Thousands of Medical Professionals Urge Supreme Court To Uphold Roe: ‘Provide Patients With the Treatment They Need’

Phoebe Kolbert

Ms. Magazine

Originally posted 21 JUN 22

Any day now, the Supreme Court will issue its decision in Dobbs v. Jackson Women’s Health Organization, which many predict will overturn or severely gut Roe v. Wade. Since the start of the Dobbs v. Jackson hearings in December, medical professionals have warned of the drastic health impacts brought on by abortion bans. Now, over 2,500 healthcare professionals from all 50 states have signed a letter urging the Supreme Court to scrap their leaked Dobbs draft opinion and uphold Roe.  

Within 30 days of a decision to overturn Roe, at least 26 states will ban abortion. Clinics in remaining pro-abortion states are preparing for increased violence from anti-abortion extremists and an influx of out-of-state patients. The number of legal abortions performed nationwide is projected to fall by about 13 percent. Many abortion clinics in states with bans will be forced to close their doors, if they haven’t already. The loss of these clinics also comes with the loss of the other essential reproductive healthcare they provide, including STI screenings and treatment, birth control and cervical cancer screenings.

The letter, titled “Medical Professionals Urge Supreme Court to Uphold Roe v. Wade, Protect Abortion Access,” argues that decisions around pregnancy and abortion should be made by patients and their doctors, not the courts.

The info from Ms. Magazine is here.

Here is how the letter begins:

Medical Professionals Urge Supreme Court to Uphold Roe v. Wade, Protect Abortion Access

As physicians and health care professionals, we are gravely concerned that the U.S. Supreme Court appears prepared to end the constitutional right to an abortion. We urge the Supreme Court to to scrap their draft opinion, uphold the constitutional right to an abortion, and ensure that abortions remain legal nationwide, as allowed for in Roe v. Wade. In this moment of crisis, we want to make crystal clear the consequences to our patients’ health if they can no longer access abortions.

Abortions are safe, common and a critical part of health care and reproductive medicine. Medical professionals and medical associations agree, including the American Medical Association, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the American College of Nurse Midwives and many others.

Prohibiting access to safe and legal abortion has devastating implications for health care. Striking down Roe v. Wade would affect not just abortion access, but also maternal care as well as fertility treatments. Pregnancy changes a person’s physiology. These changes can potentially worsen existing diseases and medical conditions.

As physicians and medical professionals, we see the real-life consequences when an individual does not get the care that they know they need, including abortions. The woman who has suffered the violation and trauma of rape would be forced to carry a pregnancy.

Denying access to abortion from people who want one can adversely affect their health, safety and economic well-being, including delayed separation from a violent partner and increased likelihood of falling into poverty by four times. These outcomes can also have drastic impacts on their health.

The entire letter is here.

South Carolina bill permits health care providers refuse non-emergency care based on beliefs

Brooke Migdon

The Hill

Originally posted 1 APR 22

Story at a glance

• Legislators in South Carolina on Friday passed a bill which would allow healthcare providers to deny care based on their personal beliefs. It would also apply to insurance companies, which may be entitled to refuse to pay for care.

• The bill would also protect those who decline to provide medical services from civil, criminal or administrative liability.

• Some say the bill, known as the “Medical Ethics and Diversity Act,” would disproportionately affect the LGBTQ+ community, as well as women and people of color.

South Carolina lawmakers on Friday passed a bill allowing medical professionals and insurance companies to deny care based on personal belief. Some say the legislation, which now heads to the state Senate for consideration, would disproportionately impact LGBTQ+ people, women, and people of color.

Under the bill, titled the “Medical Ethics and Diversity Act,” South Carolina law would be altered to excuse medical practitioners, health care institutions and health care payers from providing care that violates their “conscience.” It would also shield those who decline to provide medical services to patients from civil, criminal or administrative liability.

Dozens of state residents in February testified against the bill, calling it vague and overbroad. They also shared concerns that the legislation would disproportionately impact marginalized communities.

In a statement on Friday, Human Rights Campaign Legal Director Sarah Warbelow said she finds it “disturbing” that politicians in South Carolina are prioritizing individual providers’ beliefs over the wellbeing of patients.

