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There is influential neuroscientific data which shows that that the level of neural activity in cognitive brain areas (the dorsolateral prefrontal cortex and inferior parietal lobe) correlate positively with the characteristically consequentialist judgment, while the level of activity in emotion related areas (the posterior cingulate cortex, the medial prefrontal cortex, and the amygdala) correlate positively with the characteristically deontological judgment. These have mostly been explained by a dual process theory which ties neural mechanisms to a particular moral content, suggesting that deontological approaches to ethical decision making are preferentially supported by automatic emotional responses, whereas consequentialist approaches are preferentially supported by conscious reasoning and allied processes of cognitive control.
One piece of evidence comes from the cognitive psychology of punishing. Consequentialists would claim that punishment is justified by the prevention of future harm, while deontologists would argue that retribution is the primary justification. Some studies show that people’s motives appear to be predominantly retributivist and emotionally driven by anger and outrage when confronted with particular cases of wrongdoing (Baron et al. 1993; Kahneman et al. 1998; Sanfey et al. 2003). As long as punishment choices are sufficiently concrete, consequentialist reasoning will have no major role in punishment justification, while common-sense punitive judgment will be retributivist.
Anger and revenge do push people to punish in response to wrong doing. As Achilles famously said, revenge is “far sweeter than flowing honey wells up like smoke in the breasts of man”. Kantian oriented philosophers have rejected interpretations which tie deontology to vindictiveness. Retributivism implies institutions of justice and rational deliberation on facts in order to establish correct punishments, thus limiting revenge private justice (Dean 2010). Kant himself explains that “punishment is not an act that the injured party can undertake on his private authority but rather an act of a court distinct from him” (Metaphysics of Morals, VI:461).
However, one may grant that retributivism presupposes institutions of justice, but this only tempers revenge, without ruling it out as a basis of justification. I find unconvincing the idea that the presence of institutions makes retributivism a proper framework of punishment. It is rather the other way around. Only if retributivism is normatively sound then institutions are a proper framework of punishment. We would have a good standard of ruling out ill-grounded institutions.
I have suggested in a recent paper (Mihailov 2015) that in order to undermine sweeping conclusions about the emotional “essence” of deontology, we have to start by pointing out that the issue of punishment justification has many angles, not covered by purported evidence. Deontological thinking resists being driven by anger in cases of punishing agents with impaired autonomy. Many criminal actions, caused by brain disorders, elicit outrage and revenge, but deontologists would be reserved to justify punishment since attributing responsibility is problematic. Despite the fact that a criminal action elicits extreme anger, if the agent’s autonomy is impaired to a large extent then punishment can hardly be justified. No results have been produced for a correlation between emotions and deontological judgements in such cases.
Suppose now that we can produce some evidence and interpret it according to the standard model. Probably, it will not support the emotivist hypothesis mainly because deontological reasoning in such cases fits the cognitive model of utilitarian reasoning. According to the standard model (Greene 2004), utilitarian responses make use of cognitive control processes in order to overcome prepotent emotional reactions. Once we control our emotional reaction we are able to see other relevant features which provide reasons for actions that run counter to our initial reactions. Allegedly, this is how utilitarian reasoning unfolds in the crying baby dilemma.
You are hiding with several other people from enemy soldiers. Your baby starts to cry loudly, and if you do not cover your baby’s mouth the soldiers will find you and kill everyone. But if you cover your baby’s mouth, that will kill him. Contemplating the action of covering the baby’s mouth to his death elicits a strong aversion which makes people endorse the impermissibility of killing. However, if our cognitive processes manage to win out against the prepotent emotional response, then we will acknowledge that the baby is going to die in either scenario, and so we have much to gain in terms of lives saved by smothering it. Similarly, the deontological response would have to exercise heavy cognitive control over anger or private revenge in order to see that punishment is no longer justifiable in cases of impaired autonomy. It would not be surprising if future fMRI data will show a positive correlation between “cognitive” brain areas and deontological judgements in cases of punishing individuals with impaired autonomy.
