Physicians’ Refusal to Wear Masks to Protect Vulnerable Patients—An Ethical Dilemma for the Medical Profession

Dorfman D, Raz M, Berger Z.

JAMA Health Forum. 2023;4(11):e233780.

doi:10.1001/jamahealthforum.2023.3780

Here is an excerpt:

In theory, the solution to the problem should be simple: patients who wear masks to protect themselves, as recommended by the CDC, can ask the staff and clinicians to wear a mask as well when seeing them, and the clinicians would oblige given the efficacy masks have shown in reducing the spread of respiratory illnesses. However, disabled patients report physicians and other clinical staff having refused to wear a mask when caring for them. Although it is hard to know how prevalent this phenomenon is, what recourse do patients have? How should health care systems approach clinicians and staff who refuse to mask when treating a disabled patient?

Physicians have a history of antagonism to the idea that they themselves might present a health risk to their patients. Famously, when Hungarian physician Ignaz Semmelweis originally proposed handwashing as a measure to reduce purpureal fever, he was met with ridicule and ostracized from the profession.

Physicians were also historically reluctant to adopt new practices to protect not only patients but also physicians themselves against infection in the midst of the AIDS epidemic. In 1985, the CDC presented its guidance on workplace transmission, instructing physicians to provide care, “regardless of whether HCWs [health care workers] or patients are known to be infected with HTLV-III/LAV [human T-lymphotropic virus type III/lymphadenopathy-associated virus] or HBV [hepatitis B virus].” These CDC guidelines offered universal precautions, common-sense, nonstigmatizing, standardized methods to reduce infection. Yet, some physicians bristled at the idea that they need to take simple, universal public health steps to prevent transmission, even in cases in which infectivity is unknown, and instead advocated for a medicalized approach: testing or masking only in cases when a patient is known to be infected. Such an individualized medicalized approach fails to meet the public health needs of the moment.

Patients are the ones who pay the price for physicians’ objections to changes in practices, whether it is handwashing or the denial of care as an unwarranted HIV precaution. Yet today, with the enactment of disability antidiscrimination law, patients are protected, at least on the books.

As we have written elsewhere, federal law supports the right of a disabled individual to request masking as a reasonable disability accommodation in the workplace and at schools.

The info is here.

Here is my summary:

This article explores the ethical dilemma arising from physicians refusing to wear masks, potentially jeopardizing the protection of vulnerable patients. The author delves into the conflict between personal beliefs and professional responsibilities, questioning the ethical implications of such refusals within the medical profession. The analysis emphasizes the importance of prioritizing patient well-being and public health over individual preferences, calling for a balance between personal freedoms and ethical obligations in healthcare settings.

Professional Judges’ Disbelief in Free Will Does Not Decrease Punishment

Genschow, O., Hawickhorst, H., et al. (2020).

Social Psychological and Personality Science,

12, 357 - 362.

Abstract

There is a debate in psychology and philosophy on the societal consequences of casting doubts about individuals’ belief in free will. Research suggests that experimentally reducing free will beliefs might affect how individuals evaluate others’ behavior. Past research has demonstrated that reduced free will beliefs decrease laypersons’ tendency toward retributive punishment. This finding has been used as an argument for the idea that promoting anti-free will viewpoints in the public media might have severe consequences for the legal system because it may move judges toward softer retributive punishments. However, actual implications for the legal system can only be drawn by investigating professional judges. In the present research, we investigated whether judges (N = 87) are affected by reading anti-free will messages. The results demonstrate that although reading anti-free will texts reduces judges’ belief in free will, their recommended sentences are not influenced by their (manipulated) belief in free will.

A pdf is here.

Here is my take:

The results showed that the judges who read the anti-free will passage did indeed have a reduced belief in free will. However, there were no differences in the recommended sentences between the two groups of judges. This suggests that judges' disbelief in free will does not lead them to recommend lighter sentences for criminals.

