Resolving content moderation dilemmas between free speech and harmful misinformation.

In online content moderation, two key values may come into conflict: protecting freedom of expression and preventing harm. Robust rules based in part on how citizens think about these moral dilemmas are necessary to deal with this conflict in a principled way, yet little is known about people's judgments and preferences around content moderation. We examined such moral dilemmas in a conjoint survey experiment where US respondents (N = 2, 564) indicated whether they would remove problematic social media posts on election denial, antivaccination, Holocaust denial, and climate change denial and whether they would take punitive action against the accounts. Respondents were shown key information about the user and their post as well as the consequences of the misinformation. The majority preferred quashing harmful misinformation over protecting free speech. Respondents were more reluctant to suspend accounts than to remove posts and more likely to do either if the harmful consequences of the misinformation were severe or if sharing it was a repeated offense. Features related to the account itself (the person behind the account, their partisanship, and number of followers) had little to no effect on respondents' decisions. Content moderation of harmful misinformation was a partisan issue: Across all four scenarios, Republicans were consistently less willing than Democrats or independents to remove posts or penalize the accounts that posted them. Our results can inform the design of transparent rules for content moderation of harmful misinformation.

Does sense of coherence buffer the effects of moral dilemmas faced by psychiatric nurses in Japan? A cross-sectional study.

Psychiatric nurses face moral dilemmas that affect their mental health. We investigated whether sense of coherence (SOC) buffers psychiatric nurses' perceived effects of moral dilemmas on their psychological distress. A total of 418 nursing professionals in 6 psychiatric hospitals in Japan completed self-administered questionnaires. A negative correlation was observed between "patient rights" (r = -0.24, p < 0.001), "relationships other than patient" (r = -0.28, p < 0.001), "nursing care" (r = -0.25, p < 0.001) of moral dilemmas and "manageability" of SOC. Additionally, a negative correlation was observed between "patient rights" (r = -0.22, p < 0.001), "relationships other than patient" (r = -0.21, p < 0.001) of moral dilemmas and "comprehensibility" of SOC. Hierarchical multiple regression analysis used the Kessler Psychological Distress Scale-10 (K10), which assessed the degree of mental distress, as the dependent variable, and moral dilemmas and SOC as the independent variables, along with their interaction terms. The K10 scores significantly changed depending on the degree of moral dilemmas in the low SOC group, but not in the high SOC group. SOC buffers the effects of psychiatric nurses' perceived moral dilemmas on their psychological distress.

Ethics and frontline nursing during COVID-19: A qualitative analysis.

BACKGROUND: Nurses experienced intense ethical and moral challenges during the COVID-19 pandemic. Our 2020 qualitative parent study of frontline nurses' experiences during the COVID-19 pandemic identified ethics as a cross-cutting theme with six subthemes: moral dilemmas, moral uncertainty, moral distress, moral injury, moral outrage, and moral courage. We re-analyzed ethics-related findings in light of refined definitions of ethics concepts. RESEARCH AIM: To analyze frontline U.S. nurses' experiences of ethics during the COVID-19 pandemic. RESEARCH DESIGN: Qualitative analysis using a directed content methodology. PARTICIPANTS AND RESEARCH CONTEXT: The study included 43 nurses from three major metropolitan academic medical centers and one community hospital in the northeastern, mid-Atlantic, midwestern, and western United States. ETHICAL CONSIDERATIONS: Participant privacy and data confidentiality were addressed. FINDINGS: Moral dilemmas arose from many situations, most frequently related to balancing safety and patient care. Moral uncertainty commonly arose from lacking health information or evidence about options. Moral distress occurred when nurses knew the right thing to do, but were prevented from doing so, including with end-of-life issues. Moral injury (accompanied by suffering, shame, or guilt) occurred after doing, seeing, or experiencing wrongdoing, often involving authority figures. Nurses expressed moral outrage at events and people within and outside healthcare. Despite difficult ethical situations, some nurses exemplified moral courage, sometimes by resisting policies they perceived as preventing compassionate care, guided by thinking about what was best for patients. DISCUSSION: This content analysis of ethics-related subthemes revealed conceptual characteristics and clarified distinctions with corresponding exemplars. Conceptual clarity may inform responses and interventions to address ethical quandaries in nursing practice. CONCLUSIONS: Ethics education in nursing must address the moral dilemmas of pandemics, disasters, and other crises. Nurses need time and resources to heal from trying to provide the best care when no ideal option was available.

