The ‘community of inquiry’ as formulated by C. S. Peirce is grounded in the notion of communities of discipline-based inquiry engaged in the construction of knowledge. The phrase ‘transforming the classroom into a community of inquiry’ is commonly understood as a pedagogical activity with a philosophical focus to guide classroom discussion. But it has a broader application. Integral to the method of the community of inquiry is the ability of the classroom teacher to actively engage in the theories and practices (...) of discipline-based communities of inquiry so as to become informed by the norms of the disciplines, not only to aspire to competence within the disciplines, but also to develop habits of self-correction for reconstructing those same norms when faced with novel problems and solutions, including those in the classroom. This has implications for science education and the role of educational philosophy in developing students' ability to think scientifically. But it also has broader implications for thinking critically within all key learning areas. Here we concentrate on science education. We present the parallels between philosophical inquiry and scientific inquiry that need to be realised to promote and engage with scientific inquiry in the classroom. We also discuss the conflicts between philosophical inquiry and the way inquiry science in the classroom is portrayed in the education literature. Based on philosophical and historical perceptions of science as inquiry, a practical approach to implementation of scientific inquiry in the science classroom is presented. (shrink)

This study explored the impact of implementing Philosophy, in the tradition of 'Philosophy for Children', on pedagogy. It employed an experimental design that included 59 primary teachers. The experimental group received an intervention of training in Philosophy and the comparison group received training in Thinking Tools (graphic organisers), a subset of the Philosophy training. Lessons were coded on variables of pedagogy, across the two groups, at three time-points. Teacher interviews were conducted to gather participants' perspectives. Between group analysis of variance (...) on several measures of pedagogy revealed that Philosophy significantly broadened teachers' pedagogical repertoire. (shrink)

Thinking skills pedagogies like those employed in a community of inquiry (COI) provide a powerful teaching method that fosters reconstruction of thinking in both teachers and students. This collaborative, dialogic approach enables teachers and students to think deeply about the thinking process within a supportive, structured learning environment, by fostering the transformative potential of lived experience. This paper explores the potential for cognitive dissonance (genuine doubt) during students’ experiences of inquiry to be transformed into impetus for the acquisition and improvement (...) of social and intellectual inquiry capabilities and thinking behaviours across the curriculum. (shrink)

Developing students’ skills to pose and respond to questions and actively engage in inquiry behaviours enables students to problem solve and critically engage with learning and society. The aim of this study was to analyse the impact of providing teachers with an intervention in inquiry pedagogy alongside inquiry science curriculum in comparison to an intervention in non-inquiry pedagogy alongside inquiry science curriculum on student questioning and other inquiry behaviours. Teacher participants in the comparison condition received training in four inquiry-based science (...) units and in collaborative strategic reading. The experimental group, the community of inquiry (COI) condition, received training in facilitating a COI in addition to training in the same four inquiry-based science units. This study involved 227 students and 18 teachers in 9 primary schools across Brisbane, Australia. The teachers were randomly allocated by school to one of the two conditions. The study followed the students across years 6 and 7 and students’ discourse during small group activities was recorded, transcribed and coded for verbal inquiry behaviours. In the second year of the study, students in the COI condition demonstrated a significantly higher frequency of procedural and substantive higher-order thinking questions and other inquiry behaviours than those in the comparison condition. Implementing a COI within an inquiry science curriculum develops students’ questioning and science inquiry behaviours and allows teachers to foster inquiry skills predicated by the Australian Science Curriculum. Provision of inquiry science curriculum resources alone is not sufficient to promote the questioning and other verbal inquiry behaviours predicated by the Australian Science Curriculum. (shrink)

This study explored the impact of facilitating collaborative philosophical inquiry, in the tradition of “Philosophy for Children,” on connectedness pedagogies. The study employed an experimental design that included 59 primary teachers in 2 groups. The experimental group received an intervention that comprised training in CPI and the comparison group received training in Thinking Tools, a subset of the CPI training. Lessons were coded on four variables of connectedness pedagogies, across the two groups, at three time-points. Teacher interviews were conducted to (...) gather participants’ perspectives. Between-groups analysis of variance on particular measures of pedagogy revealed that CPI significantly broadened teachers’ pedagogical repertoires, in ways that included drawing on students’ background knowledge and preparing a problem-based curriculum which connects students to the world beyond the classroom. (shrink)

