 2016; Hutcherson & Gross, 2011), and having higher dispositional needs for stability and closure predicts more negative reactions to meaning-violations (e.g., Doherty, 1998).

Tuesday, March 29, 2022

Gene editing gets safer thanks to redesigned Cas9 protein

Science Daily
Originally posted 2 MAR 22

Summary:

Scientists have redesigned a key component of a widely used CRISPR-based gene-editing tool, called Cas9, to be thousands of times less likely to target the wrong stretch of DNA while remaining just as efficient as the original version, making it potentially much safer.

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Scientists have redesigned a key component of a widely used CRISPR-based gene-editing tool, called Cas9, to be thousands of times less likely to target the wrong stretch of DNA while remaining just as efficient as the original version, making it potentially much safer.

One of the grand challenges with using CRISPR-based gene editing on humans is that the molecular machinery sometimes makes changes to the wrong section of a host's genome, creating the possibility that an attempt to repair a genetic mutation in one spot in the genome could accidentally create a dangerous new mutation in another.

But now, scientists at The University of Texas at Austin have redesigned a key component of a widely used CRISPR-based gene-editing tool, called Cas9, to be thousands of times less likely to target the wrong stretch of DNA while remaining just as efficient as the original version, making it potentially much safer. The work is described in a paper published today in the journal Nature.

"This really could be a game changer in terms of a wider application of the CRISPR Cas systems in gene editing," said Kenneth Johnson, a professor of molecular biosciences and co-senior author of the study with David Taylor, an assistant professor of molecular biosciences. The paper's co-first authors are postdoctoral fellows Jack Bravo and Mu-Sen Liu.


Journal Reference:

Jack P. K. Bravo, Mu-Sen Liu, et al. Structural basis for mismatch surveillance by CRISPR–Cas9. Nature, 2022; DOI: 10.1038/s41586-022-04470-1