Peer commentary on: Blumenthal-Barby, J. S. (2016). Biases and heuristics in decision making and their impact on autonomy. The American Journal of Bioethics, 16(5), 5-15

Morar, Nicolae

Skorburg, Joshua August

English

PhilPapers

Full Terms & Conditions of access and use can be found athttp://www.tandfonline.com/action/journalInformation?journalCode=uajb20Download by: [University of Oregon] Date: 29 August 2016, At: 09:39The American Journal of BioethicsISSN: 1526-5161 (Print) 1536-0075 (Online) Journal homepage: http://www.tandfonline.com/loi/uajb20Toward an Ecological BioethicsNicolae Morar & Joshua August SkorburgTo cite this article: Nicolae Morar & Joshua August Skorburg (2016) Towardan Ecological Bioethics, The American Journal of Bioethics, 16:5, 35-37, DOI:10.1080/15265161.2016.1159756To link to this article:  http://dx.doi.org/10.1080/15265161.2016.1159756Published online: 25 Apr 2016.Submit your article to this journal Article views: 71View related articles View Crossmark dataunderstanding, also in a health care context. It implies thatbiases can best be tested and—if necessary—correctedthrough dialogical inquiry rather than, for instance, byproviding the patient with more information. &REFERENCESBlumenthal-Barby, J. S. 2016. Biases and heuristics in decisionmaking and their impact on autonomy. American Journal of Bioeth-ics 16(5): 5–15.Gadamer, H.-G. 1960 1994. Truth and method, trans. J. Weinsheimerand D. G. Marshall. New York, NY: Continuum.Mackenzie, C., and N. Stoljar, eds. 2000. Relational autonomy.Oxford, UK: Oxford University Press.Nagel, T. 1986. The view from nowhere. Oxford, UK: Oxford Univer-sity PressWiddershoven, G. A., and T. Abma. 2007. Hermeneutic ethicsbetween practice and theory. In Principles of health care ethics, ed. R.E. Ashcroft, A Dawson, H. Draper, and J. R. McMillan, 2nd ed.,215–21. Chichester, UK: John Wiley, Sons Ltd.Widdershoven, G., G. Meynen, and D. Denys. 2015. Autonomy inpredictive brain implants: The importance of embodiment anddialogue. AJOB Neuroscience 6(4): 16–18.Toward an Ecological BioethicsNicolae Morar, University of OregonJoshua August Skorburg, University of OregonRecent advancements in social psychology, behavioraleconomics, and even microbial biology have provideda new impetus for numerous philosophers and bioethi-cists to reassess some of the central concepts thatinform their worldviews and value systems (Beeverand Morar 2016).The outcome of such reevaluations is especially impor-tant when it directly relates to medical practices and tofundamental concepts that shape the ethical conditions fora robust doctor–patient relationship. In this sense, Blumen-thal-Barby’s (2016) article not only inscribes itself in theprocess of a bioethical reexamination coming from the cog-nitive sciences and behavioral economics (Morar andWashington Forthcoming), but also, given the cumulativeeffect of the view of the mind that emerges, it adds a signif-icant contribution to this urgent and much needed dia-logue. We certainly recognize the tremendous benefits ofsuch an interdisciplinary approach to bioethics, and weuse this opportunity to open a productive discussion abouthow to frame the relationship between the social sciencesand bioethics.We raise two interrelated worries about the targetarticle: (1) The author’s operative concept of a bias mightlimit the range of answers that can be given to the “wheredo we go from here?” question in the article’s conclusion.(2) The author’s premises—and the picture of the mindthat emerges from them—might support a more radicalconclusion about autonomy than the author seems todraw. Both of these worries highlight the importance ofbringing more ecologically oriented approaches into thedebate.TWOWORRIESFirst, we believe that how one defines the concepts of heu-ristics and biases will have important consequences for howwe answer the “where do we go from here?” question.We’re concerned that the author’s working definition israther one-sided and almost always has a negative valence.We do not wish to deny that heuristics and resultingbiases can lead to negative outcomes or even differences inmedical treatment (Morar and Washington Forthcoming).They surely can. It would be misleading, however, to sug-gest that heuristics and resulting biases are always inaccu-rate, harmful, or problematic. To be fair, the author doesmention in passing that “heuristics and resulting biasesmight, in some cases or in some ways, help people under-stand the nature of an action and its