If I am right, differences in content may not be as important as it is currently believed for dual process explanations.
Baron, Jonathan, Rajeev Gowda, and Howard Kunreuther. 1993. “Attitudes toward managing hazardous waste: What should be cleaned up and who should pay for it?.” Risk Analysis 13: 183-192.
Dean, Richard. 2010. “Does neuroscience undermine deontological theory?.” Neuroethics 3.1: 43-60.
Greene, Joshua, Leigh E. Nystrom, Engell, A. D., John M. Darley, & Jonathan D. Cohen. 2004. “The neural bases of cognitive conflict and control in moral judgment.” Neuron 44.2: 389-400.
Kahneman, Daniel, David Schkade and Cass Sunstein. 1998. “Shared outrage and erratic awards: The psychology of punitive damages.” Journal of Risk and Uncertainty 16.1: 49-86.
Kant, Immanuel. 1999. Practical philosophy. Cambridge: Cambridge University Press.
Mihailov, Emilian. 2015. “The Argument from Self-Defeating Beliefs Against Deontology.” Ethical Perspectives 22.4: 573-600.
Sanfey, Alan G., James K. Rilling, Jessica A. Aronson, Leigh E. Nystrom, and Jonathan D. Cohen. 2003. “The neural basis of economic decision-making in the ultimatum game.” Science 300.5626: 1755-1758.
Via Jennifer Chandler:
Fulbright Visiting Research Chair
in Health Law, Policy and Ethics
Start date: September 2017 or January 2018
Duration: 4 months
Eligibility: Outstanding scholar with a Ph.D. or equivalent, U.S. citizenship, not
having lived outside the U.S. for five or more consecutive years in the past six
Remuneration: $25,000 (USD) + benefits
Application Deadline: August 1, 2016
Breakthroughs in health sciences offer tremendous hope to patients and the public, but
with progress emerge new legal and ethical challenges. This position allows a scholar to
join the vibrant and growing Centre for Health Law, Policy and Ethics at the University of
Ottawa for four months. Housed in the Faculty of Law, the Centre is a hub for research
across disciplines on cutting edge problems. It is the largest of its kind in Canada and is
ideally located in the nation’s capital to allow the mobilization of new ideas and evidence
to affect national and international policy.
The Chairholder will benefit from exchanges with Centre members from Law, Social
Sciences, Sciences, Arts, Health Sciences, Management, and Medicine. Members work
on a broad range of issues, including but not limited to mental health law and policy;
medical aid in dying as recently legalized by the Supreme Court of Canada; the impact
and regulation of new technologies; innovative approaches to health governance; and
issues stemming from an aging population such as funding and regulation of long-term
care, advance directives, and capacity and consent. The Chairholder will also have the
opportunity to network with leading policy makers, jurists, and stakeholders.
To apply: Go to http://www.cies.org/application-login.
Leave Item 2 (Award Number) blank.
Set Item 3 (Type of Activity) to “Research”.
Set Item 24 (Host Institution) to “Other”.
For more information on the Centre: Go to https://commonlaw.uottawa.ca/health-law/.
Questions? Email Colleen.Flood "at" uOttawa.ca or Lorian.Hardcastle "at" uOttawa.ca.
For those who are unaware, President Obama recently published an article at the Journal of the American Medical Association. If you follow academics on Twitter, you likely saw it. President Obama is the first sitting President to publish an academic journal article, which is kind of cool, but I don't want to dwell on that observation. The article is an analysis of the effectiveness of one of the President's signature policy initiative, the Affordable Care Act (generally called "Obamacare," a term I personally loathe... but that's another story) and associated healthcare expansions. It also includes further policy recommendations.
The article falls squarely into American healthcare policy, one of my areas of interest, so I wanted to offer a short summary of the major points of the article and some comments. The article is very short, only 7-pages, and it isn't paywalled. For those who are interested, I do suggest taking a look at the original.
