Uncertain Facts or Uncertain Values? Testing the Distinction Between Empirical and Normative Uncertainty in Moral Judgments.

People can be uncertain in their moral judgments. Philosophers have argued that such uncertainty can either refer to the underlying empirical facts (empirical uncertainty) or to the normative evaluation of these facts itself (normative uncertainty). Psychological investigations of this distinction, however, are rare. In this paper, we combined factor-analytical and experimental approaches to show that empirical and normative uncertainty describe two related but different psychological states. In Study 1, we asked N = 265 participants to describe a case of moral uncertainty and to rate different aspects of their uncertainty about this case. Across this wide range of moral scenarios, our items loaded onto three reliable factors: lack of information, unclear consequences, and normative uncertainty. In Study 2, we confirmed this factor structure using predefined stimulus material. N = 402 participants each rated eight scenarios that systematically varied in their degree of uncertainty regarding the consequences of the described actions and in the value conflict that was inherent to them. The empirical uncertainty factors were mainly affected by the introduction of uncertainty regarding consequences, and the normative uncertainty factor was mainly affected by the introduction of value conflict. Our studies provide evidence that the distinction between empirical and normative uncertainty accurately describes a psychological reality. We discuss the relevance of our findings for research on moral judgments and decision-making, and folk metaethics.

Can One Health Policy Help Us Expand an Ethics of Interconnection and Interdependence?

One Health-a holistic approach to health that brings the moral status of animals and environments into consideration-is understood as a "professional imperative," a value-laden obligation that flows from the scope and objectives of professional roles. In this article, antimicrobial resistance provides a case study to demonstrate the fruitfulness of public health and bioethics collaborations by applying One Health key concepts of interconnection and interdependence. Moving toward an ethics of One Health requires a more nuanced analysis of ecological relationships, including humans' connections to other species as hosts, vectors, domestic companions, meat-eaters' food, and farmers' livelihood.

The barometer of moral distress in midwifery: A pilot study.

BACKGROUND: Moral distress is a phenomena that occurs following a compromise to moral beliefs. Moral distress has been reported across health professions, including midwifery. Although there are validated tools to assess for moral distress, none have been identified that suit the Australian healthcare system or midwifery. AIM: The aim of this study was to pilot the Barometer of Moral Distress in Midwifery. METHODS: This study was the fourth stage of a mixed method project. Using a cross-sectional approach, a survey tool including demographic questions, the Barometer of Moral Distress in Midwifery, and the Copenhagen Burnout Inventory assessed tool stability, reliability, and validity. FINDINGS: A total of 103 surveys were completed. A test-retest demonstrated tool reliability and stability (a =.97). Factor analysis confirmed internal consistency; Factor 1 - Professional Identity (a=.91), Factor 2 - Inadequate Resources (a=.85), and Factor 3 - Unethical Cultures (a=.88). Concurrent validity was demonstrated through positive correlations between self-reported types of moral distress with mean scores for each Factor. Strong correlations were identified between work-related burnout and mean scores, while only weak correlations were noted between client-related burnout and mean scores. Only Factor 1 demonstrated a correlation between leaving the profession and mean scores. DISCUSSION/CONCLUSION: This was the first moral distress tool that assessed both frequency of exposure and psychological outcomes to score moral distress. Findings indicate that moral distress in midwifery is not associated with caring work but with occupational environments. Further research is required to assess self-sacrifice in moral distress.

Moral justification for the use of 'add-ons' in assisted reproductive technology: experts' views and experiences.

RESEARCH QUESTION: What factors do assisted reproductive terchnology (ART) providers take into account when they make decisions about offering 'add-ons'? DESIGN: A qualitative analysis of interviews with 31 ART professionals, focusing on their views and experiences in relation to add-ons, including the factors that are considered when doctors make decisions about their use. RESULTS: The participants reported that a range of considerations are taken into account when it comes to justifying the use of a particular add-on in a given circumstance, including the likelihood of benefit and harm, patients' perceived psychological needs and preferences, and organizational expectations. Importantly, patient preferences, psychological factors and low risk of harm appear to be stronger motivations than increasing the likelihood of a live birth or the desire to innovate. CONCLUSIONS: These findings suggest that it cannot be taken for granted that add-ons and innovation are closely linked. One possible response to this would be regulatory reform; for example, only allowing 'unproven' add-ons to be used in the context of formal scientific evaluation. Alternatively, it could be made clear that add-ons that are not undergoing formal evaluation have more in common with other therapies lacking a clear evidence base, such as complementary and alternative medicines, than with conventional medical practice. Practices in relation to add-ons may also require a focus on the responsibilities of corporations, and the standards applying to purveyors of consumer goods and services.