“This legislation is dangerously silent in regards to the needs of patients and fails to consider the impact that expanding refusals can have on their health,” she said. “Religious freedom is a fundamental American value that is entirely compatible with providing quality, non-discriminatory healthcare. It is not a license to deprive others of their rights simply because of personal beliefs.”

Warbelow said the bill sends a message to patients with non-medical views inconsistent with that of their doctors that they are “not equal members of society entitled to dignity and respect.”

The info is here.

Editor's Note: Those politicians who pass laws based on culture wars are clearly violating the principle-based ethics on which all medical ethics rely.  If they pass harmful laws that conflict with health care ethics, then they are not fit to serve.

Gina Haspel Observed Waterboarding at CIA Black Site, Psychologist Testifies

Carol Rosenberg and J. E. Barnes

The New York Times

Originally posted 4 JUN 22

During Gina Haspel’s confirmation hearing to become director of the CIA in 2018, Sen. Dianne Feinstein, D-Calif., asked her if she had overseen the interrogations of a Saudi prisoner, Abd al-Rahim al-Nashiri, which included the use of a waterboard.

Haspel declined to answer, saying it was part of her classified career.

While there has been reporting about her oversight of a CIA black site in Thailand where al-Nashiri was waterboarded, and where Haspel wrote or authorized memos about his torture, the precise details of her work as the chief of base, the CIA officer who oversaw the prison, have been shrouded in official secrecy.

But testimony at a hearing last month in Guantánamo Bay, Cuba, included a revelation about the former CIA director’s long and secretive career. James E. Mitchell, a psychologist who helped develop the agency’s interrogation program, testified that the chief of base at the time, whom he referred to as Z9A in accordance with court rules, watched while he and a teammate subjected al-Nashiri to “enhanced interrogation” that included waterboarding at the black site.

Z9A is the code name used in court for Haspel.

The CIA has never acknowledged Haspel’s work at the black site, and the use of the code name represented the court’s acceptance of an agency policy of not acknowledging state secrets — even those that have already been spilled. Former officials long ago revealed that she ran the black site in Thailand from October 2002 until December 2002, during the time al-Nashiri was being tortured, which Mitchell described in his testimony.

Guantánamo Bay is one of the few places where America is still wrestling with the legacy of torture in the aftermath of the Sept. 11, 2001, attacks. Torture has loomed over the pretrial phase of the death penalty cases for years and is likely to continue to do so as hearings resume over the summer.

The info is here.

The Christian Right is violating the First Amendment by banning abortion

Noah Berlatsky

NBC News Cultural Critic

Originally published 18 JUN 22

The anti-abortion rights movement is largely faith based. Catholics and evangelical Christians argue that life begins at conception, and that fetuses have souls. On those grounds, they want to prevent anyone from obtaining abortion services.

They’ve had a good deal of success with that recently. A leaked Supreme Court draft opinion suggests the high court is set to overturn Roe v. Wade, effectively gutting the constitutional right to abortion. In anticipation, many conservative states have passed sweeping anti-abortion legislation.

But not everyone is Christian. And imposing Christian morality and Christian dogma on non-Christians is a good working definition of religious tyranny — which the First Amendment of the Constitution explicitly rejects. 

That principle of religious freedom is the basis of a lawsuit brought by Congregation L’Dor Va-Dor, a synagogue in Boynton Beach, Florida, against a sweeping state abortion ban set to take effect on July 1. Congregation L’Dor Va-Dor is challenging a single law on behalf of a single religion. But the case is also a broader challenge to the anti-abortion rights movement, which conflates a right-wing Christian demand for forced birth with universal morality, and insists on subjugating the country to a sectarian code.

The new Florida law bans most abortions after 15 weeks. There are no exceptions for cases of incest, rape or human trafficking. It does allow an abortion to save a pregnant person’s life or to prevent serious physical injury. But these exceptions aren’t enough to keep the law from violating the free exercise of the Jewish faith. The congregation’s lawsuit states that the Florida law violates Jewish religious beliefs holding that abortion “is required if necessary to protect the health, mental or physical well-being of the woman,” among other reasons.

The info is here.

