Biden administration rescinds much of Trump ‘conscience’ rule for health workers

Nathan Weixel

The Hill

Originally published 9 Jan 24

The Biden administration will largely undo a Trump-era rule that boosted the rights of medical workers to refuse to perform abortions or other services that conflicted with their religious or moral beliefs.

The final rule released Tuesday partially rescinds the Trump administration’s 2019 policy that would have stripped federal funding from health facilities that required workers to provide any service they objected to, such as abortions, contraception, gender-affirming care and sterilization.

The health care conscience protection statutes represent Congress’s attempt to strike a balance between maintaining access to health care and honoring religious beliefs and moral convictions, the Department of Health and Human Services said in the rule.

“Some doctors, nurses, and hospitals, for example, object for religious or moral reasons to providing or referring for abortions or assisted suicide, among other procedures. Respecting such objections honors liberty and human dignity,” the department said.

But at the same time, Health and Human Services said “patients also have rights and health needs, sometimes urgent ones. The Department will continue to respect the balance Congress struck, work to ensure individuals understand their conscience rights, and enforce the law.”

The info is here.

Summary from Healthcare Dive

The HHS Office of Civil Rights has again updated guidance on providers’ conscience rights. The latest iteration, announced on Tuesday, aims to strike a balance between honoring providers’ religious and moral beliefs and ensuring access to healthcare, according to the agency.

President George W. Bush created conscience rules in 2008, which codify the rights of healthcare workers to refuse to perform medical services that conflict with their religious or moral beliefs. Since then, subsequent administrations have rewritten the rules, with Democrats limiting the scope and Republicans expanding conscience protections. 

The most recent revision largely undoes a 2019 Trump-era policy — which never took effect — that sought to expand the rights of healthcare workers broadly to refuse to perform medical services, such as abortions, on religious or moral grounds.

Trump Is Coming for Obamacare Again

Ronald Brownstein

The Atlantic

Originally posted 10 Jan 24

Donald Trump’s renewed pledge on social media and in campaign rallies to repeal and replace the Affordable Care Act has put him on a collision course with a widening circle of Republican constituencies directly benefiting from the law.

In 2017, when Trump and congressional Republicans tried and failed to repeal the ACA, also known as Obamacare, they faced the core contradiction that many of the law’s principal beneficiaries were people and institutions that favored the GOP. That list included lower-middle-income workers without college degrees, older adults in the final years before retirement, and rural communities.

The info is paywalled here.

Here's the gist:

• Trump's stance: He believes Obamacare is a "catastrophe" and wants to replace it with "MUCH BETTER HEALTHCARE."
• Challenges: Repealing Obamacare is likely an uphill battle. Its popularity has increased, and even some Republicans benefit from the law.
• Potential consequences: If Trump succeeds, millions of Americans could lose their health insurance, while others face higher premiums.
• Political implications: Trump's renewed focus on Obamacare could energize his base but alienate moderate voters.

Criminal Justice Reform Is Health Care Reform

Haber LA, Boudin C, Williams BA.

JAMA.

Published online December 14, 2023.

doi:10.1001/jama.2023.25005

Here is an excerpt:

Health Care While Incarcerated

Federal law mandates provision of health care for incarcerated persons. In 1976, the US Supreme Court ruled in Estelle v Gamble that “deliberate indifference to serious medical needs of prisoners constitutes the ‘unnecessary and wanton infliction of pain,’” prohibited under the Eighth Amendment. Subsequent cases established that incarcerated individuals must receive access to medical care, enactment of ordered care, and treatment without bias to their incarcerated status.

Such court decisions establish rights and responsibilities, but do not fund or oversee health care delivery. Community health care oversight, such as the Joint Commission, does not apply to prison health care. When access to quality care is inadequate, incarcerated patients must resort to lawsuits to advocate for change—a right curtailed by the Prison Litigation Reform Act of 1996, which limited prisoners’ ability to file suit in federal court.

Despite Eighth Amendment guarantees, simply entering the criminal-legal system carries profound personal health risks: violent living conditions result in traumatic injuries, housing in congregate settings predisposes to the spread of infectious diseases, and exceptions to physical comfort, health privacy, and informed decision-making occur during medical care delivery. These factors compound existing health disparities commonly found in the incarcerated population.

The First Step Act

Signed under then-president Trump, the First Step Act of 2018 (FSA) was a bipartisan criminal justice reform bill designed to reduce the federal prison population while also protecting public safety. The legislation aimed to decrease entry into prison, provide rehabilitation during incarceration, improve protections for medically vulnerable individuals, and expedite release.

