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, May 20, 2023

ChatGPT Answers Beat Physicians' on Info, Patient Empathy, Study Finds

Michael DePeau-Wilson
MedPage Today
Originally published 28 April 23

The artificial intelligence (AI) chatbot ChatGPT outperformed physicians when answering patient questions, based on quality of response and empathy, according to a cross-sectional study.

Of 195 exchanges, evaluators preferred ChatGPT responses to physician responses in 78.6% (95% CI 75.0-81.8) of the 585 evaluations, reported John Ayers, PhD, MA, of the Qualcomm Institute at the University of California San Diego in La Jolla, and co-authors.

The AI chatbot responses were given a significantly higher quality rating than physician responses (t=13.3, P<0.001), with the proportion of responses rated as good or very good quality (≥4) higher for ChatGPT (78.5%) than physicians (22.1%), amounting to a 3.6 times higher prevalence of good or very good quality responses for the chatbot, they noted in JAMA Internal Medicine in a new tab or window.

Furthermore, ChatGPT's responses were rated as being significantly more empathetic than physician responses (t=18.9, P<0.001), with the proportion of responses rated as empathetic or very empathetic (≥4) higher for ChatGPT (45.1%) than for physicians (4.6%), amounting to a 9.8 times higher prevalence of empathetic or very empathetic responses for the chatbot.

"ChatGPT provides a better answer," Ayers told MedPage Today. "I think of our study as a phase zero study, and it clearly shows that ChatGPT wins in a landslide compared to physicians, and I wouldn't say we expected that at all."

He said they were trying to figure out how ChatGPT, developed by OpenAI, could potentially help resolve the burden of answering patient messages for physicians, which he noted is a well-documented contributor to burnout.

Ayers said that he approached this study with his focus on another population as well, pointing out that the burnout crisis might be affecting roughly 1.1 million providers across the U.S., but it is also affecting about 329 million patients who are engaging with overburdened healthcare professionals.

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"Physicians will need to learn how to integrate these tools into clinical practice, defining clear boundaries between full, supervised, and proscribed autonomy," he added. "And yet, I am cautiously optimistic about a future of improved healthcare system efficiency, better patient outcomes, and reduced burnout."

After seeing the results of this study, Ayers thinks that the research community should be working on randomized controlled trials to study the effects of AI messaging, so that the future development of AI models will be able to account for patient outcomes.

Friday, May 19, 2023

What’s wrong with virtue signaling?

Hill, J., Fanciullo, J. 
Synthese 201, 117 (2023).

Abstract

A novel account of virtue signaling and what makes it bad has recently been offered by Justin Tosi and Brandon Warmke. Despite plausibly vindicating the folk?s conception of virtue signaling as a bad thing, their account has recently been attacked by both Neil Levy and Evan Westra. According to Levy and Westra, virtue signaling actually supports the aims and progress of public moral discourse. In this paper, we rebut these recent defenses of virtue signaling. We suggest that virtue signaling only supports the aims of public moral discourse to the extent it is an instance of a more general phenomenon that we call norm signaling. We then argue that, if anything, virtue signaling will undermine the quality of public moral discourse by undermining the evidence we typically rely on from the testimony and norm signaling of others. Thus, we conclude, not only is virtue signaling not needed, but its epistemological effects warrant its bad reputation.

Conclusion

In this paper, we have challenged two recent defenses of virtue signaling. Whereas Levy ascribes a number of good features to virtue signaling—its providing higher-order evidence for the truth of certain moral judgments, its helping us delineate groups of reliable moral cooperators, and its not involving any hypocrisy on the part of its subject—it seems these good features are ascribable to virtue signaling ultimately and only because they are good features of norm signaling, and virtue signaling entails norm signaling. Similarly, whereas Westra suggests that virtue signaling uniquely benefits public moral discourse by supporting moral progress in a way that mere norm signaling does not, it seems virtue signaling also uniquely harms public moral discourse by supporting moral regression in a way that mere norm signaling does not. It therefore seems that in each case, to the extent it differs from norm signaling, virtue signaling simply isn’t needed.

Moreover, we have suggested that, if anything, virtue signaling will undermine the higher order evidence we typically can and should rely on from the testimony of others. Virtue signaling essentially involves a motivation that aims at affecting public moral discourse but that does not aim at the truth. When virtue signaling is rampant—when we are aware that this ulterior motive is common among our peers—we should give less weight to the higher-order evidence provided by the testimony of others than we otherwise would, on pain of double counting evidence and falling for unwarranted confidence. We conclude, therefore, that not only is virtue signaling not needed, but its epistemological effects warrant its bad reputation. 

