Xenotransplantation has great potential as an alternative to alleviate the shortage of organs for donation. However, given that the animal most suited for xenotransplantation is the pig, there are concerns that people in Muslim countries may be more hesitant to morally approve of these procedures. In this study, the moral approval of xenotransplantation was assessed in a group of 895 participants in Egypt. The results showed that religiosity itself does not predict moral approval of xenotransplantation, but (...) religious identity does, as Muslims are less likely to approve of xenotransplantation than Christians. However, the strongest predictor of moral approval of xenotransplantation was gender, with women displaying less approval. A partial mediating factor in this association was concern for animal welfare. Based on these results, some implications for public policy are discussed. (shrink)

By founding morality on the particular sentiments of approbation and disapprobation, Shaftesbury, Hutcheson, Hume, and Smith implied that the nature of moral judgment was far more intuitive and accessible than their rationalist predecessors and contemporaries would, or at least easily could, allow. And yet, these ‘Sentimentalists’ faced the longstanding belief that the human affective psyche is a veritable labyrinth – an obstacle to practical morality if not something literally brutish in us. The Scottish Sentimentalists thus implicitly tasked themselves with (...) distinguishing and locating the particular sentiments of approbation and disapprobation in the human psyche. In this paper, I argue that this task led Shaftesbury, Hutcheson, Hume, and Smith to adopt a remarkable thesis when it came to the nature of the moral sentiments, namely, that the sentiments of moral approbation and disapprobation are peculiar – somehow radically unlike other sentiments. (shrink)

Hume thinks moral judgments are based on sentiments of approval and disapproval we feel when we contemplate someone from a "general point of view." We view her through the eyes of her "narrow circle" and judge her in accordance with general rules. Why do we take up the general point of view? Hume also argues that approval is a calm form of love, love of character, which sets a normative standard for other forms of love. In this (...) paper I explain why, and argue that character, as a form of causality, is constructed from the point of view of one's narrow circle. We take up the general view to view people as persons, that is, as possible objects of love. (shrink)

OVERVIEWWe ambitiously reexamine Smith’s moral theory in relation to Hume’s. We regard Smith's developments as glorious and important. We also see them as quite fully agreeable to Hume, as enhancement, not departure. But Smith represents matters otherwise! Why would Smith overstate disagreement with his best friend?One aspect of Smith’s enhancement, an aspect he makes very conspicuous, is that between moral approval and beneficialness there is another phase, namely, the moral judge's sense of propriety. With that phase (...) now finding formulation, Smith, if only implicitly, generates a spiral of beneficialness and propriety, a spiral shown in Figure 7 in the present paper. We consider Figure 7, illustrating the spiral, to be the most important arrival point in the present paper; it highlights the non-foundationalism of Smith's ethics. But to arrive at the spiral, we must engage in extensive exegesis.In Part IV of The Theory of Moral Sentiments, Smith presents a foil against which he develops his own theory, a foil supposedly representing Hume. According to the foil, moral approval derives from ‘utility.’ But, in multiple ways, the foil is misleading. We provide an interpretation of Hume, notably his four-factor account of moral approval, before examining Smith's representation of Hume.One twist is that Smith used the words utility and useful differently than Hume did – Smith quietly stretched them to include species of agreeableness, thereby obscuring the importance of agreeableness in Hume’s theory.Another, more significant problem is that Smith allows the impression that in Hume moral approval derives quite determinately from beneficialness. In fact Hume conveys the interpretive and sentimental spaciousness of the operations that generate moral approval; here, Hume even speaks repeatedly of ‘proper sentiments’, thus almost using the term propriety himself.But the propriety phase in Smith opens up to a key facet of Smith’s development on Hume: He poeticizes a locus of sympathy not emphasized in Hume – namely, that between the moral judge and her own man within the breast; that locus enters the theory in addition to the sympathies emphasized in Hume, not in lieu of them. We distinguish lateral sympathy, which is important in Hume’s thought, and vertical sympathy, which is especially characteristic of Smith’s more inner-directed and allegorical thought. Smith embraces Hume’s lateral sympathy and enhances moral theory by adding formulations that elaborate vertical sympathy.Next, we come to something of a twist in the whole matter: We show that – as Smith well knew all along! – propriety is a species of agreeableness! Smith’s propriety phase represents another dimension within which such agreeableness lives: Smith’s vertical dimension thus gives rise to a spiral representing the diachronic development of the judge herself. It is a spiral of beneficialness and propriety: Each propriety phase in the next loop of the spiral engenders a species of agreeableness now as a part of beneficialness.Smith's developments on Hume, then, involve the following three facets: formulation of the propriety phase; the poetic elaboration of vertical sympathy; the diachronic spiral of propriety and beneficialness.The three facets come together, especially in Ed. 6 of The Theory of Moral Sentiments. The whole development goes beyond Hume, but, really, is agreeable to Hume – though Smith himself portrays his developments as disagreeing with features of Hume's moral theory.We speculate that Smith was more or less aware of all that that we say, including the absense of any really substantive disagreement. Why, in that case, would Smith have proceeded as he did? We address that question at the end of the piece. Our speculations suggest a method in the madness. (shrink)

If a reliable testifier tells you that a song is beautiful or that an act is wrong, do you thereby have a reason to approve of the painting and disapprove of the agent's action? Many insist that we don’t: normative testimony does not give us reasons for affective attitudes like approval. This answer is often treated as a datum in the literatures on moral and aesthetic testimony. I argue that once we correct for a common methodological mistake in (...) these literatures, the answer must be Yes. I then show why this matters for the broader discussion of the puzzle(s) posed by deference to moral and aesthetic testimony. (shrink)

This discussion explores the moral psychology and metaethics of Michael Slote's Moral Sentimentalism. I argue that his account of empathy has an important lacuna, because the sense in which an empathizer feels the same feeling that his target feels requires explanation, and the most promising candidates are unavailable to Slote. I then argue that the (highly original) theory of moral approval and disapproval that Slote develops in his book is implausible, both phenomenologically and for the role (...) it accords to empathy. Finally, I suggest that these problems in moral psychology undermine Slote's metaethical argument for identifying rightness and wrongness with agential warmth and coldness in action. (shrink)

