The workshop explores ways to teach ethical reasoning using decision science, cognitive errors, and biases as part of being human. Categories include: the need to act fast, too much information, insufficient evidence, faulty memory processes, and tribal knowledge.

1. Ethical Reasoning:
Decision Science, Biases,
and Errors
JOHN GAVAZZI, PSY.D., ABPP
Ethics Educator Conference - PPA
Distance Learning: October 2020

2. Workshop Description
An opportunity for participants
to reflect on their own cognitive
styles, biases and heuristics.
There will be participant
interaction.

3. Learning Objectives
By the end of this program the workshop
participants will be able to:
1. Highlight the five general biases in human
cognition;
2. Provide one clinical and ethical decision-
making bias for each general area; and,
3. Describe three quality enhancement
strategies to counter biases.

4. 3 Hour Outline
• Intro: Biology, Cognition, Relationships
• Desjardin’s 4 + 1 biases
TMI, IE, Act Fast, Memory, & Tribes
• Group Exercise + Break
• Group Reports/discussion
• Quality Enhancement Strategies

5. Biological and Cultural
Evolution Matter
• We are human, biologically-based animals in
complex social networks
• We are in a helping/healing profession involving
cooperation
• Most people function better with sufficient sleep,
good food, regular exercise, and low stress
• An emphasis of self-care based on biological needs

6. Cognitive Pluses and
Minuses
• We can learn, change, and develop skills. We
develop a certain level of expertise within our
social group.
• While we have cognitive limitations, heuristics,
and short-cuts, we can improve upon on our
limitations.
• Benefits to deliberate practice, continue to
educate ourselves, consult with others, and
engage in self-reflection.

7. Asymmetrical assessments
from the past
We are good lawyers for our
own mistakes,
And good judges for the
mistakes of others.
Manuscript found in Accra: P. Coelho

8. Relationship Dynamics are
Key
• Ethics and morality involve relationships. They do
not occur in a vacuum.
• Self-interest versus other interests
• Power dynamics
• Structuring social relationships
• Care, Fairness, Loyalty, Authority, Sanctity

9. Biology & Decisions
• Hunger influences decision-making skills
• Proper nutrients to feed the brain
• Poor decisions when hungry/hangry
• Poor decisions when physically anxious

10. There are multiple sources
of errors
How can we group
these limitations?

11. Desjardins’ Four Groupings of
Cognitive Biases & Errors + 1
1. Too Much Information
2. Insufficient Meaning
3. A Desire to Act Fast
4. Limited (and even faulty) Memory Skills
5. Social Influences on Cognition

12. Tough Decisions
There is an outbreak of a deadly disease in a 600-
person community.
With Treatment A, 200 people would be saved.
With Treatment B, there is a 33% of saving 600 lives
and a 66% chance that 600 people will die?
Which option would you choose?

13. Tough Decisions: Framing
There is an outbreak of a deadly disease in a 600-
person community.
With Treatment A, 400 people would die.
With Treatment B, there is a 33% that no one dies
and a 66% chance of 600 people will die?
Which option would you choose?
Kahnemann & Tversky, 1981

14. Too Much Information
We are limited cognitively and emotionally
Hard-wired for certain processes

15. I. Too Much Information
Cultural and biological evolution have created
ways to help deal with the literally trillions of bits of
information we can process.
These small tricks can be helpful or harmful.
• We see objects moving at us faster than they
truly are.
• Our “blink response” or flinching

16. Too Much Info Biases
• We notice primed or repeated information better
• Bizarre, unusual, funny, and anthropomorphic
events are a focus of our attention
• We are drawn to data, people, and events that
confirm our beliefs about ourselves
• We notice flaws in others more easily than flaws in
ourselves. Asymmetry is key!!

17. TMI Cognitive Styles
• Availability Heuristic
• Trait Negativity Bias
• Framing Effect
• Confirmation Bias

18. Insufficient Meaning
We are meaning makers
Looking to recognize patterns

19. Johansson and Hall: Choice Blindness

20. II. Insufficient Meaning
The world can be a confusing and meaningless
place. We engage in pattern recognition
where none may exist.
These small tricks can be helpful or harmful.
•See Jesus’s face in a potato chip
•Preying on gamblers/superstitious thinking

21. Not Enough Meaning Bias
• We project meaning onto sparse or incomplete
information (countertransference)
• With gaps, we fill in through stereotypes,
generalities, or our histories (beliefs, values)
• We simplify probabilities and numbers to make
them easier
• We project biases into the past and future

22. Not Enough Meaning Styles
• Outcome Bias
• Halo Effect
• Just World Effect
• Hindsight Bias/Planning Bias

23. Desire to Act Fast
We want to feel confident
We want to use resources efficiently

24. Daniel Kahneman: Optimism Bias

25. III. Desire to Act Fast
We are constrained by time. When we
experience time pressure, we are likely to
make more errors.
These small tricks can be helpful or harmful.
•Emotion arousal on decision-making
•Doing things quickly increases sense of
confidence and competence

26. Drowning Child Dilemma
On your way to job interview, you see a child
who has fallen into a polluted, muddy creek.
Because you were on your way to a job
interview, you are wearing a recently
purchased $5,000 suit. In order to rescue the
child, you will ruin a $5,000 suit. The moral
question is: Do you save the child’s life, and
ruin the suit the process?

