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

Tuesday, May 31, 2022

Artificial Intelligence, Humanistic Ethics

John Tasioulas
AI & Society
Spring 2022

Abstract

Ethics is concerned with what it is to live a flourishing life and what it is we morally owe to others. The optimizing mindset prevalent among computer scientists and economists, among other powerful actors, has led to an approach focused on maximizing the fulfillment of human preferences, an approach that has acquired considerable influence in the ethics of AI. But this preference-based utilitarianism is open to serious objections. This essay sketches an alternative, “humanistic” ethics for AI that is sensitive to aspects of human engagement with the ethical often missed by the dominant approach. Three elements of this humanistic approach are outlined: its commitment to a plurality of values, its stress on the importance of the procedures we adopt, not just the outcomes they yield, and the centrality it accords to individual and collective participation in our understanding of human well-being and morality. The essay concludes with thoughts on how the prospect of artificial general intelligence bears on this humanistic outlook.

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I have mainly focused on narrow AI, conceived as AI-powered technology that can perform limited tasks (such as facial recognition or medical diagnosis) that typically require intelligence when performed by humans. This is partly because serious doubt surrounds the likelihood of artificial general intelligence emerging within any realistically foreseeable time frame, partly because the operative notion of “intelligence” in discussions of AGI (artificial general intelligence) is problematic, and partly because a focus on AGI often distracts us from the more immediate questions of narrow AI.

With these caveats in place, however, one can admit that thought experiments about AGI can help bring into focus two questions fundamental to any humanistic ethic: What is the ultimate source of human dignity, understood as the inherent value attaching to each and every human being? And how can we relate human dignity to the value inhering in nonhuman beings? Toward the end of Kazuo Ishiguro’s novel Klara and the Sun, the eponymous narrator, an “Artificial Friend,” speculates that human dignity–the “human heart” that “makes each of us special and individual”–has its source not in something within us, but in the love of others for us. But a threat of circularity looms for this boot-strapping humanism, for how can the love of others endow us with value unless those others already have value? Moreover, if the source of human dignity is contingent on the varying attitudes of others, how can it apply equally to every human being? Are the unloved bereft of the “human heart”?

Monday, May 30, 2022

Free will without consciousness?

L. Mudrik, I. G. Arie, et al.
Trends in Cognitive Sciences
Available online 12 April 2022

Abstract

Findings demonstrating decision-related neural activity preceding volitional actions have dominated the discussion about how science can inform the free will debate. These discussions have largely ignored studies suggesting that decisions might be influenced or biased by various unconscious processes. If these effects are indeed real, do they render subjects’ decisions less free or even unfree? Here, we argue that, while unconscious influences on decision-making do not threaten the existence of free will in general, they provide important information about limitations on freedom in specific circumstances. We demonstrate that aspects of this long-lasting controversy are empirically testable and provide insight into their bearing on degrees of freedom, laying the groundwork for future scientific-philosophical approaches.

Highlights
  • A growing body of literature argues for unconscious effects on decision-making.
  • We review a body of such studies while acknowledging methodological limitations, and categorize the types of unconscious influence reported.
  • These effects intuitively challenge free will, despite being generally overlooked in the free will literature. To what extent can decisions be free if they are affected by unconscious factors?
  • Our analysis suggests that unconscious influences on behavior affect degrees of control or reasons-responsiveness. We argue that they do not threaten the existence of free will in general, but only the degree to which we can be free in specific circumstances.

Concluding remarks

Current findings of unconscious effects on decision-making do not threaten the existence of free will in general. Yet, the results still show ways in which our freedom can be compromised under specific circumstances. More experimental and philosophical work is needed to delineate the limits and scope of these effects on our freedom (see Outstanding questions). We have evolved to be the decision-makers that we are; thus, our decisions are affected by biases, internal states, and external contexts. However, we can at least sometimes resist those, if we want, and this ability to resist influences contrary to our preferences and reasons is considered a central feature of freedom. As long as this ability is preserved, and the reviewed findings do not suggest otherwise, we are still free, at least usually and to a significant degree.