The study's authors suggest that this finding may be due to the fact that judges are trained to uphold the law and to base their sentencing decisions on legal factors, such as the severity of the crime and the defendant's criminal history. They also suggest that judges may be reluctant to reduce sentences based on metaphysical beliefs about free will.

Key findings:

• Reading anti-free will messages reduces judges' belief in free will.
• Judges' disbelief in free will does not lead them to recommend lighter sentences for criminals.

How moral bioenhancement affects perceived praiseworthiness

Lucas, S., Douglas, T., & Faber, N. S. (2023).

Bioethics. https://doi.org/10.1111/bioe.13237

Abstract

Psychological literature indicates that actions performed with the assistance of cognition-enhancing biomedical technologies are often deemed to be less praiseworthy than similar actions performed without such assistance. This study examines (i) whether this result extends to the bioenhancement of moral capacities, and (ii) if so, what explains the effect of moral bioenhancement on perceived praiseworthiness. The findings indicate that actions facilitated by morally bioenhanced individuals are considered less deserving of praise than similar actions facilitated by ‘traditional’ moral enhancement—for example, moral self-education. This diminished praise does not seem to be driven by an aversion to (moral) bioenhancement per se. Instead, it appears to be primarily attributable to a perceived lack of effort exerted by bioenhanced individuals in the course of their moral enhancement. Our findings advance the philosophical discourse on the foundations of praise in the context of moral bioenhancement by elucidating the empirical basis underlying some assumptions commonly employed to argue for or against the permissibility of moral bioenhancement.

It is an open source article.  Link above works.

My summary:

This research shows whether people are less likely to praise morally bioenhanced individuals for their actions. The authors found that people do perceive morally bioenhanced individuals as less deserving of praise than those who achieve moral enhancement through traditional means, such as moral self-education.

The authors argue that this diminished praise is not due to an aversion to moral bioenhancement per se, but rather to a perceived lack of effort on the part of the bioenhanced individual. In other words, people believe that bioenhanced individuals have not had to work as hard to achieve their moral excellence, and therefore deserve less praise for their accomplishments.

This finding has important implications for the development and use of moral bioenhancement technologies. If people are less likely to praise morally bioenhanced individuals, it could lead to a number of negative consequences, such as social stigma and discrimination. Additionally, it could discourage people from using moral bioenhancement technologies, even if they believe that these technologies could help them to become more moral people.

People are increasingly following their heart and not the Bible - poll

Ryan Foley

Christian Today

Originally published 2 DEC 23

A new study reveals that less than one-third of Americans believe the Bible should serve as the foundation for determining right and wrong, even as most people express support for traditional moral values.

The fourth installment of the America's Values Study, released by the Cultural Research Center at Arizona Christian University Tuesday, asked respondents for their thoughts on traditional moral values and what they would like to see as "America's foundation for determining right and wrong." The survey is based on responses from 2,275 U.S. adults collected in July 2022.

Overall, when asked to identify what they viewed as the primary determinant of right and wrong in the U.S., a plurality of participants (42%) said: "what you feel in your heart." An additional 29% cited majority rule as their desired method for determining right and wrong, while just 29% expressed a belief that the principles laid out in the Bible should determine the understanding of right and wrong in the U.S. That figure rose to 66% among Spiritually Active, Governance Engaged Conservative Christians.

The only other demographic subgroups where at least a plurality of respondents indicated a desire for the Bible to serve as the determinant of right and wrong in the U.S. were respondents who attend an evangelical church (62%), self-described Republicans (57%), theologically defined born-again Christians (54%), self-identified conservatives (49%), those who are at least 50 years of age (39%), members of all Protestant congregations (39%), self-identified Christians (38%) and those who attend mainline Protestant churches (36%).

