A mixed-methods analysis of moral injury among healthcare workers during the COVID-19 pandemic.

During the COVID-19 pandemic, healthcare workers faced grave responsibilities amidst rapidly changing policies and material and staffing shortages. Moral injury, psychological distress following events where actions transgress moral beliefs/ expectations, increased among healthcare workers. We used a sequential mixed methods approach to examine workplace and contextual factors related to moral injury early in the pandemic. Using a Total Worker Health® framework, we 1) examined factors associated with moral injury among active healthcare professionals (N = 14,145) surveyed between May-August 2020 and 2) qualitatively analyzed open-ended responses from 95 randomly selected participants who endorsed moral injury on the survey. Compared to inpatient hospital, outpatient (OR = 0.74 [0.65, 0.85]) or school clinic settings (OR = 0.37 [0.18, 0.75]) were associated with lower odds of moral injury; while group care settings increased odds (OR = 1.36 [1.07, 1.74]). Working with COVID+ patients (confirmed+ OR = 1.27 [1.03, 1.55]), PPE inadequacy (OR = 1.54 [1.27, 1.87]), and greater role conflict (OR = 1.57 [1.53, 1.62]) were associated with greater odds of moral injury. Qualitative findings illustrate how outside factors as well as organizational policies and working conditions influenced moral injury. Moral injury experiences affected staff turnover and patient care, potentially producing additional morally injurious effects. Worker- and patient-centered organizational policies are needed to prevent moral injury among healthcare workers. The generalizability of these findings may be limited by our predominantly white and female sample. Further research is indicated to replicate these findings in minoritized samples.

Inconsistent advice by ChatGPT influences decision making in various areas.

The ChatGPT technology is increasingly becoming a part of our daily lives and is starting to be utilized in various decision-making contexts. The current study builds upon prior research, demonstrating that people's moral decision-making is influenced by ChatGPT across three perspectives, as evidenced by two studies (total n = 1925). The findings suggested that ChatGPT advice impacted decision-making similarly to expert advice, although not all decisions were susceptible to influence, particularly those based on negative emotions. Additionally, ChatGPT advice affected decisions beyond moral judgments, but no effect was observed when the advice recommended immediate low rewards. Moreover, individuals with a higher tendency for personal fear of invalidity were more likely to be influenced by both expert and AI advice, but this was not related to trust in AI.

Time pressure and deliberation affect moral punishment.

The deliberate-morality account implies that moral punishment should be decreased with time pressure and increased with deliberation while the intuitive-morality account predicts the opposite. In three experiments, moral punishment was examined in a simultaneous one-shot Prisoner's Dilemma game with a costly punishment option. The players cooperated or defected and then decided whether or not to punish their partners. In Experiment 1, the punishment decisions were made without or with time pressure. In Experiment 2, the punishment decisions were immediate or delayed by pauses in which participants deliberated their decisions. In Experiment 3, participants were asked to deliberate self-interest or fairness before deciding whether to punish their partners. Different types of punishment were distinguished using the cooperation-and-punishment model. In Experiment 1, time pressure decreased moral punishment. In Experiment 2, deliberation increased moral punishment. So far, the evidence supports the deliberate-morality account. Experiment 3 demonstrates that the effect of deliberation depends on what is deliberated. When participants deliberated self-interest rather than fairness, moral punishment was decreased. The results suggest that unguided deliberation increases moral punishment, but the effects of deliberation are modulated by the type of deliberation that takes place. These results strengthen a process-based account of punishment which offers a more nuanced understanding of the context-specific effect of deliberation on moral punishment than the deliberate-morality account.

Different judgment frameworks for moral compliance and moral violation.

In recent decades, the field of moral psychology has focused on moral judgments based on some moral foundations/categories (e.g., harm/care, fairness/reciprocity, ingroup/loyalty, authority/respect, and purity/sanctity). When discussing the moral categories, however, whether a person judges moral compliance or moral violation has been rarely considered. We examined the extent to which moral judgments are influenced by each other across moral categories and explored whether the framework of judgments for moral violation and compliance would be different. For this purpose, we developed the episodes set for moral and affective behaviors. For each episode, participants evaluated valence, arousal, morality, and the degree of relevance to each of the Haidt's 5 moral foundations. The cluster analysis showed that the moral compliance episodes were divided into three clusters, whereas the moral violation episodes were divided into two clusters. Also, the additional experiment indicated that the clusters might not be stable in time. These findings suggest that people have different framework of judgments for moral compliance and moral violation.

