Professional Civil Disobedience — Medical-Society Responsibilities after Dobbs

Matthew Wynia

September 15, 2022

N Engl J Med 2022; 387:959-961

DOI: 10.1056/NEJMp2210192

Here is an excerpt:

Beyond issuing strongly worded statements, what actions should medical organizations take in the face of laws that threaten patients’ well-being? Should they support establishing committees to decide when a pregnant person’s life is in sufficient danger to warrant an abortion? Should they advocate for allowing patients to travel elsewhere for care? Or should they encourage their members to provide evidence-based medical care, even if doing so means accepting — en masse — fines, suspensions of licensure, and potential imprisonment? How long could a dangerous state law survive if the medical profession, as a whole, refused to be intimidated into harming patients, even if such a refusal meant that many physicians might go to jail?

There are several arguments in favor of professional associations supporting civil disobedience by their members. First, collective civil disobedience by a professional group would avert the most common and powerful criticism leveled against civil disobedience, which is that it could lead to anarchy.

Civil disobedience is a “public, nonviolent, conscientious yet political act contrary to law,” carried out with the aim of bringing about a change in an unjust law.2 But respect for laws is necessary to maintain a civil society. Having each person choose which laws to obey and which to disobey is a recipe for chaos. The most well-known proponents of civil disobedience — Henry David Thoreau, Mahatma Gandhi, Martin Luther King, Jr. — all took seriously the threat of unrestrained disregard of laws under the guise of civil disobedience. In his 1963 Letter from Birmingham Jail, King argued that people must respect just laws, but he also wrote, “law and order exist for the purpose of establishing justice,” and he agreed with St. Augustine that “an unjust law is no law at all.” He described a “moral responsibility to disobey unjust laws” and laid out criteria to help people decide when laws, such as those upholding racial segregation, are sufficiently unjust as to warrant open disobedience. Gandhi was even more worried about chaos and launched hunger strikes to rein in his own supporters when he believed they had gone too far in their disobedience of laws.

But professional civil disobedience poses little threat of anarchy. Unlike a situation in which each person decides whether to obey or disobey a law, a professional group’s deciding together, after frank and rational debate, to support disobedience of an unjust law might eventually reinforce social cohesion, elevate trust in the profession, and help communities avoid tragic errors. Professions, after all, are expected to protect vulnerable people and core social values. Such a decision would still be contentious, however. Civil disobedience is nonviolent, but it elevates and highlights conflict and often leads to violence against people disobeying the law. Professional civil disobedience would undoubtedly require tremendous courage.

Proposing professional civil disobedience of state laws prohibiting abortion might seem naive. Historically, physicians have rarely been radical, and most have conformed with bad laws and policies, even horrific ones — such as those authorizing forced-sterilization programs in the United States and Nazi Germany, the use of psychiatric hospitals as political prisons in the Soviet Union, and police brutality under apartheid in South Africa. Too often, organized medicine has failed to fulfill its duty to protect patients when doing so required acting against state authority. Although there are many examples of courageous individual physicians defying unjust laws or regulations, examples of open support for these physicians by their professional associations — such as the AMA’s offer to support physicians who refused to be involved in “enhanced” interrogations (i.e., torture) during the Iraq War — are uncommon. And profession-wide civil disobedience — such as Dutch physicians choosing to collectively turn in their licenses rather than practice under Nazi rule — is rare.

The info is here.

The Supreme Court has lost its ethical compass. Can it find one fast?

Ruth Marcus

The Washington Post

Originally published 23 Nov 22

The Supreme Court must get its ethics act together, and Chief Justice John G. Roberts Jr. needs to take the lead. After a string of embarrassments, the justices should finally subject themselves to the kind of rules that govern other federal judges and establish a standard for when to step aside from cases — one that is more stringent than simply leaving it up to the individual justice to decide.

Recent episodes are alarming and underscore the need for quick action to help restore confidence in the institution.

Last week, the Supreme Court wisely rebuffed an effort by Arizona GOP chair Kelli Ward to prevent the House Jan. 6 committee — the party in this case — from obtaining her phone records. The court’s brief order noted that Justice Clarence Thomas, along with Justice Samuel A. Alito Jr., would have sided with Ward.

