Moral distress is one of the core topics of clinical ethics. Although there is a large and growing empirical literature on the psychological aspects of moral distress, scholars, and empirical investigators of moral distress have recently called for greater conceptual clarity. To meet this recognized need, we provide a philosophical taxonomy of the categories of what we call ethically significant moral distress: the judgment that one is not able, to differing degrees, to act on one’s moral knowledge about what one (...) ought to do. We begin by unpacking the philosophical components of Andrew Jameton’s original formulation from his landmark 1984 work and identify two key respects in which that formulation remains unclear: the origins of moral knowledge and impediments to acting on that moral knowledge. We then selectively review subsequent literature that shows that there is more than one concept of moral distress and that explores the origin of the values implicated in moral distress and impediments to acting on those values. This review sets the stage for identifying the elements of a philosophical taxonomy of ethically significant moral distress. The taxonomy uses these elements to create six categories of ethically significant moral distress: challenges to, threats to, and violations of professional integrity; and challenges to, threats to, and violations of individual integrity. We close with suggestions about how the proposed philosophical taxonomy of ethically significant moral distress sheds light on the concepts of moral residue and crescendo effect of moral distress and how the proposed taxonomy might usefully guide prevention of and future qualitative and quantitative empirical research on ethically significant moral distress. (shrink)

Moral distress is a complex phenomenon experienced by individuals across multiple healthcare professions, teams, organizations, and educational settings. It arises when any healthcare professional...

In this commentary on Carse and Rushton’s call for reorientation of moral distress, we state agreement with the authors that the discourse of moral distress should refocus on the moral components of integrity. We then explain how our philosophical taxonomy of moral distress, mentioned by the authors, appeals to moral integrity. In this process, we clarify our taxonomy’s appeal to Aristotle’s concept of akrasia. We conclude by offering support of Carse and Rushton’s challenge to organizations to strengthen moral integrity by (...) fostering resilience. (shrink)

There has been an ongoing appeal in the bioethics literature for a broader understanding and conceptual clarity of the phenomenon of moral distress. Several authors argue that greater conceptual cl...

A psychiatric advance directive (PAD) is a communication tool that promotes patients’ autonomy and gives capacitated adults who live with serious mental illnesses the ability to record their preferences for care and designate a proxy decision maker before a healthcare crisis. Despite a high degree of interest by patients and previous studies that recommend that clinicians facilitate the completion of PADs, the rate of implementation of PADs remains low. Research indicates that many clinicians lack the necessary experience to facilitate the (...) completion of PADs and to use them, and, as a consequence, do not effectively engage patients about PADs. This study developed practical recommendations for clinicians to improve their ability to communicate and facilitate PADs. We (1) thematically analyze definitions of PADs published in 118 articles across disciplines, and (2) present our recommendations for enhanced communication in clinical practice that emphasize patient-centeredness, usefulness, and clarity, aligned with evidence-based practices that put patients’ autonomy and understanding first. While there is no one-sizefits- all script to engage patients in complex conversations, our recommended strategies include an emphasis on patients’ autonomy, the adaptation of word choices, the use of metaphor not simile, and checking for patients’ understanding as effective methods of clinical communication. (shrink)

Increasing emphasis on patient self-management, including having patients advocate for their needs and priorities, is generally a good thing, but it is not always wanted or attainable by patients. The aim of this critical ethical review is to deepen the current discourse in patient self-advocacy by exposing various situations in which patients struggle to self-advocate. Using examples from oncology patient populations, we disambiguate different notions of self-advocacy and then present limits to the more demanding varieties (i.e., health-related, trust-based, and psychological); (...) we argue that these limits create ethical dilemmas with respect to whether it is always desirable to encourage patients to self-advocate. We conclude that self-advocacy can be both under and overrated with respect to how much it benefits the patient with cancer, with many instances being indeterminate. Ultimately, providers must understand the patient's perspective relative to the challenges they are experiencing and work with them to meet their needs. (shrink)

Graphical AbstractUnderstanding epigenetic modifications to chromatin that regulate gene expression and cell-fate decisions is now possible in single cells thanks to recent technological advances. As interdisciplinary approaches are required to derive biological principles, this workshop brought together some of Europe's leading researchers in single-cell epigenetics to share technologies and biological insights.

The past decade has seen a rapid development and proliferation of sophisticated computer systems in organizations. Designers, however, have minimized the importance of security control systems, (except for those systems where data security and access control have obviously been of major importance). The result is an increasing recognition that computer systems security is often easily compromised.This research will provide the initial step in assessing ways in which attorneys retained to prosecute computer crimes and computer people who discover these violations can (...) work together to strengthen both our computer systems to thwart violators and the laws that are currently on the books that can be used to prosecute violators. (shrink)