Blackburn’s “quasi-realism” aims to show that expressivism can accommodate the sorts of claims about moral truth, facts, objectivity, and the like that are found in ordinary moral thought and discourse. Egan argues that expressivists cannot accommodate certain claims about the possibility that one’s own fundamental moral commitments are mistaken. He criticizes what I call the approved change strategy, which explains that judgment in terms of the belief that one might change one’s mind as a result of favored (...) processes such as getting more information. Egan targets a simple version of that strategy; I raise objections to a more sophisticated expressivist alternative. I argue against Horgan and Timmons’ claim that quasi-realists need not accommodate certain thoughts about moral fallibility on the grounds that they are metaethical rather than first-order moral claims, and that the implied orientation toward others that results is not objectionably smug. I also argue that the sophisticated strategy problematically commits the expressivist to an ideal observer or advisor theory in first-order ethics. (shrink)

Background There is longstanding consensus on the need to include pregnant women in research. The goal of clinical research is to find highly regulated, carefully controlled, morally responsible ways to generate evidence about how to effectively and safely prevent illness or treat sick people. This manuscripts present a conceptual analysis of the ethicality of clinical trials in 3 scenarios: where the pregnant is involved in clinical trials as a participant during pregnancy for data that addresses pregnancy complications, where the pregnant (...) woman consents to clinical trial participation for an unborn baby that has complications, to generate data on complications at this stage of life, and where the mother may consent for participation of their newborn child in clinical trials. Methods Conceptual analysis. Findings Investigators often choose to exclude pregnant women and newborns from research, even where there is possibility for them to benefit from the study intervention. Objections include vulnerability of pregnant women, altered pharmacokinetics and risk of adverse effects, with a need to balance potential maternal and fetal risks and benefits of research participation. While the objections may be valid, not performing research magnifies what should be a carefully controlled risk during research, pushing this risk into the clinical setting, and subsequently posing a challenge to clinicians who are faced with making treatment decisions for pregnant patients with limited evidence of efficacy and safety. The potential benefits of fair inclusion in clinical trials outweigh the potential risks. Conclusion Research involving pregnant women is necessary to provide women with effective treatment during pregnancy, to promote fetal safety, and to reduce avoidable harm from suboptimal care and to provide pregnant women, their fetuses and newborns. (shrink)

Background There is longstanding consensus on the need to include pregnant women in research. The goal of clinical research is to find highly regulated, carefully controlled, morally responsible ways to generate evidence about how to effectively and safely prevent illness or treat sick people. This manuscripts present a conceptual analysis of the ethicality of clinical trials in 3 scenarios: where the pregnant is involved in clinical trials as a participant during pregnancy for data that addresses pregnancy complications, where the pregnant (...) woman consents to clinical trial participation for an unborn baby that has complications, to generate data on complications at this stage of life, and where the mother may consent for participation of their newborn child in clinical trials. Methods Conceptual analysis. Findings Investigators often choose to exclude pregnant women and newborns from research, even where there is possibility for them to benefit from the study intervention. Objections include vulnerability of pregnant women, altered pharmacokinetics and risk of adverse effects, with a need to balance potential maternal and fetal risks and benefits of research participation. While the objections may be valid, not performing research magnifies what should be a carefully controlled risk during research, pushing this risk into the clinical setting, and subsequently posing a challenge to clinicians who are faced with making treatment decisions for pregnant patients with limited evidence of efficacy and safety. The potential benefits of fair inclusion in clinical trials outweigh the potential risks. Conclusion Research involving pregnant women is necessary to provide women with effective treatment during pregnancy, to promote fetal safety, and to reduce avoidable harm from suboptimal care and to provide pregnant women, their fetuses and newborns. (shrink)

There is longstanding consensus on the need to include pregnant women in research. The goal of clinical research is to find highly regulated, carefully controlled, morally responsible ways to generate evidence...

We often assume that hypothetical approval – either in the form of preferences or consent – under ideal conditions adds to the legitimacy of an arrangement or act. I want to show that this assumption, reasonable as it may seem, will also give rise to ethical problems. I focus on three problem areas: prudence, euthanasia and coercive psychiatric treatment. If we are to count as prudentially or morally␣relevant those preferences you would have if you were informed and rational, we (...) will run into difficulties in all these areas if your actual and rational preferences are at variance with each other. In the prudential sphere we may question the personal value of satisfying preferences that a person does not actually have. In this case our problem concerns the point of satisfying a rational preference in conflict with an actual one. In the cases of euthanasia and coercive care it concerns instead whether it would be morally right to do such a thing. I doubt there is a simple solution to our problem. In this paper at most I prepare the way for a solution or for wiser decisions in the hard cases, by pointing out what they will have to deal with. (shrink)

Computers are already approving financial transactions, controlling electrical supplies, and driving trains. Soon, service robots will be taking care of the elderly in their homes, and military robots will have their own targeting and firing protocols. Colin Allen and Wendell Wallach argue that as robots take on more and more responsibility, they must be programmed with moral decision-making abilities, for our own safety. Taking a fast paced tour through the latest thinking about philosophical ethics and artificial intelligence, the authors (...) argue that even if full moral agency for machines is a long way off, it is already necessary to start building a kind of functional morality, in which artificial moral agents have some basic ethical sensitivity. But the standard ethical theories don't seem adequate, and more socially engaged and engaging robots will be needed. As the authors show, the quest to build machines that are capable of telling right from wrong has begun. -/- Moral Machines is the first book to examine the challenge of building artificial moral agents, probing deeply into the nature of human decision making and ethics. (shrink)

The main goals of this paper are two. First, it articulates what kinds of knowing pure knowing is in its narrow sense pure knowing as the capacity of moral judgment; pure knowing as moral knowledge and standard. Besides, it analyses pure knowing’s different features through a phenomenological description. All these aspects of pure knowing are tied by moral feeling. Second, this paper addresses two sets of theoretical problems that have been raised in Confucian discourse with respect to (...) pure knowing and Heavenly principle, primarily those that render Wang’s notion of pure knowing to be static recognition toward particular moral issues, or immediate response, which reading cannot really admit the possibilities of extension, reflection, moral cultivation, and reform of institution; and those that understand pure knowing to be merely abstract without concrete content, such as merely being a metaphysical substance. When properly understood, that is, from the perspective of moral emotions, Wang Yangming’s account of pure knowing provides for the possibilities of enhancement and cultivation, while insisting that the content of pure knowing is always accessible to us. (shrink)