Thomas’s involvement, though it didn’t affect the outcome of the dispute, is nothing short of outrageous. Federal law already requires judges, including Supreme Court justices, to step aside from involvement in any case in which their impartiality “might reasonably be questioned.”

Perhaps back in January, when he was the only justice to disagree when the court refused to grant former president Donald Trump’s bid to stop his records from being turned over to the Jan. 6 committee, Thomas didn’t realize the extent of his wife’s involvement with disputing the election results. (I’m being kind here: Ginni Thomas had signed a letter the previous month calling on House Republicans to expel Reps. Liz Cheney of Wyoming and Adam Kinzinger of Illinois from the House Republican Conference for participating in an “overtly partisan political persecution.”)

But here’s what we know now, and Justice Thomas does, too: The Jan 6. committee has subpoenaed and interviewed his wife. We — and he — know that she contacted 29 Arizona lawmakers, urging them to “fight back against fraud” and choose a “clean slate of electors” after the 2020 election.

Some recusal questions are close. Not this one. Did the chief justice urge Thomas to recuse? He should have. This will sound unthinkable, but if Roberts asked and Thomas refused, maybe it’s time the chief, or other justices, to publicly note their disagreement.

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One obvious step is to follow the ethics rules that apply to other federal judges, perhaps adapting them to the particular needs of the high court. That would send an important — and overdue — message that the justices are not a law unto themselves. It’s symbolic, but symbolism matters.

The info is here.

What is behind the rise in girls questioning their gender identity?

Amelia Gentleman

The Guardian

Originally posted 24 Nov 22

Here is an excerpt:

The trend was confirmed by clinicians who spoke to the Guardian.

“In the past few years it has become an explosion. Many of us feel confused by what has happened, and it’s often hard to talk about it to colleagues,” said a London-based psychiatrist working in a child and adolescent mental health unit, who has been a consultant for the past 17 years.

Like all NHS employees interviewed, she asked for anonymity due to the sensitivity of the subject.

“I might have seen one child with gender dysphoria once every two years when I started practising. It was very niche and rare.” Now, somewhere between 10% and 20% of her caseload is made up of adolescents registered as female at birth who identify as non-binary or trans, with just an occasional male-registered teenager who identifies as trans.

Another senior child psychiatrist said girls who wanted to transition made up about 5% of her caseload.

“In the last five to 10 years we’ve seen a huge surge in young women who, at the age of around 12 or 13, want to become boys. They’ve changed their name and they are pressing … to have hormones or puberty blockers”

The psychiatrist added: “Often those girls are children who are going through the normal identity and developmental problems of adolescence and finding a solution for themselves in this way.”

Greater awareness of trans issues is likely to be one common-sense explanation for the rise in requests for referrals.

“Left-handedness increased over time after we stopped punishing left-handed children in schools, because some children are naturally left-handed and were now able to express it,” said Cleo Madeleine, a spokesperson for the trans support group Gendered Intelligence.

“In the same way, increased visibility and acceptance of trans people has led to a gradual increase in young people who feel comfortable expressing their trans identity. The most important thing is to recognise that this is not a problem to be solved or a bad outcome to be avoided.”

The mother of a 17-year-old A-level student (who came out as trans at 13, leaving a handwritten letter for his parents on his bed) agreed: “It’s discussed so much more – on Facebook and on social media. It’s no longer a taboo.”

She is confident this was the right decision for her child. “I think I wondered if this was a phase, but I didn’t look to dissuade him. As he began to socially transition he was a different person. It has made him happier,” she said.

The info is here.

Towards a Social Psychology of Cynicism

Neumann, E., & Zaki, j. (2022, September 13).

https://doi.org/10.31234/osf.io/gjm8c

Abstract

Cynicism is the attitude that people are primarily motivated by self-interest. It tracks numerous negative outcomes, and yet many people are cynical. To understand this “cynicism paradox,” we review and call for more social psychological work on how cynicism spreads, with implications for how we might slow it down.