The key points of the analysis are in the summary, but they are also well-chewed talking points you're likely to hear on the Sunday morning talk shows. (Well, you would hear them if the guests on such shows were inclined to indulge in arcane things like facts and statistics.) I present those claims in order of their credibility, and I dispense with some of the mushy, politically expedient anecdotes the President included that make the thing read less like a scholarly article and more like a policy speech.
1. The enactment of the Affordable Care Act, particularly the Medicaid expansion provision, is responsible for the largest decrease in the uninsured rate since the creation of medicare.
2. Predictions that the Affordable Care Act would have an adverse effects on employment seem not only unfounded, but outright mistaken.
3. The quality of care patients receive under the provisions of the Affordable Care Act is measurably better than what patients received, and various research initiatives put forward by the administration will improve that quality even further.
I take it that (1) is probably the most important claim in the article, and one of the most important claims in understanding the legacy of the Affordable Care Act. While the percentage of uninsured Americans had been decreasing since 2006 (it peaked at 15.8%; about 47 million Americans, according to the Census Bureau), the President's article shows a dramatic decrease of about 5 points during enacting the Affordable Care Act. This number is uncontroversial amongst reality-oriented people; the Census Bureau and the CDC have reported all-time lows of just under 10%.
For those who are skeptical of the causal responsibility of the Affordable Care Act initiative, President Obama's article provides a persuasive case (though hardly original) based on a few significant data-points. The most important is that there seems to be an enormous difference between states that adopted the Medicaid expansion provision and states that didn't. He provides the following graphic:
Now, for the skeptic, it is important to keep in mind that there are some pretty significant sociological differences between the states that are inclined to adopt Medicaid expansion (e.g. CA, CN, MA, NY, etc.) and those that aren't (e.g. FL, GA, SC, TX). See the current list of states that have adopted medicare expansion here to get the picture.
Still, that's not a particularly compelling argument against the ACA as much as an observation that states that aren't going to provide increased access to Medicaid are going to have fewer folks in their states who are insured. That seems basically tautological.
The more interesting version of the observation has been made by groups including the Kaiser Family Foundation, that about 11 million people gained access to Medicaid following the introduction of the expansion.
I am not sure how many hardline skeptics are going to be compelled by the data that the Affordable Care Act increased access to coverage; still, these statistics seem pretty hard to dispute and the dramatic swing following the introduction of Medicaid expansion seems to be largely facilitated by this work, given that the 11 million additions to Medicaid alone contribute to that reduction in the uninsured rate.
The second point is really just a jab, so far as I can tell, at those who said that increasing mandates on employers would lead to large scale layoffs and a dramatic increase in unemployment. There's not that much to say about those claims beyond the fact that unemployment has been dropping pretty steadily since 2010 (which, coincidentally, is when the Affordable Care Act was passed). There have been a number of claims about the "true unemployment rate" being far higher, but those claims are not supported by Census Bureau or Bureau of Labor Statistics data.
Now, no one should suggest that the Affordable Care Act improved unemployment numbers, though there have been jobs added in the healthcare industry over the last six years. (The health care and social assistance industry has been consistently adding jobs, including adding 58,000 jobs last month, June '16.) At the very least, this original objection to mandates on employer coverage seems not to have come true.
The third part of the article is the one that demands the most skepticism, and is not even really defended in the article. There is no information (so far as I can tell) that suggests qualitative healthcare outcomes have improved since the implementation of the Affordable Care Act. The Department of Health and Human Services differentiates qualitative metrics for healthcare, and while one of those metrics (namely access) has decidedly improved under the ACA, for all of the reasons sketched above, the other metrics have not followed.
It is hard to map things like patient outcomes over short periods of time, because the impact of access to healthcare in 2010 may not have a clear beneficial outcome for a patient until 2020 or 2030; this is especially true when it comes to talking about young people, who were one of the major targeted demographics in the ACA reform. It just isn't feasible to make a judgment about whether the quality of American healthcare has improved. In 15 or 20 years, when we have data done on these long term metrics, like patient outcomes in life expectancy and quality of life, we can make that judgment.