This paper advances a new agentially undemanding account of the conditions of attributability, the Minimal Approval account, and argues that it has a number of advantages over traditional Deep Self theories, including the way in which it handles agents with conditions like addiction, Tourette syndrome, and misophonia. It is argued that in order for an agent to be attributionally responsible, the mental process that leads to her action must dispose her to be such that she would, upon reflec-tion, approve (...) to some minimal degree of being moved to action by the motive on which she in fact acts. (shrink)

If what is morally right or wrong were ultimately a function of our opinions, then even such reprehensible actions as genocide and slavery would be morally right, had we approved of them. Many moral philosophers find this conclusion objectionably permissive, and to avoid it they posit a moral reality that exists independently of what anyone thinks. The notion of an independent moral reality has been subjected to meticulous metaphysical, epistemological and semantic criticism, but it is hardly ever (...) examined from a moral point of view. In this essay I offer such a critique. I argue that the appeal to an independent moral reality as a ground for moral obligations constitutes a substantive moral mistake. However, I do not conclude from this that we must therefore embrace the opposite view that moral truths are ultimately dependent on our attitudes. Rather, I suggest that we reject both of these views and answer the classic meta-ethical question “Is what we morally ought to do ultimately a function of our actual attitudes, or determined independently of them?” with Neither. (shrink)

Background:Moral distress, moral sensitivity, and moral courage among healthcare professionals have been explored considerably in recent years. However, there is a paucity of studies exploring these topics among baccalaureate nursing students.Aim/objective:The purpose of this study was to explore the relationship between and among moral distress, moral sensitivity, and moral courage of undergraduate baccalaureate nursing students.Research design:The research employed a descriptive-correlational design to explore the relationships between and among moral distress, moral sensitivity, and (...) moral courage of undergraduate nursing students.Participants and research context:A total of 293 baccalaureate Filipino nursing students who have been exposed to various clinical areas participated in the study.Ethical considerations:Institutional review board approval was sought prior to the conduct of the study. Self-determination was assured and anonymity and confidentiality were guaranteed to all participants.Findings:Results indicate that a majority of the nursing students in the clinical areas encounter morally distressing situations that compromise quality patient care. However, despite the fact that they want to do what is in the best interest of their patients, their perception of being the inexperienced among the healthcare team drives the majority of them to ignore morally distressing situations to avoid conflict and confrontation. Another interesting finding is that 79.20% of the respondents hardly consider quitting the nursing profession even if they frequently encounter morally distressing situations. Analysis also shows associations between moral distress intensity and frequency ( r = 0.13, p < 0.05) and moral distress intensity and moral sensitivity ( r = 0.25, p < 0.05). The dimensions of moral courage are also related to both moral distress and moral sensitivity.Conclusion:Results of the study imply that moral distress is a reality among all healthcare professionals including nursing students and requires more consideration by nurse educators. (shrink)

Background:Moral distress occurs when constraints prevent healthcare providers from acting in accordance with their core moral values to provide good patient care. The experience of moral distress in nurses might be magnified during the current Covid-19 pandemic.Objective:To explore causes of moral distress in nurses caring for Covid-19 patients and identify strategies to enhance their moral resiliency.Research design:A qualitative study using a qualitative content analysis of focus group discussions and in-depth interviews. We purposively sampled 31 nurses (...) caring for Covid-19 patients in the acute care units within large academic medical systems in Maryland and New York City during April to June 2020.Ethical considerations:We obtained approval from the Institutional Review Board at the University of Maryland, Baltimore.Results:We identified themes and sub-themes representative of major causes of moral distress in nurses caring Covid-19 patients. These included (a) lack of knowledge and uncertainty regarding how to treat a new illness; (b) being overwhelmed by the depth and breadth of the Covid-19 illness; (c) fear of exposure to the virus leading to suboptimal care; (d) adopting a team model of nursing care that caused intra-professional tensions and miscommunications; (e) policies to reduce viral transmission (visitation policy and PPE policy) that prevented nurses to assume their caring role; (f) practicing within crisis standards of care; and (g) dealing with medical resource scarcity. Participants discussed their coping mechanisms and suggested future strategies.Discussion/Conclusion:Our study affirms new causes of moral distress related to the Covid-19 pandemic. Institutions need to develop a supportive ethical climate that can restore nurses’ moral resiliency. Such a climate should include non-hierarchical interdisciplinary spaces where all providers can meet together as moral peers to discuss their experiences. (shrink)

I argue in favor of the Minimal Approval account, an original account of an agent’s moral responsibility for her actions, understood as the conditions that must be met so that an agent’s actions speak for her such that she can appropriately be blamed on their basis. My account shares a general theoretical orientation with Deep Self views, but diverges in several respects. I argue that Deep Self views tend to seriously over-generate exemptions, such that agents are exempt from (...) responsibility even from ordinary weak-willed actions. Accordingly, much of my focus is on giving a more nuanced, and in certain senses narrower, explanation of genuine exemption cases. While I address the advantages the Minimal Approval account has over competing accounts throughout these chapters, the account also aims to provide an empirically informed response to a certain sort of skeptical worry about how it could be the case that anyone is ever responsible for what they do at all. One commonplace thought is that when agents’ behaviors are due to compulsion their “brains make them do it.” But, in a literal sense, it might seem that our brains make all of us do everything that we do. In this dissertation I head off this worry by directly addressing both what the difference is, and what it should mean for our practices. (shrink)

It is often assumed that Fichte's aim in Part I of the System of Ethics is to provide a deduction of the moral law, the very thing that Kant – after years of unsuccessful attempts – deemed impossible. On this familiar reading, what Kant eventually viewed as an underivable 'fact' (Factum), the authority of the moral law, is what Fichte traces to its highest ground in what he calls the principle of the 'I'. However, scholars have largely overlooked (...) a passage in the System of Ethics where Fichte explicitly invokes Kant's doctrine of the fact of reason with approval, claiming that consciousness of the moral law grounds our belief in freedom (GA I/5:65). On the reading I defend, Fichte's invocation of the Factum is consistent with the structure of Part I when we distinguish (a) the feeling of moral compulsion from (b) the moral law itself. (shrink)