The Cynicism Paradox

Out of almost 8,000 respondents from 41 countries, many agree that “powerful people tend to exploit others” or that “kind-hearted people usually suffer losses”. This indicates widespread cynicism, the attitude that people are primarily motivated by self-interest, often accompanied by emotions such as contempt, anger, and distress, and antagonistic interactions with others. What explains such cynicism? Perhaps it reflects a realistic perception of the suffering caused by human self-interest. But workin social psychology regularly demonstrates that attitudes are not always perfect  mirrors of reality.  We will argue  that  people  often  overestimate self-interest,  create  it through their expectations, or overstate their own to not appear naïve. Cynicism rises when people witness self-interest, but social psychology –so far relatively quiet on the topic –can explain why they get trapped in this worldview even when it stops tracking reality.

Cynicism is related, but not reducible to, a lack of trust. Trust is often defined as accepting vulnerability based on positive expectations of others. Generalized trust implies a general tendency to  have  positive  expectations  of  others,  and  shares  with  cynicism  the  tendency  to  judge  the character of a whole group of people. But cynicism is more than reduced positive expectations.It entails a strongly negative view of human nature. The intensity of cynicism’s hostility further differentiates it from mere generalized distrust. Finally, while people can trust and distrust others’ competence,  integrity,  and  predictability,  cynicism  usually  focuses  on  judgments  of  moral character.  This  differentiates  cynicism  from  mere  pessimism,  which  encompasses  any  negative beliefs about the future, moral or non-moral alike. 

The info is here.

Direct applications to psychotherapy.

Why are scientists growing human brain cells in the lab?

Hannah Flynn

Medical News Today

Originally posted 24 OCT 22

Here is an excerpt:

Ethical boundaries

One of the limitations of using organoids for research is that it is observed in vitro. The way an organ might act in a system, in connection with different organs, or when exposed to metabolites in the blood, for example, could be different from how it behaves when cells are isolated in a single tissue.

More recently, researchers placed an organoid derived from human cells inside the brain of a rat, in a study outlined in Nature.

Using neural organoids that had been allowed to self-organize, these were implanted into the somatosensory cortex — which is in the middle of the brain — of newborn rats. The scientists then found that these cortical organoids had grown axons throughout the rat brain, and were able to contribute to reward-seeking behavior in the rat.

This breakthrough suggested that the lab-created cells are recognizable to other tissues in the body and can influence systems.

Combining the cells of animals and humans is not without some ethical considerations. In fact, this has been the focus of a recent project.

The Brainstorm Organoid Project published its first paper in the form of a comment piece outlining the benefits of the project in Nature Neuroscience on October 18, 2022, the week after the aforementioned study was published.

The Project brought together prominent bioethicists as part of the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative of the US National Institutes of Health, which funded the project.

Co-author of the comment piece Dr. Jeantine E Lunshof, head of collaborative ethics at the Wyss Institute for Biologically Inspired Engineering at Harvard University, MA, told Medical News Today in an interview that existing biomedical research and animal welfare guidelines already provide a framework for this type of work to be done ethically.

Pointing to the International Society for Stem Cell Research guidelines published last year, she stated that those do cover the creation of chimeras, where cells of two species are combined.

These hybrids with non-primates are permitted, she explained: “This is very, very strong emphasis on animal welfare in this ISSCR guideline document that also aligns with existing animal welfare and animal research protocols.”

The potential benefits of this research needed to be considered, “though at this moment, we are still at the stage that a lot of fundamental research is necessary. And I think that that really must be emphasized,” she said.

The info is here.

White (but Not Black) Americans Continue to See Racism as a Zero-Sum Game; White Conservatives (but Not Moderates or Liberals) See Themselves as Losing

Rasmussen, R., Levari, D. E.,  et al.

Perspectives on Psychological Science, 0(0).

Abstract

In a 2011 article in this journal entitled “Whites See Racism as a Zero-Sum Game That They Are Now Losing” (Perspectives on Psychological Science, 6, 215–218), Norton and Sommers assessed Black and White Americans’ perceptions of anti-Black and anti-White bias across the previous 6 decades—from the 1950s to the 2000s. They presented two key findings: White (but not Black) respondents perceived decreases in anti-Black bias to be associated with increases in anti-White bias, signaling the perception that racism is a zero-sum game; White respondents rated anti-White bias as more pronounced than anti-Black bias in the 2000s, signaling the perception that they were losing the zero-sum game. We collected new data to examine whether the key findings would be evident nearly a decade later and whether political ideology would moderate perceptions. Liberal, moderate, and conservative White (but not Black) Americans alike believed that racism is a zero-sum game. Liberal White Americans saw racism as a zero-sum game they were winning by a lot, moderate White Americans saw it as a game they were winning by only a little, and conservative White Americans saw it as a game they were losing. This work has clear implications for public policy and behavioral science and lays the groundwork for future research that examines to what extent racial differences in perceptions of racism by political ideology are changing over time.