Thursday, May 18, 2023

People Construe a Corporation as an Individual to Ascribe Responsibility in Cases of Corporate Wrongdoing

Sharma, N., Flores-Robles, G., & Gantman, A. P.
(2023, April 11). PsyArXiv

Abstract

In cases of corporate wrongdoing, it is difficult to assign blame across multiple agents who played different roles. We propose that people have dualist ideas of corporate hierarchies: with the boss as “the mind,” and the employee as “the body,” and the employee appears to carry out the will of the boss like the mind appears to will the body (Wegner, 2003). Consistent with this idea, three experiments showed that moral responsibility was significantly higher for the boss, unless the employee acted prior to, inconsistently with, or outside of the boss’s will. People even judge the actions of the employee as mechanistic (“like a billiard ball”) when their actions mirror the will of the boss. This suggests that the same features that tell us our minds cause our actions, also facilitate the sense that a boss has willed the behavior of an employee and is ultimately responsible for bad outcomes in the workplace.

From the General Discussion

Practical Implications

Our findings offer a number of practical implications for organizations. First, our research provides insight into how people currently make judgments of moral responsibility within an organization (and specifically, when a boss gives instructions to an employee). Second, our research provides insight into the decision-making process of whether to fire a boss-figure like a CEO (or other decision-maker) or invest in lasting change in organizational culture following an organizational wrongdoing. From a scapegoating perspective, replacing a CEO is not intended to produce lasting change in underlying organizational problems and signals a desire to maintain the status quo (Boeker, 1992; Shen & Cannella, 2002). Scapegoating may not always be in the best interest of investors. Previous research has shown that following financial misrepresentation, investors react positively only to CEO successions wherein the replacement comes from the outside, which serves as a costly signal of the firm’s understanding of the need for change (Gangloff et al., 2016). And so, by allocating responsibility to the CEO without creating meaningful change, organizations may loseinvestors. Finally, this research has implications for building public trust in organizations. Following the Wells Fargo scandal, two-thirds of Wells Fargo customers (65%) claimed they trusted their bank less, and about half of Wells Fargo customers (51%) were willing to switch to another bank, if they perceived them to be more trustworthy (Business Wire, 2017).Thus, how organizations deal with wrongdoing (e.g., whether they fire individuals, create lasting change or both) can influence public trust. If corporations want to build trust among the general public, and in doing so, create a larger customer base, they can look at how people understand and ascribe responsibility and consequently punish organizational wrongdoings.

Wednesday, May 17, 2023

In Search of an Ethical Constraint on Hospital Revenue

Lauren Taylor
The Hastings Center
Originally published 14 APR 23

Here are two excerpts:

A physician whistleblower came forward alleging that Detroit Medical Center, owned by for-profit Tenet Healthcare, refused to halt elective procedures in early days of the pandemic, even after dozens of patients and staff were exposed to a COVID-positive patient undergoing an organ transplant. According to the physician, Tenet persisted on account of the margin it stood to generate. “Continuing to do this [was] truly a crime against patients,” recalled Dr. Shakir Hussein, who was fired shortly thereafter.

Earlier in 2022, nonprofit Bon Secours health system was investigated for its strategic downsizing of a community hospital in Richmond, Va., which left a predominantly Black community lacking access to standard medical services such as MRIs and maternity care. Still, the hospital managed to turn a $100 million margin, which buoyed the system’s $1 billion net revenue in 2021. “Bon Secours was basically laundering money through this poor hospital to its wealthy outposts,” said one emergency department physician who had worked at Richmond Community Hospital. “It was all about profits.”  

The academic literature further substantiates concerns about hospital margin maximization. One paper examining the use of municipal, tax-exempt debt among nonprofit hospitals found evidence of arbitrage behavior, where hospitals issued debt not to invest in new capital (the stated purpose of most municipal debt issuances) but to invest the proceeds of the issuance in securities and other endowment accounts. A more recent paper, focused on private equity-owned hospitals, found that facilities acquired by private equity were more likely to “add specific, profitable hospital-based services and less likely to add or continue those with unreliable revenue streams.” These and other findings led Donald Berwick to write that greed poses an existential threat to U.S. health care.

None of the hospital actions described above are necessarily illegal but they certainly bring long-lurking issues within bioethics to the fore. Recognizing that hospitals are resource-dependent organizations, what normative, ethical responsibilities–or constraints–do they face with regard to revenue-generation? A review of the health services and bioethics literature to date turns up three general answers to this question, all of which are unsatisfactory.

