Hastings Center Report 46 (3):33-43 (2016)

Authors
Natalia Washington
University of Utah
Nicolae Morar
University of Oregon
Abstract
This article takes the following two assumptions for granted: first, that gifts influence physicians and, second, that the influences gifts have on physicians may be harmful for patients. These assumptions are common in the applied ethics literature, and they prompt an obvious practical question, namely, what is the best way to mitigate the negative effects? We examine the negative effects of gift giving in depth, considering how the influence occurs, and we assert that the ethical debate surrounding gift-giving practices must be reoriented. Our main claim is that the failure of recent policies addressing gift giving can be traced to a misunderstanding of what psychological mechanisms are most likely to underpin physicians’ biased behavior as a result of interaction with the medical industry. The problem with gift giving is largely not a matter of malicious or consciously self-interested behavior, but of well-intentioned actions on the part of physicians that are nonetheless perniciously infected by the presence of the medical industry. Substantiating this claim will involve elaboration on two points. First, we will retrace the history of policies regarding gift giving between the medical profession and the medical industry and highlight how most policies assume a rationalistic view of moral agency. Reliance on this view of agency is best illustrated by past attempts to address gift giving in terms of conflicts of interest. Second, we will introduce and motivate an alternate view of moral agency emerging from recent literature in social psychology on implicit social cognition. We will show that proper consideration of implicit social cognition paints a picture of human psychology at odds with the rationalistic model assumed in discussions of COIs. With these two pieces on the table we will be able to show that, without fully appreciating the social-psychological mechanisms of implicit cognition, policy-makers are likely to overlook significant aspects of how gifts influence doctors
Keywords biomedical ethics  implicit cognition  policy recommendations  gift giving  medical practice
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DOI 10.1002/hast.588
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References found in this work BETA

Implicit Bias, Character and Control.Jules Holroyd & Dan Kelly - 2016 - In Jonathan Webber & Alberto Masala (eds.), From Personality to Virtue. New York, NY, USA: pp. 106-133.
Ironic Processes of Mental Control.Daniel M. Wegner - 1994 - Psychological Review 101 (1):34-52.
The Long, Steep Path to Equality: Progressing on Egalitarian Goals.Nikki H. Mann & Kerry Kawakami - 2012 - Journal of Experimental Psychology: General 141 (1):187-197.

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Citations of this work BETA

Toward an Ecological Bioethics.Nicolae Morar & Joshua August Skorburg - 2016 - American Journal of Bioethics 16 (5):35-37.

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