consequences” (10).Still, we find the omission of a more detailed, positiveaccount troubling.Such a positive account can be found in Gerd Giger-enzer and colleagues’ research on the “less is more” effect.For example, in Goldstein and Gigerenzer’s (2002) workon the recognition heuristic, they showed that Germanswere better than Americans at judging which of two largeAmerican cities was larger, and Americans were betterthan Germans at judging which of two large German citieswas larger. Why? It is complicated, but in part, it seemsthat Americans were less familiar with German cities (andGermans less familiar with American cities) and they wereable to infer that the city they recognized was larger thanthe city they didn’t recognize. In this context, having lessinformation and less knowledge actually led to better andmore accurate guesses. Importantly, these effects are notAuthor names are listed in alphabetical order, which reflects equal contribution to the authorship of the article.Address correspondence to Nicolae Morar, Department of Philosophy & the Environmental Studies Program, 1295 University ofOregon, University of Oregon, Eugene, OR 97403, USA. E-mail: nmorar@uoregon.eduBiases and Heuristics in Decision MakingMay, Volume 16, Number 5, 2016 ajob 35limited to the recognition heuristic (e.g., Beaman et al.2010).More to the point, Gigerenzer and Todd open their(1999) Simple Heuristics That Make us Smart in a similar veinby claiming that the simple three-step decision for assess-ing risk of heart attack victims (Is systolic blood pressureless than 91? Is age less than 62.5? Is sinus tachycardia pre-sent?) is “more accurate in classifying heart attack patientsaccording to risk status than are some rather complex sta-tistical classification methods” (4–5). If this is on the righttrack, then the use of some heuristics might sometimeslead to biases (e.g., only paying attention blood pressure,age, etc.) that produce better, more desirable outcomes.We think it is crucially important to take seriously thispositive account, so as to keep options open for co-optingand exploiting the use of heuristics and resulting biases,much in the way the “nudge” approach cited by the authorseems to require.Our second worry similarly relates to the nature ofbiases, and what we might call their cumulative effect. Sev-eral psychological models have tried to provide an explana-tion for such cognitive processes that seem to have a robustinfluence on our behavior. Whether one appeals to single-process models (Olson and Fazio 2009), dual-process mod-els (Gawronski and Bondehausen 2011), or multisystemmodels from neuroanatomy and neuroscience (Amodioand Ratner 2011), it seems that some of the features thatsuch cognitive mechanisms consist in are impulsive, rigid,nearly automatic associations. Those cognitive mechanismstend to function under our conscious awareness, and thus,we seem to be limited in our capacity to control or to alterthem. Here, we are primarily worried that the author failsto fully appreciate the cumulative effect of the view ofhuman cognition that emerges. Once this view is properlyacknowledged, serious questions will remain about howmuch of the notion of autonomy can be salvaged.We think that the most important aspect of the article isits synoptic view of the cognitive biases that potentiallyimpact the exercise of autonomy in a medical context. It isthis very same aspect, however, that is also the most trou-bling. We agree with the author that “they [heuristics andbiases] are, after all, built in facts about our psychologicaltendencies” (13). The catalog of 19 biases and heuristicsfurther attests to this fact, and we see no reason to believethe list won’t expand in the future. We have to wonder,then: If this view of the mind is on the right track, what’sgoing to be left of autonomy? It seems that given theauthor’s premises, a skeptical or eliminativist conclusionthreatens: Given the ubiquity of heuristics and resultingbiases in human cognition, perhaps the traditional notionof autonomy as envisaged by philosophers just isn’t thesort of thing creatures like us can (reliably) attain.FUTURE DIRECTIONSThe one-sidedness worry and the cumulative effect worrycome together now, because they are both concerns abouthow we ought to think about biases. The way we think ofbiases, in turn, informs the sorts of answers we can give tothe question “where do we go from here?” Depending onthe operative definition, some solutions will emerge asbeing more attractive than