By contrast, an outright majority of respondents who do not identify with a particular faith at all (53%), along with half of LGBT respondents (50%), self-described moderates (47%), political independents (47%), Democrats (46%), self-described liberals (46%) and Catholic Church attendees (46%) maintained that "what you feel in your heart" should form the foundation of what Americans view as right and wrong.

The info is here.

On Edge: Understanding and Preventing Young Adults’ Mental Health Challenges

Making Caring Common. (2023).

https://mcc.gse.harvard.edu/reports/on-edge

From the Executive Summary

Our recent data suggests that the young adults of Generation Z are experiencing emotional struggles at alarming rates. While the emotional struggles of teens have been in the national spotlight since the pandemic—and this attention has been vital—according to our nationally representative survey, young adults report roughly twice the rates of anxiety and depression as teens. Compared to 18% of teens, a whopping 36% of young adults in our survey reported anxiety; in contrast to 15% of teens, 29% of young adults reported depression. Far too many young adults report that they feel on edge, lonely, unmoored, directionless, and that they worry about financial security. Many are “achieving to achieve” and find little meaning in either school or work. Yet these struggles of young adults have been largely off the public radar.

From the Press Release:

The report identifies a variety of stressors that may be driving young adults’ high rates of anxiety and

depression. The top drivers of young adults’ mental health challenges include:

• A lack of meaning, purpose, and direction: Nearly 3 in 5 young adults (58%) reported that they lacked “meaning or purpose” in their lives in the previous month. Half of young adults reported that their mental health was negatively influenced by “not knowing what to do with my life.
• Financial worries and achievement pressure: More than half of young adults reported that financial worries (56%) and achievement pressure (51%) were negatively impacting their mental health.
• A perception that the world is unraveling: Forty-five percent (45%) of young adults reported that a general "sense that things are falling apart” was impairing their mental health.
• Relationship deficits: Forty-four percent (44%) of young adults reported a sense of not mattering to others and 34% reported loneliness.
• Social and political issues: Forty-two percent (42%) reported the negative influence on their mental health of gun violence in schools, 34% cited climate change, and 30% cited worries that our political leaders are incompetent or corrupt.

(cut)

The report also suggests strategies for promoting young adults’ mental health and mitigating their

emotional challenges. These include:

• Cultivating meaning and purpose in young people, including by engaging them in caring for
• others and service;
• Supporting young people in developing gratifying and durable relationships; and
• Helping young people experience their lives as more than the sum of their achievements.

“We need to do much more to support young adults’ mental health and devote more resources to prevention,” said Kiran Bhai, MCC’s Schools & Parenting Programs Director and a co-author of the

report. “This includes reducing the stressors that young people are facing and helping them develop

the skills they need to thrive.”

The psychological causes and societal consequences of authoritarianism

Osborne, D., Costello, T. H., Duckitt, J., & 

Sibley, C. G. (2023).

Nature reviews psychology, 2(4), 220–232.

https://doi.org/10.1038/s44159-023-00161-4

Abstract

Over the past two decades, citizens' political rights and civil liberties have declined globally. Psychological science can play an instrumental role in both explaining and combating the authoritarian impulses that underlie these attacks on personal autonomy. In this Review, we describe the psychological processes and situational factors that foster authoritarianism, as well as the societal consequences of its apparent resurgence within the general population. First, we summarize the dual process motivational model of ideology and prejudice, which suggests that viewing the world as a dangerous, but not necessarily competitive, place plants the psychological seeds of authoritarianism. Next, we discuss the evolutionary, genetic, personality and developmental antecedents to authoritarianism and explain how contextual threats to safety and security activate authoritarian predispositions. After examining the harmful consequences of authoritarianism for intergroup relations and broader societal attitudes, we discuss the need to expand the ideological boundaries of authoritarianism and encourage future research to investigate both right-wing and left-wing variants of authoritarianism.

A pdf is here.

Here is my summary:

The article explores the complex interplay between individual psychological factors and societal dynamics that contribute to the rise and impact of authoritarianism. It delves into the dual process motivational model of ideology and prejudice, suggesting that perceiving the world as dangerous, but not necessarily competitive, fosters authoritarian tendencies.