The ‘community of inquiry’ as formulated by C. S. Peirce is grounded in the notion of communities of discipline‐based inquiry engaged in the construction of knowledge. The phrase ‘transforming the classroom into a community of inquiry’ is commonly understood as a pedagogical activity with a philosophical focus to guide classroom discussion. But it has a broader application. Integral to the method of the community of inquiry is the ability of the classroom teacher to actively engage in the theories and practices (...) of discipline‐based communities of inquiry so as to become informed by the norms of the disciplines, not only to aspire to competence within the disciplines, but also to develop habits of self‐correction for reconstructing those same norms when faced with novel problems and solutions, including those in the classroom. This has implications for science education and the role of educational philosophy in developing students' ability to think scientifically. But it also has broader implications for thinking critically within all key learning areas. Here we concentrate on science education. We present the parallels between philosophical inquiry and scientific inquiry that need to be realised to promote and engage with scientific inquiry in the classroom. We also discuss the conflicts between philosophical inquiry and the way inquiry science in the classroom is portrayed in the education literature. Based on philosophical and historical perceptions of science as inquiry, a practical approach to implementation of scientific inquiry in the science classroom is presented. (shrink)

Teaching children to ask and answer questions is critically important if they are to learn to talk and reason effectively together, particularly during inquiry-based science where they are required to investigate topics, consider alternative propositions and hypotheses, and problem-solve together to propose answers, explanations, and prediction to problems at hand. This study involved 108 students (53 boys and 55 girls) from seven, Year 7 teachers’ classrooms in five primary schools in Brisbane, Australia. Teachers were randomly allocated by school to one (...) of two conditions: the metacognitive questioning condition (Trained condition) or the prescriptive questioning condition (Untrained condition). Data on students’ discourse and reasoning and problem-solving (RP-S) were collected across Times 1 and 2. The results showed that while there were significant differences in the discourse categories of the students in the two conditions at Time 1, the only significant difference was in questioning behaviour at Time 2 with the students in the trained condition continuing to ask more questions than their untrained peers. Given that these students had been taught to specifically ask ‘thinking’ questions that probed and interrogated information, these results are not surprising. A follow-up examination of students’ discourse during their small group discussions illustrated how these students interacted with each other to probe and interrogate information by providing explanations and reasons to make their thinking explicit and by using analogies to verbally represent concepts they were trying to express. Results on the follow-up reasoning and problem-solving (RP-S) tasks indicated that students in the Trained and Untrained conditions improved their scores from Time 1 to Time 2 although the change was not significantly different between conditions. (shrink)

Teaching students to ask and answer questions is critically important if they are to engage in reasoned argumentation, problem-solving, and learning. This study involved 35 groups of grade 6 children from 18 classrooms in three conditions (cognitive questioning condition, community of inquiry condition, and the comparison condition) who were videotaped as they worked on specific inquiry-based science tasks. The study also involved the teachers in these classrooms who were audio-taped as they interacted with the children during these tasks. The results (...) show that while there were no significant differences in the children's explanatory behaviour across the two time periods, there were significant differences in the total verbal interactions between the children in the cognitive questioning condition and their peers in the community of inquiry and comparison conditions. Furthermore, the children in the cognitive questioning condition obtained higher reasoning and problem-solving scores than peers in the other conditions. Interestingly, while there were no significant differences between the teachers’ basic and extended mediating behaviours in the three conditions at Times 1 and 2, there was a significant difference in extended mediation behaviours with the teachers demonstrating nearly three times more extended mediation to promote students’ learning at Time 2 than they did at Time 1. Teacher intervention in providing guidance in how to interact during cooperative, inquiry-based science appears to be critical to helping students engage in higher-level thinking and learning. (shrink)

This paper reports on a study that was conducted on the effects of training students in specific strategic and meta-cognitive questioning strategies on the development of reasoning, problem-solving, and learning during cooperative inquiry-based science activities. The study was conducted in 18 sixth grade classrooms and involved 35 groups of students in three conditions: the cognitive questioning condition; the Philosophy for Children condition; and the comparison condition. The students were videotaped as they worked on a specific inquiry-science task once each term (...) for two consecutive school terms. The results show that the students in all conditions demonstrated more helping discourses or discourses known to mediate learning than any other of the discourse categories. This outcome is encouraging because it is the helping discourses where students provide explanations, elaborations, and reasons that promote follow-up learning. (shrink)