Ethical considerations during Mpox Outbreak: a scoping review.

BACKGROUND: Historically, epidemics have been accompanied by the concurrent emergence of stigma, prejudice, and xenophobia. This scoping review aimed to describe and map published research targeting ethical values concerning monkeypox (mpox). In addition, it aimed to understand the research gaps related to mpox associated stigma. METHODS: We comprehensively searched databases (PubMed Central, PubMed Medline, Scopus, Web of Science, Ovid, and Google Scholar) to identify published literature concerning mpox ethical issues and stigma from May 6, 2022, to February 15, 2023. The key search terms used were "monkeypox", "ethics", "morals", "social stigma", "privacy", "confidentiality", "secrecy", "privilege", "egoism", and "metaethics". This scoping review followed the framework proposed by Arksey and O'Malley in 2005 and was further improved by the recommendations of Levac et al. in 2010. RESULTS: The search strategies employed in the scoping review yielded a total of 454 articles. We analyzed the sources, types, and topics of the retrieved articles/studies. The authors were able to identify 32 studies that met inclusion criteria. Six of the 32 included studies were primary research. The study revealed that the ongoing mpox outbreak is contending with a notable surge in misinformation and societal stigma. It highlights the adverse impacts of stigma and ethical concerns associated with mpox, which can negatively affect people with the disease. CONCLUSION: The study's findings underscore the imperative need to enhance public awareness; involve civil society; and promote collaboration among policymakers, medical communities, and social media platforms. These collective endeavors are crucial for mitigating stigma, averting human-to-human transmission, tackling racism, and dispelling misconceptions associated with the outbreak.

Applying process dissociation to self-sacrificial moral dilemmas: Extending the dual-process model.

There is considerable evidence linking cognitive reflection with utilitarian judgments in dilemmas that involve sacrificing someone else for the greater good. However, the evidence is mixed on the question of whether cognitive reflection is associated with utilitarian judgments in self-sacrificial dilemmas. We employed process dissociation to extract a self-sacrificial utilitarian (SU) parameter, an altruism (A) parameter, an other-sacrificial (OU) utilitarian parameter, and a deontology (D) parameter. In Study 1, the cognitive reflection test (CRT) positively correlated with both SU and OU (replicated in Studies 2 and 4, pre-registered). In Study 2, we found that instructing participants to rely on reason increased SU and OU (replicated in Study 4, pre-registered). In Study 3, we found that SU and OU positively correlated with giving in the single-game version of the public goods game (replicated in Study 4, pre-registered), which provides behavioral validation that they are genuine moral tendencies. Together, these studies constitute strong cumulative evidence that SU and OU are both valid measures that are associated with reliance on cognitive reflection.

Perceptions of artificial intelligence system's aptitude to judge morality and competence amidst the rise of Chatbots.

This paper examines how humans judge the capabilities of artificial intelligence (AI) to evaluate human attributes, specifically focusing on two key dimensions of human social evaluation: morality and competence. Furthermore, it investigates the impact of exposure to advanced Large Language Models on these perceptions. In three studies (combined N = 200), we tested the hypothesis that people will find it less plausible that AI is capable of judging the morality conveyed by a behavior compared to judging its competence. Participants estimated the plausibility of AI origin for a set of written impressions of positive and negative behaviors related to morality and competence. Studies 1 and 3 supported our hypothesis that people would be more inclined to attribute AI origin to competence-related impressions compared to morality-related ones. In Study 2, we found this effect only for impressions of positive behaviors. Additional exploratory analyses clarified that the differentiation between the AI origin of competence and morality judgments persisted throughout the first half year after the public launch of popular AI chatbot (i.e., ChatGPT) and could not be explained by participants' general attitudes toward AI, or the actual source of the impressions (i.e., AI or human). These findings suggest an enduring belief that AI is less adept at assessing the morality compared to the competence of human behavior, even as AI capabilities continued to advance.

Influences of past moral behavior on future behavior: A review of sequential moral behavior studies using meta-analytic techniques.