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In sum, we cannot rely on laws alone to provide an effective check on hospital revenue generation due to the law’s inevitably limited scope. We therefore must identify an internalized ethic to guide hospital revenue generation. The concept of an organizational mission is a weak check on nonprofit hospitals and virtually meaningless among for-profit hospitals, and reliance on professionalism is incongruous with the empirical data about who has final decision-making authority over hospitals today. We need a new way to conceptualize hospital responsibilities.

Two critiques of this idea merit confrontation. The first is that there is no urgent need for an internalized constraint on revenue generation because more than half of hospitals are currently operating in the red; seeking to curb their revenue further is counterproductive. But just because a proportion of this sector is in the red does not undercut the egregiousness of the hospital actions described earlier. Moreover, if hospitals are running a deficit in part because they choose not to undertake unethical action to generate revenue, then any rule developed saying they can’t undertake ethical actions to generate revenue won’t apply to them. The second critique is that the current revenues that hospitals generate are legitimate because they bolster institutional “rainy day funds” of sorts, which can be deployed to help people and communities in need at a future date. But with a declining national life expectancy, a Black maternal mortality rate hovering at roughly that of Tajikistan, and medical debt the leading cause of personal bankruptcy in the U.S. – it is already raining. Increasing reserves, by any means, can no longer be defended with this logic.

Tuesday, May 16, 2023

Approaches to Muslim Biomedical Ethics: A Classification and Critique

Dabbagh, H., Mirdamadi, S.Y. & Ajani, R.R.
Bioethical Inquiry (2023).

Abstract

This paper provides a perspective on where contemporary Muslim responses to biomedical-ethical issues stand to date. There are several ways in which Muslim responses to biomedical ethics can and have been studied in academia. The responses are commonly divided along denominational lines or under the schools of jurisprudence. All such efforts classify the responses along the lines of communities of interpretation rather than the methods of interpretation. This research is interested in the latter. Thus, our criterion for classification is the underlying methodology behind the responses. The proposed classification divides Muslim biomedical-ethical reasoning into three methodological categories: 1) textual, 2) contextual, and 3) para-textual.

Conclusion

There is widespread recognition among Muslim scholars dealing with biomedical ethical issues that context plays an essential role in forming ethical principles and judgements. The context-sensitive approaches in Muslim biomedical ethics respond to the requirements of modern biomedical issues by recognizing the contexts in which scriptural text has been formed and developed through the course of Muslim intellectual history. This paves the way for bringing in different context-sensitive interpretations of the sacred texts through different reasoning tools and methods, whether they are rooted in the uṣūl al-fiqh tradition for the contextualists, or in moral philosophy for the para-textualists. For the textualists, reasoning outside of the textual boundaries is not acceptable. While contextualists tend to believe that contextual considerations make sense only in light of Sharīʿa law and should not be understood independently of Sharīʿa law, para-textualists believe that moral perceptions and contextual considerations are valid irrespective of Sharīʿa law, insofar as they do not neglect the moral vision of the scriptures. The common ground between the majority of the textualists and the contextualists lies in giving primacy to the Sharīʿa law. Moral requirements for both the textualists and the contextualists are only determined by Sharīʿa commandments, and Sharīʿa commandments are the only basis on which to decide what is morally permissible or impermissible in biomedical ethical issues. This is an Ashʿarī-inspired approach to biomedical ethics with respect to human moral reasoning (Sachedina 2005; Aramesh 2020; Reinhart 2004; Moosa 2004; Moosapour et al. 2018).

Para-textualists, on the other hand, do not deny the relevance of Sharīʿa, but treat the reasoning embedded in Sharīʿa as being on a par with moral reasoning in general. Thus, if there are contending strands of moral reasoning on a particular biomedical ethical issue, Sharīʿa-based reasoning will need to compete with other moral reasoning on the issue. If the aḥkām (religious judgements) are deemed to be reasonably sound, then for para-textualists there are no grounds for not accepting them. Although using and referring to Sharīʿa might work in many cases, it is not the case that Sharīʿa is enough in every case to judge on moral issues. For instance, morally speaking, it is not enough to refer to Sharīʿa when someone is choosing or refusing euthansia or abortion. For para-textualists what matters most is how Sharīʿa morally reasons about the permissibility or impermissibility of an action. If it is morally justified to euthanize or abort, we are rationally (and morally) bound to accept it, and if it is not morally justified, we will then either have to leave our judgement about choosing or refusing euthanasia or abortion or find another context-sensitive interpretation to rationalize the relevant commandment derived from Sharīʿa. Thus, the departure point for the para-textualist approach is moral reasoning, whether it is found in moral philosophy, Muslim jurisprudence, or elsewhere (Soroush 2009; Shahrur 1990, 2009; Hallaq 1997; An-Na’im 2008). Para-textualist methodology tries to remain open to the possibility of morally criticizing religious judgements (aḥkām), while remaining true to the moral vision of the scriptures. This is a Muʿtazilī-inspired approach to biomedical ethics (Hourani 1976; Vasalou 2008; Sheikh 2019; Farahat 2019; Reinhart 1995; Al-Bar and Chamsi-Pasha 2015; Hallaq 2014).