Since Hilary Putnam offered multiple realization as an empirical hypothesis in the 1960s, philosophical consensus has turned against the idea that mental processes are identifiable with brain processes, and multiple realization has become the keystone of the 'antireductive consensus' across philosophy of science. Thomas W. Polger and Lawrence A. Shapiro offer the first book-length investigation of multiple realization, which serves as a starting point to a series of philosophically sophisticated and empirically informed arguments that cast doubt on the generality (...) of multiple realization in the cognitive sciences. They argue that mind-brain identities have played an important role in the growth and achievements of the cognitive sciences, and suggest that there is little prospect for multiple realization in an empirically-based theory of mind. This leads Polger and Shapiro to offer an alternative framework for understanding explanations in the cognitive sciences, as well as in chemistry, biology, and other non-basic sciences. (shrink)

Natural kinds are often contrasted with other kinds of scientific kinds, especially functional kinds, because of a presumed categorical difference in explanatory value: supposedly, natural kinds can ground explanations, while other kinds of kinds cannot. I argue against this view of natural kinds by examining a particular type of explanation—mechanistic explanation—and showing that functional kinds do the same work there as traditionally recognized natural kinds are supposed to do in “standard” scientific explanations. Breaking down this categorical distinction between traditional natural (...) kinds and other kinds of kinds, I argue, delivers two goods: It provides us with a view of natural kindhood that does justice to the epistemic roles of kinds in scientific explanations. And it allows us to solve a problem that HPC theory, currently one of the more popular accounts of natural kindhood, confronts. (shrink)

With its roots in clinical and educational psychology, school psychology is an ever-changing field that encompasses a diversity of topics. The Oxford Handbook of School Psychology synthesizes the most vital and relevant literature in all of these areas, producing a state-of-the-art, authoritative resource for practitioners, researchers, and parents.Comprising chapters authored by the leading figures in school psychology, The Oxford Handbook of School Psychology focuses on the significant issues, new developments, and scientific findings that continue to change the practical landscape. The (...) handbook's focuses include:allegiance to the reciprocal relationship between science and practice to promote problem-solving and enrichment modelsservice delivery designed to improve competencies of all studentsthe relationship between general cognitive ability and important life outcomesthe development of viable and enduring educational, family, and community systems to support studentsincreasing student diversity and the necessity of increased sensitivity to the influences of social, cultural, political, and legislative variables of schoolingoutlining tenable reasons why, since the end of World War II, children from kindergarten through the secondary grades have generally not been the recipients of a superior or efficient educational systemall relevant legislation, including the No Child Left Behind Act, and the ongoing question of who or what is responsible for the inadequate academic preparation of inner-city childrenbuilding a cumulative knowledge base to better facilitate students' academic, social, and personal competencies including the promotion of positive mental health and subjective well-beingThe scholarship compiled here is a must-read for practitioners, students, and faculty, and an ideal resource for parents seeking a scientific approach to the efficacy of school psychology practices. In both breadth and depth, this handbook promises to serve as the benchmark reference work for years to come. (shrink)

A key source of support for the view that challenging people’s beliefs about free will may undermine moral behavior is two classic studies by Vohs and Schooler (2008). These authors reported that exposure to certain prompts suggesting that free will is an illusion increased cheating behavior. In the present paper, we report several attempts to replicate this influential and widely cited work. Over a series of five studies (sample sizes of N = 162, N = 283, N = 268, N (...) = 804, N = 982) (four preregistered) we tested the relationship between (1) anti-free-will prompts and free will beliefs and (2) free will beliefs and immoral behavior. Our primary task was to closely replicate the findings from Vohs and Schooler (2008) using the same or highly similar manipulations and measurements as the ones used in their original studies. Our efforts were largely unsuccessful. We suggest that manipulating free will beliefs in a robust way is more difficult than has been implied by prior work, and that the proposed link with immoral behavior may not be as consistent as previous work suggests. (shrink)

Monetary intelligence theory asserts that individuals apply their money attitude to frame critical concerns in the context and strategically select certain options to achieve financial goals and ultimate happiness. This study explores the dark side of monetary Intelligence and behavioral economics—dishonesty. Dishonesty, a risky prospect, involves cost–benefit analysis of self-interest. We frame good or bad barrels in the environmental context as a proxy of high or low probability of getting caught for dishonesty, respectively. We theorize: The magnitude and intensity of (...) the relationship between love of money and dishonest prospect may reveal how individuals frame dishonesty in the context of two levels of subjective norm—perceived corporate ethical values at the micro-level and Corruption Perceptions Index at the macro-level, collected from multiple sources. Based on 6382 managers in 31 geopolitical entities across six continents, our cross-level three-way interaction effect illustrates: As expected, managers in good barrels, mixed barrels, and bad barrels display low, medium, and high magnitude of dishonesty, respectively. With high CEV, the intensity is the same across cultures. With low CEV, the intensity of dishonesty is the highest in high CPI entities —the Enron Effect, but the lowest in low CPI entities. CPI has a strong impact on the magnitude of dishonesty, whereas CEV has a strong impact on the intensity of dishonesty. We demonstrate dishonesty in light of monetary values and two frames of social norm, revealing critical implications to the field of behavioral economics and business ethics. (shrink)

