I’ve been trying to write this post (on and off, obviously) for days now. I’ve been thinking a bit about personal responsibility and what exactly constitutes responsibility. I happened to be reading Out of Character by David DeSteno and Piercarlo Valdesolo and the “self” was a central theme. Near the end of the book, the authors related a particular study that I found relevant.
“The team presented more than sixty white physicians with medical information about several African American patients who were experiencing chest pains. The physicians had to recommend whether or not to treat each patient with clot-busting drugs that would reduce the likelihood of a subsequent cardiac failure.
[. . .]
physicians […] were significantly less likely to recommend potentially lifesaving treatment for black patients than for white ones. What’s more, these same physicians didn’t report any prejudiced feelings on their questionnaires; they seem to have no conscious awareness of their bias.”
There aren’t many professions as trusted as doctors. While they definitely aren’t 100% trusted by the public, they are usually absurdly high ranking (number 2 behind nurses in this gallop poll). We trust doctors to do their best to help in almost every situation. When a patient comes in from an accident, we expect them to do all they can to save the person. When someone comes in with an illness or complaint, we expect them to listen and respond to every patient only using the facts. The person on the table doesn’t matter. I think most people feel this way and trust doctors are doing their best.
And it turns out, they are doing their best. They try to treat every patient the same regardless of any extenuating or unrelated circumstances. But if this is how it worked, I probably wouldn’t be writing a post about it.
Unfortunately, we humans have some called implicit biases. The IAT (implicit association test) was designed to sort through our explicit feelings about all sorts of things, including skin color. So when researchers looked at doctors, we might expect them to score the same as most people on IATs. And there’s no concern from those results. But what they do reveal is connected to how they behave. They don’t feel any outwardly racist way towards anyone, but their treatment isn’t reflecting that, it’s reflecting their implicit biases.
Can we place any blame on these doctors? Are they responsible for their decisions in any way? Certainly I can’t imagine a scenario in which a doctor could be charged with malpractice. There are few people who would argue that all these doctors are purposely treating black people differently than white people, that they care less, or that they even consider skin color when treating someone. But the results of the study are clear. Different treatment does occur. If it’s not the doctors doing, who is it?
There’s something very odd about thinking of our own free will. We acknowledge these situations. Certain decision. Certain behaviors are motivated by things we aren’t aware of and likely can’t be aware of. In addition to not knowing why we do certain things, oftentimes we don’t even realize we’re doing them in the first place. We know this from countless studies but we don’t apply this information widely to our lives. I feel like I have free will. I feel as though I’m making decisions. But wouldn’t making a decision include being responsible for the consequences of that decision? If I’m not responsible then in what sense am I doing it/am I deciding? And if I grant that there are possibly some things that are being decided without my conscious awareness, how do I know how far that goes? With the complexity of life, experience, and behavior, how do I untangle any decision I make from underlying, unknown influences and biases? How do I know when it’s me? What does that even mean?
* As I mentioned, I had a lot of trouble writing this. Not that I think what I wrote is completely terrible, though it is terribly incomplete. And that was the problem I couldn’t shake. There are volumes of books on the subject so I shouldn’t expect to wrap it up, but I did have more to say, without a clever way to say it.
* Last note for any hard-nosed philosophers out there. I’m using me, I and the like to refer to the conscious part of the self. I know the unconscious processes are also part of me, but for the sake of making it easier on me (there it is again), I’m being relaxed with their meaning. I’m not a dualist. Should go without saying but some people (assholes like me, for instance) like extreme clarity.