The Effectiveness of the Educational Model Based on "Moral and Medical Integration" in the Nursing Students' Education in the Operating Theatre.

Objective: As the reform of China's medical and healthcare system progresses and the demand for medical and healthcare services increases, the humanistic quality of medical personnel has received more attention and concern. The humanistic quality of medicine for medical staff is specifically translated into the ethics of nursing for nursing staff. In this study, we explored the effectiveness of the education model based on "moral and medical integration" in the nursing students' education in the operating room. Methods: The "moral and medical integration" education model was implemented in The Affiliated Changzhou No. 2 People's Hospital since September 1, 2021, and 50 nursing students who received the traditional education model before the implementation from May 1, 2021, to August 31, 2021, were selected as the control group. The study group was composed of 50 nursing trainees who received the traditional education model from 1 September 2021 to 30 November 2021 and 50 nursing trainees who received the education model based on the "integration of moral and medical science". The nursing theory and nursing skills scores, professional nursing practice scores, moral courage scores, and satisfaction with teaching were compared between the two groups. Results: The nursing theory scores (t = 14.36, P < .001), nursing skills scores (t = 11.27, P < .001), and teaching satisfaction of the study group (t = 4.76, P < .029) were all higher than those of the control group . After the education, all the professional nursing practice ability scores(t=9.16, P < .001; t = 12.24, P < .001; t = 10.42, P < .001; t = 10.95, P < .001) and moral courage scores(t=7.81, P < .001; t = 11.76, P < 0.001; t = 15.11, P < .001; t = 12.24, P < .001) of the study group were higher than those of the control group (P < .05). Conclusion: The education model based on "moral and medical integration" can help improve the professional nursing level of nursing students in the operating theatre.

The Impact of Negative Moral Character on Health and the Role of Spirituality: A Narrative Literature Review.

Although negative moral character is highly prevalent, it is not included in the International Classification of Diseases (ICD). Along with the modification of WHO ICD-11, spirituality should be acknowledged for its potetnial role in the prevention of negative moral traits. This study aimed to explore the effects of negative moral character on health and determine the role of spirituality in improving negative moral traits. This narrative literature review was conducted from 2020 to 2023 in Kabul, Afghanistan. The articles were obtained from the Web of Science, PubMed, and Google Scholar databases. As demonstrated in this narrative literature review, most of the relevant experimental and observational studies have found that negative moral character can have significant negative impact on overall health and well-being. Many studies have established the positive role of spirituality in improving negative moral character. These studies concluded that facilities must be available within schools, universities, and communities for everyone to gain knowledge of spirituality and improve their negative moral character. Considering the adverse impacts of negative moral character on health, the current study proposes the addition of moral disorder to the WHO International Classification of Diseases. According to this literature review, spirituality will improve negative moral character and strengthen excellent moral traits.

Ethics, Abortion Access, and Emergency Care Post-Dobbs: The Gray Areas.

Clinical management of emergency pregnancy care, such as ectopic pregnancy or heavy bleeding with pregnancy of unknown location, includes upholding legal and ethical standards. For health care providers unwilling to provide evidence-based life-saving abortion care due to personal beliefs, clear guidance dictates disclosure of these limitations to the patient and colleagues, followed by immediate referral for appropriate care. However, this decision-making pathway may not be engaged due to a variety of factors: providers' beliefs preclude adherence to referral responsibilities, political discourse confuses patients as to their options and rights, and a constantly changing state and national legal landscape leads providers to question their ability to practice to their full scope of clinical care. Although this disruption of evidence-based standard of care existed pre-Dobbs, the moral disorder is now heightened. This Clinical Rounds highlights a patient vignette describing the risks of abortion restrictions for patients and providers alike, particularly when an individual provider's concerns for violating institutional guidelines sets a precedent for nursing response and forecloses on collaborative input or ethics consultation. The history of physician-only abortion exceptionalism and exclusion of nurses and midwives despite a significant history of nurses and midwives in abortion care grounds an argument for focusing on the impact of unethical and substandard care on the interprofessional care team leading to moral distress and negative patient outcomes. Patient-centered models of care, such as frameworks common in nursing and midwifery, offer opportunities to consider how all providers practicing to their full scope in interprofessional and collaborative ways, such as in emergency rooms and labor departments, might mitigate obstructions to abortion care that risk pregnant people's lives.