Background:Nurses and nursing students appear vulnerable to moral distress when faced with ethical dilemmas or decision-making in clinical practice. As a result, they may experience professional dissatisfaction and their relationships with patients, families, and colleagues may be compromised. The impact of moral distress may manifest as anger, feelings of guilt and frustration, a desire to give up the profession, loss of self-esteem, depression, and anxiety.Objectives:The purpose of this review was to describe how dilemmas and environmental, relational, and organizational (...) factors contribute to moral distress in undergraduate student nurses during their clinical experience and professional education.Research design:The research design was a systematic literature review.Method:The search produced a total of 157 articles published between 2004 and 2014. These were screened with the assessment sheet designed by Hawker and colleagues. Four articles matched the search criteria (one quantitative study and three qualitative), and these were separately read and analyzed by the researchers. The process of review and analysis of the data was supervised by a colleague experienced in moral distress who provided an independent quality check.Ethical consideration:Since this was a systematic review, no ethical approval was required.Findings:From the analysis, it emerged that inequalities and healthcare disparities, the relationship with the mentor, and students’ individual characteristics can all impact negatively on the decisions taken and the nursing care provided, generating moral distress. All these factors condition both the clinical experience and learning process, in addition to the professional development and the possible care choices of future nurses.Conclusion:Few studies dealt with moral distress in the setting of nurse education, and there is a knowledge gap related to this phenomenon. The results of this review underline the need for further research regarding interventions that can minimize moral distress in undergraduate nursing students. (shrink)

The advent of moral pluralism in the post-modern age leads to a set of issues about how pluralistic societies can function. The questions of biomedical ethics frequently highlight the larger issues of moral pluralism and social cooperation. Reflection on these issues has focused on the decision making roles of the health care professionals, the patient, and the patient's family. One species of actor that has been neglected has been those institutions which are part of the public, secular realm (...) and which have a particular moral heritage. Keywords: approval, compromise, condemnation, integrity, toleration CiteULike Connotea Del.icio.us What's this? (shrink)

Background:Moral distress is a common problem among professionals working in the field of healthcare. Moral distress is the distress experienced by a professional when he or she cannot fulfill the correct action due to several obstacles, although he or she is aware of what it is. The level of moral distress experienced by nurses working in intensive care units varies from one country/culture/institution to another. However, in Turkey, there is neither a measurement tool used to assess (...) class='Hi'>moral distress suffered by nurses nor a study conducted on the issue.Aim/objective:The study aims to (a) validate the Turkish version of the Moral Distress Scale–Revised to be used in intensive care units and to examine the validity and reliability of the Turkish version of the scale, and (b) explore Turkish intensive care nurses’ moral distress level.Method:The sample of this methodological, descriptive, and cross-sectional design study comprises 200 nurses working in the intensive care units of internal medicine and surgical departments of four hospitals in three cities in Turkey. The data were collected with the Socio-Demographic Characteristics Form and The Turkish Version of Moral Distress Scale–Revised.Ethical considerations:The study proposal was approved by the ethics committee of the Faculty of Medicine, Cumhuriyet University. All participating nurses provided informed consent and were assured of data confidentiality.Results:In parallel with the original scale, Turkish version of Moral Distress Scale–Revised consists of 21 items, and shows a one-factor structure. It was determined that the moral distress total and item mean scores of the nurses participating in the study were 70.81 ± 48.23 and 3.36 ± 4.50, respectively.Conclusion:Turkish version of Moral Distress Scale–Revised can be used as a reliable and valid measurement tool for the evaluation of moral distress experienced by nurses working in intensive care units in Turkey. In line with our findings, it can be said that nurses suffered low level of moral distress. However, factors which caused the nurses in our study to experience higher levels of moral distress are inadequate communication within the team, working with professionals they considered as incompetent, and futile care. (shrink)

Background:Moral distress is a common problem among professionals working in the field of healthcare. Moral distress is the distress experienced by a professional when he or she cannot fulfill the correct action due to several obstacles, although he or she is aware of what it is. The level of moral distress experienced by nurses working in intensive care units varies from one country/culture/institution to another. However, in Turkey, there is neither a measurement tool used to assess (...) class='Hi'>moral distress suffered by nurses nor a study conducted on the issue.Aim/objective:The study aims to (a) validate the Turkish version of the Moral Distress Scale–Revised to be used in intensive care units and to examine the validity and reliability of the Turkish version of the scale, and (b) explore Turkish intensive care nurses’ moral distress level.Method:The sample of this methodological, descriptive, and cross-sectional design study comprises 200 nurses working in the intensive care units of internal medicine and surgical departments of four hospitals in three cities in Turkey. The data were collected with the Socio-Demographic Characteristics Form and The Turkish Version of Moral Distress Scale–Revised.Ethical considerations:The study proposal was approved by the ethics committee of the Faculty of Medicine, Cumhuriyet University. All participating nurses provided informed consent and were assured of data confidentiality.Results:In parallel with the original scale, Turkish version of Moral Distress Scale–Revised consists of 21 items, and shows a one-factor structure. It was determined that the moral distress total and item mean scores of the nurses participating in the study were 70.81 ± 48.23 and 3.36 ± 4.50, respectively.Conclusion:Turkish version of Moral Distress Scale–Revised can be used as a reliable and valid measurement tool for the evaluation of moral distress experienced by nurses working in intensive care units in Turkey. In line with our findings, it can be said that nurses suffered low level of moral distress. However, factors which caused the nurses in our study to experience higher levels of moral distress are inadequate communication within the team, working with professionals they considered as incompetent, and futile care. (shrink)

Drugs addressing unmet medical needs can change the lives of millions. Developing and validating new drugs can, however, take many years. To streamline the assessment of new drugs, regulatory agencies have long established shortened review pathways. Among these programs, Accelerated Approval (AA) has recently come under scrutiny due to the U.S. Food and Drug Administration's decision to authorize Aducanumab, the first Alzheimer's disease drug. This decision attracted fierce criticism due to the allegedly insufficient evidence about the safety and efficacy (...) of the drug. While considerable scholarly attention has been devoted to this case, the ethical aspects of the AA regulatory pathway have so far remained relatively unexplored. In this paper, we set out to fill this gap. We illustrate six conditions that should be met for AA to be ethically acceptable: moral solicitude, evidence, risk mitigation, impartiality, sustainability, and transparency. We discuss such conditions and suggest practical steps to implement them in regulatory and oversight processes. Taken together, our six conditions represent a benchmark for assessing the ethical validity of AA processes and decisions. (shrink)