Anti-Black Racism as a Chronic Condition

Nneka Sederstrom and Tamika Lasege, 

In A Critical Moment in Bioethics: Reckoning 

with Anti-Black Racism through Intergenerational 

Dialogue,  ed.  Faith  E.  Fletcher  et  al., 

Special  Report, Hastings Center Report 52, no. 2 

(2022):  S24-S29.

Abstract

Because America has a foundation of anti-Black racism, being born Black in this nation yields an identity that breeds the consequences of a chronic condition. This article highlights several ways in which medicine and clinical ethics, despite the former's emphasis on doing no harm and the latter's emphasis on nonmaleficence, fail to address or acknowledge some of the key ways in which physicians can—and do—harm patients of color. To understand harm in a way that can provide real substance for ethical standards in the practice of medicine, physicians need to think about how treatment decisions are constrained by a patient's race. The color of one's skin can and does negatively affect the quality of a person's diagnosis, promoted care plan, and prognosis. Yet racism in medicine and bioethics persist—because a racist system serves the interests of the dominant caste, White people. As correctives to this system, the authors propose several antiracist commitments physicians or ethicists can make.

(cut)

Here are some commitments to add to a newly revised Hippocratic oath: We shall stop denying that racism exists in medicine. We shall face the reality that we fail to train and equip our clinicians with the ability to effectively make informed clinical decisions using the reality of how race impacts health outcomes. We shall address the lack of the declaration of racism as a bioethics priority and work to train ethicists on how to engage in antiracism work. We shall own the effects of racism at every level in health care and the academy. Attempting to talk about everything except racism is another form of denial, privilege, and power that sustains racism. We will not have conversations about disproportionally high rates of “minority” housing insecurity, food scarcity, noncompliance with treatment plans, “drug-seeking behavior,” complex social needs, or “disruptive behavior” or rely on any other terms that are disguised proxies for racism without explicitly naming racism. As ethicists, we will not engage in conversations around goal setting, value judgments, benefits and risks of interventions, autonomy and capacity, or any other elements around the care of patients without naming racism.

So where do we go from here? How do we address the need to decolonize medicine and bioethics? When do we stop being inactive and start being proactive? It starts upstream with improving the medical education and bioethics curricula to accurately and thoroughly inform students on the social and biological sciences of human beings who are not White in America. Then, and only then, will we breed a generation of race-conscious clinicians and ethicists who can understand and interpret the historic inequities in our system and ultimately be capable of providing medical care and ethical analysis that reflect the diversity of our country. Clinical ethics program development must include antiracism training to develop clinical ethicists who have the skills to recognize and address racism at the bedside in clinical ethics consultation. It requires changing the faces in the field and addressing the extreme lack of racial diversity in bioethics. Increasing the number of clinicians of color in all professions within medicine, but especially the numbers of physicians, advance practice providers, and clinical ethicists, is imperative to the goal of improving patient outcomes for Black and brown populations.

The info is here.

If you rise, I fall: Equality is prevented by the misperception that it harms advantaged groups

Brown, N. D., Jacoby-Senghor, D. S., 

& Raymundo, I. (2022). 

Science advances, 8(18)

https://doi.org/10.1126/sciadv.abm2385

Abstract

Nine preregistered studies (n = 4197) demonstrate that advantaged group members misperceive equality as necessarily harming their access to resources and inequality as necessarily benefitting them. Only when equality is increased within their ingroup, instead of between groups, do advantaged group members accurately perceive it as unharmful. Misperceptions persist when equality-enhancing policies offer broad benefits to society or when resources, and resource access, are unlimited. A longitudinal survey of the 2020 U.S. voters reveals that harm perceptions predict voting against actual equality-enhancing policies, more so than voters’ political and egalitarian beliefs. Finally two novel-groups experiments experiments reveal that advantaged participants’ harm misperceptions predict voting for inequality-enhancing policies that financially hurt them and against equality-enhancing policies that financially benefit them. Misperceptions persist even after an intervention to improve decision-making. This misperception that equality is necessarily zero-sum may explain why inequality prevails even as it incurs societal costs that harm everyone.