others.If heuristics and biases are rendered as cognitive blem-ishes, then it of course makes sense to talk about removingthem, or at least counteracting them. But if heuristics andbiases are rendered as, at least sometimes, useful and effec-tive (after all, is it such a bad thing that fear biases ourattention to nearby threats?), then it would make sense totalk about exploiting them to our advantage, or at least,not counteracting them.Unless we start the conversation in this way, it is par-ticularly difficult to propose bioethical and policy-orientedamendments, since one would not know how and whereto even measure the success of such procedures. Paintingall heuristics as impediments to autonomy, for example,would stop us short of thinking of how to integrate theminto a more sensitive conception of human cognition andautonomous behavior. Moreover, underplaying the cumu-lative effect of such a catalog of human biases is detrimen-tal to our intervention strategies, since it would seem thatsome strategies (i.e., removal strategies) are equally usefulin comparison to more ecologically oriented ones (e.g.,Clark 2007).The risk of decoupling these two points and of ignor-ing the empirical literature on interventions to reduce biaseffects on our behavior is substantial since bioethicists, inparticular, should strongly resist the temptation of produc-ing “just-so stories” about eliminating, mitigating, andcountering biases and heuristics.Given all of this, we believe that the next set ofresearch questions becomes: What version of autonomycan accommodate the fact that most of the time, for bet-ter or worse, human cognition employs heuristics andbiases? If we are better at noticing these biases in othersthan in ourselves, does this point toward anti-individu-alism about autonomy? What version of autonomy canaccommodate the fact that, for better or worse, featuresof the environment (often outside of an agent’s control)form constitutive components of heuristics and biases(e.g., Alfano and Skorburg Forthcoming)? Only by tak-ing seriously the cumulative and constitutive dimen-sions of heuristics and biases can we see why thequestion is not primarily about getting rid of them, butof learning how to harness them in accordance withour values. Hence, the need for an ecological bioethicsthat looks at how we can design our environments sothat they promote rather than undermine our values. &REFERENCESAlfano, M., and J. A. Skorburg. Forthcoming. Extended knowl-edge, the recognition heuristic, and epistemic injustice. In Extendedknowledge, ed. D. Pritchard et al. Oxford, UK: Oxford UniversityPress.The American Journal of Bioethics36 ajob May, Volume 16, Number 5, 2016Amodio, D., and K. Ratner. 2011. A memory systems model ofimplicit social cognition. Current Directions in Psychological Science20(3): 143–48.Beaman, C. P., et al. 2010. Less-is-more effects without the recogni-tion heuristic. Judgment and Decision-Making 5 (4):258–271.Beever, J., and N. Morar. 2016. The porosity of autonomy: Socialand biological constitution of the patient in biomedicine. AmericanJournal of Bioethics 16(2): 34–45.Blumenthal-Barby, J. S. 2016. Biases and heuristics in decisionmaking and their impact on autonomy. American Journal of Bioeth-ics 16(5): 5–15.Clark, A. 2007. Soft selves and ecological control. In Distributedcognition and the will: Individual volition and social context, ed. D.Ross, D. Spurrett, H. Kincaid, and G. L. Stephens, 101–22.Cambridge, MA: MIT PressGawronski, B., and G. Bodenhausen. 2011. The associative-propo-sitional evaluation model: Theory, evidence, and open questions.Advances in Experimental Social Psychology 44:59–127.Goldstein, D., and G. Gigerenzer. 2002. Models of ecologicalrationality: The recognition heuristic. Psychological Review 109(1):75–90Gigerenzer, G., P. Todd, and ABC Research Group. 1999. Simpleheuristics that make us smart. Oxford, UK: Oxford University Press.Morar, N., and N. Washington. Forthcoming. Implicit cognitionand gifts: How does social psychology help us think differentlyabout medical practice? Hastings Center ReportOlson, M., and R. Fazio. 2009. Implicit and explicit measures ofattitudes: The perspective of the MODE model. In Attitudes:Insights from the new implicit measures, ed. R. Petty, R. Fazio, and P.Bri~nol, 19–63. Hillsdale, NJ: Lawrence Erlbaum Associates.Biases and Heuristics in Decision MakingMay, Volume 16, Number 5, 2016 ajob 37

Toward an Ecological Bioethics

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