No Peace for the Wicked? Immorality Is Thought to Disrupt Intrapersonal Harmony, Impeding Positive Psychological States and Happiness.

Why do people think that someone living a morally bad life is less happy than someone living a good life? One possibility is that judging whether someone is happy involves not only attributing positive psychological states (i.e., lots of pleasant emotions, few unpleasant emotions, and satisfaction with life) but also forming an evaluative judgment. Another possibility is that moral considerations affect happiness attributions because they tacitly influence attributions of positive psychological states. In two studies, we found strong support for the second hypothesis. Moral considerations only appear to affect happiness attributions when they also affect attributions of positive psychological states. Additionally, both studies supported a hypothesis about why moral judgments have these effects. Specifically, we found that when people judge that someone is living a bad life, they infer that the person is not at peace with themselves. However, when this inference is blocked, moral considerations do not affect attributions of happiness or positive psychological states. In sum, although "happiness" appears to be a purely psychological concept, happiness judgments are sensitive to moral considerations because people often assume that immorality disrupts intrapersonal harmony.

The puritanical moral contract: Purity, cooperation, and the architecture of the moral mind.

Commentators raise fundamental questions about the notion of purity (sect. R1), the architecture of moral cognition (sect. R2), the functional relationship between morality and cooperation (sect. R3), the role of folk-theories of self-control in moral judgment (sect. R4), and the cultural variation of morality (sect. R5). In our response, we address all these issues by clarifying our theory of puritanism, responding to counter-arguments, and incorporating welcome corrections and extensions.

Little puritans?

I propose that young children may be a useful test case for Fitouchi et al.'s theory that certain seemingly harmless acts are moralized because they are seen as risk factors for future poor cooperation. The theory predicts that prior to the development of certain folk-psychological beliefs about self-control, children should be untroubled by violations of puritanical morality, and that an adult-like folk psychology of self-control should develop in tandem with disapproval of such violations.

Spiritual care competence, moral distress and job satisfaction among Iranian oncology nurses.

BACKGROUND: Nurses have a crucial role in identifying spiritual needs and providing spiritual care to patients living with cancer. AIM: This study evaluated Iranian oncology nurses' spiritual care competence and its relationship with job satisfaction and moral distress. METHOD: This cross-sectional study was conducted on 280 Iranian oncology nurses in 2020 using four questionnaires: demographic questionnaires, the Spiritual Care Competence Questionnaire (SCCQ), the Minnesota Job Satisfaction Questionnaire (MSQ) and the nurses' Moral Distress Questionnaire (MDS-R). FINDINGS: The mean scores indicated a medium to high Spiritual Care Competence (SCC), mild to moderate moral distress and high job satisfaction. There was a positive correlation between SCC and external job satisfaction (r=184, p<0.05) and a negative correlation between SCC and moral distress (r=-0.356, p<0.05). CONCLUSIONS: SCC diminishes with decreasing external job satisfaction and increasing moral distress. To improve the SCC of nurses working with patients living with cancer, it is recommended that nursing managers and policymakers revise the organisational policies to tackle the obstacles and consider the related factors to provide an ethical climate, implement quality spiritual care and increase job satisfaction.

Pastoral Narrative Disclosure: The Development and Evaluation of an Australian Chaplaincy Intervention Strategy for Addressing Moral Injury.