To achieve these goals, the FSA included prospective and retroactive sentencing reforms, most notably expanded relief from mandatory minimum sentences for drug distribution offenses that disproportionately affect Black individuals in the US. The FSA additionally called for the use of evidence-based tools, such as the Prisoner Assessment Tool Targeting Estimated Risk and Needs, to facilitate release decisions.

The legislation also addressed medical scenarios commonly encountered by professionals providing care to incarcerated persons, including prohibitions on shackling pregnant patients, deescalation training for correctional officers when encountering people with psychiatric illness or cognitive deficits, easing access to compassionate release for those with advanced age or life-limiting illness, and mandatory reporting on the use of medication-assisted treatment for opioid use disorder. With opioid overdose being the leading cause of postrelease mortality, the latter requirement has been particularly important for those transitioning out of correctional settings.

During the recent COVID-19 pandemic, FSA amendments expanding incarcerated individuals’ access to the courts led to a marked increase in successful petitions for early release from prison. Decarcerating those individuals most medically at risk during the public health crisis reduced the spread of viral illness associated with prison overcrowding, protecting both incarcerated individuals and those working in carceral settings.

The info is here.

The man helping prevent suicide with Google adverts

Looi, M.-K. (2023).

BMJ.

https://doi.org/10.1136/bmj.p2847 

Here are two excerpts:

Always online

A big challenge in suicide prevention is that people often experience suicidal crises at times when they’re away from clinical facilities, says Nick Allen, professor of psychology at the University of Oregon.

“It’s often in the middle of the night, so one of the great challenges is how can we be there for someone when they really need us, which is not necessarily when they’re engaged with clinical services.”

Telemedicine and other digital interventions came to prominence at the height of the pandemic, but “there’s an app for that” does not always match the patient in need at the right time. Says Onie, “The missing link is using existing infrastructure and habits to meet them where they are.”

Where they are is the internet. “When people are going through suicidal crises they often turn to the internet for information. And Google has the lion’s share of the search business at the moment,” says Allen, who studies digital mental health interventions (and has had grants from Google for his research).

Google’s core business stores information from searches, using it to fuel a highly effective advertising network in which companies pay to have links to their websites and products appear prominently in the “sponsored” sections at the top of all relevant search results.

The company holds 27.5% of the digital advertising market—earning the company around $224bn from search advertising alone in 2022.

If it knows enough about us to serve up relevant adverts, then it knows when a user is displaying red flag behaviour for suicide. Onie set out to harness this.

“It’s about the ‘attention economy,’” he says, “There’s so much information, there’s so much noise. How do we break through and make sure that the first thing that people see when they’re contemplating suicide is something that could be helpful?”

(cut)

At its peak the campaign was responding to over 6000 searches a day for each country. And the researchers saw a high level of response.

Typically, most advertising campaigns see low engagement in terms of clickthrough rates (the number of people that actually click on an advert when they see it). Industry benchmarks consider 3.17% a success. The Black Dog campaign saw 5.15% in Australia and 4.02% in the US. Preliminary data show Indonesia to be even higher—as much as 12%.

Because this is an advertising campaign, another measure is cost effectiveness. Google charges the advertiser per click on its advert, so the more engaged an audience is (and thus what Google considers to be a relevant advert to a relative user) the higher the charge. Black Dog’s campaign saw such a high number of users seeing the ads, and such high numbers of users clicking through, that the cost was below that of the industry average of $2.69 a click—specifically, $2.06 for the US campaign. Australia was higher than the industry average, but early data indicate Indonesia was delivering $0.86 a click.

-------

I could not find a free pdf.  The link above works, but is paywalled. Sorry. :(

Google is Free: Moral Evaluations of Intergroup Curiosity

Mosley, A. J., & Solomon, L. H. (2023).

Personality and Social Psychology Bulletin, 0(0).

https://doi.org/10.1177/01461672231180149

Abstract

Two experiments investigated how evaluations of intergroup curiosity differed depending on whether people placed responsibility for their learning on themselves or on outgroup members. In Study 1, participants (n = 340; 51% White-American, 49% Black-American) evaluated White actors who were curious about Black culture and placed responsibility on outgroup members to teach versus on themselves to learn. Both Black and White participants rated the latter actors as more moral, and perceptions of effort mediated this effect. A follow-up preregistered study (n = 513; 75% White-American) asked whether perceptions of greater effort cause greater perceptions of moral goodness. Replicating Study 1, participants rated actors as more moral when they placed responsibility on themselves versus others. Participants also rated actors as more moral when they exerted high versus low effort. These results clarify when and why participants view curiosity as morally good and help to strengthen bridges between work on curiosity, moral cognition, and intergroup relations.