Moral judgment, decision times and emotional salience of a new developed set of sacrificial manual driving dilemmas.

The growing interest in the subject of moral judgment in driver and autonomous vehicle behavior highlights the importance of investigating the suitability of sacrificial dilemmas as experimental tools in the context of traffic psychology. To this aim a set of validated sacrificial trolley problems and a new set of trolley-like driving dilemmas were compared through an online survey experiment, providing normative values for rates of participants' choices; decision times; evaluation of emotional valence and arousal experienced during the decision process; and ratings of the moral acceptability. Results showed that while both sets of dilemmas led to a more frequent selection of utilitarian outcomes, the driving-type dilemmas seemed to enhance faster decisions mainly based on the utilitarian moral code. No further differences were observed between the two sets, confirming the reliability of the moral dilemma tool in the investigation of moral driving behaviors. We suggest that as moral judgments and behaviors become more lifelike, the individual's moral inclination emerge more automatically and effectively. This new driving-type dilemma set may help researchers who work in traffic psychology and moral decision-making to approach the complex task of developing realistic moral scenarios more easily in the context of autonomous and nonautonomous transportation.

Moral ambivalence. A comment on non-invasive prenatal testing from an ethical perspective.

BACKGROUND: Non-invasive prenatal testing (NIPT) has been available for almost 10 years. In many countries the test attracted considerable criticism from the start. While most critical comments in this context deal with the (alleged) problem of eugenic selection, I will concentrate on a somewhat broader issue. CONTENT: I will argue that NIPT clearly has the potential to increase reproductive autonomy and benefit expectant parents. However, NIPT can also put people in a situation that is morally overwhelming for them and from which there is no easy way out. In this sense, such tests can have a dilemma-generating effect. SUMMARY AND OUTLOOK: I will conclude that this can be adequately described by the term "moral ambivalence".

Trust in Autonomous Cars: Exploring the Role of Shared Moral Values, Reasoning, and Emotion in Safety-Critical Decisions.

OBJECTIVE: Autonomous cars (ACs) controlled by artificial intelligence are expected to play a significant role in transportation in the near future. This study investigated determinants of trust in ACs. BACKGROUND: Trust in ACs influences different variables, including the intention to adopt AC technology. Several studies on risk perception have verified that shared value determines trust in risk managers. Previous research has confirmed the effect of value similarity on trust in artificial intelligence. We focused on moral beliefs, specifically utilitarianism (belief in promoting a greater good) and deontology (belief in condemning deliberate harm), and tested the effects of shared moral beliefs on trust in ACs. METHOD: We conducted three experiments (N = 128, 71, and 196, for each), adopting a thought experiment similar to the well-known trolley problem. We manipulated shared moral beliefs (shared vs. unshared) and driver (AC vs. human), providing participants with different moral dilemma scenarios. Trust in ACs was measured through a questionnaire. RESULTS: The results of Experiment 1 showed that shared utilitarian belief strongly influenced trust in ACs. In Experiment 2 and Experiment 3, however, we did not find statistical evidence that shared deontological belief had an effect on trust in ACs. CONCLUSION: The results of the three experiments suggest that the effect of shared moral beliefs on trust varies depending on the values that ACs share with humans. APPLICATION: To promote AC implementation, policymakers and developers need to understand which values are shared between ACs and humans to enhance trust in ACs.