27. Drowning Child Dilemma
You inherit $5,000 from a relative you never met.
Basically, you recently received free money, meaning
money you did not earn the money, but acquired by
something akin to pure luck. The next day, a close
friend comes to you and tells you that he heard
about a relief organization called Oxfam. For $5,000,
your donation will save a child’s life. Your friend
identified a child in a distant country, shows you a
picture of a similar or same race child, describes how
the money will be spend, and all the reasons why
saving this child’s life is more important than $5,000.

28. Need to Act Fast Research
• To increase confidence and sense of
competence
• We are motivated to complete tasks we
already started to help maintain focus and
confidence
• We prefer quick and simple tasks rather than
more complex and ambiguous tasks

29. Act Fast Styles
• Self-Serving Bias
• Fundamental Attribution Error
• Dunning-Krueger Effect
• Loss Aversion/Optimism Bias

30. Limits and Fallibility of
Memory
Every recollection is a recreation
Don’t know what’s important

31. Julia Shaw: Memory

32. IV. Limited (Fallible) Memory
We take in large amounts of information;
however, we have limited storage capacity
and organizational skills.
These small tricks can be helpful or harmful.
•Chunking information
•Other Mnemonics

33. What To Remember
• We actively edit and reinforce memories
after the fact
• We disregard specifics and form
generalities
• We reduce lists and events to key
elements

34. Remembering Styles
• Suggestibility/False Memories
• Prejudice
• Primacy/Recency Effect
• Google Effect/Planned forgetting

35. Tribal Knowledge
We bond and bind into social groups
Groups support beliefs

36. Paul Bloom: In v. Out Group

37. V. Tribal Knowledge
We don’t think alone. We find ourselves in
tribes that help us to think, make decisions,
judge actions, and form attitudes and
opinions.
These small tricks can be helpful or harmful.
•Bind us into tribes
•Blind us to other possibilities/realities

38. Tribal thinking patterns
• Group Think
• In Group/Out Group Bias
• Illusion of Explanatory Depth
• Overconfidence Effect

39. Group Breakout Time
20 minutes
Task: Contemplate and write out clinical and
ethical examples of errors in thinking based on
your domain.
10 Minute Break
Then, we will have each group take 10 minutes to review
their clinical and ethical examples with errors in clinical
decision-making and discussion.

40. Quality Enhancement Strategies:
Treatment Issues
THE POSITIVE REFRAME ON RISK
MANAGEMENT STRATEGIES

41. Quality Enhancing Strategies
As the legal risks, the possibility of
treatment failure, or patient
complexity increases,
the greater the level of attention
should be given to quality
enhancing strategies.

42. Quality Enhancing Strategies
Consultation
Empowered Collaboration
Documentation
Redundant Protections

43. Consultation
▪ Technique oriented information
▪ Emotional reactions
▪ Reduction of emotional turmoil
▪ Thinking through solution together

44. Consultation
▪ Write down issues in advance
▪ Need to be open and honest
▪ Be willing to admit mistakes or
clinical errors

45. Empowered Collaboration
▪ Empowering psychologists respect a
patient’s autonomy and decision
making skills about the goals of
treatment, process of treatment, and
life choices.
▪ Examples of tough decisions and
ambivalent patients

46. Documentation: Legal Purposes
▪ Required by insurers, State Board of Psychology, APA Ethics
Code, etc.
▪ A record of treatment for future providers
▪ Useful risk management tool
▪ Write out evaluation, decision-making steps, consultations, and
final decision

47. Redundant Protections
Multiple layers of information in order to
provide the highest level of care
▪ Another health care provider
▪ Psychological testing or screening device
▪ Family member or significant other
▪ Consultation

48. Why Redundant
Protections?
Avoid errors in judgment
Obtain essential information
Promote greater chance of
success

49. Suggested Checklist for Ongoing
Treatment
Patient Collaboration Self-Reflection
1. Does the patient think you have
a good working relationship?
2. Do my patient and me share the
same treatment goals?
3. Does the patient report any
progress in therapy?
4. Does the patient want to
continue in treatment?
1. Do I believe I have a positive
working relationship with my
patient?
2. Is my assessment of the patient
sufficiently comprehensive?
3. Do unresolved clinical issues
impede the course of
treatment?
4. Have I documented
appropriately?

50. Vignettes
TO AID IN THE LEARNING PROCESS

51. The End
PLEASE COMPLETE COURSE EVALUATION