Sunday, May 29, 2022

Unemployment, Behavioral Health, And Suicide

R. Ramchand, L. Ayer, & S. O'Connor
Health Affairs
Originally posted 7 APR 22

Key Points:
  • A large body of research, most of which is ecological, has investigated the relationship between job loss or unemployment rates and mental health, substance use, and suicide.
  • Groups historically experiencing health disparities (for example, Black and Hispanic populations and those without a high school or college degree) have been differently affected by unemployment during the COVID-19 pandemic. Similarly, preliminary evidence from three states suggests that suicide has disproportionately affected Americans who are members of racial and ethnic minority groups over the course of the pandemic.
  • COVID-19 has affected the workforce in unique ways that differentiate the pandemic from previous economic downturns. However, previous research indicates that increases in suicide rates associated with economic downturns were driven by regional variation in unemployment, availability of unemployment benefits, and duration and magnitude of changes in unemployment.
  • Policy mitigation strategies may have offset the potential impact of unemployment fluctuations on suicide rates during the pandemic. Policies include expanded unemployment benefits and food assistance, as well as tax credits and subsidies that reduced child care and health care costs.
  • Research is needed to disentangle which populations experienced the most benefit when these strategies were present and which had the greatest risk when they were discontinued.
  • Evidence-based strategies that expand the mental health workforce and integrate mental health supports into employment and training settings may be promising ways to help workers as they navigate persistent changes to workforce demands.

Suicide In The United States

A recent Health Affairs Health Policy Brief provides an overview of suicide in the United States. In 2019, 47,511 Americans intentionally ended their lives, making suicide the tenth leading cause of death. This is likely an underestimate—in 2019, 75,795 Americans died of poisonings, the majority of which were drug poisonings categorized as unintentional, although some were likely suicide overdoses that were misclassified.

Suicide is a growing national concern despite the fact that the national suicide rate decreased between 2018 and 2019 and again in 2020. This decrease comes after nearly twenty years of the national suicide rate increasing annually, and it was not observed in some minority racial and ethnic groups. In addition, although suicide rates decreased between 2018 and 2020, the drug overdose death rate increased.

Saturday, May 28, 2022

The “Equal-Opportunity Jerk” Defense: Rudeness Can Obfuscate Gender Bias

Belmi, P., Jun, S., & Adams, G. S. (2022). 
Psychological Science, 33(3), 397–411.
https://doi.org/10.1177/09567976211040495

Abstract

To address sexism, people must first recognize it. In this research, we identified a barrier that makes sexism hard to recognize: rudeness toward men. We found that observers judge a sexist perpetrator as less sexist if he is rude toward men. This occurs because rudeness toward men creates the illusion of gender blindness. We documented this phenomenon in five preregistered studies consisting of online adult participants and adult students from professional schools (total N = 4,663). These attributions are problematic because sexism and rudeness are not mutually exclusive. Men who hold sexist beliefs about women can be—and often are—rude toward other men. These attributions also discourage observers from holding perpetrators accountable for gender bias. Thus, rudeness toward men gives sexist perpetrators plausible deniability. It protects them and prevents the first perceptual step necessary to address sexism.

Statement of Relevance

Sexism can be challenging to identify and eventually root out. However, we contend that even blatant forms of sexism are sometimes difficult to recognize. In this research, we demonstrated how rudeness can makes blatant forms of sexism harder to identify. We found that a man does not seem sexist if he treats everyone—both men and women—poorly. This is problematic because sexism and rudeness are not mutually exclusive.  Men who are sexist can be—and often are—rude toward other men. We found that rudeness obscures the recognition of sexism by creating the perception that the sexist perpetrator does not
notice or pay attention to gender when dealing with other people. This misleads observers into thinking that an intervention such as gender-bias training is less necessary. Rudeness can therefore protect sexist perpetrators, making their prejudice harder to recognize and correct.

From the Discussion

It has been noted that overtly discriminatory conduct—characterized by blatant antipathy, antiquated
beliefs about women, and endorsement of pejorative stereotypes—is becoming less common because of
sweeping changes in antidiscrimination laws, practices, and ideologies in the United States (Brief et al., 1997; Dovidio & Gaertner, 1998; Swim et al., 1995). However, blatant, unambiguous, and obvious forms of sexist conduct continue to exist in society (Dovidio & Gaertner, 1998) and within organizations in particular (e.g., Cortina, 2008). Our findings suggest that one reason for their persistence is that observers may not recognize that everyday acts of rudeness can serve as a convenient mask for bias against women (Cortina, 2008). This has an important practical implication: When a sexist manager is rude toward men, it may appear as though he is not sexist. Thus, women victimized by his behavior will have a more difficult time proving that he is sexist. Rudeness can therefore protect perpetrators.