This paper describes the development and initial chaplaincy user evaluation of 'Pastoral Narrative Disclosure' (PND) as a rehabilitation strategy developed for chaplains to address moral injury among veterans. PND is an empirically informed and integrated intervention comprising eight stages of pastoral counselling, guidance and education that was developed by combining two previously existing therapeutic techniques, namely Litz et al's (2017) 'Adaptive Disclosure' and 'Confessional Practice' (Joob & Kettunen, 2013). The development and results of PND can be categorized into five phases. Phase 1: PND Strategy Formation-based upon extensive international research demonstrating that MI is a complex bio-psycho-social-spiritual syndrome with symptoms sufficiently distinct from post-traumatic stress disorder. The review also provided evidence of the importance of chaplains being involved in moral injury rehabilitation. Phase II: Development and Implementation of 'Moral Injury Skills Training' (MIST)-which involved the majority of available Australian Defence Force (ADF) Chaplains (n = 242/255: 94.9%) completing a basic 'Introduction to Moral Injury' (MIST-1) as well as an 'Introduction to PND' (MIST-2). Phase III: MIST-3-PND-Pilot evaluation-involved a representative chaplaincy cohort (n = 13) undergoing the PND eight-stage strategy to ensure the integrity and quality of PND from a chaplaincy perspective prior to wider implementation. The pilot PND evaluation indicated a favourable satisfaction rating (n = 11/13: 84.6%; M = 4.73/5.0 satisfaction). Phase IV: MIST-3-PND Implementation-involved a larger cohort of ADF Chaplaincy participants (n = 210) completing a revised and finalized PND strategy which was regarded favourably by the majority of ADF Chaplains (n = 201/210: 95.7%; M = 4.73/5.0 satisfaction). Phase V: Summation. In conclusion the positive satisfaction ratings by a significant number of ADF chaplaincy personnel completing MIST-3-PND, provided evidence that chaplains evaluated PND as a suitable counselling, guidance and education strategy, which affirmed its utilisation and justifies further research for using PND to address MI among veterans, that may also prove valuable for other chaplains working in community health and first responder contexts.

Towards a Holistic Model of Care for Moral Injury: An Australian and New Zealand Investigation into the Role of Police Chaplains in Supporting Police Members following exposure to Moral Transgression.

Police members can be exposed to morally transgressive events with potential for lasting psychosocial and spiritual harm. Through interviews with police members and police chaplains across Australia and New Zealand, this qualitative study explores the current role that police chaplains play in supporting members exposed to morally transgressive events. The availability of chaplains across police services and the close alignment between the support they offer, and the support sought by police, indicates they have an important role. However, a holistic approach should also consider organizational factors, the role of leaders, and access to evidence-based treatment in collaboration with mental health practitioners.

Do contemplative practices make us more moral?

Contemplative practices are a staple of modern life and have historically been intertwined with morality. However, do these practices in fact improve our morality? The answer remains unclear because the science of contemplative practices has focused on unidimensional aspects of morality, which do not align with the type of interdependent moral functioning these practices aspire to cultivate. Here, we appeal to a multifactor construct, which allows the assessment of outcomes from a contemplative intervention across multiple dimensions of moral cognition and behavior. This offers an open-minded and empirically rigorous investigation into the impact of contemplative practices on moral actions. Using this framework, we gain insight into the effect of mindfulness meditation on morality, which we show does indeed have positive influences, but also some negative influences, distributed across our moral functioning.

Mitochondrial Replacement Therapy: An Islamic Perspective.

Mitochondrial replacement technology (MRT) is an emerging and complex bioethical issue. This treatment aims to eliminate maternal inherited mitochondrial DNA (mtDNA) disorders. For Muslims, its introduction affects every aspect of human life, especially the five essential interests of human beings-namely, religion, life, lineage, intellect, and property. Thus, this technology must be assessed using a comprehensive and holistic approach addressing these human essential interests. Consequently, this article analyses and assesses tri-parent baby technology from the perspective of Maqasidic bioethics-that is, Islamic bioethics based on the framework of Maqasid al-Shariah. Using this analysis, this article suggests that tri-parent baby technology should not be permitted for Muslims due to the existence of third-party cell gametes which lead to lineage mixing and due to the uncertain safety of the therapy itself and because the major aim of the technology is to fulfil the affected couples interest to conceive their own genetically healthy child, not to treat and cure mtDNA disorders sufferers.

Which kind of sameness? Disambiguating two senses of identity with a novel linguistic task.

When people report that a person's identity has changed, what do they mean by this? Recent research has often assumed that participants are indicating a change in numerical, rather than qualitative, identity. Investigations into this matter have been hampered by the fact that English has no clear way to demarcate one type of identity from the other. To resolve this matter, we develop and test a novel task in Lithuanian, which has lexical markers for numerical and qualitative identity. We apply this task to intuitions about changes in moral capacities, which has previously shown to lead to high ratings in identity change. We discover that, when people say that a morally altered person is dramatically different, they mean the person is qualitatively transformed, but numerically intact. We conclude that this methodology is a valuable tool not only for illuminating the specific phenomenon of the moral self, but for general use in studying folk ascriptions of identity persistence.