During the last few months, the President's administration has talked about the expansion of medical research in pursuit of treatments for, in particular, cancer. The goal is to improve patient outcomes through an increase in research spending, and the President acknowledges this effort in his article. This project, the "Moonshot" as they're pitching it, is not particularly well founded. Oncologist and (dare I label him as such?) sociologist of medicine Vinay Prasad has an op-ed on the scientific skepticism, there have been renewed discussions about if and how to share data, and (most cynically) it seems like a political stunt preying on the hope and naivety of those who don't understand how scientific research actually progresses. The increases in spending associated with the initiative are probably going to be good for a lot of cancer researchers, but (at a minimum) have blown expectations way out of proportion.
I'm reminded of an episode of the West Wing where President Bartlett overhears some oncologists talking about prospective treatments for cancer, and decides to announce in the State of the Union that they're going to cure cancer in a decade. (I wonder what White House aid was watching that episode, aired in 2002, and thought, "Hey, we should actually do that.")
I should say, there is no evidence that healthcare outcomes have gotten worse, and very little reason to suppose that initiatives like Moonshot will do any damage to medical research. (There are issues with apportionment and opportunity costs, but those are more technical worries than just the worry of, to quote a great philosopher, "mo' money, mo' problems.")
At best, though, there isn't adequate evidence that there have been significant improvement in patient outcomes as a result of changes in the Affordable Care Act. Those qualitative outcomes, while we might be cautiously optimistic and work hard to improve them, are something that has to be assessed more in the long term. For those who are interested in the studies on the ACA, though, President Obama's article does act as a good study of the improvements in coverage brought about by the marketplaces and Medicaid expansion, and shows that the legislation has accomplished several of its most important goals in increasing access to healthcare and decreasing the number of individuals without insurance.
Joshua Stein is a guest blogger at Neuroethics and Law. He has studied at the graduate level at New York University and is starting in the fall as a doctoral student at the University of Calgary.
Claims that deontology may very well be a confabulation are notorious, but there is loose talk around them. Clarification work needs to be done.
Greene (2008) proposes two conditions for confabulation:
To illustrate this, he imagines a case relating to romantic choices. Alice goes on many dates and evaluates the people she likes as brilliant, kind, charming, and the ones she does not like as self-absorbed. At the same time, those who were evaluated positively are exceptionally tall, while the ones rejected are less than six-foot-four. As it turns out height is a near-perfect predictor of Alice’s preferences. However, she believes that her romantic choices are based on personality traits. Thus, Alice’s talk about personality traits is a confabulation.
The first condition is straightforward, as one just needs to identify the influencing factors in controlled experiments. The second is not. How we should understand the idea that the factors are not plausibly related? It is clear that height is not related to personality traits. But it does not follow from this alone that the factors that Alice believes are the bases of her judgments are actually a mere rationalization. What follows is that two kinds of factors are the bases of her judgments, and that she invokes only one, being unaware of additional influencing factors. This is not quite a mere rationalization. The second condition needs to prove that the “official” factors do not have a significant enough causal contribution to be a predictive factor, contrary to what a confabulator believes. Therefore, “plausibly unrelated” must refer to a relation of causal influence on belief or action. This understanding is in line with the first condition which requires identifying a factor that is the main causal influence and with the psychological characteristics the confabulator’s factors do not drive ex ante his judgments. The model can be stated as:
(1) Alice believes that plausible factors X, Y, Z preferentially support her romantic choices.
(2) Alice’s romantic choices are preferentially supported by W.
(3) Alice is unaware and does not believe that W drives her choices.
(4) X, Y, Z do not preferentially support Alice’s romantic choice.
(5) Therefore, Alice’s citation of factors X, Y, Z is a confabulation.