From the Discussion Section

Across nine studies, we show that advantaged group members misperceive equality-enhancing policies as harming their access to resources, even when the policies do no such thing. We identify this misperception across various inequality contexts (e.g., mortgage lending, salary, and hiring), various group boundaries (e.g., race, gender, disability, and arbitrary group distinctions), and different types of resources (e.g., money and jobs). Advantaged group members also misperceive policies that maintain the status quo or magnify inequality as improving their resource access, even when the policies actually leave them no better off. This tendency for advantaged group members to think that equality necessarily incurs a cost to their group lingered even when equality-enhancing policies mutually benefited disadvantaged and advantaged groups in a win-win fashion. That is, advantaged group members misperceive having greater inequality and fewer resources available to their group as more advantageous than having greater overall resources that were shared more equally.

We also find that these harm perceptions can have profound implications for individuals’ attitudinal and behavioral opposition to policies that promote equality. During the 2020 election, California Proposition 16 proposed relegalizing the use of affirmative action policies in the public sector. We find that the more white and Asian voters perceived that California Proposition 16 would harm their access to resources, the less likely they were to express support or vote for Proposition 16, independent of their political leaning. Moreover, we find that behavioral opposition occurs even when harm perceptions are objectively false and the effects of equality-enhancing policies are unambiguously positive. In an experimental setting, advantaged group participants were just as likely to vote for an inequality-enhancing policy that financially harmed them as they were to vote for an equality-enhancing policy that financially benefitted them. These studies suggest that real-world opposition to equality is likely caused by unduly negative perceptions of policies that could reduce inequality and unduly positive perceptions of policies that exacerbate it.

The research is here.

Capable but Amoral? Comparing AI and Human Expert Collaboration in Ethical Decision Making

S. Tolmeijer, M. Christen, et al.

In CHI Conference on Human Factors in 

Computing Systems (CHI '22), April 29-May 5,

2022, New Orleans, LA, USA. ACM

While artificial intelligence (AI) is increasingly applied for decision-making processes, ethical decisions pose challenges for AI applications. Given that humans cannot always agree on the right thing to do, how would ethical decision-making by AI systems be perceived and how would responsibility be ascribed in human-AI collaboration? In this study, we investigate how the expert type (human vs. AI) and level of expert autonomy (adviser vs. decider) influence trust, perceived responsibility, and reliance. We find that participants consider humans to be more morally trustworthy but less capable than their AI equivalent. This shows in participants’ reliance on AI: AI recommendations and decisions are accepted more often than the human expert's. However, AI team experts are perceived to be less responsible than humans, while programmers and sellers of AI systems are deemed partially responsible instead.

From the Discussion Section

Design implications for ethical AI

In sum, we find that participants had slightly higher moral trust and more responsibility ascription towards human experts, but higher capacity trust, overall trust, and reliance on AI. These different perceived capabilities could be combined in some form of human-AI collaboration. However, lack of responsibility of the AI can be a problem when AI for ethical decision making is implemented. When a human expert is involved but has less autonomy, they risk becoming a scapegoat for the decisions that the AI proposed in case of negative outcomes.

At the same time, we find that the different levels of autonomy, i.e., the human-in-the-loop and human-on-the-loop setting, did not influence the trust people had, the responsibility they assigned (both to themselves and the respective experts), and the reliance they displayed. A large part of the discussion on usage of AI has focused on control and the level of autonomy that the AI gets for different tasks. However, our results suggest that this has less of an influence, as long a human is appointed to be responsible in the end. Instead, an important focus of designing AI for ethical decision making should be on the different types of trust users show for a human vs. AI expert.

One conclusion of this finding that the control conditions of AI may be of less relevance than expected is that the focus on human-AI collaboration should be less on control and more on how the involvement of AI improves human ethical decision making. An important factor in that respect will be the time available for actual decision making: if time is short, AI advice or decisions should make clear which value was guiding in the decision process (e.g., maximizing the expected number of people to be saved irrespective of any characteristics of the individuals involved), such that the human decider can make (or evaluate) the decision in an ethically informed way. If time for deliberation is available, a AI decision support system could be designed in a way to counteract human biases in ethical decision making (e.g., point to the possibility that human deciders solely focus on utility maximization and in this way neglecting fundamental rights of individuals) such that those biases can become part of the deliberation process.

The research is here.