It was about half a century ago that the mind–body problem, which like much else in serious metaphysics had been moribund for several decades, was resurrected as a mainstream philosophical problem. The first impetus came from Gilbert Ryle's The Concept of Mind , published in 1948, and Wittgenstein's well-known, if not well-understood, reflections on the nature of mentality and mental language, especially in his Philosophical Investigations which appeared in 1953. The primary concerns of Ryle and Wittgenstein, however, focused on (...) the logic of mental discourse rather than the metaphysical issue of how our mentality is related to our bodily nature. In fact, Ryle and Wittgenstein would have regarded, each for different reasons, the metaphysical problem of the mind-body relation as arising out of deplorable linguistic confusions and not amenable to intelligible discussion. There was C. D. Broad's earlier and much neglected classic, The Mind and Its Place in Nature , which appeared in 1925, but this work, although robustly metaphysical, failed to connect with, and shape, the mind–body debate in the second half of this century. (shrink)

It was about half a century ago that the mind–body problem, which like much else in serious metaphysics had been moribund for several decades, was resurrected as a mainstream philosophical problem. The first impetus came from Gilbert Ryle'sThe Concept of Mind, published in 1948, and Wittgenstein's well-known, if not well-understood, reflections on the nature of mentality and mental language, especially in hisPhilosophical Investigationswhich appeared in 1953. The primary concerns of Ryle and Wittgenstein, however, focused on the logic of mental (...) discourse rather than the metaphysical issue of how our mentality is related to our bodily nature. In fact, Ryle and Wittgenstein would have regarded, each for different reasons, the metaphysical problem of the mind-body relation as arising out of deplorable linguistic confusions and not amenable to intelligible discussion. There was C. D. Broad's earlier and much neglected classic,The Mind and Its Place in Nature, which appeared in 1925, but this work, although robustly metaphysical, failed to connect with, and shape, the mind–body debate in the second half of this century. (shrink)

ABSTRACT This article aims to elucidate a philosophical foundation of a post-labor paradigm through the transindividual technical-psychic-collective culture based on Gilbert Simondon and Bernard Stiegler. Simondon predicts that the problem of the alienation of labor due to mechanical industrialization can be overcome through the spread of post-industrial technical culture based on both technical mentality and information technology. In contrast, Stiegler claims that, along with information networks, hyper-industrialization rather than post-industrialization has arrived and that, in order to recover human values (...) in a machine empire devoid of caring, the strengthening of the ability for non-automation based on automaticity is necessary. However, Simondon’s technical culture beyond labor implies a posthumanistic vision in that it assumes the capacity of technology to mediate between the preindividual and the transindividual beyond technical instrumentalism, which is anthropocentric, and opens up transductive relationships among humans and non-humans. I will argue that Stiegler’s urgent proposal that seeks to save human life from the control of a techno-capital system, such as the reinvention of work transcending employment, must be concretized within the Simondonian posthumanistic project. RESUMO O objetivo deste artigo é elucidar a base filosófica do paradigma pós-laboral por meio da cultura técnica-psiquica-coletiva transindividual de Gilbert Simondon e Bernard Stiegler. Simondon prediz que o problema da alienação laboral surgido da industrialização mecânica pode ser vencido mediante a expansão da cultura técnica pós-industrial baseada tanto na mentalidade técnica quanto na tecnologia da informação. Em contraste, Stiegler afirma que, além das redes de informação, a hiper-industrialização se estabeleceu para além da pós-industrialização e que, para recuperar valores humanos em um império das máquinas sem carinho, é necessário o fortalecimento da capacidade de não automação baseada em automatismo. Entretanto, a cultura técnica além do trabalho de Simondon implica uma visão pós-humanista em que se presume a capacidade da tecnologia em mediar entre o pré-individual e o transindividual, que é antropocêntrico, e inaugura relações transdutivas entre humanos e não humanos. Defendo que a proposta urgente de Stiegler busca salvar a vida humana do controle de um sistema de tecno-capital, como a reinvenção do trabalho transcendendo o emprego deve ser concretizada dentro do projeto pós-humanista simondoniano. (shrink)

This book, based on Jaegwon Kim's 1996 Townsend Lectures, presents the philosopher's current views on a variety of issues in the metaphysics of the mind...