Fenomenología de la angustia moral: implicancias para la humanización de la educación y la práctica médica / Phenomenology of moral distress: implications for the humanization of medical education and practice

En el contexto de la salud, la angustia moral (AM) se refiere a las emociones negativas que surgen cuando una persona conoce el curso de acción correcto en una situación determinada pero no es capaz de seguirlo debido a impedimentos personales, jerárquicos o institucionales. La AM se ha relacionado con diversos problemas profesionales, tales como desorientación vocacional, baja motivación laboral, trato despersonalizado a los pacientes, abandono de funciones y cambios de especialidad o profesión. Si bien este fenómeno no ha sido suficientemente estudiado en Chile, se asume que existe e incluso habría aumentado durante la pandemia de COVID-19, siendo desconocidas sus repercusiones. En consecuencia, este artículo tiene como objetivos, en primer lugar, promover el estudio fenomenológico de la AM en nuestro país, considerando la importancia de prevenir su potencial impacto adverso en la salud mental de futuros profesionales, y, en segundo lugar, destacar la necesidad de incluir enfoques narrativos en la educación médica, a fin de desarrollar una aproximación más holística hacia la comprensión de los pacientes y de su condición de vulnerabilidad. En última instancia, se espera que el abordaje de las implicancias de la AM en la educación y la práctica médica contribuya con su humanización, optimizando la calidad de la atención en salud.

In the healthcare context, moral distress (MD) refers to the negative emotions that arise when a person knows the correct course of action in a given situation but is not able to follow it due to personal, hierarchical or institutional impediments. MD has been related to various professional problems, such as vocational disorientation, low work motivation, depersonalized treatment of patients, abandonment of duties, and changes of specialty or profession. Although this phenomenon has not been sufficiently studied in Chile, it presumably exists and would have even increased during the COVID-19 pandemic, leaving its repercussions unknown. Accordingly, this article has the objectives, firstly, to promote the phenomenological study of MD in our country, considering the importance of preventing its potential adverse impact on the mental health of future professionals, and, secondly, to highlight the need to include narrative approaches in medical education, in order to develop a more holistic approach to understanding patients and their condition of vulnerability. Ultimately, it is expected that addressing the implications of MD in medical education and practice will contribute to its humanization, optimizing the quality of healthcare.

Development of a Moral Resilience Collaborative Program During a Pandemic.

Elevated psychological stress can lead to moral distress affecting health care workers and organizations affecting patient care, job satisfaction, and retention. A Moral Resilience Collaborative program was implemented through an academic partnership between a school of nursing and a rehabilitation facility to provide the health care workers in the facility the skills necessary for self-management of moral distress and move them toward moral resilience. Moral distress and resiliency were measured pre-implementation using the Measure of Moral Distress for Healthcare Professionals (MMD-HP) and Short Resiliency Survey (SRS), respectively. Unfortunately, postsurvey quantitative data collection failed due to COVID-19 surges though qualitative data obtained during debriefing sessions demonstrated effectiveness of the project. Based on debriefing comments and the preimplementation MMD-HP mean score and SRS decompression score, the staff in this facility experienced similar types of moral distress as those working in acute care or critical care settings. Even when resiliency programs are needed the most and readily available, patient care demands, a busy work environment, and external factors can hinder staff participation in such endeavors.

Moral distress in midwifery practice: A Delphi study.

BACKGROUND: Moral distress is a psychological concept that describes the harm associated with actions or inactions that oppose an individuals' moral beliefs. Moral distress is linked to moral compromise in the workplace that may negatively impact mental wellbeing. Current tools available to assess moral distress are not specific for the Australian health care system or midwifery practice. AIM: The aim of this study was to develop a list of situational and outcome statements associated with moral compromise and levels of moral distress in midwifery to inform the development of a tool to measure levels of moral distress in midwives. METHODS: This e-Delphi study was the third stage of a sequential exploratory mixed-methods study. Using an online strategy, three iterative rounds of e-Delphi were collected and analysed for consensus on situations leading to moral distress and the associated psychological outcomes. FINDINGS: Twenty participants contributed across the three rounds. Consensus was met in 40 morally compromising situation statements. The highest level of consensus related to excessive workloads and the associated negative impact of this on women and families. Consensus on outcomes following exposure to morally distressing situations led to the development of a continuum scale from moral frustration to moral injury. DISCUSSION/CONCLUSION: This is the first study to use a consensus method to establish different levels of moral compromise, frustration, distress, and injury in midwifery practice. The findings of this study contribute to a growing body of literature that supports the concept of moral distress occurring across a continuum.