A pdf is here.

Here is my summary:

The researchers found that people evaluate intergroup curiosity more favorably when they perceive that the curious individual is placing responsibility on themselves to learn rather than on the outgroup to teach. The researchers also found that perceptions of effort mediate this effect, such that people view curious individuals who exert greater effort as more moral. These findings suggest that people view intergroup curiosity as more morally good when they perceive that the curious individual is taking responsibility for their own learning and is putting in the effort to understand the outgroup.

Consciousness does not require a self

James Coook

iai.tv

Originally published 14 DEC 23

Here is an excerpt:

Beyond the neuroscientific study of consciousness, phenomenological analysis also reveals the self to not be the possessor of experience. In mystical experiences induced by meditation or psychedelics, individuals typically enter a mode of experience in which the psychological self is absent, yet consciousness remains. While this is not the default state of the mind, the presence of consciousness in the absence of a self shows that consciousness is not dependent on an experiencing subject. What is consciousness if not a capacity of an experiencing subject? Such an experience reveals consciousness to consist of a formless awareness at its core, an empty space in which experience arises, including the experience of being a self. The self does not possess consciousness, consciousness is the experiential space in which the image of a psychological self can appear. This mode of experience can be challenging to conceptualise but is very simple when experienced – it is a state of simple appearances arising without the extra add-on of a psychological self inspecting them.

We can think of a conscious system as a system that is capable of holding beliefs about the qualitative character of the world. We should not think of belief here as referring to complex conceptual beliefs, such as believing that Paris is the capital of France, but as the simple ability to hold that the world is a certain way. You do this when you visually perceive a red apple in front of you, the experience is one of believing the apple to exist with all of its qualities such as roundness and redness. This way of thinking is in line with the work of Immanuel Kant, who argued that we never come to know reality as it is but instead only experience phenomenal representations of reality [9]. We are not conscious of the world as it is, but as we believe it to be.

The info is here.

Here is my take:

For centuries, we've assumed consciousness and the sense of self are one and the same. This article throws a wrench in that assumption, proposing that consciousness can exist without a self. Imagine experiencing sights, sounds, and sensations without the constant "me" narrating it all. That's what "selfless consciousness" means – raw awareness untouched by self-reflection.

The article then posits that our familiar sense of self, complete with its stories and memories, isn't some fundamental truth but rather a clever prediction concocted by our brains. This "predicted self" helps us navigate the world and interact with others, but it's not necessarily who we truly are.

Decoupling consciousness from the self opens a Pandora's box of possibilities. We might find consciousness in unexpected places, like animals or even artificial intelligence. Understanding brain function could shift dramatically, and our very notions of identity, free will, and reality might need a serious rethink. This is a bold new perspective on what it means to be conscious, and its implications are quite dramatic.

Out, damned spot: Can the “Macbeth Effect” be replicated?

Earp, B. D., Everett, J. A. C., et al. (2014).

Basic and Applied Social Psychology, 36(1), 91–98.

https://doi.org/10.1080/01973533.2013.856792

Abstract

Comments on an article by Zhong, and Liljenquist (see record 2004-22267-003). Zhong and Liljenquist (2006) reported evidence of a “Macbeth Effect” in social psychology: a threat to people's moral purity leads them to seek, literally, to cleanse themselves. In an attempt to build upon these findings, we conducted a series of direct replications of Study 2 from Z&L's seminal report. We used Z&L's original materials and methods, investigated samples that were more representative of the general population, investigated samples from different countries and cultures, and substantially increased the power of our statistical tests. Despite multiple good-faith efforts, however, we were unable to detect a “Macbeth Effect” in any of our experiments. We discuss these findings in the context of recent concerns about replicability in the field of experimental social psychology.

A pdf is here.

Here is my summary:

In a seminal study published in 2006, Zhong and Liljenquist introduced the concept of the "Macbeth Effect," which suggests that moral transgressions lead to a desire for physical cleansing. This phenomenon was inspired by Shakespeare's play "Macbeth," in which Lady Macbeth's obsession with washing her hands reflects her guilt over her murderous actions.