Conclusions

Our results suggest that zero-sum thinking about racism pervades the entire political ideological spectrum among White Americans; even liberal White Americans believe that gains for Black people mean losses for White people. However, views of whether and by how much White people are seen as now winning or losing the zero-sum game vary by political ideology. Liberal, moderate, and conservative White Americans agree that White people were winning the zero-sum racism game in the past. They disagree on the outcome more recently; in the most recent decade, liberal White Americans see it as a game they are still winning by a lot, moderate White Americans see it as a game they are still winning but by a little, and conservative White Americans see racism as a zero-sum game they are now losing by a little.

Win or lose, why do White Americans, even liberal White Americans, view racism as a zero-sum game? The zero-sum pattern may be a logical consequence of structural racism, “racial practices that reproduce racial inequality in contemporary America [that] (1) are increasingly covert, (2) are embedded in normal operations of institutions, (3) avoid direct racial terminology, and (4) are invisible to most Whites” (Bonilla-Silva, 1997, p. 476). Racial progress by Black Americans may signal deviation from normal operations of American institutions, which is perceived as a threat to White Americans that motivates them to reassert cultural dominance (Wilkins et al., 2021).

A pdf of the research is here.

Powerlessness Also Corrupts: Lower Power Increases Self-Promotional Lying

Li, H.(., Chen, Y., & Hildreth, J.A. (2022).

Organization Science.

Abstract

The popular maxim holds that power corrupts, and research to date supports the view that power increases self-interested unethical behavior. However, we predict the opposite effect when unethical behavior, specifically lying, helps an individual self-promote: lower rather than higher power increases self-promotional lying. Drawing from compensatory consumption theory, we propose that this effect occurs because lower power people feel less esteemed in their organizations than do higher power people. To compensate for this need to view themselves as esteemed members of their organizations, lower power individuals are more likely to inflate their accomplishments. Evidence from four studies supports our predictions: compared with those with higher power, executives with lower power in their organizations were more likely to lie about their work achievements (Study 1, n = 230); graduate students with lower power in their Ph.D. studies were more likely to lie about their publication records (Study 2, n = 164); and employees with lower power were more likely to lie about having signed a business contract (Studies 3 and 4). Mediation analyses suggest that lower power increased lying because lower power individuals feel lower esteem in their organizations (Study 3, n = 562). Further supporting this mechanism, a self-affirmation intervention reduced the effect of lower power on self-promotional lying (Study 4, n = 536). These converging findings show that, when lies are self-promotional, lower power can be more corruptive than higher power.

Conclusion

The popular maxim that power corrupts has long held sway over the public imagination, but recently, scholarly research has challenged the universality of this maxim and added an important modifier: power corrupts when corruption is selfish in nature. In the current research, we drive another nail into this maxim’s coffin, finding that lower rather than higher power can increase certain self-interested unethical behaviors.  Specifically, we find that lower power increases self-promotional lying because it triggers the aversive feeling of low esteem. Therefore, the effects of power on corruption depend critically on the motivations underlying a particular unethical behavior. Even when corruption is self-interested in nature, power need not always corrupt.

A pdf of this research can be found on Dr. Li's website here.

You Can't Win at Morality

Kurt Gray, Will Blakey, and Carlos Rebollar

Moral Understanding Substack

Originally posted 26 OCT 22

Here is an excerpt:

Moral Ideals

Most of us want to do good in the world, and follow a set of moral guidelines, or “ideals.” But the word “ideals” has dangerous roots. The etymology of the very word “ideal” implies perfection, which we authors believe is bad.

 In 1796, Immanuel Kant used the word “ideal” to describe a hypothetically perfect person, thing, or state. It may have been easy for Kant to fetishize the perfect moral person, but it’s not clear that he is the best role model for us modern people (or anyone else). Kant was a weird guy. He once likened sex to sucking dry a lemon (scholars think he died a virgin), he thought you had to tell the truth even if it meant the slaughter of an innocent family, and he thought it was a good idea to get a portrait taken that highlighted his giant bald forehead and left most of his face in darkness (see picture).