Friday, May 27, 2022

What to Do If Your Job Compromises Your Morals

R. Carucci and L. N. Praslova
Harvard Business Review
Originally posted 29 APR 22

Here are two excerpts:

The emerging scholarship on reconciling the various terms used to describe responses to moral events points toward a continuum of moral harm. Of course, the complexity and variety of moral situations make any classification imperfect. Situations involving committing moral transgressions are more likely to lead to shame and guilt, while being a victim of betrayal is more likely to result in anger or sadness. In addition, there are also individual differences in sensitivity to morally distressing events, which can be determined by both biology and experience. Nevertheless, here is a useful summary:

  • Moral challenges are isolated incidents of relatively low-stakes transgressions. For example, workers might be instructed to use lower-quality materials in creating a product (e.g., substituting a non-organic product when running out of organic). A manager may require an employee to stay late, as a rare exception. This may result in a somewhat distressing but transitory “moral frustration,” with moderate levels of anger or guilt.
  • Moral stressors can lead to more significant moral distress. This may involve more substantial and/or regular moral transgressions — for example, a manager pushing employees to stay late several times every month, or an HR professional administering a morale survey knowing that the results will never be used, just like all the previous surveys. A dental practice may upsell patients on unnecessary, but not harmful treatments. This may result in negative moral emotions that are bothersome and might be lasting, but do not interfere with daily functioning. (However, in some nursing research, the experience referred to as “moral distress” is seen as very intense, possibly meeting the criteria for moral injury).
  • Injurious events are the most egregious. Executives could pressure a manager into manipulating burned-out employees to regularly sacrifice their time off and well being, while the organization intentionally keeps positions open for months. A health care worker might be required to provide medical treatments that are likely to lead to more treatments even though a cure is available. Situations like these could result in a highly distressing moral injury in which negative moral emotions are sufficiently intense and frequent to interfere with daily functioning. In particular, a person may experience intense shame leading to self-isolation or self-harm, or may quit their job in disgust. This level of moral stress response is similar to and at least partially overlaps with post-traumatic stress disorder (PTSD).
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Moral injuries can leave lasting impacts on our psyche, but they don’t have to remain debilitating. Like other trauma and hurt, we can grow from them. We can find the resilience we need to rise above the injury and restore our moral centers. Sometimes we’re able to take the environments along on that journey, and sometimes we have to leave them. Either way, if you’re carrying the weight of moral injury, don’t wait until it overtakes your whole outlook on life, and yourself. Find the courage to face what you’ve experienced and done, and with it, reclaim the values you hold most dear.

Thursday, May 26, 2022

Do You Still Believe in the “Chemical Imbalance Theory of Mental Illness”?

Bruce Levine
counterpunch.org
Originally published 29 APR 22

Here are two excerpts:

If you knew that psychiatric drugs—similar to other psychotropic substances such as marijuana and alcohol—merely “take the edge off” rather than correct a chemical imbalances, would you be more hesitant about using them, and more reluctant to give them to your children? Drug companies certainly believe you would be less inclined if you knew the truth, and that is why we were early on flooded with commercials about how antidepressants “work to correct this imbalance.”

So, when exactly did psychiatry discard its chemical imbalance theory? While researchers began jettisoning it by the 1990s, one of psychiatry’s first loud rejections was in 2011, when psychiatrist Ronald Pies, Editor-in-Chief Emeritus of the Psychiatric Times, stated: “In truth, the ‘chemical imbalance’ notion was always a kind of urban legend—never a theory seriously propounded by well-informed psychiatrists.” Pies is not the highest-ranking psychiatrist to acknowledge the invalidity of the chemical imbalance theory.

Thomas Insel was the NIMH director from 2002 to 2015, and in his recently published book, Healing (2022), he notes, “The idea of mental illness as a ‘chemical imbalance’ has now given way to mental illnesses as ‘connectional’ or brain circuit disorders.” While this latest “brain circuit disorder” theory remains controversial, it is now consensus at the highest levels of psychiatry that the chemical imbalance theory is invalid.