Background:Moral distress is recognized as a problem affecting healthcare professionals globally. Unaddressed moral distress may lead to withdrawal from the moral dimensions of patient care, burnout, or leaving the profession. Despite the importance, studies related to moral distress are scant in Thailand.Objective:This study aims to describe the experience of moral distress and related factors among Thai nurses.Design:A convergent parallel mixed-methods design was used. The quantitative and qualitative data were collected in parallel using the Measure of (...) Moral Distress for Healthcare Professionals and interview guide. The analysis was conducted separately and then integrated.Participants:Participants were Thai nurses from two large tertiary care institutions in a Southern province of Thailand.Ethical considerations:This study was approved by our organization's Institutional Review Board for Health Sciences Research, and by the Institutional Review Boards of the two local institutions in Thailand. Permission from the publisher was received to translate and utilize the Measure of Moral Distress (MMD-HP) under the license number: 4676990097151.Results:A total of 462 participants completed the survey questions. The top 7 causes of moral distress were related to system-level root causes and end-of-life care situations. Hierarchical multiple regression showed that work units, considering leaving position, and number of moral distress episodes in the past year were significant predictors of moral distress. Twenty interviews demonstrated three main themes of distressing causes: (1) powerlessness (at patients/family-, team-, and organizational-levels), (2) end-of-life issues, and (3) poor team function (poor communication and collaboration, incompetent healthcare providers, and inappropriate behavior of colleagues). The integration of data from both components indicated that the qualitative interviews enrich the quantitative findings, especially as related to the top 7 causes of moral distress.Discussion:Although the experience of moral distress among Thai nurses is similar to studies conducted elsewhere, the patient’s and family’s religious perspective that ties into the concept of moral distress needs to be explored.Conclusions:Although the root causes of moral distress are similar among different cultures, the experience of Thai nurses may vary according to culture and context. (shrink)

Commentators on the ethics of translational research find it morally problematic. Types of translational research are said to involve questionable benefits, special risks, additional barriers to informed consent, and severe conflicts of interest. Translational research conducted on the global poor is thought to exploit them and increase international disparities. Some commentators support especially stringent ethical review. However, such concerns are grounded only in pre-approval translational research. Whether or not T1 has these features, translational research beyond approval is unlikely (...) to and, when conducted on the global poor, may support development. Therefore, insofar as T1 is morally problematic, and no independent objections to T2 exist, the ethics of translational research is diverse: while some translational research is problematic, some is not. Funding and oversight should reflect this diversity, and T2 should be encouraged, particularly when conducted among the global poor. (shrink)

Background:Nurses exposed to community health nursing commonly encounter situations that can be morally distressing. However, most research on moral distress has focused on acute care settings and very little research has explored moral distress in a community health nursing setting especially among nursing students.Aim:To explore the moral distress experiences encountered by undergraduate baccalaureate nursing students in community health nursing.Research design:A descriptive qualitative design was employed to explore the community health nursing experiences of the nursing students that led (...) them to have moral distress.Participants and research context:The study included 14 senior nursing students who had their course in Community Health Nursing in their sophomore year and stayed in the partner communities in their junior year for 6 and 3 weeks during their senior year.Ethical considerations:Institutional review board approval was sought prior to the conduct of the study. Self-determination was assured and anonymity and confidentiality were guaranteed to all participants.Findings:Nursing students are vulnerable and likely to experience moral distress when faced with ethical dilemmas. They encounter numerous situations which make them question their own values and ideals and those of that around them. Findings of the study surfaced three central themes which included moral distress emanating from the unprofessional behavior of some healthcare workers, the resulting sense of powerlessness, and the differing values and mindsets of the people they serve in the community.Conclusion:This study provides educators a glimpse of the morally distressing situations that often occurs in the community setting. It suggests the importance of raising awareness and understanding of these situations to assist nursing students to prepare themselves to the “real world,” where the ideals they have will be constantly challenged and tested. (shrink)

In this short paper, I argue that the phenomenology of moral judgment is not unified across different areas of morality (involving harm, hierarchy, reciprocity, and impurity) or even across different relations to harm. Common responses, such as that moral obligations are experienced as felt demands based on a sense of what is fitting, are either too narrow to cover all moral obligations or too broad to capture anything important and peculiar to morality. The disunity of moral (...) phenomenology is, nonetheless, compatible with some uses of moral phenomenology for moral epistemology and with the objectivity and justifiability of parts of morality. (shrink)

There has been a good deal of interest in moral sentimentalism in recent years, but most of that interest has been exclusively either in meta-ethical questions or in normative issues about caring or benevolence. This book presents a systematic revival of moral sentimentalism across both normative and meta-ethical issues.

Background:Moral distress and workplace bullying are important issues in the nursing workplace that appear to affect nurse’s burnout.Aim:To investigate the relationship between moral distress and burnout in Iranian nurses, as mediated by their perceptions of workplace bullying.Ethical considerations:The research was approved by the committee of ethics in research of the Urmia University of Medical Sciences.Method:This is a correlation study using a cross-sectional design with anonymous questionnaires as study instruments (i.e. Moral Distress Scale-Revised, Maslach Burnout Inventory and The (...) Negative Acts Questionnaire-Revised). Data were collected from 278 nurses from five teaching hospitals in Urmia, the capital of Western Azerbaijan, northwest of Iran. Structural equation modeling and bootstrapping procedures were employed to recognize the mediating role of their perceptions of workplace bullying.Results:The mean score of moral distress, burnout, and the Negative Acts Questionnaire-Revised Scale among the participants were 91.02 ± 35.26, 79.9 ± 18.27, and 45.4 ± 15.39, respectively. The results confirmed our hypothesized model. All the latent variables of study were significantly correlated in the predicted directions. The moral distress and bullying were significant predictors of burnout. Perception of bullying partially mediated the relationship between moral distress and burnout. The mediating role of the bullying suggests that moral distress increases burnout, directly and indirectly.Conclusion:Nursing administrators should be conscious of the role of moral distress and bullying in the nursing workplace in increasing burnout. (shrink)

BackgroundSerious ethical problems have been anecdotally identified in the care of children with osteogenesis imperfecta (OI), which may negatively impact their moral experiences, defined as their sense of fulfillment towards personal values and beliefs.Research aimsTo explore children’s actual and desired participation in discussions, decisions, and actions in an OI hospital setting and their community using art-making to facilitate their self-expression.Research designA focused ethnography was conducted using the moral experiences framework with data from key informant interviews; participant observations, semi-structured (...) interviews, and practice-based research (art-making) with 10 children with OI; and local documents.Participants and research contextThe study was conducted at a pediatric, orthopedic hospital.Ethical considerationsThis study was approved by McGill University Institutional Review Board.Findings/resultsChildren expressed desires to participate in their care, but sometimes lacked the necessary resources and encouragement from healthcare providers. Art-making facilitated children’s voice and participation in health-related discussions.ConclusionsHealthcare providers are recommended to consider the benefits of art-making and educational resources to reduce discrepancies between children’s actual and desired participation in care and promote positive moral experiences. (shrink)