Conflict, confusion and inconsistencies: Pre-registration nursing students' perceptions and experiences of speaking up for patient safety.

There is growing evidence demonstrating that nursing students encounter unsafe and poor clinical practice when on clinical placement. The impact on nursing students remains relatively under-explored, especially in the Australian context. This two-phased qualitative study used Interpretive Description to explore 53 pre-registration nursing students' perceptions and experiences of speaking up for patient safety. Results of the study identified students believe speaking up is the right thing to do, and their professional responsibility. The study results add to previous research by describing the dissonance students experience due to the inconsistencies between what is taught at university and performed in practice. Student's distress arises when observing nurses taking short cuts, justifying such actions and making excuses about poor practice. Students report experiencing dissonance, bewilderment and confusion and at times, anger when observing poor practice. The clinical environment culture influences students' decisions to speak up or remain silent. Understanding students' perceptions and responses will promote awareness and discussion essential to the future development of curricula and clinical support strategies that will enable students to speak up.

Student nurses' strategies when speaking up for patient safety: A qualitative study.

The purpose of this study was to understand student nurses' perceptions and experiences of witnessing and responding to risks to patient safety during their integrated learning experiences. This qualitative study's two-phased approach included individual semi-structured interviews, followed by focus group discussions with students. Participants included 53 pre-registration nursing students recruited from the first, second, and third years of study at two Australian universities. All had attended at least one clinical placement experience. Interpretive Description was used as a framework to guide the study. The findings highlight that students engage in specific and deliberate strategies when attempting to speak up. Students weigh up the risk to the patient and themselves. They use questioning techniques and their knowledge, experiences, and resources when speaking up. Students highlighted the need for caution and persistence while aiming to reduce the risk of reprisal. Exposing the challenges and successes students experience will provide educators, managers, and clinicians with the understanding necessary to better support both students and clinicians to achieve safe outcomes for patients as well a students.

Moral Dilemmas of Nurses and Paramedics During In-Flight Medical Emergencies on Commercial Airlines.

During commercial flights, in-flight medical emergencies may lead the cabin crew to request assistance from qualified health care professionals among the passengers. Although a physician's function and role are well known and virtually universal globally, the role, education, and scope of practice of nurses and paramedics varies significantly. This article analyzes the possible dilemmas that medical professionals other than physicians who assist during in-flight medical emergencies may face and presents recommendations for aviation authorities. There is an identified need for universal cross-border regulations and an awareness of legal and ethical boundaries for medical responders other than physicians on board commercial international aircraft.

Artificial Moral Agents: A Survey of the Current Status.

One of the objectives in the field of artificial intelligence for some decades has been the development of artificial agents capable of coexisting in harmony with people and other systems. The computing research community has made efforts to design artificial agents capable of doing tasks the way people do, tasks requiring cognitive mechanisms such as planning, decision-making, and learning. The application domains of such software agents are evident nowadays. Humans are experiencing the inclusion of artificial agents in their environment as unmanned vehicles, intelligent houses, and humanoid robots capable of caring for people. In this context, research in the field of machine ethics has become more than a hot topic. Machine ethics focuses on developing ethical mechanisms for artificial agents to be capable of engaging in moral behavior. However, there are still crucial challenges in the development of truly Artificial Moral Agents. This paper aims to show the current status of Artificial Moral Agents by analyzing models proposed over the past two decades. As a result of this review, a taxonomy to classify Artificial Moral Agents according to the strategies and criteria used to deal with ethical problems is proposed. The presented review aims to illustrate (1) the complexity of designing and developing ethical mechanisms for this type of agent, and (2) that there is a long way to go (from a technological perspective) before this type of artificial agent can replace human judgment in difficult, surprising or ambiguous moral situations.

Human Decisions in Moral Dilemmas are Largely Described by Utilitarianism: Virtual Car Driving Study Provides Guidelines for Autonomous Driving Vehicles.