The jettisoning of the chemical imbalance theory should have been uncontroversial twenty-five years ago, when it became clear to research scientists that it was a disproved hypothesis. In Blaming the Brain (1998), Elliot Valenstein, professor emeritus of psychology and neuroscience at the University of Michigan, detailed research showing that it is just as likely for people with normal serotonin levels to feel depressed as it is for people with abnormal serotonin levels, and that it is just as likely for people with abnormally high serotonin levels to feel depressed as it is for people with abnormally low serotonin levels. Valenstein concluded, “Furthermore, there is no convincing evidence that depressed people have a serotonin or norepinephrine deficiency.” But how many Americans heard about this?

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Apparently, authorities at the highest levels have long known that the chemical imbalance theory was a disproven hypothesis, but they have viewed it as a useful “noble lie” to encourage medication use.

If you took SSRI antidepressants believing that these drugs helped correct a chemical imbalance, how does it feel to learn that this theory has long been disproven? Will this affect your trust of current and future claims by psychiatry? Were you prescribed an antidepressant not from a psychiatrist but from your primary care physician, and will this make you anxious about trusting all healthcare authorities?

Wednesday, May 25, 2022

Illusory Feelings, Elusive Habits: People Overlook Habits in Explanations of Behavior

Mazar, A., & Wood, W. (2022).
Psychological science, 33(4), 563–578
https://doi.org/10.1177/09567976211045345

Abstract

Habits underlie much of human behavior. However, people may prefer agentic accounts that overlook habits in favor of inner states, such as mood. We tested this misattribution hypothesis in an online experiment of helping behavior (N = 809 adults) as well as in an ecological momentary assessment (EMA) study of U.S. college students' everyday coffee drinking (N = 112). Both studies revealed a substantial gap between perceived and actual drivers of behavior: Habit strength outperformed or matched inner states in predicting behavior, but participants' explanations of their behavior emphasized inner states. Participants continued to misattribute habits to inner states when incentivized for accuracy and when explaining other people's behavior. We discuss how this misperception could adversely influence self-regulation.

General Discussion

In two studies, participants’ attributions overemphasized inner states and underemphasized habit. Participants’ actual willingness to donate time in a laboratory task as well as their everyday coffee drinking were determined as much or more by habits than by inner states (mood and fatigue, respectively). However, participants’ attributions for why they acted the way they did emphasized inner states more than habit. Thus, participants appear to be both undervaluing habit compared with its actual influence on behavior and overvaluing inner states such as mood and fatigue. This pattern is understandable given the  disproportionate value people place on personal introspections (Pronin, 2009) as well as general information- and motivation-based tendencies to interpret actions as goal-directed (Rosset, 2008). Through these forces, people may form socially-shared lay theories about behavior that inform their attributions. This lure of phenomenology not only biases lay theories but also may have oriented psychological theories to overvalue salient, motivational determinants of behavior (Duckworth et al., 2016).

The combination of experimental manipulation in Study 1 and naturalistic observation in Study 2 provides evidence for the causal role of habits as well as the relevance of this attribution bias in everyday settings. Furthermore, the results replicated across the different measures of habit strength appropriate in these different tasks: Study 1’s manipulation of practice along with a reaction time measure; Study 2’s self-report measures of behavioral repetition in a given context (a determinant of habit formation) and experienced automaticity (a consequence of habit formation); and Study 2’s exploratory within-person, context-specific habit measure tapping participants’ history of repetition in specific situations.  


Editor's note: Important data with direct implications for psychotherapy.

Tuesday, May 24, 2022

Bombshell 400-page report finds Southern Baptist leaders routinely silenced sexual abuse survivors

Robert Downen and John Tedesco
Houston Chronicle
Originally posted 22 MAY 22

For 20 years, leaders of the Southern Baptist Convention — including a former president now accused of sexual assault — routinely silenced and disparaged sexual abuse survivors, ignored calls for policies to stop predators, and dismissed reforms that they privately said could protect children but might cost the SBC money if abuse victims later sued.

Those are just a few findings of a bombshell, third-party investigation into decades of alleged misconduct by Southern Baptist leaders that was released Sunday, nearly a year after 15,000 SBC church delegates demanded their executive committee turn over confidential documents and communications as part of an independent review of abuse reports that were purportedly mishandled or concealed since 2000.

The historic, nearly 400-page report details how a small, insular and influential group of leaders “singularly focused on avoiding liability for the SBC to the exclusion of other considerations” to prevent abuse. The report was published by Guidepost Solutions, an independent firm that conducted 330 interviews and reviewed two decades of internal SBC files in the seven-month investigation.