Objective:The purpose of this study was to describe the current situation of moral distress and to explore its influencing factors among Chinese nurses.Methods:This is an exploratory, descriptive design study. A total of 465 clinical nurses from different departments in three Grade-III, Level-A hospitals in Jinan, Shandong Province, completed the questionnaires, including demographics questionnaire, Chinese version of Moral Distress Scale–Revised, and Job Diagnostic Survey.Ethical considerations:The study was approved by the university ethics board and the local health service director.Results:The total (...) score of Moral Distress Scale–Revised was 36.01 ± 24.02 points. The mean frequency and intensity scores of moral distress were 1.13 ± 0.49 and 1.09 ± 0.58, respectively. The level of moral distress among Chinese clinical nurses was low, and the frequency and intensity of moral distress were on low to moderate level. The level of moral distress experienced by clinical nurses is associated with demographics features and job characteristics, including age, education degree, department, task significance, autonomy, and dealing with others.Conclusion:Our conclusion suggests that hospital and organizational administrations should attach much importance to the moral distress experienced by clinical nurses in China. Further studies should focus on interventions about how to reduce the levels of the frequency and intensity of moral distress among clinical nurses. (shrink)

Victoria Davion confuses seeking approval with the desire for recognition of and respect for one's difference. Ironically, when she asserts that the desire to please others provides an incentive to do well (and thus constitutes a positive aspect of competition) Davion undermines her argument that competition enhances one's sense of self. Rather than enhancing one's sense of self, striving to win approval from others sabotages one's ability to rely on her own judgment and take moral responsibility for (...) herself. (shrink)

Background: Moral distress is an important and well-studied phenomenon among nurses and other healthcare providers, yet the conceptualization of parental moral distress remains unclear. Objective: The objective of this dimensional analysis was to describe the nature of family moral distress in serious pediatric illness. Design and methods: A dimensional analysis of articles retrieved from a librarian-assisted systematic review of Scopus, CINAHL, and PsychInfo was conducted, focusing on how children, parents, other family members, and healthcare providers describe parental (...) moral distress, both explicitly through writings on parental moral experience and implicitly through writings on parental involvement in distressing aspects of the child’s serious illness. Ethical considerations: To promote child and family best interest and minimize harm, a nuanced understanding of the moral, existential, emotional, and spiritual impact of serious pediatric illness is needed. The cases used in this dimensional analysis come from the first author’s IRB approved study at the Children’s Hospital of Philadelphia and subsequent published studies; or have been adapted from the literature and the authors’ clinical experiences. Findings: Three dimensions emerged from the literature surrounding parent moral distress: an intrapersonal dimension, an interpersonal dimension, and a spiritual/existential dimension. The overarching theme is that parents experience relational solace and distress because of the impact of their child’s illness on relationships with themselves, their children, family, healthcare providers, their surrounding communities, and society. Discussion: Elucidating this concept can help nurses and other professionals understand, mitigate, or eliminate antecedents to parental moral distress. We discuss how this model can facilitate future empirical and conceptual bioethics research, as well as inform the manner in which healthcare providers engage, collaborate with, and care for families during serious pediatric illness. Conclusion: Parent moral distress is an important and complex phenomenon that requires further theoretical and empirical investigation. We provide an integrated definition and dimensional schematic model that may serve as a starting point for future research and dialogue. (shrink)

Moral legitimacy entails intrinsic value and helps executives convince firm’s stakeholders and the general public of the ethical acceptability of an institution or its activities or projects. Social license to operate is the social approval of those affected by a certain business activity, and it is receiving increasing attention, especially in the context of controversial projects such as mining and public works. Moral legitimacy provides ethical support to SLO. Drawing from the Aristotelian-Thomistic tradition and taking substantive justice (...) and the common good of society as the key references, this paper applies the Triple Font of Morality Theory and proposes four criteria which serve to evaluate moral legitimacy: contribution of the project or activity to the common good in a better way than other alternatives, morality of the means and procedures employed, ethical evaluation of the situation including stakeholder concerns and needs, and ethical evaluation of reasonably foreseeable consequences associated with the project and how to minimize possible damage or risks, and balance foreseeable negative consequences and benefits. The application of these criteria is illustrated through a project, presented as a case study, which certainly involved controversy and problems with SLO. The project was the construction of a rail tunnel for a high-speed train near the foundations of the Sagrada Familia, the well-known monumental church in Barcelona, Spain. (shrink)

Background Moral courage is a recognized virtue. In the context of the COVID-19 pandemic, the master’s students of nursing (MSNs) in China have shown tenacious moral courage. Objective This study elaborates on the moral courage of Chinese MSNs through their experiences of volunteering during the pandemic. Research Design Descriptive qualitative, interview-based. Participants and Research Context Participants were nursing postgraduate students who participated in the prevention and control of the COVID-19 pandemic selected by purposeful sampling. The sample size (...) was determined by data saturation, which was reached with 10 participants. Data were analyzed using a deductive method of content analysis. Because of the isolation policy, telephone interviews were adopted. Ethical considerations After obtaining the approval of the ethical institution of the author’s school (No. 138, 30 August 2021), verbal consent was obtained before the interview with the participants. All data were processed anonymously and confidentially. In addition, we recruited participants through MSNs’ counselors, and obtained their phone numbers with their permission. Results Data analysis resulted in 15 subcategories that were subsequently grouped into 3 major categories including proceed without hesitation, the outcome of practicing moral courage, and develop and maintain moral courage. Conclusion This qualitative study is based on the special background of the COVID-19 pandemic, and the MSNs in China have shown tenacious moral courage in the work of epidemic prevention and control. Five factors led them to take action without hesitation, and six possible outcomes followed. Lastly, this study provides some suggestions for nurses and nursing students to enhance their moral courage. To better develop and support moral courage in the future, it is necessary to use different methods and multidisciplinary approaches to study moral courage. (shrink)