Greene suggests that something similar to Alice’s thought process reflects the way deontological philosophy is done. Deontologists seem to be confident that certain factors, such as thoughts of duties and rights, generate deontological judgments, but in fact something else is decisive to issuing these judgments. Now, we get the following:
(1) Deontologists believe that plausible factors X, Y, Z preferentially support characteristic deontological (CD) judgments.
(2) Characteristic deontological judgments are preferentially supported by W.
(3) Deontologists are unaware and do not believe that W drives CD judgments.
(4) X, Y, Z do not preferentially support CD judgments.
(5) Therefore, deontologists’ citation of X, Y, Z is a confabulation.
I will call this the neutral confabulation model (NC) because the two conditions do not stipulate the nature of the predictive factor W. But this is not the relevant model. Greene insists that the existence of a certain type of moral emotions in conjunction with confabulatory tendencies gives rise to deontological philosophy. He draws the distinction between currency emotions, specific to consequentialism, and alarm-like emotions, specific to deontology. Currency emotions are relevant input in a weighing process, whereas alarm like emotions are highly salient, blunt, simple and forces one to issue strong commands (“Don’t do it!”, “Must do it!”) We now get what I will call the alarm-like emotion based confabulation model (AEC), in which W is qualified as an alarm-like affective factor in premise (2).
One famous example of moral confabulation which seems to fit the AEC model is the incest experiment. Haidt and colleagues (2000) devised scenarios to elicit responses that involve two separate processes: an averse emotional reaction followed by a post hoc justification. In the incest story, Julie and Mark (brother and sister) decide to make love. Julie was already taking birth control pills and Mark used a condom. After hearing the story most subjects immediately judged the action to be wrong, and began to justify their response by pointing out psychological and inbreeding risks.
The incest story elicits a judgement of moral condemnation which is driven by an alarm-like emotion such as disgust. However, subjects immediately abandon their justifications when features from the story are reinforced. They point out psychological and inbreeding risks, but after the experimenter reiterates the use of birth control, and the fact the story presupposes no psychological harm, they admit failure of justification. It is highly implausible that these results mirror the way deontological philosophy is done. It is immediately transparent that the reasoning involved is badly done. Subjects are neither confident about their justifications, nor do they provide at least prima facie plausible reasons. When retracting the proposed justifications, subjects say something like “I do not know, I can’t explain it, I just know it’s wrong.” This is indeed a confabulation driven by alarm-like emotions, but one that ultimately is not endorsed by the subjects themselves, and lacks a minimal plausibility.
Recently published on SSRN:
MICHAEL S. PARDO, University of Alabama School of Law
DENNIS PATTERSON, European University Institute, Rutgers University School of Law, Camden, Swansea University School of Law, European University Institute - Department of Law (LAW)
This is the introductory chapter to the forthcoming collection, Philosophical Foundations of Law and Neuroscience (Dennis Patterson & Michael S. Pardo eds., Oxford University Press, 2016). We first offer some observations about this rapidly growing field and the variety of issues raised by the interaction of law and neuroscience. We then discuss how philosophy may contribute to the field. Finally, we summarize the chapters in the book.
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See here for this piece by former Neuroethics & Law Blog guest blogger Andrea Lavazza.
The Neuroskeptic walks some of the discussion on the topic away from the ledge here.
Erika Hayasaki writes in this Newsweek article about traumatic brain injury, punishment, and rehabilitation. I offer a couple of thoughts inside as well.
A dominant philosophical practice is to design hypothetical scenarios that elicit strong moral intuitions which run against a particular moral theory. Critics of consequentialism rely heavily on this methodology.
Bernard Williams, for example, devised the famous scenario which strikes a chord of discontent among many people, who nevertheless may sympathize occasionally with the consequentialist idea that best outcomes matter. Imagine that you are an explorer and wander into a village. There you will find a military official, named Pedro, who is about to shoot 10 Indians, randomly selected. Since you’re an honored visitor from another land, Pedro offers you the guest’s privilege of killing one of the Indians with the firm promise that the other Indians will be let off. If you refuse, then Pedro will kill all of them. Surely, you’re not happy to be the decision maker in the scenario. You can save 9 lives, but the thought of killing one person is excruciating and it’s likely you’ll find it repugnant. I myself tend to feel the same way.