Ethical thought experiments such as the trolley dilemma have been investigated extensively in the past, showing that humans act in utilitarian ways, trying to cause as little overall damage as possible. These trolley dilemmas have gained renewed attention over the past few years, especially due to the necessity of implementing moral decisions in autonomous driving vehicles (ADVs). We conducted a set of experiments in which participants experienced modified trolley dilemmas as drivers in virtual reality environments. Participants had to make decisions between driving in one of two lanes where different obstacles came into view. Eventually, the participants had to decide which of the objects they would crash into. Obstacles included a variety of human-like avatars of different ages and group sizes. Furthermore, the influence of sidewalks as potential safe harbors and a condition implicating self-sacrifice were tested. Results showed that participants, in general, decided in a utilitarian manner, sparing the highest number of avatars possible with a limited influence by the other variables. Derived from these findings, which are in line with the utilitarian approach in moral decision making, it will be argued for an obligatory ethics setting implemented in ADVs.

Ethical conflict among nurses working in the intensive care units.

BACKGROUND: Ethical conflict is a barrier to decision-making process and is a problem derived from ethical responsibilities that nurses assume with care. Intensive care unit nurses are potentially exposed to this phenomenon. A deep study of the phenomenon can help prevent and treat it. OBJECTIVES: This study was aimed at determining the frequency, degree, level of exposure, and type of ethical conflict among nurses working in the intensive care units. RESEARCH DESIGN: This was a descriptive cross-sectional research. PARTICIPANTS AND RESEARCH CONTEXT: In total, 382 nurses working in the intensive care units in Iranian hospitals were selected using the random sampling method. Data were collected using the Ethical Conflict in Nursing Questionnaire-Critical Care Version (Persian version). ETHICAL CONSIDERATIONS: This study was approved by the Medical Research Ethics Committee. Ethical considerations such as completing the informed consent form, ensuring confidentiality of information, and voluntary participation were observed. FINDINGS: The results showed that the average level of exposure to ethical conflict was 164.39 ± 79.06. The most frequent conflict was related to "using resources despite believing in its futility," with the frequency of at least once a week or a month (68.6%, n = 262). The most conflictive situation was violation of privacy (76.9%, n = 294). However, the level of exposure to ethical conflict according to the theoretical model followed was the situation of "working with incompetent staff." The most frequently observed type of conflict was moral dilemma. CONCLUSION: The moderate level of exposure to ethical conflict was consistent with the results of previous studies. However, the frequency, degree, and type of ethical conflict were different compared to the results of other studies. Recognizing ethical conflict among intensive care unit nurses can be useful as it allows to consolidate those measures that favor low levels of ethical conflict, design appropriate strategies to prevent ethical conflicts, and improve the nursing work environment.

The logic of the interaction between beneficence and respect for autonomy.

Beneficence and respect for autonomy are two of the most fundamental moral duties in general and in bioethics in particular. Beyond the usual questions of how to resolve conflicts between these duties in particular cases, there are more general questions about the possible forms of the interactions between them. Only recognition of the full spectrum of possible interactions will ensure optimal moral deliberation when duties potentially conflict. This paper has two simultaneous objectives. The first is to suggest a typological scheme of all possible modes of interaction; these will be classified under the "discrete," "semi-discrete," and "non-discrete" categories, according to whether the meaning and/or forms of expression of each duty are treated as independent from or rather as constrained by the other. The second objective is to show that all logical possibilities of interaction indeed have real expressions in medical ethics, to provide clear illustrations of each, and in particular to stress those that have usually escaped recognition.

Developing an ethics support tool for dealing with dilemmas around client autonomy based on moral case deliberations.