“Survivors and others who reported abuse were ignored, disbelieved, or met with the constant refrain that the SBC could take no action due to its (structure) — even if it meant that convicted molesters continued in ministry with no notice or warning to their current church or congregation,” Guidepost’s report concluded.

Guidepost investigated the SBC’s 86-member executive committee, the convention’s highest governing entity. The firm’s investigators had unprecedented access to the SBC’s leadership and reviewed thousands of internal documents — including previously confidential communications between SBC lawyers.

The investigation sheds new and unprecedented light on the backroom politicking and deceit that has stymied attempts at reforms and allowed for widespread mistreatment of child sexual abuse victims. And it exhaustively corroborates what many survivors have said for decades: that Southern Baptist leaders downplayed their own abuse crisis and instead prioritized shielding the SBC – and its hundreds of millions of dollars in annual donations — from lawsuits by abuse victims.

Among the findings:

A small group of SBC leaders routinely misled other members of the SBC’s executive committee on abuse issues, and rarely mentioned the frequent and persistent warnings and pleas for help from survivors.
  • Fearing lawsuits, leaders similarly failed to inform the SBC’s 15 million members that predators and pedophiles were targeting churches.
  • Longtime SBC leaders kept a private list of abusive pastors and ministers despite claiming for years that such an idea was impractical for stopping predators and impossible to adopt because of the SBC’s decentralized structure. Compiled since 2007, the roster contained the names of 703 offenders, most with an SBC connection. A few still work at churches in the SBC or other denominations.
  • Former SBC President Johnny Hunt is accused of sexually assaulting a woman weeks after his presidential tenure ended in 2010. The woman said Hunt manipulated her into silence by saying a disclosure of the incident would harm the SBC’s churches. Four other people corroborated much of the woman’s allegations to Guidepost. Hunt denied the allegations, but resigned from the SBC’s North American Mission Board days before the report was published.

Monday, May 23, 2022

Recognizing and Dismantling Raciolinguistic Hierarchies in Latinx Health

Ortega, P., et al.
AMA J Ethics. 2022;24(4):E296-304.
doi: 10.1001/amajethics.2022.296.

Abstract

Latinx individuals represent a linguistically and racially diverse, growing US patient population. Raciolinguistics considers intersections of language and race, prioritizes lived experiences of non-English speakers, and can help clinicians more deftly conceptualize heterogeneity and complexity in Latinx health experiences. This article discusses how raciolinguistic hierarchies (ie, practices of attaching social value to some languages but not others) can undermine the quality of Latinx patients’ health experiences. This article also offers language-appropriate clinical and educational strategies for promoting health equity.

Raciolinguistics

Hispanic/Latinx (hereafter, Latinx) individuals in the United States represent a culturally, racially, and linguistically diverse and rapidly growing population. Attempting to categorize all Latinx individuals in a single homogeneous group may result in inappropriate stereotyping,1 inaccurate counting,2, 3 ineffective health interventions that insufficiently target at-risk subgroups,4 and suboptimal health communication.5 A more helpful approach is to use raciolinguistics to conceptualize the heterogeneous, complex Latinx experience as it relates to health. Raciolinguistics is the study of the historical and contemporary co-naturalization of race and language and their intertwining in the identities of individuals and communities. As an emerging field that grapples with the intersectionality of language and race, raciolinguistics provides a unique perspective on the lived experiences of people who speak non-English languages and people of color.6 As such, understanding raciolinguistics is relevant to providing language-concordant care7 to patients with limited English proficiency (LEP), who have been historically marginalized by structural barriers, racism, and other forms of discrimination in health care.

In this manuscript, we explore how raciolinguistics can help clinicians to appropriately conceptualize the heterogeneous, complex Latinx experience as it relates to health care. We then use the raciolinguistic perspective to inform strategies to dismantle structural barriers to health equity for Latinx patients pertaining to (1) Latinx patients’ health care experiences and (2) medical education.

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Conclusions

A raciolinguistic perspective can inform how health care practices and medical education should be critically examined to support Latinx populations comprising heterogeneous communities and complex individuals with varying and intersecting cultural, social, linguistic, racial, ancestral, spiritual, and other characteristics. Future studies should explore the outcomes of raciolinguistic reforms of health services and educational interventions across the health professions to ensure effectiveness in improving health care for Latinx patients.