However, an interesting shift may take place under the pressure of “the new science of morality”, as it has been labeled. Drawing upon data from neuroscience, Joshua Greene contends that deontological judgments are preferentially supported by automatic emotional responses which, in many cases, respond to irrelevant moral features, while characteristically consequentialist judgments are preferentially supported by conscious processes of cognitive control. What seems a strong methodological weapon may turn out an Achilles’ heel.
Yet, non-consequentialist philosophers do engage in highly demanding conscious reasoning. But what if the effort of philosophical theorizing is an exercise in moral confabulation to polish off track emotional responses? Greene speculates that if you put together the fact that most of the time we are driven by strong emotional responses with the tendency to fabricate plausible sounding stories in order to justify or explain these responses, you get deontological moral philosophy.
As a philosopher with sympathies for the Kantian tradition, am I confabulating? In my paper, recently published in Neuroethics, I argue, hopefully non-motivated, that the evidence used by Greene does not support the confabulation hypothesis and that even if we accept it we should not be too worried about its debunking power.
One suspicion I start with is that paradigmatic cases of confabulation do not seem to fit the relevant model for Greene’s ambitious attack on deontology, namely what I call alarm-like emotion based confabulation. Since established cases tend to favor a neutral model, which is not committed to a particular content of behavioral causes (cognitive/emotional), it is puzzling to expect outright alarm-like confabulations in philosophical theorizing.
This puzzle leads to a deeper reason as to why the confabulation hypothesis is problematic. Why is the case that paradigmatic cases are not driven by alarm-like emotions? By looking at the conducive conditions for confabulation, I argue that there is an inherent resistance on the part of alarm-like emotions to be subject to confabulation. A confabulation is likely to occur when stimuli are not salient and are not plausible causes of belief or action. And vice versa, a confabulation is unlikely to occur when stimuli are salient and plausible causes.
But alarm-like emotions are highly salient, blunt, simple and almost forces one to issue strong commands such as “Don’t do it!”. Thus, it is unlikely to expect people to have alarm-like emotions that are activated by the tragic conditions of moral dilemmas, used to pit deontological judgments against consequentialist judgments, and not know what the tragedy is about. Understanding what is conducive to confabulatory behavior suggests that it is resistant to Greene’s profile of the psychological “essence” of deontology.
Now suppose that the justification of a particular deontological judgment is, indeed, a confabulation. How worried should deontological theory be? The deployment of knowledge in particular cases is ill-grounded in confabulation tendencies, not the content of the justifications or explanations in general. Once we make the distinction between application and content of knowledge, we can see more clearly that confabulation data can support an argument that deontology is incorrectly applied in particular cases, not that it is faulty theory in general.
And if a deontological confabulation is to sound like a plausible story, then it has to involve some valid features, because non-pathological confabulation works by picking out content from shared knowledge and norms which are endorsed in general. Ironically, admitting cases of deontological confabulation as rational appealing stories implies accepting that, in general, deontology has some epistemic merit from which confabulations get their prima facie plausibility.
Dear N&LB readers,
I will blog post this month about topics in neuroethics and moral psychology. I am the executive director of the Research Centre in Applied Ethics (CCEA) and a teaching assistant at the Faculty of Philosophy, University of Bucharest. My recent work has focused on the implications of experimental moral psychology and neuroscience for normative and applied ethics.
I will start with a post that presents some ideas I developed in my paper “Is deontology a moral confabulation?”, published in the April issue of Neuroethics.
I would like to thank Adam for the kind invitation! Looking forward to engage with your reactions.
Recently published on SSRN (and forthcoming in: Journal of Law and Crime Sciences (2016)):
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