Background:Moral distress is considered to be the negative feelings that arise when one knows the morally correct response to a situation but cannot act because of institutional or hierarchal constraints.Objectives:To analyze moral distress and its relation with sociodemographic and academic variables in undergraduate students from different universities in Brazil.Method:Quantitative study with a cross-sectional design. Data were collected through the Moral Distress Scale for Nursing Students, with 499 nursing students from three universities in the extreme south of Brazil (...) answering the scale. The data were analyzed in the statistical software SPSS version 22.0, through descriptive statistical analysis, association tests (t-test and analysis of variance), and linear regression models.Ethical considerations:Approval for the study was obtained from the Research Ethics Committee at Universidade Federal do Rio Grande.Findings:The mean intensity of moral distress in the constructs ranged from 1.60 to 2.55. As to the occurrence of situations leading to moral distress in the constructs, the frequencies ranged from 1.21 to 2.43. The intensity level of moral distress showed higher averages in the more advanced grades of the undergraduate nursing course, when compared to the early grades of this course (between 5 and 10 grade, average = 2.60–3.14, p = 0.000).Conclusion:The demographic and academic characteristics of the undergraduate nursing students who referred higher levels of moral distress were being enrolled in the final course semesters, were at a federal university, and had no prior degree as an auxiliary nurse/nursing technician. (shrink)

Background Moral sensitivity and academic integrity discernment hold paramount importance for healthcare professionals. Owing to distinct undergraduate educational backgrounds, nurses and physicians may exhibit divergent moral perspectives, academic integrity cognisance, and moral sensitivity within clinical environments. A limited number of studies have investigated the disparities and congruencies pertaining to moral sensitivity and academic ethical awareness among nursing and medical students. Objective The study compares moral sensitivity and academic ethical awareness of undergraduate nursing and medical students (...) with and without clinical exposure. Research design A self-administered cross-sectional survey conducted from January to February 2022 was used to collect data from a medical school in Hong Kong. Participants and research context A total of 545 respondents, including 137 nursing students and 408 medical students, completed the questionnaire. Ethical consideration Ethics approval of the study was obtained. Written consent was waived to maintain anonymity because completing the questionnaire was considered implied consent. Findings Both groups of undergraduates demonstrated a high level of bioethics knowledge. In terms of academic integrity, medical students were found to have a less concerned attitude towards punctuality, attendance, and skipping classes. Regarding moral sensitivity, senior medical students with clinical experience put less emphasis on decision-making involving patient participation, while senior nursing students were more hesitant in withholding treatment for incompetent patients who refused treatment. Both nursing and medical students showed decreased moral sensitivity in the ‘conflicts’ domain with increased clinical exposure. Conclusion Study findings contribute to the discussion comparing the ethical attitudes of nursing and medical students. More effort should be made in nursing and medical education to promote practices in line with high academic integrity and to develop the ability to be morally sensitive in professional settings. (shrink)

Moral response-dependent metaethical theories characterize moral properties in terms of the reactions of certain classes of individuals. Nick Zangwill has argued that such theories are flawed: they are unable to accommodate the motive of duty. That is, they are unable to provide a suitable reason for anyone to perform morally right actions simply because they are morally right. I argue that Zangwill ignores significant differences between various approvals, and various individuals, and that moral response-dependent theories can accommodate (...) the motive of duty. (shrink)

Non-cognitivism is a variety of irrealism about ethics with a number of influential variants. Non-cognitivists agree with error theorists that there are no moral properties or moral facts. But rather than thinking that this makes moral statements false, noncognitivists claim that moral statements are not in the business of predicating properties or making statements which could be true or false in any substantial sense. Roughly put, noncognitivists think that moral statements have no truth conditions. Furthermore, (...) according to non-cognitivists, when people utter moral sentences they are not typically expressing states of mind which are beliefs or which are cognitive in the way that beliefs are. Rather they are expressing non-cognitive attitudes more similar to desires, approval or disapproval. Cognitivism is the denial of non-cognitivism. Thus it holds that moral statements do express beliefs and that they are apt for truth and falsity. But cognitivism need not be a species of realism since a cognitivist can be an error theorist and think all moral statements false. Still, moral realists are cognitivists insofar as they think moral statements are apt for truth and falsity and that many of them are in fact true. (shrink)

BackgroundAlthough, moral distress presents a serious problem among critical care nurses in many countries, limited research has been conducted on it. A validated scale has been developed to evaluate moral distress and has enabled cross-cultural comparison for seeking its root causes.Research aimsThis study aimed to (1) clarify the current status of moral distress among nurses who worked in critical care areas in Japan, (2) compare the moral distress levels among nurses in Japan with previously reported results (...) from the United States (US), and (3) explore the factors associated with moral distress.Research designA nationwide cross-sectional study was conducted.Participants and research contextWe conducted a self-administered questionnaire survey using the Measure of Moral Distress–Healthcare Professionals (MMD-HP) among critical care nurses who were randomly selected from hospitals across Japan. The mean differences between the two countries were compared using a Student's t-test with summary statistics. The factors associated with higher levels of moral distress were examined using a multiple regression analysis.Ethical considerationsThe study was approved by the Ethics Committee of the Tokyo Medical and Dental University (approval nos. M2018-214 and M2019-045).ResultsWe obtained 955 valid responses from 94 facilities. In Japan, the items with the highest moral distress scores were those related to aggressive/inappropriate treatment. The total MMD-HP score was significantly higher in Japanese nurses compared to US nurses (122.8 ± 70.8 vs 112.3 ± 73.2). Some factors, such as leadership experience, were associated with higher moral distress.DiscussionThe top root causes of moral distress were similar to potentially inappropriate treatments in both countries.ConclusionThis study revealed the factors associated with higher moral distress and its characteristics in each country. These results can be used for reducing moral distress in the future. (shrink)

BackgroundSocial responsibility can motivate disaster relief nurses to devote themselves to safeguarding rights and interests of people when facing challenges that threaten public health. However, few studies focused on the relationship of moral courage, job-esteem, and social responsibility among disaster relief nurses.ObjectiveTo explore the influence of moral courage and job-esteem on the social responsibility in disaster relief nurses and clarify the relationship model between them.MethodsA cross-sectional study was conducted among 716 disaster relief nurses from 14 hospitals in central (...) China through an online survey, including moral courage scale, job-esteem scale, and social responsibility questionnaire. The data were analyzed by Pearson’s correlation, and the mechanism of the effect of moral courage and job-esteem on social responsibility was completed.Ethical considerationsThis study was approved by the Medical Ethics Committee of the Second Xiangya Hospital of Central South University (Approval Number: 2019016).ResultsDisaster relief nurses’ moral courage positively impacted social responsibility (r = 0.677, p < 0.01), and moral courage could affect social responsibility through the mediating role of job-esteem.ConclusionJob-esteem mediated between moral courage and social responsibility among disaster relief nurses. Nursing managers regular assessment of nurses’ moral courage and interventions such as meetings and workshops can reduce moral distress, foster morally courageous behavior, enhance job-esteem, and improve social responsibility performance among disaster relief nurses. (shrink)

