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

Saturday, April 9, 2022

Deciding to be authentic: Intuition is favored over deliberation when authenticity matters

K. Oktar & T. Lombrozo
Cognition
Volume 223, June 2022, 105021

Abstract

Deliberative analysis enables us to weigh features, simulate futures, and arrive at good, tractable decisions. So why do we so often eschew deliberation, and instead rely on more intuitive, gut responses? We propose that intuition might be prescribed for some decisions because people's folk theory of decision-making accords a special role to authenticity, which is associated with intuitive choice. Five pre-registered experiments find evidence in favor of this claim. In Experiment 1 (N = 654), we show that participants prescribe intuition and deliberation as a basis for decisions differentially across domains, and that these prescriptions predict reported choice. In Experiment 2 (N = 555), we find that choosing intuitively vs. deliberately leads to different inferences concerning the decision-maker's commitment and authenticity—with only inferences about the decision-maker's authenticity showing variation across domains that matches that observed for the prescription of intuition in Experiment 1. In Experiment 3 (N = 631), we replicate our prior results and rule out plausible confounds. Finally, in Experiment 4 (N = 177) and Experiment 5 (N = 526), we find that an experimental manipulation of the importance of authenticity affects the prescribed role for intuition as well as the endorsement of expert human or algorithmic advice. These effects hold beyond previously recognized influences on intuitive vs. deliberative choice, such as computational costs, presumed reliability, objectivity, complexity, and expertise.

From the Discussion section

Our theory and results are broadly consistent with prior work on cross-domain variation in processing preferences (e.g., Inbar et al., 2010), as well as work showing that people draw social inferences from intuitive decisions (e.g., Tetlock, 2003). However, we bridge and extend these literatures by relating inferences made on the basis of an individual's decision to cross-domain variation in the prescribed roles of intuition and deliberation. Importantly, our work is unique in showing that neither judgments about how decisions ought to be made, nor inferences from decisions, are fully reducible to considerations of differential processing costs or the reliability of a given process for the case at hand. Our stimuli—unlike those used in prior work (e.g., Inbar et al., 2010; Pachur & Spaar, 2015)—involved deliberation costs that had already been incurred at the time of decision, yet participants nevertheless displayed substantial and systematic cross-domain variation in their inferences, processing judgments, and eventual decisions. Most dramatically, our matched-information scenarios in Experiment 3 ensured that effects were driven by decision basis alone. In addition to excluding the computational costs of deliberation and matching the decision to deliberate, these scenarios also matched the evidence available concerning the quality of each choice. Nonetheless, decisions that were based on intuition vs. deliberation were judged differently along a number of dimensions, including their authenticity.

Friday, April 8, 2022

What predicts suicidality among psychologists? An examination of risk and resilience

S. Zuckerman, O. R. Lightsey Jr. & J. White
Death Studies (2022)
DOI: 10.1080/07481187.2022.2042753

Abstract

Psychologists may have a uniquely high risk for suicide. We examined whether, among 172 psychologists, factors predicting suicide risk among the general population (e.g., gender and mental illness), occupational factors (e.g., burnout and secondary traumatic stress), and past trauma predicted suicidality. We also tested whether resilience and meaning in life were negatively related to suicidality and whether resilience buffered relationships between risk factors and suicidality. Family history of mental illness, number of traumas, and lifetime depression/anxiety predicted higher suicidality, whereas resilience predicted lower suicidality. At higher levels of resilience, the relationship between family history of suicide and suicidality was stronger.

From the Discussion section:

Contrary to hypotheses, however, resilience did not consistently buffer the relationship between vulnerability factors and suicidality. Indeed, resilience appeared to strengthen the relationships between having a family history of suicide and suicidality. It is plausible that psychologists may overestimate their resilience or believe that they “should” be resilient given their training or their helping role (paralleling burnout-related themes identified in the culture of medicine, “show no weakness” and “patients come first;” see Williams et al., 2020, p. 820). Similarly, persons who believe that they are generally resilient may be demoralized by their inability to prevent family history of suicide from negatively affecting them, and this demoralization may result in family history of suicide being a particularly strong predictor among these individuals. Alternatively, this result could stem from the BRS, which may not measure components of resilience that protect against suicidality, or it could be an artifact of small sample size and low power for detecting moderation (Frazier et al., 2004). Of course, interaction terms are symmetric, and the resilience x family history of suicide interaction can also be interpreted to mean that family history of suicide strengthens the relationship between resilience and suicidality: When there is a family history of suicide, resilience has a positive relationship with suicidality whereas, when there is no family history of suicide, resilience has a negative relationship with suicidality.

Thursday, April 7, 2022

How to Prevent Robotic Sociopaths: A Neuroscience Approach to Artificial Ethics

Christov-Moore, L., Reggente, N.,  et al.
https://doi.org/10.31234/osf.io/6tn42

Abstract

Artificial intelligence (AI) is expanding into every niche of human life, organizing our activity, expanding our agency and interacting with us to an increasing extent. At the same time, AI’s efficiency, complexity and refinement are growing quickly. Justifiably, there is increasing concern with the immediate problem of engineering AI that is aligned with human interests.

Computational approaches to the alignment problem attempt to design AI systems to parameterize human values like harm and flourishing, and avoid overly drastic solutions, even if these are seemingly optimal. In parallel, ongoing work in service AI (caregiving, consumer care, etc.) is concerned with developing artificial empathy, teaching AI’s to decode human feelings and behavior, and evince appropriate, empathetic responses. This could be equated to cognitive empathy in humans.

We propose that in the absence of affective empathy (which allows us to share in the states of others), existing approaches to artificial empathy may fail to produce the caring, prosocial component of empathy, potentially resulting in superintelligent, sociopath-like AI. We adopt the colloquial usage of “sociopath” to signify an intelligence possessing cognitive empathy (i.e., the ability to infer and model the internal states of others), but crucially lacking harm aversion and empathic concern arising from vulnerability, embodiment, and affective empathy (which permits for shared experience). An expanding, ubiquitous intelligence that does not have a means to care about us poses a species-level risk.

It is widely acknowledged that harm aversion is a foundation of moral behavior. However, harm aversion is itself predicated on the experience of harm, within the context of the preservation of physical integrity. Following from this, we argue that a “top-down” rule-based approach to achieving caring, aligned AI may be unable to anticipate and adapt to the inevitable novel moral/logistical dilemmas faced by an expanding AI. It may be more effective to cultivate prosociality from the bottom up, baked into an embodied, vulnerable artificial intelligence with an incentive to preserve its real or simulated physical integrity. This may be achieved via optimization for incentives and contingencies inspired by the development of empathic concern in vivo. We outline the broad prerequisites of this approach and review ongoing work that is consistent with our rationale.

If successful, work of this kind could allow for AI that surpasses empathic fatigue and the idiosyncrasies, biases, and computational limits of human empathy. The scaleable complexity of AI may allow it unprecedented capability to deal proportionately and compassionately with complex, large-scale ethical dilemmas. By addressing this problem seriously in the early stages of AI’s integration with society, we might eventually produce an AI that plans and behaves with an ingrained regard for the welfare of others, aided by the scalable cognitive complexity necessary to model and solve extraordinary problems.

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.