The article highlights the role of evolutionary, genetic, personality, and developmental antecedents in shaping authoritarian predispositions. It emphasizes how contextual threats to safety and security can activate these predispositions, leading to increased support for authoritarian leaders and policies.

Furthermore, the article discusses the societal consequences of authoritarianism, including prejudice, intergroup conflict, and the suppression of individual rights and freedoms. It underscores the importance of understanding the psychological roots of authoritarianism to effectively combat its harmful effects.

ChatGPT one year on: who is using it, how and why?

Ghassemi, M., Birhane, A., et al.

Nature 624, 39-41 (2023)

doi: https://doi.org/10.1038/d41586-023-03798-6

Here is an excerpt:

More pressingly, text and image generation are prone to societal biases that cannot be easily fixed. In health care, this was illustrated by Tessa, a rule-based chatbot designed to help people with eating disorders, run by a US non-profit organization. After it was augmented with generative AI, the now-suspended bot gave detrimental advice. In some US hospitals, generative models are being used to manage and generate portions of electronic medical records. However, the large language models (LLMs) that underpin these systems are not giving medical advice and so do not require clearance by the US Food and Drug Administration. This means that it’s effectively up to the hospitals to ensure that LLM use is fair and accurate. This is a huge concern.

The use of generative AI tools, in general and in health settings, needs more research with an eye towards social responsibility rather than efficiency or profit. The tools are flexible and powerful enough to make billing and messaging faster — but a naive deployment will entrench existing equity issues in these areas. Chatbots have been found, for example, to recommend different treatments depending on a patient’s gender, race and ethnicity and socioeconomic status (see J. Kim et al. JAMA Netw. Open 6, e2338050; 2023).

Ultimately, it is important to recognize that generative models echo and extend the data they have been trained on. Making generative AI work to improve health equity, for instance by using empathy training or suggesting edits that decrease biases, is especially important given how susceptible humans are to convincing, and human-like, generated texts. Rather than taking the health-care system we have now and simply speeding it up — with the risk of exacerbating inequalities and throwing in hallucinations — AI needs to target improvement and transformation.

The info is here.

Here is my summary:

The article on ChatGPT's one-year anniversary presents a comprehensive analysis of its usage, exploring the diverse user base, applications, and underlying motivations driving its adoption. It reveals that ChatGPT has found traction across a wide spectrum of users, including writers, developers, students, professionals, and hobbyists. This broad appeal can be attributed to its adaptability in assisting with a myriad of tasks, from generating creative content to aiding in coding challenges and providing language translation support.

The analysis further dissects how users interact with ChatGPT, showcasing distinct patterns of utilization. Some users leverage it for brainstorming ideas, drafting content, or generating creative writing, while others turn to it for programming assistance, using it as a virtual coding companion. Additionally, the article explores the strategies users employ to enhance the model's output, such as providing more context or breaking down queries into smaller parts.  There are still issues with biases, inaccurate information, and inappropriate uses.

Spontaneous dyadic behavior predicts the emergence of interpersonal neural synchrony

Koul, A., et al. (2023).

NeuroImage, 277, 120233.