Experimental research on sequential moral behavior (SMB) has found that engaging in an initial moral (or immoral) behavior can sometimes lead to moral balancing (i.e., switching between positive and negative behavior) and sometimes to moral consistency (i.e., maintaining a consistent pattern of positive or negative behavior). In two meta-analyses, we present the first comprehensive syntheses of SMB studies and test moderators to identify the conditions under which moral balancing and moral consistency are most likely to occur. Meta-Analysis 1 (k = 217 effect sizes, N = 31,242) revealed that engaging in an initial positive behavior only reliably resulted in moral licensing (i.e., balancing) in studies that measured engagement in negative target behaviors (Hedges' g = 0.25, 95% CI [0.16, 0.44]) and only resulted in positive consistency in foot-in-the-door studies using prosocial requests (Hedges' g = -0.44, 95% CI [-0.59, -0.29]). Meta-Analysis 2 (k = 132 effect sizes, N = 14,443) revealed that engaging in an initial negative behavior only reliably resulted in moral compensation (i.e., balancing) in studies that measured engagement in positive target behaviors (Hedges' g = 0.27, 95% CI [0.18, 0.37]). We found no evidence for reliable negative consistency effects in any conditions. These results cannot be readily explained by current theories of SMB effects, and so further research is needed to better understand the mechanisms that drive moral balancing and consistency under the conditions observed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Psychiatric Hospitals and the Ethics of Salutogenic Design: The Return of Moral Architecture?

ABSTRACT: Bioethicists have long been concerned with the mistreatment of institutionalized patients, including those suffering from mental illness. Despite this attention, the built environments of health care settings have largely escaped bioethical analysis. This is a striking oversight given that architects and social scientists agree that buildings reflect and reinforce prevailing social, cultural, and medical attitudes. Architectural choices are therefore ethical choices. We argue that mental health institutions are fertile sites for ethical analysis. Examining the ethics of architecture calls attention to the potential for hospitals to hinder autonomy. Additionally, such examination highlights the salutogenic possibilities of institutional design, that is to care, nurture, and enhance patient and provider well-being.

Opioid Epidemic Grief and Characterological Harm Reduction.

This article considers what it might mean to do the moral work of grieving during an opioid epidemic. Becoming callous, bitter, or resentful are harms we can suffer to our characters when grieving losses, especially at epidemic scale. This article suggests how appreciating beauty can play roles in grieving that could help mitigate these harms.

Understanding the moral cognition of aggression: Longitudinal serial effects of personal relative deprivation and hostility on within-person changes in civic moral disengagement.

Moral disengagement is an important aggressive and moral cognition. The mechanisms of changes in moral disengagement remain unclear, especially at the within-person level. We attempted to clarify this by exploring the serial effects of personal relative deprivation and hostility on civic moral disengagement. We conducted a three-wave longitudinal survey with 1058 undergraduates (63.61% women; mean age = 20.97). The results of the random intercept cross-lagged panel model showed that personal relative deprivation at Wave 1 and hostility at Wave 2 formed a serial effect on the within-person changes in civic moral disengagement at Wave 3, and the longitudinal indirect effect test showed that the within-person dynamics in hostility at Wave 2 acted as a mediator. The results of multiple group analysis across genders further showed that the longitudinal indirect role of hostility at Wave 2 was only observed for men, but not for women, which indicates the moderating effect of gender. These findings facilitate an understanding of the mechanisms of aggressive cognitions at the within-person level and offer implications for the prevention and intervention of aggression from the perspective of moral cognition.

From active duty to activism: how moral injury and combat trauma drive political activism and societal reintegration among Israeli veterans.