BACKGROUND: Moral Case Deliberations (MCDs) are reflective dialogues with a group of participants on their own moral dilemmas. Although MCD is successful as clinical ethics support (CES), it also has limitations. 1. Lessons learned from individual MCDs are not shared in order to be used in other contexts 2. Moral learning stays limited to the participants of the MCD; 3. MCD requires quite some organisational effort, 4. MCD deals with one individual concrete case. It does not address other, similar cases (it is case based). These limitations warrant research into complementary ways of providing CES to healthcare professionals. Our research objective was therefore to develop a low threshold CES tool based on a series of MCDs on autonomy in long-term care. METHODS: We used a qualitative research design in which we analyzed the process and content of a series of MCDs, combined with reflections on the theoretical background of MCD. In total 28 MCDs (10 transcripts and 18 summary reports) were analyzed by means of a thematic content analysis. In various rounds of development, the results of the analysis were combined with theoretical reflections on CES. Consequently, the tool was evaluated in three focus groups and adjusted. RESULTS: The CES tool, called 'moral compass', guides the users through a series of six subsequent questions in order to methodically reflect on their concrete moral dilemma, in the form of a booklet of 23 pages. It combines a methodical element that encourages and structures a reflection process with a substantive element, including norms, values, options, strategies, and insights regarding dealing with client autonomy. CONCLUSION: By using data from a series of MCDs, combined with theoretical reflections on MCD, ethics support and moral learning, we developed a thematic, low-threshold CES tool that supports healthcare professionals in daily practice in dealing with moral questions regarding client autonomy. It integrates examples and insights from earlier MCDs on the same topic. The moral compass is not a replacement of, but can be used complementary to MCD. The feasibility and impact of the moral compass need to be investigated in an evaluative follow-up study. The methodology presented in this paper may be used to develop moral compasses on different topics in various healthcare organizations.

Uncovering a New Moral Dilemma of Economic Optimization in Biotechnological Processing.

The trend of emerging biorefineries is to process the harvest as efficiently as possible and without any waste. From the most valuable phytomass, refined medicines, enzymes, dyes and other special reactants are created. Functional foods, food ingredients, oils, alcohol, solvents, plastics, fillers and a wide variety of other chemical products follow. After being treated with nutrient recovery techniques (for fertilizer production), biofuels or soil improvers are produced from the leftovers. Economic optimization algorithms have confirmed that such complex biorefineries can be financially viable only when a high degree of feedstock concentration is included. Because the plant material is extremely voluminous before processing, the farming intensity of special plants increases in the nearest vicinity of agglomerations where the biorefineries are built for logistical reasons. Interdisciplinary analyses revealed that these optimization measures lead to significantly increased pollen levels in neighbouring urban areas and subsequently an increased risk of allergies, respectively costs to the national health system. A new moral dilemma between the shareholder's profit and public interest was uncovered and subjected to disputation.

Stress reactions following acute situations involving moral challenges among health care professionals.

Many health care professionals have to make morally difficult decisions during acute, stressful situations. The aim was to explore the applicability of an existing qualitatively developed model of individual reactions among professional first responders following such situations using a quantitative approach. According to the model, the interaction of antecedent individual and contextual characteristics affect the immediate emotional reactions to acute, stressful events involving a moral dilemma. Continuous coping efforts and the quality of social support will also affect the long-term positive and negative reactions to the event. The participants (n = 204, about 50% response rate) represented three Swedish health care professions stationed at a university hospital and a regional hospital: Physicians (n = 50), nurses (n = 94) and "others" (n =60, mainly social welfare officers and assistant nurses). Except for the personality dimension emotional stability which was measured using an established instrument, all measurement scales were operationalizations of codes and categories from the qualitative study (ten scales altogether). Four multiple regression analyses were performed with long-term positive and negative reactions in everyday acute and morally extremely taxing situations respectively as dependent variables. The outcome showed that long-term positive reactions covaried with much use of the coping strategies Emotional distancing and Constructive emotional confrontation and a perception of a well-functioning Formal social support. Regarding long-term negative reactions, higher age and little use of Emotional distancing accounted for much of the variance. Immediate emotional reactions also contributed significantly. CONCLUSION: the results largely supported the model concepts and their assumed relationships.