Despite Kant’s questionable judgment, an ideal-driven ethics is widely promoted. Christianity’s most popular role model is Jesus, and they say he was perfect. Tony Robbins, self-help guru, says that we should become the best version of ourselves. The reasoning goes, “if our ideals are unachievable, that’s the whole point! They’re supposed to make you shoot for the moon.” This is why Kant’s idealism is so seductive. We think it’ll make us never stop improving ourselves. When it comes to role models, we don’t search for pretty good people, we search for moral perfection and emulate it to the best of our abilities.

As advocates for increasing moral understanding in the world, we are not arguing that people should stop striving to do good. But we do think that the quest for moral perfection can lead us astray. “The perfect is the enemy of the good” is a quote that’s useful in a lot of cases, but it’s especially useful when it comes to morality.

We argue that striving for moral perfection or “trying to win at morality,” has at least two main drawbacks: First, it can contribute to unhealthy thinking, and second, it can deter us from taking steps in the right direction. Instead, we propose that striving for more moral good (not the most) and practicing moral humility can help us do good in the world around us.

Anxiety is the Dizziness of Freedom… When Your Goal is Perfection

Achieving moral perfection is tricky because, as we saw with Janet, answers to the “most moral good” are uncertain. And this is a problem because uncertainty about big questions doesn’t feel good.

Take these big questions: Is God real? Are we living in a simulation? Why are we here and what is the meaning of life? For many, the uncertainty inherent in these questions is a background feature of life. But for others, including me (Will), it is too often an anxiety-provoking challenge. I struggle with “existential OCD,” a psychological disorder involving anxiety resulting from intrusive thoughts and discomfort about these big life questions. Not knowing why we’re all here or where we’re all going often stresses me out. But I’ve largely been able to combat this stress through therapy and renegotiating a better relationship with uncertainty.

The info is here.

America Is Pursuing Happiness in All the Wrong Places

Arthur Brooks

The Atlantic

Originally posted 16 NOV 22

Here are two excerpt:

As a social scientist, I believe that happiness should be understood as a combination of three phenomena: enjoyment, satisfaction, and meaning. Enjoyment is pleasure consciously and purposefully experienced, so it can create a positive memory. Satisfaction is the joy of an achievement, the reward for a job well done.

And then, there’s meaning. You can make do without enjoyment for a while, and even without a lot of satisfaction. But without meaning, you will be utterly lost. That is the psychiatrist and Holocaust survivor Viktor Frankl’s argument in his classic book Man’s Search for Meaning. Without a sense of meaning—a sense of the why of our existence–our lives cannot be endured.

Here is a quick diagnostic tool I sometimes use to find out if someone has a good sense of their life’s meaning. I ask them two questions:

1. Why do you exist?
2. For what would you be willing to die?

There is no greater joy than seeing someone you love find their answers. I remember this in the case of my son Carlos. He struggled in high school, like so many adolescents, to find a sense of his life’s meaning.  After high school, he joined the military. Today, at 22, he is Corporal Carlos Brooks, Scout Sniper, Third Battalion, Fifth Marine Regiment, Weapons Company.

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But my goal is not just to tell you our troubles. It is to suggest solutions. Let me propose three that we all can undertake.

First, share your secrets of meaning. When I explained the importance of faith, family, friendship, and work, perhaps you said to yourself, I practice those things! That’s great. But it’s not enough to practice these things in our own lives—we need to celebrate them openly and recommend them to others. We all need to preach what we practice. To keep quiet about your sources of meaning because you are worried about looking judgmental is an act of selfishness.

Second, go out of your way to reject identity politics, and tell our shared story as Americans instead. If we want to find our way back as a nation, we must repudiate the poison of grievance and victimization and work instead to reestablish a healthy sense of meaning by constructing a narrative for our country that includes all of us.

Please don’t dismiss this as impossibly idealistic. On the contrary, some of our most successful presidents, from Washington to Lincoln to Franklin D. Roosevelt, did exactly this in times of crisis and trouble—they told a shared story to unite Americans against a common threat rather than balkanizing our people against one another.

The info is here.