Trigger warning: This article deals with combat experiences and their consequences and could be potentially disturbing. Introduction: Moral injury (MI) is a severe form of combat trauma that shatters soldiers' moral bearings as the result of killing in war. Among the myriad ways that moral injury affects veterans' reintegration into civilian life, its impact on political and societal reintegration remains largely unstudied but crucial for personal, community, and national health. Methods: 13 in-depth interviews examine combat soldiers' exposure to potentially morally injurious events (PMIEs) that include killing enemy combatants, harming civilians, and betrayal by commanders, the military system, and society. Interviewees also described their political activities (e.g., voting, fundraising, advocacy, protest) and social activism (e.g., volunteering, teaching, charitable work). Interviewees also completed the Moral Injury Symptom Scale. Results: Two distinct narratives process PMIEs. In a humanitarian narrative, soldiers hold themselves or their in-group morally responsible for perpetrating, witnessing, or failing to prevent a morally transgressive act such as killing or injuring civilians or placing others at unnecessary risk. In contrast, a national security perspective blames an out-group for leaving soldiers with no choice but to act in ways that trigger moral distress. Associated with shame and guilt, the humanitarian perspective triggered amends-making and social activism after discharge. In contrast, a national security perspective associated with anger and frustration fostered protest and intense political activism. Discussion: Despite its harmful health effects, moral trauma and injury can drive intense political and social activism, depending upon the narrative veterans adopt to interpret PMIEs. Aside from moral injury's personal, familial, and social effects, moral injury drives veterans' return to the political arena of civil society. As such, veterans play a central role in politics and dramatically affect post-war policy in democratic nations following conflict.

Evidence for core social goal understanding (and, perhaps, core morality) in preverbal infants.

Spelke's What Babies Know masterfully describes infants' impressive repertoire of core cognitive concepts, from which the suite of human knowledge is eventually built. The current commentary argues for the existence of a core concept that Spelke claims preverbal infants lack: social goal. Core social goal concepts, operative extremely early in human development, underlie infants' basic abilities to interpret and evaluate entities within the moral world; such abilities support claims for a core moral domain.

Minding some animals but not others: Strategic attributions of mental capacities and moral worth to animals used for food in pescatarians, vegetarians, and omnivores.

While moral concern for animals has become increasingly important for both consumer food choice and food policy makers, previous research demonstrated that meat eaters attribute lower moral status and mental capacities to animals raised for meat compared to non-food animals. The current research investigated whether this strategic flexibility in moral concern and mind perceptions also occurs when considering aquatic food animals and animals used for dairy and egg products, and the degree to which these concerns and perceptions are evident in pescatarians and vegetarians. We compared perceptions (mind attributions and moral concern) of land food animals versus aquatic food animals, and of animals in the meat versus dairy and egg industry between omnivores (n = 122), pescatarians (n = 118), vegetarians (n = 138), vegans (n = 120), and flexitarians (n = 60). Pescatarians scored lower than other dietary groups on moral concern and mind attribution for aquatic animals relative to farmed land animals. Unlike the other dietary groups, pescatarians and vegetarians scored lower on moral concern and mind attribution for dairy than beef cows and for layer chickens than broiler chickens. These findings demonstrate that pescatarians and vegetarians were flexible in their moral thinking about different types of food animals in ways that suited their consumption habits, even when the same animal was evaluated (e.g., dairy vs beef cows). This research highlights the psychological barriers that might prevent people from reducing animal product consumption and may need to be addressed in interventions to encourage transitioning towards more plant-based diets.

"I feel like I'm walking on eggshells": a qualitative study of moral distress among Chinese emergency doctors.

BACKGROUND: While the number of emergency patients worldwide continues to increase, emergency doctors often face moral distress. It hampers the overall efficiency of the emergency department, even leading to a reduction in human resources. AIM: This study explored the experience of moral distress among emergency department doctors and analyzed the causes of its occurrence and the strategies for addressing it. METHOD: Purposive and snowball sampling strategies were used in this study. Data were collected through in-depth, semi-structured interviews with 10 doctors working in the emergency department of a tertiary general hospital in southwest China. The interview data underwent processing using the Nvivo 14 software. The data analysis was guided by Colaizzi's phenomenological analysis method. STUDY FINDINGS: This study yielded five themes: (1) imbalance between Limited Medical Resources and High-Quality Treatment Needs; (2) Ineffective Communication with Patients; (3) Rescuing Patients With no prospect of treatment; (4) Challenges in Sustaining Optimal Treatment Measures; and (5) Strategies for Addressing Moral Distress. CONCLUSION: The moral distress faced by emergency doctors stems from various aspects. Clinical management and policymakers can alleviate this distress by enhancing the dissemination of emergency medical knowledge to the general public, improving the social and economic support systems, and strengthening multidisciplinary collaboration and doctors' communication skills.