Optogenetics is being optimistically presented in contemporary media for its unprecedented capacity to control cell behavior through the application of light to genetically modified target cells. As such, optogenetics holds obvious potential for application in a new generation of invasive medical devices by which to potentially provide treatment for neurological and psychiatric conditions such as Parkinson's disease, addiction, schizophrenia, autism and depression. Design of a first-in-human optogenetics experimental trial has already begun for the treatment of blindness. Optogenetics trials involve a (...) combination of highly invasive genetic and electronic interventions that results in irreversible and permanent modifications of an individual's nervous system. Given its novelty, its uncertain benefit to patients, and its unique risk profile of irreversible physiological alteration, optogenetics requires a reassessment of the ethical challenges for protecting human participants in clinical trials, particularly at formative stages of clinical evaluation. This study explores the evolving ethical issues surrounding optogenetics’ potential harm to participants within trial design, especially focusing on whether Phase 1 trials should incorporate efficacy as well as safety endpoints in ways that are fair and respectful to research trial participants. (shrink)

Contains an overall account of morality in its philosophical format particularly with regard to problems of observation, evidence, and truth.

This article explores a case study of a mindfulness teacher, Beth, and her experiences of teaching mindfulness to 11- to 16-year-olds in several English schools. It shows why Beth was drawn to teaching mindfulness, which was both to alleviate the stress amongst her pupils and improve her own mental health. It illustrates how and why she became a confident, successful mindfulness teacher: she learnt about mindfulness at various classes, retreats and teacher-education training sessions, spending thousands of pounds on her own (...) training. It argues that her positioning as a mindfulness teacher in an unmindful school system created an overwhelming demand for her services, but also huge stress upon her. It develops McCaw’s conceptions of ‘thin’ and ‘thick’ mindfulness (2020), arguing that while Beth began by practising ‘thin’ mindfulness – seeing it as a way of solving exam stress amongst her pupils – she became increasingly a ‘thick’ practitioner; her experiences of mindfulness led to profound personal change and, ultimately, to her becoming very disillusioned about teaching mindfulness in an unwelcoming educational, ‘unmindful’ environment. (shrink)

In an age where previous frames of reference lose their certainty nurses are finding themselves rethinking their relations to the ‘real’. In this paper I interrogate an empirical ‘text’ of a local nursing cultural practice through a poststructural critique of the ways in which language, discourses, representation and experience intersect to construct ‘reality’ for us with specific consequences. I do this in an attempt to disclose the micro‐politics at work in the processes of signifying and thus representing nursing to a (...) world of potential students. The discourses of science and caring find themselves exposed in particular representational technologies and practices that mark nursing's collusion with the ‘truths’ of science at the expense of those we loosely name ‘caring’. This cultural theoretical work constitutes a provisional and historical fragment of analysis designed to trouble the relations we often unwittingly sustain with dominant ‘regimes of truth’. (shrink)

Direction of fit theories usually claim that beliefs are such that they “aim at truth” or “ought to fit” the world and desires are such that they “aim at realization” or the world “ought to fit” them. This essay argues that no theory of direction of fit is correct. The two directions of fit are supposed to be determinations of one and the same determinable two-place relation, differing only in the ordering of favored terms. But there is no such determinable (...) because of ineliminable asymmetries between the way that beliefs “aim at truth” and the way that desires “aim at realization.” This essay traces the ills of direction of fit theory to a misunderstanding of Anscombe and proposes a cure that distinguishes theoretical and practical thought by appeal to a distinction between thought in the form of a state and thought in the form of an event. (shrink)

Although informed consent is important in clinical research, questions persist regarding when it is necessary, what it requires, and how it should be obtained. The standard view in research ethics is that the function of informed consent is to respect individual autonomy. However, consent processes are multidimensional and serve other ethical functions as well. These functions deserve particular attention when barriers to consent exist. We argue that consent serves seven ethically important and conceptually distinct functions. The first four functions pertain (...) principally to individual participants: (1) providing transparency; (2) allowing control and authorization; (3) promoting concordance with participants' values; and (4) protecting and promoting welfare interests. Three other functions are systemic or policy focused: (5) promoting trust; (6) satisfying regulatory requirements; and (7) promoting integrity in research. Reframing consent around these functions can guide approaches to consent that are context sensitive and that maximize achievable goals. (shrink)