Building on Zhong and Liljenquist's work, Earp et al. (2014) conducted a series of experiments to replicate the Macbeth Effect. They used various methods, including manipulating participants' moral states through writing tasks and exposing them to reminders of moral cleanliness. However, despite their efforts, they were unable to consistently find evidence for the Macbeth Effect.

The authors' inability to replicate the original findings raises questions about the robustness of the Macbeth Effect. They suggest that more research is needed to understand the conditions under which moral transgressions lead to a desire for physical cleansing. Additionally, they emphasize the importance of conducting replications in psychological research to ensure the reliability of findings.

The paucity of morality in everyday talk

Atari, M., Mehl, M.R., Graham, J. et al. 

Sci Rep 13, 5967 (2023).

https://doi.org/10.1038/s41598-023-32711-4

Abstract

Given its centrality in scholarly and popular discourse, morality should be expected to figure prominently in everyday talk. We test this expectation by examining the frequency of moral content in three contexts, using three methods: (a) Participants’ subjective frequency estimates (N = 581); (b) Human content analysis of unobtrusively recorded in-person interactions (N = 542 participants; n = 50,961 observations); and (c) Computational content analysis of Facebook posts (N = 3822 participants; n = 111,886 observations). In their self-reports, participants estimated that 21.5% of their interactions touched on morality (Study 1), but objectively, only 4.7% of recorded conversational samples (Study 2) and 2.2% of Facebook posts (Study 3) contained moral content. Collectively, these findings suggest that morality may be far less prominent in everyday life than scholarly and popular discourse, and laypeople, presume.

Summary

Overall, the findings of this research suggest that morality is far less prevalent in everyday talk than previously assumed. While participants overestimated the frequency of moral content in their self-reports, objective measures revealed that moral topics are relatively rare in everyday conversations and online interactions.

The study's authors propose several explanations for this discrepancy between subjective and objective findings. One possibility is that people tend to remember instances of moral talk more vividly than other types of conversation. Additionally, people may be more likely to report that they engage in moral talk when they are explicitly asked about it, as this may make them more aware of their own moral values.

Regardless of the underlying reasons, the findings of this research suggest that morality is not as prominent in everyday life as is often assumed. This may have implications for how we understand and promote moral behavior in society.

Indigenous data sovereignty—A new take on an old theme

Tahu Kukutai (2023).

Science, 382.

DOI:10.1126/science.adl4664

A new kind of data revolution is unfolding around the world, one that is unlikely to be on the radar of tech giants and the power brokers of Silicon Valley. Indigenous Data Sovereignty (IDSov) is a rallying cry for Indigenous communities seeking to regain control over their information while pushing back against data colonialism and its myriad harms. Led by Indigenous academics, innovators, and knowledge-holders, IDSov networks now exist in the United States, Canada, Aotearoa (New Zealand), Australia, the Pacific, and Scandinavia, along with an international umbrella group, the Global Indigenous Data Alliance (GIDA). Together, these networks advocate for the rights of Indigenous Peoples over data that derive from them and that pertain to Nation membership, knowledge systems, customs, or territories. This lens on data sovereignty not only exceeds narrow notions of sovereignty as data localization and jurisdictional rights but also upends the assumption that the nation state is the legitimate locus of power. IDSov has thus become an important catalyst for broader conversations about what Indigenous sovereignty means in a digital world and how some measure of self-determination can be achieved under the weight of Big Tech dominance.

Indigenous Peoples are, of course, no strangers to struggles for sovereignty. There are an estimated 476 million Indigenous Peoples worldwide; the actual number is unknown because many governments do not separately identify Indigenous Peoples in their national data collections such as the population census. Colonial legacies of racism; land dispossession; and the suppression of Indigenous cultures, languages, and knowledges have had profound impacts. For example, although Indigenous Peoples make up just 6% of the global population, they account for about 20% of the world’s extreme poor. Despite this, Indigenous Peoples continue to assert their sovereignty and to uphold their responsibilities as protectors and stewards of their lands, waters, and knowledges.

The rest of the article is here.

Here is a brief summary:

This is an article about Indigenous data sovereignty. It discusses the importance of Indigenous communities having control over their own data. This is because data can be used to exploit and harm Indigenous communities. Indigenous data sovereignty is a way for Indigenous communities to protect themselves from this harm. There are a number of principles that guide Indigenous data sovereignty, including collective consent and the importance of upholding cultural protocols. Indigenous data sovereignty is still in its early stages, but it has the potential to be a powerful tool for Indigenous communities.