Monday, May 15, 2023

The Folk Concept of the Good Life: Neither Happiness nor Well-Being

Kneer, M., & Haybron, D. M. (2023).
ResearchGate.
https://doi.org/10.13140/RG.2.2.33569.89445

Abstract

The concept of a good life is usually assumed by philosophers to be equivalent to that of well-being, or perhaps of a morally good life, and hence has received little attention as a potentially distinct subject matter.  In a series of experiments participants were presented with vignettes involving socially sanctioned wrongdoing toward outgroup members.  Findings indicated that, for a large majority, judgments of bad character strongly reduce ascriptions of the good life, while having no impact at all on ascriptions of happiness or well-being. Taken together with earlier findings these results suggest that the lay concept of a good life is clearly distinct from those of happiness, well-being, or morality, likely encompassing both morality and well-being, and perhaps other values as well: whatever matters in a person’s life. Importantly, morality appears not to play a fundamental role in either happiness or well-being among the folk. 

General Discussion

Our studies yielded two main results of note. First, a person’s moral qualities appear to have no direct bearing on ordinary assessments of happiness and well-being among the great majority of individuals.  This finding is consistent with an earlier study involving similar vignettes focusing just on happiness
ascriptions (Kneer and Haybron 2023). These studies suggest that among the folk, these studies suggest that the ancient and much-debated idea that happiness or well-being requires moral virtue seems to hold little currency: a bad person can perfectly well be happy and do just fine.

This of course does not settle the philosophical debate, as the folk may be wrong, or further studies may reveal that these results do not generalize, or apply only among American English-speaking populations. But it does suggest that philosophers following Plato in claiming that serious immorality precludes flourishing are defending a less-than-intuitive position, despite the widespread use of intuition pumps in this literature.

Why might many philosophers’ intuitions, and earlier research on the influence of morality on happiness ascriptions, have pointed to a different verdict? As the current paper focuses primarily on a different question, the concept of a good life, we refer the reader to (Kneer and Haybron 2023) for more extensive discussion of the differences between our findings and those of Phillips et al.

But one possibility is that the claims in question rest on the intuitions of a small but significant minority—roughly a quarter—whose judgments of happiness and well-being showed some impact of morality. But even among this group our studies here and in previous work found a modest impact of morality compared to the very strong philosophical claims at issue: not just that morality exacts some toll on the wrongdoer, but that such a person cannot do well at all. Indeed, establishing the latter claim is essentially the point of
Plato’s Republic.

Sunday, May 14, 2023

Consciousness begins with feeling, not thinking

A. Damasio & H. Dimasio
iai.tv
Originally posted 20 APR 23

Please pause for a moment and notice what you are feeling now. Perhaps you notice a growing snarl of hunger in your stomach or a hum of stress in your chest. Perhaps you have a feeling of ease and expansiveness, or the tingling anticipation of a pleasure soon to come. Or perhaps you simply have a sense that you exist. Hunger and thirst, pain, pleasure and distress, along with the unadorned but relentless feelings of existence, are all examples of ‘homeostatic feelings’. Homeostatic feelings are, we argue here, the source of consciousness.

In effect, feelings are the mental translation of processes occurring in your body as it strives to balance its many systems, achieve homeostasis, and keep you alive. In a conventional sense feelings are part of the mind and yet they offer something extra to the mental processes. Feelings carry spontaneously conscious knowledge concerning the current state of the organism as a result of which you can act to save your life, such as when you respond to pain or thirst appropriately. The continued presence of feelings provides a continued perspective over the ongoing body processes; the presence of feelings lets the mind experience the life process along with other contents present in your mind, namely, the relentless perceptions that collect knowledge about the world along with reasonings, calculations, moral judgments, and the translation of all these contents in language form. By providing the mind with a ‘felt point of view’, feelings generate an ‘experiencer’, usually known as a self. The great mystery of consciousness in fact is the mystery behind the biological construction of this experiencer-self.