Some people of colour feel shame in response to racist incidents. This phenomenon seems puzzling since, plausibly, they have nothing to feel shame about. This puzzle arises because we assume that targets of racism feel shame about their race. However, I propose that when an individual is racialised as non-White in a racist incident, shame is sometimes prompted, not by a negative self-assessment of her race, but by her inability to choose when her stigmatised race is made salient. I argue (...) that this can make sense of some shame responses to racism. My account also helps to highlight some of the emotional and cognitive costs of racism that have their root in shame as well as a new form of hermeneutical injustice and distinctive communicative harms, contributing to a fuller picture of what is objectionable about racism. (shrink)

Le proslogion de saint Anselme n'est pas une oeuvre tres connue, bien que les commentaires de ses chapitres 2 a 4 sur l'argument appele par Kant ontologique soient en nombre infini.

Is Anscombean practical knowledge independent of what the agent actually does on an occasion? Failure to understand Anscombe’s answer to this question is a major obstacle to appreciating the subtlety and plausibility of her view. I argue that Anscombe’s answer is negative, and turns on the nature of mistakes in performance, and reveals a distinctive implicit metaphysics of mind and knowledge, structured by related capacities and exercises of capacities. If my interpretation is correct, then practical knowledge shares features with knowledge-how (...) and knowledge-that, but deserves its own epistemic category. (shrink)

In men and women sexual arousal culminates in orgasm, with female orgasm solely from sexual intercourse often regarded as a unique feature of human sexuality. However, orgasm from sexual intercourse occurs more reliably in men than in women, likely reflecting the different types of physical stimulation men and women require for orgasm. In men, orgasms are under strong selective pressure as orgasms are coupled with ejaculation and thus contribute to male reproductive success. By contrast, women's orgasms in intercourse are highly (...) variable and are under little selective pressure as they are not a reproductive necessity. The proximal mechanisms producing variability in women's orgasms are little understood. In 1924 Marie Bonaparte proposed that a shorter distance between a woman's clitoris and her urethral meatus (CUMD) increased her likelihood of experiencing orgasm in intercourse. She based this on her published data that were never statistically analyzed. In 1940 Landis and colleagues published similar data suggesting the same relationship, but these data too were never fully analyzed. We analyzed raw data from these two studies and found that both demonstrate a strong inverse relationship between CUMD and orgasm during intercourse. Unresolved is whether this increased likelihood of orgasm with shorter CUMD reflects increased penile–clitoral contact during sexual intercourse or increased penile stimulation of internal aspects of the clitoris. CUMD likely reflects prenatal androgen exposure, with higher androgen levels producing larger distances. Thus these results suggest that women exposed to lower levels of prenatal androgens are more likely to experience orgasm during sexual intercourse. . (shrink)

The aim of the present study was to investigate the association between work-related moral stress, moral climate and moral sensitivity in mental health nursing. By means of the three scales Hospital Ethical Climate Survey, Moral Sensitivity Questionnaire and Work-Related Moral Stress, 49 participants’ experiences were assessed. The results of linear regression analysis indicated that moral stress was determined to a degree by the work place’s moral climate as well as by two aspects of the mental health staff’s moral sensitivity. The (...) nurses’ experience of ‘moral burden’ or ‘moral support’ increased or decreased their experience of moral stress. Their work-related moral stress was determined by the job-associated moral climate and two aspects of moral sensitivity. Our findings showed an association between three concepts: moral sensitivity, moral climate and moral stress. Despite being a small study, the findings seem relevant for future research leading to theory development and conceptual clarity. We suggest that more attention be given to methodological issues and developing designs that allow for comparative research in other disciplines, as well as in-depth knowledge of moral agency. Copyright © 2011 by SAGE Publications. (shrink)

Responsible leadership is rare. It is not that most leaders are irresponsible, but responsibility in leadership is frequently defined so that an important connotation of responsible leadership is ignored. This article equates responsible leadership with virtuousness. Using this connotation implies that responsible leadership is based on three assumptions—eudaemonism, inherent value, and amplification. Secondarily, this connotation produces two important outcomes—a fixed point for coping with change, and benefits for constituencies who may never be affected otherwise. The meaning and advantages of responsible (...) leadership as virtuous leadership are discussed. (shrink)

