Can Social Media Save Us from the “Spiral of Silence?”

by Karen Solomon, Bioethics Program Student

Studies suggest that, before the advent of the Internet, we are unlikely to share minority or unpopular viewpoints with our co-workers, friends and relatives. This inclination creates, in essence, a “Spiral of Silence.”

But does the Internet provide a remedy to the “Spiral of Silence,” by encouraging online discussion of viewpoints that may be unpopular? Contrary to the hopes of social media advocates, new research finds that social media may not provide a voice to those who feel uncomfortable expressing minority viewpoints in face-to-face relationships.

Scientists at the Pew Research Center surveyed 1801 adults regarding a political issue over which public opinion was divided: Edward Snowden’s leak of the US government’s extensive surveillance program. The survey examined three areas: subjects’ opinions about the leaks, subjects’ willingness to express their opinions about the leaks in both online and face-to-face contexts, and subjects’ perceptions of others’ opinions in online and face-to-face settings.

They found that those who were not comfortable discussing their opinion about the Snowden leaks in face-to-face discussions were also unwilling to use social media as an outlet to post their viewpoints. Among the 14% who would not discuss the leaks in face-to-face discussions, only 0.3% of these were willing to post their opinions on social media.

In fact, researchers found that the “Spiral of Silence” also applied to social media. Those on Facebook were twice as willing to share their views with their Facebook network when they believed their network was in agreement.

Several factors may explain our continued unwillingness to share controversial opinions, including concerns that online posts may be viewed by future employers or by those in authority. It could also be that social media users, exposed to a wide range of opinions via their social networks, are less willing to speak up because they are “especially tuned into” others’ opinions.

But what would it mean if use of social media does not provide a voice for discussing viewpoints we believe are unpopular? What if social media does not encourage more diverse outlooks on topics we care about? What if instead of encouraging discussions, it turns out that use of social media does the opposite and actually stifles expressing opinions our face-to-face interactions, even when we feel others would agree?

Social media is still relatively new, despite its far-reaching impact on how many of us communicate. If we accept that our willingness to share opinions and reactions to events and information is important to how we learn, understand, and think about what is important for us in managing work, school, and our relationships, then this study provides plenty of food for thought. Online learning is ever more important for higher education, which is increasingly provided online and integral to the training and education of professionals, including tomorrow’s bioethicists.

Discussions that nurture diversity of opinion foster sound ethical decision-making. Research into group decision-making cites diversity of opinion as an essential quality of “wise groups.” Diversity of opinion allows for the consideration of all relevant information, surmounting the “herd mentality” that can rob groups of their independence when tackling ethical dilemmas. Recognizing and addressing obstacles to deliberative decision-making is integral to the consistent application of ethical principles across domains, including social media and ethics blogs, discussion boards in online bioethics courses, and hospital ethics committee meetings.

[The contents of this blog are solely the responsibility of the author and do not represent the views of the Bioethics Program or Union Graduate College.]

Reasonable Accommodation to Objections to a Brain Death Determination: Religious Principle Versus Disputed Diagnosis

This guest post is part of The Bioethics Program’s Online Symposium on the Munoz and McMath cases. To see all symposium contributions, click here.

by James Zisfein, M.D.
Chief, Division of Neurology, and Chair, Ethics Committee, Lincoln Medical Center

Is the objection to determination of brain death by Jahi McMath’s parents based on religious principle, disputed diagnosis, or both? Media reports go in all directions. And does it matter? Should it matter?

In New York (considered as a transfer destination for Jahi), it matters. New York Department of Health regulations require hospitals to provide “reasonable accommodation” (as defined by each hospital) when there is an objection to a brain death determination on a religious or moral basis:

Hospitals must establish written procedures for the reasonable accommodation of the individual’s religious or moral objections to use of the brain death standard to determine death when such an objection has been expressed by the patient prior to the loss of decision-making capacity, or by the Surrogate Decision-maker. Policies may include specific accommodations, such as the continuation of artificial respiration under certain circumstances, as well as guidance on limits to the duration of the accommodation.

Please note that “reasonable accommodation” does not give the family veto power over the determination of death nor the performance of tests necessary to make that determination. It does, however, allow continuation of ventilator support and routine nursing care after a brain death determination, thereby preserving for the family the illusion of life until the heart stops. Other medical supports are discontinued, e.g., ICU care, physiologic monitoring, blood and radiologic testing, CPR status, medications, and nutrition and hydration support.

Printing New Parts

by Jacob Dahlke, Bioethics Program Alum (MSBioethics 2012)

So this happened. “3-D Printer makes life-saving splint for baby boy’s airway.” Take a moment. Let that sentence wash over you for a moment. I envision it as a TV drama, with the surgeon rushing down the hallway, mask on and gloved hands pointed to the ceiling. Turning a corner, through the double doors and into the … IT department? I can hear it now, with the printer noise not unlike the old-school dot matrix printer, grinding and loud.

I suppose the scene was perhaps not quite the same. But the impact may be just as dramatic. 3-D printing is a relatively new technology in general, with home printers around longer than many people realize. And aside from the recent news of 3-D printers being used for other reasons, using them to make body parts compels some space-age style potential. Even this notion of making body parts is not new; I personally had my first exposure to it in 2007 when I had the fortunate opportunity to visit Anthony Atala‘s lab at Wake Forest. Not just bladders, but tissues, heart valves, bones, blood vessels, and soon entire limbs. How does this play into medicine today, and how could it be utilized to enact real change for patients?

One area of obvious impact is in the realm of organ donation. If one thinks about it, organ donation is a raw and crude process. Granted, the field has advanced dramatically since its inception. But the premise has always been fatally flawed, in my opinion; namely, the attempt to combine alien tissues with native ones in the setting of having to suppress an entire immune system. But if the new tissues were somehow recognized as familial – or better, if they were genetically identical to the host – then the rigorous process associated with immunosuppression could be put to rest. And that’s where 3-D printing comes in.

Let’s say I want to print an ear. Traditional printers take the digital image of the ear, use ink and spray it out onto a substrate, paper. It is spit out in a specific pattern based upon its digital instructions. 3-D printers use the same process, but use a more complicated (3-D) set of instructions (multiple pics of the ear to enable a composite image from all angles), with an often plastic-like ‘ink’ that dries as a solid, which can then be built upon by the next layer of printed instructions. The resulting product is a three dimensional object that looks like, well, an ear. But if the plastic-like ink were replaced by a different material altogether, or even by living cells, then the resulting object would have the potential for actually being put to use. Even better, if those living cells weren’t just any old cells but ones from the host himself, then it could be attached without having to trick the body into thinking it’s a foreign object.

I think that this technology holds great promise for medicine, as ethical concerns often arise with limited organs available to donate. It remains to be seen how this can help alleviate this vital but scarce resource, but I cannot help but believe that it will at least will improve medicine in the very near future. After all, “the future is here. It’s just not evenly distributed.” – William Gibson

Besides, 3-D is already passé. 4-D is where it’s at.

[This blog entry was originally posted in slightly edited form on Mr. Dahlke’s blog on May 28, 2013. Its contents are solely the responsibility of the author alone and do not represent the views of the Bioethics Program or Union Graduate College.]