https://doi.org/10.1016/j.neuroimage.2023.120233 

Abstract

Synchronization of neural activity across brains – Interpersonal Neural Synchrony (INS) – is emerging as a powerful marker of social interaction that predicts success of multi-person coordination, communication, and cooperation. As the origins of INS are poorly understood, we tested whether and how INS might emerge from spontaneous dyadic behavior. We recorded neural activity (EEG) and human behavior (full-body kinematics, eye movements, and facial expressions) while dyads of participants were instructed to look at each other without speaking or making co-verbal gestures. We made four fundamental observations. First, despite the absence of a structured social task, INS emerged spontaneously only when participants were able to see each other. Second, we show that such spontaneous INS, comprising specific spectral and topographic profiles, did not merely reflect intra-personal modulations of neural activity, but it rather reflected real-time and dyad-specific coupling of neural activities. Third, using state-of-art video-image processing and deep learning, we extracted the temporal unfolding of three notable social behavioral cues – body movement, eye contact, and smiling – and demonstrated that these behaviors also spontaneously synchronized within dyads. Fourth, we probed the correlates of INS in such synchronized social behaviors. Using cross-correlation and Granger causality analyses, we show that synchronized social behaviors anticipate and in fact Granger cause INS. These results provide proof-of-concept evidence for studying interpersonal neural and behavioral synchrony under natural and unconstrained conditions. Most importantly, the results suggest that INS could be conceptualized as an emergent property of two coupled neural systems: an entrainment phenomenon, promoted by real-time dyadic behavior.

Highlights

• Interpersonal neural synchrony (INS) emerges spontaneously.

• INS only requires individuals to see each other (not a structured social task).

• Spontaneous INS emerges from dyad-specific behavioral synchrony.

• Reciprocated eye contact, body movement and smiling Granger cause INS.

• INS is an emergent property of two coupled neural systems.

The research is here.

Note: It would be interesting to measure the neurosynchronization between psychologist and patient to determine if it could improve psychotherapy outcomes.

To Lead a Meaningful Life, Become Your Own Hero

B. Rogers, K. Gray, & M. Christian

Scientific American

Originally published 30 OCT 23

Here is an excerpt:

With our condensed version of the hero’s journey, we looked at the connection between how people told their life story and their feelings of meaning in life. Across four separate studies, we collected life stories from more than 1,200 people, including online participants and a group of middle-aged adults in Chicago. We also used questionnaires to measure the storytelling participants’ sense of meaning in life, amount of life satisfaction and level of depression.

We then examined these stories for the seven elements of the hero’s journey. We found that people who had more hero’s journey elements in their life stories reported more meaning in life, more flourishing and less depression. These “heroic” people (men and women were equally likely to see their life as a hero’s journey) reported a clearer sense of themselves than other participants did and more new adventures, strong goals, good friends, and so on.

We also found that hero’s journey narratives provided more benefits than other ones, including a basic “redemptive” narrative, where a person’s life story goes from defeat to triumph. Of course, redemption is often a part of the “transformation” part of the hero’s journey, but compared with people whose life story contained only the redemptive narrative, those with a full hero’s journey reported more meaning in life.

We then wondered whether altering one’s life story to be more “heroic” would increase feelings of meaning in life. We developed a “restorying” intervention in which we prompted people to retell their story as a hero’s journey. Participants first identified each of the seven elements in their life, and then we encouraged them to weave these pieces together into a coherent narrative.

In six studies with more than 1,700 participants, we confirmed that this restorying intervention worked: it helped people see their life as a hero’s journey, which in turn made that life feel more meaningful. Intervention recipients also reported higher well-being and became more resilient in the face of personal challenges; these participants saw obstacles more positively and dealt with them more creatively.

The info is here.

Here is a take for clinicians:

Here are some specific ways that therapists can use the hero's journey framework in psychotherapy:

• Help clients to identify their values and goals. This can be done through a variety of exercises, such as writing exercises, role-playing, and journaling.
• Help clients to develop a plan to achieve their goals. This may involve setting realistic goals, developing a timeline, and identifying resources and support systems.
• Help clients to identify and overcome the challenges that are holding them back. This may involve addressing negative beliefs, developing coping skills, and processing past traumas.
• Help clients to explore their purpose and find ways to live a life that is true to themselves. This may involve exploring their interests, values, and strengths.

The hero's journey is a powerful framework that can be used to help people find meaning and purpose in their lives. By framing their lives as hero's journeys, people can develop a greater sense of agency and control over their lives. They can also become more resilient in the face of challenges and setbacks.