Courting competency: nursing and the politics of performance in practiceNurses have long anguished over how best to assess performance in clinical practice. The ‘competency’ movement appears to have provided a solution to this problem. In this paper I undertake a ‘radical hermeneutic’ interrogation of the cultural text of clinical practice doubled with a poststructuralist interpretation of the literal text of the Australian competency project. Through this work I attempt to expose some of the deeply embedded assumptions that underwrite the competency (...) movement and amplify the problems posed by an uncritical appropriation of competency based training and assessment in nursing education. (shrink)

The aim of this Swedish study was to develop the concept of moral sensitivity in health care practice. This process began with an overview of relevant theories and perspectives on ethics with a focus on moral sensitivity and related concepts, in order to generate a theoretical framework. The second step was to construct a questionnaire based on this framework by generating a list of items from the theoretical framework. Nine items were finally selected as most appropriate and consistent with the (...) research team’s understanding of the concept of moral sensitivity. The items were worded as assumptions related to patient care. The questionnaire was distributed to two groups of health care personnel on two separate occasions and a total of 278 completed questionnaires were returned. A factor analysis identified three factors: sense of moral burden, moral strength and moral responsibility. These seem to be conceptually interrelated yet indicate that moral sensitivity may involve more dimensions than simply a cognitive capacity, particularly, feelings, sentiments, moral knowledge and skills. (shrink)

Depression experienced by older adults is proving an increasing global health burden, with rates generally 7% and as high as 27% in the USA. This is likely to significantly increase in coming years as the number and proportion of older adults in the population rises all around the world. Therefore, it is imperative that the effectiveness of approaches to the prevention and treatment of depression are understood. Creative arts interventions, including art, dance movement, drama and music modalities, are utilised internationally (...) to target depression and depressive symptoms in older adults. This includes interventions led by trained arts therapists as well as other health and arts professionals. However, to date there has not been a systematic review that reports effects and examines the processes (why) and mechanisms (how) of creative arts interventions are used to address depression in this older age group. This systematic review of studies on creative arts interventions for older adults experiencing depression examined: outcomes of four creative arts modalities (art, dance movement, drama, and music); with particular attention paid to processes documented as contributing to change in each modality; and mechanisms considered to result from these processes. Our analysis of 75 articles (17 art, 13 dance, 4 drama and 41 music) indicates mostly significant quantitative or positive qualitative findings, particularly for interventions led by creative arts therapists. Mechanisms of change gleaned from the studies that were common across modalities include physical (e.g. increased muscle strength; neurochemical effects, such as endorphin release), intra-personal (e.g. enhanced self-concept, strengthened agency and mastery; processing and communication of emotions), cultural (e.g. creative expression, aesthetic pleasure), cognitive (e.g. stimulation of memory) and social (e.g. increased social skills and connection), that were all considered to contribute to reduced depression and symptoms. Recommendations for future research include a stronger focus on testing of processes and mechanisms. (shrink)

Alvarez and Steward think the power of agency is a two-way power; Lowe thinks the will is. There is a problem for two-way powers. Either there is a unified description of the manifestation-type of the power, or not. If so, two-way powers are really one-way powers. If not, two-way powers are really combinations of one-way powers. Either way, two-way powers cannot help distinguish free agents from everything else. I argue the problem is best avoided by an Aristotelian view, which posits (...) a distinctive unity of explanation proper to two-way powers, grounded in a distinctive form of reasoning. (shrink)

The aim of this article is to describe the synthesis of the concept of moral stress and to attempt to identify its preconditions. Qualitative data from two independent studies on professional issues in nursing were analysed from a hypothetical-deductive approach. The findings indicate that moral stress is independent of context-given specific preconditions: (1) nurses are morally sensitive to the patient’s vulnerability; (2) nurses experience external factors preventing them from doing what is best for the patient; and (3) nurses feel that (...) they have no control over the specific situation. The findings from this analysis are supported by recent research on stress in the workplace but differ in that the imperatives directing work are moral in nature. Stress researchers have found that persons who experience that they have no control over their work situation and at the same time experience high demands may be prone to cardiovascular diseases. An important question raised by this study is whether moral stress should be recognized as a health risk in nursing. Further research is required in order to generate intervention models to prevent or deal with moral stress. (shrink)