Moral Distress Among School Nurses.

School nurses are well positioned to provide care to a diverse population of school-age children, but their role and work environment can present a variety of moral dilemmas leading to moral distress. The purpose of this study is to identify the moral distress level that exists in school nurses and to describe its relationship to common moral dilemmas and school nurse characteristics. Data were collected through face-to-face attendance at school nurse meetings in North Carolina where 307 school nurses participated in the survey. Moral distress was measured using the moral distress thermometer, and common moral dilemmas were identified using a researcher developed questionnaire. Almost all of the school nurses (97.3%) experienced some degree of moral distress. Each of the common moral dilemmas was positively correlated with moral distress levels. The findings suggest that many of the common moral dilemmas experienced by school nurses are strongly related to moral distress.

Virtues and humanitarian ethics.

This paper analyses the contribution of virtue ethics, the study of good character traits, to the humanitarian context. It argues that a virtue ethics perspective paints a realistic picture of the use of ethical standards in morally complex circumstances. Virtuous relief workers can employ standards in their thinking, but they are also committed to professional excellence that goes beyond any formal code. The concept of virtue ethics places a stress on moral development, which can be facilitated by role models that impart modest and feasible ideals. However, virtue ethics cannot provide simple guidelines on how to resolve difficult situations. It is possible that two virtuous persons can disagree on what should be done in a particular instance. In addition, a virtue ethics perspective emphasises the need for both individuals and organisations to discuss the actual purpose of relief work in order to pinpoint the virtues of a good relief professional.

Moral dilemmas of women undergoing pregnancy termination for medical reasons in Poland.

OBJECTIVES: We explored the religious views and dilemmas of Polish women making the decision to terminate a pregnancy. The article discusses the highly restrictive legislation and significant influence of the Church on the lives of Polish citizens. METHODS: This study was designed to investigate the effect of religious and political beliefs, social and moral conditioning and professional support on the decision to abort a fetus. A 65-item questionnaire was administered to 60 participants at the time of their pregnancy termination. RESULTS: Pregnancy termination was performed outside the resident county in 32% of cases. Approximately 88% of respondents declared themselves Catholic, but only 22% intended to admit to the pregnancy termination during confession. Five percent of respondents feared the reaction of the priest, while the remaining respondents did not perceive termination of pregnancy for medical reasons as a sin. Of the women who had previously opposed pregnancy termination, 27% changed their mind once they were personally involved. CONCLUSIONS: The decision to abort a pregnancy for medical reasons is sensitive to religious and social determinants, especially in the current political situation in which abortion may become prohibited in Poland. The high response rate (100%) was probably the result of the patients' attitudes: they repeatedly emphasised they were thankful for the help and empathy of the medical personnel and for being allowed to undergo the procedure. In Poland, the majority of centres use conscience clauses to justify their refusal to terminate a pregnancy.

Probability, measurement mismatches, and sacrificial moral decision-making.

Despite the importance of uncertainty in decision-making, few published studies have examined how individuals make moral judgments under uncertainty. Across four experiments (N = 445), we examined whether a relatively small shift in probability affected participants' judgments of both moral acceptability and choice. Overall, reading dilemmas where the characters were either certain or likely to die, the probability of the sacrificed individual and the group at risk dying both had independent effects on participants' responses. That is, participants were more accepting of sacrificing the individual if they were not certain to die, but less accepting if the group was only likely to die when the individual was not sacrificed. Furthermore, a number of participants made acceptability ratings that did not match the action they endorsed, either finding the sacrificial decision more acceptable but refusing to make it, or choosing the sacrificial decision while viewing it as less acceptable. Many participants also stated that this was because they recognised a crucial difference between what they viewed as morally acceptable in a dilemma and what they were actually willing to do. Such mismatches may reflect the sensitivity and complexity of the moral principles that individuals employ during their moral decision-making.