This textbook brings the humanities to students in order to evoke the humanity of students. It helps to form individuals who take charge of their own minds, who are free from narrow and unreflective forms of thought, and who act compassionately in their public and professional worlds. Using concepts and methods of the humanities, the book addresses undergraduate and premed students, medical students, and students in other health professions, as well as physicians and other healthcare practitioners. It encourages them to (...) consider the ethical and existential issues related to the experience of disease, care of the dying, health policy, religion and health, and medical technology. Case studies, images, questions for discussion, and role-playing exercises help readers to engage in the practical, interpretive, and analytical aspects of the material, developing skills for critical thinking as well as compassionate care. (shrink)

Corruption involves greed, money, and risky decision-making. We explore the love of money, pay satisfaction, probability of risk, and dishonesty across cultures. Avaricious monetary aspiration breeds unethicality. Prospect theory frames decisions in the gains-losses domain and high-low probability. Pay dissatisfaction (in the losses domain) incites dishonesty in the name of justice at the individual level. The Corruption Perceptions Index, CPI, signals a high-low probability of getting caught for dishonesty at the country level. We theorize that decision-makers adopt avaricious love-of-money aspiration (...) as a lens and frame dishonesty in the gains-losses domain (pay satisfaction-dissatisfaction, Level 1) and high-low probability (CPI, Level 2) to maximize expected utility and ultimate serenity. We challenge the myth: Pay satisfaction mitigates dishonesty across nations consistently. Based on 6500 managers in 32 countries, our cross-level three-dimensional visualization offers the following discoveries. Under high aspiration conditions, pay dissatisfaction excites the highest- (third-highest) avaricious justice-seeking dishonesty in high (medium) CPI nations, supporting the certainty effect. However, pay satisfaction provokes the second-highest avaricious opportunity-seizing dishonesty in low CPI entities, sustaining the possibility effect—maximizing expected utility. Under low aspiration conditions, high pay satisfaction consistently leads to low dishonesty, demonstrating risk aversion—achieving ultimate serenity. We expand prospect theory from a micro and individual-level theory to a cross-level theory of monetary wisdom across 32 nations. We enhance the S-shaped Curve to three 3-D corruption surfaces across three levels of the global economic pyramid, providing novel insights into behavioral economics, business ethics, the environment, and responsibility. (shrink)

Monetary Intelligence theory asserts that individuals apply their money attitude to frame critical concerns in the context and strategically select certain options to achieve financial goals and ultimate happiness. This study explores the bright side of Monetary Intelligence and behavioral economics, frames money attitude in the context of pay and life satisfaction, and controls money at the macro-level and micro-level. We theorize: Managers with low love of money motive but high stewardship behavior will have high subjective well-being: pay satisfaction and (...) quality of life. Data collected from 6586 managers in 32 cultures across six continents support our theory. Interestingly, GDP per capita is related to life satisfaction, but not to pay satisfaction. Individual income is related to both life and pay satisfaction. Neither GDP nor income is related to Happiness. Our theoretical model across three GDP groups offers new discoveries: In high GDP entities, “high income” not only reduces aspirations—“Rich, Motivator, and Power,” but also promotes stewardship behavior—“Budget, Give/Donate, and Contribute” and appreciation of “Achievement.” After controlling income, we demonstrate the bright side of Monetary Intelligence: Low love of money motive but high stewardship behavior define Monetary Intelligence. “Good apples enjoy good quality of life in good barrels.” This notion adds another explanation to managers’ low magnitude of dishonesty in entities with high Corruption Perceptions Index. In low GDP entities, high income is related to poor Budgeting skills and escalated Happiness. These managers experience equal satisfaction with pay and life. We add a new vocabulary to the conversation of monetary intelligence, income, GDP, happiness, subjective well-being, good and bad apples and barrels, corruption, and behavioral ethics. (shrink)

We theorize that social media will reduce the incidence of corporate greenwash. Drawing on the management literature on decoupling and the economic literature on information disclosure, we characterize specifically where this effect is likely to be most pronounced. We identify important differences between social media and traditional media, and present a theoretical framework for understanding greenwash in which corporate environmental communications may backfire if citizens and activists feel a company is engaging in excessive self-promotion. The framework allows us to draw (...) out a series of propositions regarding the impact of social media on corporate decisions whether to greenwash, and what channels to use for environmental communication. We conclude with a number of suggestions for future research. (shrink)

This work argues for the need to close the gap between the fields of the philosophy of religion and religious studies. Thomas A. Lewis takes up what, in recent years, has often been seen as a fundamental reason for excluding religious ethics and philosophy of religion from religious studies: their explicit normativity. Against this presupposition, Lewis argues that normativity is pervasive--not unique to ethics and philosophy of religion--and therefore not a reason to exclude them from religious studies. He bridges (...) more philosophical and historical subfields by arguing for the importance of history to the philosophy of religion. He considers the future of religious ethics, explaining that the field as whole should learn from the methodological developments associated with recent work in comparative religious ethics and 'comparative religious ethics' should no longer be conceived as a distinct subfield. The concluding chapter engages broader, post-9/11 arguments about the importance of studying religion, arguing that prominent contemporary notions of 'religious literacy' actually hinder our ability to grasp the significance of religion and impact in the world today. (shrink)

The Protean Character of Mathematics SAUNDERS MAC LANE (Chicago) 1. Introduction The thesis of this paper is that mathematics is protean. ...