Record-High 50% of Americans Rate U.S. Moral Values as 'Poor'

Megan Brenan & Nicole Willcoxon

www.gallup.com

Originally posted 15 June 22

Story Highlights

• 50% say state of moral values is "poor"; 37% "only fair"
• 78% think moral values in the U.S. are getting worse
• "Consideration of others" cited as top problem with state of moral values

A record-high 50% of Americans rate the overall state of moral values in the U.S. as "poor," and another 37% say it is "only fair." Just 1% think the state of moral values is "excellent" and 12% "good."

Although negative views of the nation's moral values have been the norm throughout Gallup's 20-year trend, the current poor rating is the highest on record by one percentage point.

These findings, from Gallup's May 2-22 Values and Beliefs poll, are generally in line with perceptions since 2017 except for a slight improvement in views in 2020 when Donald Trump was running for reelection. On average since 2002, 43% of U.S. adults have rated moral values in the U.S. as poor, 38% as fair and 18% as excellent or good.

Republicans' increasingly negative assessment of the state of moral values is largely responsible for the record-high overall poor rating. At 72%, Republicans' poor rating of moral values is at its highest point since the inception of the trend and up sharply since Trump left office.

At the same time, 36% of Democrats say the state of moral values is poor, while a 48% plurality rate it as only fair and 15% as excellent or good. Independents' view of the current state of moral values is relatively stable and closer to Democrats' than Republicans' rating, with 44% saying it is poor, 40% only fair and 16% excellent or good.

Outlook for State of Moral Values Is Equally Bleak

Not only are Americans feeling grim about the current state of moral values in the nation, but they are also mostly pessimistic about the future on the subject, as 78% say morals are getting worse and just 18% getting better. The latest percentage saying moral values are getting worse is roughly in line with the average of 74% since 2002, but it is well above the past two years' 67% and 68% readings.

The info is here.

A Constructionist Review of Morality and Emotions: No Evidence for Specific Links Between Moral Content and Discrete Emotions

Cameron, C. D., Lindquist, K. A., & Gray, K. (2015). 

Personality and Social Psychology Review

19(4), 371–394.

Abstract

Morality and emotions are linked, but what is the nature of their correspondence? Many “whole number” accounts posit specific correspondences between moral content and discrete emotions, such that harm is linked to anger, and purity is linked to disgust. A review of the literature provides little support for these specific morality–emotion links. Moreover, any apparent specificity may arise from global features shared between morality and emotion, such as affect and conceptual content. These findings are consistent with a constructionist perspective of the mind, which argues against a whole number of discrete and domain-specific mental mechanisms underlying morality and emotion. Instead, constructionism emphasizes the flexible combination of basic and domain-general ingredients such as core affect and conceptualization in creating the experience of moral judgments and discrete emotions. The implications of constructionism in moral psychology are discussed, and we propose an experimental framework for rigorously testing morality–emotion links.

Conclusion

The tension between whole number and constructionist accounts has existed in psychology since its beginning (e.g., Darwin, 1872/2005 vs. James, 1890; see Gendron & Barrett, 2009; Lindquist, 2013). Commonsense and essentialism suggest the existence of distinct and immutable psychological constructs. The intuitiveness of whole number accounts is reinforced by the communicative usefulness of distinguishing harm from purity (Graham et al., 2009), and anger from disgust (Barrett, 2006; Lindquist, Gendron, et al., 2013), but utility does not equal ontology. As decades of psychological research have demonstrated, intuitive experiences are poor guides to the structure of the mind (Barrett, 2009; Davies, 2009; James, 1890; Nisbett & Wilson, 1977; Roser & Gazzaniga, 2004; Ross & Ward, 1996; Wegner, 2003).  Although initially less intuitive, we suggest that constructionist approaches are actually better at capturing the nature of the powerful subjective phenomena long treasured by social psychologists (Gray & Wegner, 2013; Wegner & Gilbert, 2000). Whereas whole number theories impose taxonomies onto human experience and treat variability as noise or error, constructionist theories allow that experience is complex and messy. Rather than assuming that human experience is “wrong” when it fails to conform to a preferred taxonomy, constructionist theories appreciate this diversity and use domain-general mechanisms to explain it. Returning to our opening example, Jack and Diane may be soul-mates with a love that is unique, unchanging, and eternal, or they may just be two similar American kids who feel the rush of youth and the heat of a summer’s day. The first may be more romantic, but the second is more likely to be true.

A pdf is here.