In sum, we propose that consciousness is the result of the continued presence of homeostatic feelings. We continuously experience feelings of one kind or another, and feelings naturally tell each of us, automatically, not only that we exist but that we exist in a physical body, vulnerable to discomfort yet open to countless pleasures as well. Feelings such as pain or pleasure provide you with consciousness, directly; they provide transparent knowledge about you. They tell you, in no uncertain terms, that you exist and where you exist, and point to what you need to do to continue existing – for example, treating pain or taking advantage of the well-being that came your way. Feelings illuminate all the other contents of mind with the light of consciousness, both the plain events and the sublime ideas. Thanks to feelings, consciousness fuses the body and mind processes and gives our selves a home inside that partnership.

That consciousness should come ‘down’ to feelings may surprise those who have been led to associate consciousness with the lofty top of the physiological heap. Feelings have been considered inferior to reason for so long that the idea that they are not only the noble beginning of sentient life but an important governor of life’s proceedings may be difficult to accept. Still, feelings and the consciousness they beget are largely about the simple but essential beginnings of sentient life, a life that is not merely lived but knows that it is being lived.

Saturday, May 13, 2023

Doctors are drowning in paperwork. Some companies claim AI can help

Geoff Brumfiel
NPR.org - Health Shots
Originally posted 5 APR 23

Here are two excerpts:

But Paul kept getting pinged from younger doctors and medical students. They were using ChatGPT, and saying it was pretty good at answering clinical questions. Then the users of his software started asking about it.

In general, doctors should not be using ChatGPT by itself to practice medicine, warns Marc Succi, a doctor at Massachusetts General Hospital who has conducted evaluations of how the chatbot performs at diagnosing patients. When presented with hypothetical cases, he says, ChatGPT could produce a correct diagnosis accurately at close to the level of a third- or fourth-year medical student. Still, he adds, the program can also hallucinate findings and fabricate sources.

"I would express considerable caution using this in a clinical scenario for any reason, at the current stage," he says.

But Paul believed the underlying technology can be turned into a powerful engine for medicine. Paul and his colleagues have created a program called "Glass AI" based off of ChatGPT. A doctor tells the Glass AI chatbot about a patient, and it can suggest a list of possible diagnoses and a treatment plan. Rather than working from the raw ChatGPT information base, the Glass AI system uses a virtual medical textbook written by humans as its main source of facts – something Paul says makes the system safer and more reliable.

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Nabla, which he co-founded, is now testing a system that can, in real time, listen to a conversation between a doctor and a patient and provide a summary of what the two said to one another. Doctors inform their patients that the system is being used in advance, and as a privacy measure, it doesn't actually record the conversation.

"It shows a report, and then the doctor will validate with one click, and 99% of the time it's right and it works," he says.

The summary can be uploaded to a hospital records system, saving the doctor valuable time.

Other companies are pursuing a similar approach. In late March, Nuance Communications, a subsidiary of Microsoft, announced that it would be rolling out its own AI service designed to streamline note-taking using the latest version of ChatGPT, GPT-4. The company says it will showcase its software later this month.

Friday, May 12, 2023

‘Mind-reading’ AI: Japan study sparks ethical debate

David McElhinney
Aljazeera.com
Originally posted 7 APR 203

Yu Takagi could not believe his eyes. Sitting alone at his desk on a Saturday afternoon in September, he watched in awe as artificial intelligence decoded a subject’s brain activity to create images of what he was seeing on a screen.

“I still remember when I saw the first [AI-generated] images,” Takagi, a 34-year-old neuroscientist and assistant professor at Osaka University, told Al Jazeera.

“I went into the bathroom and looked at myself in the mirror and saw my face, and thought, ‘Okay, that’s normal. Maybe I’m not going crazy'”.

Takagi and his team used Stable Diffusion (SD), a deep learning AI model developed in Germany in 2022, to analyse the brain scans of test subjects shown up to 10,000 images while inside an MRI machine.

After Takagi and his research partner Shinji Nishimoto built a simple model to “translate” brain activity into a readable format, Stable Diffusion was able to generate high-fidelity images that bore an uncanny resemblance to the originals.

The AI could do this despite not being shown the pictures in advance or trained in any way to manufacture the results.

“We really didn’t expect this kind of result,” Takagi said.

Takagi stressed that the breakthrough does not, at this point, represent mind-reading – the AI can only produce images a person has viewed.

“This is not mind-reading,” Takagi said. “Unfortunately there are many misunderstandings with our research.”

“We can’t decode imaginations or dreams; we think this is too optimistic. But, of course, there is potential in the future.”


Note: If AI systems can decode human thoughts, it could infringe upon people's privacy and autonomy. There are concerns that this technology could be used for invasive surveillance or to manipulate people's thoughts and behavior. Additionally, there are concerns about how this technology could be used in legal proceedings and whether it violates human rights.