Background Morality is a fundamental component of nurses’ daily work. Nurses’ cognitive tendencies toward moral disengagement in high-stress work environments can easily lead them to engage in counterproductive work behaviors that are not conducive to the organization. However, there is limited research on how to mitigate the impact of moral disengagement on counterproductive work behavior. Objective The objective was to explore the impact of moral disengagement on counterproductive work behavior, as well as the reverse regulatory mechanism of (...) moral identity on the relationship between moral disengagement and counterproductive work behavior. Research design This was a quantitative, cross-sectional study. Participants and research context From September to October 2023, nurses from emergency departments of major hospitals in Hunan Province were recruited, and 500 questionnaires were distributed and collected using the WeChat app Credamo Seeing Numbers. Ethical consideration All study procedures were approved by the Ethics Committee of Hunan Normal University (No. 2023-388). Findings Moral disengagement had a positive effect on counterproductive work behavior directed at the organization (CWB-O) as well as counterproductive work behavior directed at individuals (CWB-I). Moral identity was not significant in moderating the relationship between moral disengagement and CWB-O. Moral identity had an inverse moderating effect on the mechanism of action between moral disengagement and CWB-I. Conclusion Counterproductive work behavior guided by moral disengagement is detrimental to organizations, and moral identity can inhibit the effect of moral disengagement on CWB-I. Nursing administrators should focus on improving nurses’ moral identity and improving the healthcare workplace environment so that moral identity can better exert its inhibitory effect on counterproductive work behavior among nurses. (shrink)

BackgroundThe concept of career identity is integral to nursing practices and forms the basis of the nursing professions. Positive career identity is essential for providing high-quality care, optimizing patient outcomes, and enhancing the retention of health professionals. Therefore, there is a need to explore potential influencing variables, thereby developing effective interventions to improve career identity.ObjectivesTo investigate the relationship between moral distress, moral courage, and career identity, and explore the mediating role of moral courage between moral distress (...) and career identity among nurses.DesignA quantitative, cross-sectional study.MethodsA convenient sample of 800 nurses was recruited from two tertiary care hospitals between February and March 2022. Participants were assessed using the Moral Distress Scale-revised, Nurses’ Moral Courage Scale, and Nursing Career Identity Scale. This study was described in accordance with the STROBE statement.Ethical considerationResearch ethics approval was obtained from the researcher’s university and hospital where this study was conducted prior to data collection.FindingsMoral distress is negatively associated while moral courage is positively associated with career identity among nurses. Moral courage partially mediates the relationship between moral distress and career identity ( β = −0.230 to −0.163, p < 0.01).DiscussionThe findings reveal a relationship between moral distress, moral courage, and career identity among nurses.ConclusionBy paying attention to nurses’ moral distress and courage, healthcare providers can contribute to the development of effective interventions to improve career identity, and subsequently performance, among nurses. (shrink)

Background Moral courage means courage to act according to individual’s own ethical values and principles despite the risk of negative consequences for them. Research about the moral courage of whistle-blowers in health care is scarce, although whistleblowing involves a significant risk for the whistle-blower. Objective To analyse the moral courage of potential whistle-blowers and its association with their background variables in health care. Research design Was a descriptive-correlational study using a questionnaire, containing Nurses Moral Courage Scale©, (...) a video vignette of the wrongdoing situation with an open question about the vignette, and several background variables. Data were analysed statistically and inductive content analysis was used for the narratives. Participants and research context Nurses as healthcare professionals (including registered nurses, public health nurses, midwives, and nurse paramedics) were recruited from the membership register of the Nurses’ Association via email in 2019. A total of 454 nurses responded. The research context was simulated using a vignette. Ethical considerations Good scientific inquiry guidelines were followed. Permission to use the Nurses’ Moral Courage Scale© was obtained from the copyright holder. The ethical approval and permission to conduct the study were obtained from the participating university and the Nurses’ Association. Findings The mean value of potential whistle-blowers’ moral courage on a Visual Analogue Scale (0–10) was 8.55 and the mean score was 4.34 on a 5-point Likert scale. Potential whistle-blowers’ moral courage was associated with their socio-demographics, education, work, personality and social responsibility related background variables. Discussion and conclusion In health care, potential whistle-blowers seem to be quite morally courageous actors. The results offer opportunities for developing interventions, practices and education to support and encourage healthcare professionals in their whistleblowing. Research is needed for developing a theoretical construction to eventually increase whistleblowing and decrease and prevent wrongdoing. (shrink)

In a way reminiscent of Hume's approach in the Treatise, a reviving moral sentimentalism can use the notion of empathy to ground both its normative account of moral obligation and its metaethical account of moral language. A virtuous person is empathically caring about others and expresses such feeling/motivation in her actions. But the judgment that something is right or good is also based in empathy, and the sentimentalist can espouse a form of moral realism by making (...) use of a Kripkean reference-fixer theory of the role of feelings of approval and disapproval in moral judgment. (shrink)

Three studies test eight hypotheses about (1) how judgment differs between people who ascribe greater vs. less moral relevance to choices, (2) how moral judgment is subject to task constraints that shift evaluative focus (to moral rules vs. to consequences), and (3) how differences in the propensity to rely on intuitive reactions affect judgment. In Study 1, judgments were affected by rated agreement with moral rules proscribing harm, whether the dilemma under consideration made moral rules (...) versus consequences of choice salient, and by thinking styles (intuitive vs. deliberative). In Studies 2 and 3, participants evaluated policy decisions to knowingly do harm to a resource to mitigate greater harm or to merely allow the greater harm to happen. When evaluated in isolation, approval for decisions to harm was affected by endorsement of moral rules and by thinking style. When both choices were evaluated simultaneously, total harm -- but not the do/allow distinction -- influenced rated approval. These studies suggest that moral rules play an important, but context-sensitive role in moral cognition, and offer an account of when emotional reactions to perceived moral violations receive less weight than consideration of costs and benefits in moral judgment and decision making. (shrink)